July 23, 2009

Repeated Lessons

A little hydrocortisone cream was all that was needed to clear up the rash caused by the calendula. The parents had noticed a little rash, and did what parents everywhere would do. They went to the ‘natural pharmacy’ and asked what would be good for a rash.

The rash caused by the calendula cream cleared up within a day or so of starting hydrocortisone. This seemed to control the baby’s mild eczema. So maybe it was natural for me to suppose that this aspect of the baby’s care was under control. when I was in the house, examining the baby on her changing table, I noticed a bottle of moisturizer next to the table. I said to the parents, “That’s for you, right?” The mother said that she used it on the baby. I asked her why she used it on the baby—she said that it made the baby’s skin soft. Was the baby’s skin soft before using the moisturizer? We had a talk about what the baby actually needed on her skin. This baby in particular, given our experience with her eczema and reaction to calendula cream, had sensitive skin at very least.

These were the parents for whom I had to spend a half hour explaining why the hydrocortisone cream wasn’t a dangerous steroid. Even as their baby cried with her rash. How long did the sales clerk have to explain the safety of calendula?

So when they called and said that they need to put their baby to sleep on her stomach, I suspected some detective work might be needed.sheep toy on crib

It seems to be true that some babies just prefer to sleep on their fronts, and not on their backs. Unfortunately for them, the epidemiology is fairly convincing. Babies placed on their tummies to sleep have about 6 times the risk of SIDS. The right thing to do would be to try and convince these parents that putting her on her back would be the safest thing for the baby.

They told me that the baby didn’t mind being on her back when she was on the changing table. Didn’t mind when on a blanket on the floor. In fact, the baby didn’t mind so much when first placed in the co-sleeper at the beginning of the night. But she would wake up with increasing frequency as the night went on, and was screaming when put down on her back in the early hours of the morning. Desperate at this point, they put her down on her tummy, and she quickly fell asleep.

Maybe it wasn’t the position that was bothering her. I asked them to describe the co-sleeper for me. I asked for and was told all the details. The padded sides were of undyed fair-trade cotton, and the frame was of sustainably-harvested wood, unpainted and unstained. The baby was placed on a very soft unbleached untreated natural Australian fleece.fleece

I stopped them at the fleece.

Wool allergy is actually rare. Most of the people who get itchy with certain types of wool fabric are not truly allergic. They have sensitive skin and it’s irritated by the tough wool fibers. But people can be allergic to a class of natural chemicals called wool alcohols. These chemicals are a major sheep-fleececomponent of lanolin. Lanolin is in a lot of the skin lotions and creams, including medicated creams, that we put on our skin. It’s the major component of creams used on breastfeeding moms.

I suggested they remove the fleece completely, and use a folded towel as padding. They weren’t happy with this plan, since the fleece was sent to them direct from a relative in Australia. I suggested they use a plastic trash bag over the fleece, then a baby blanket or two to keep the baby from getting too sweaty on the plastic. That night, the baby slept on her back.

What was happening was contact dermatitis, an itchy eczema-like rash that we get from something we come in contact with. At the beginning of the night, it wasn’t a problem. As time passed, the baby’s back got more and more irritated. When it was irritated, it became more and more sensitive. Tsheep2he more sensitive it got, the more irritated it became with continued contact with the fleece. By the end of the night, the baby was really uncomfortable and unhappy. When they put her down on her tummy—which was not irritated—she calmed right away and went back to sleep.

These caring parents had the best intentions for the comfort of their baby. My role was really being a seasoned detective, who might know 'usual suspects' when I meet them.

This is a baby with sensitive skin. We should learn, eventually, to be sensitive to that.

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Please let me know what you think. Do you know a child or situation like this?