RTS - Colic, Teething, Nappy Rash

Question 1

What are the main infant and childhood conditions?

Answer 1

crying and colic
teething
nappy rash
cradle cap
threadworms

Question 2

How to identify colic?

Answer 2

happens in babies usually under 3 months old

can start within 2-4 weeks after birth and last up to 3 months

Rule of 3 - by Wessel et al
baby cries 3 hours a day for more than 3 days a week for more than 3 weeks

Question 3

What are the symptoms of colic?

Answer 3

crying for more than 3 hours at roughly the same time per day (late in the afternoon)

bowel pains

• baby pulls feet up under their body and clenches their fists = rigid abdomen
• some babies stomach rumble severely and produce wind

pain
mild - restless
severe - rhythmical screaming attacks every frequency minutes with equally quiet periods

Question 4

What are the causes of colic?

Answer 4

possible causes - poorly understood
- smoking during pregnancy
- gut spasms
- bubbles of trapped air in the digestion system
- sensitivity to feed - babies gut is sensitive to different milk products
- immature digestive systems
- problems in under or over feeding
bottle fed - teat is too small
breast fed - air swallowed due to longer duration or empty breast

Question 5

What are conditions to eliminate when treating colic?

Answer 5

acute infection

• ear and UTIs have identical symptoms to colic
• check if there is a previous history of excessive crying or if a fever is present

intolerance to cow’s milk protein

Question 6

When should colic be referred?

Answer 6

infants that are failing to put on weight
medication failure
overanxious parents

Question 7

What are OTC medications for treatment of colic?

Answer 7

does not need prescription 
Simeticone (activated dimeticone)
- antifoaming properties = reduces the surface tension of the bubbles of gas by breaking the tiny bubbles of air to form larger bubbles
- larger bubbles are easier to bring up
example - infacol, dentinox

lactase

• breaks down the lactose in babies milk making it easier to digest
• can be added to formula

gripe water
- contains alkaline substances and soothing ingredients = some are unsuitable for children under one month old
example - woodward’s gripe water

Question 8

What are non medicinal treatments for colic?

Answer 8

comforting/ carrying the baby - rocking chair

gently massaging the baby’s stomach
music or monotonous sounds

get the child to drink their milk slowly
burp the baby more often
sit the child straight while they eat
try a different product or brand if the child drinks formula milk

Question 9

When does teething occur?

Answer 9

first teeth = 6-8 months
but can happen anytime from birth until 13-14 months

all milk/deciduous teeth are present between 2.5 - 5 years

permanent teeth break through at about 6 years

Question 10

What are the symptoms of teething?

Answer 10

• restlessness, irritability and disturbed sleep patterns
• dribbling
• sore, red gums
• flushed cheeks
• loss of appetite
• sudden desire to chew on things
• an urge to bite

Question 11

What are medicinal treatment options for teething?

Answer 11

paracetamol, ibuprofen - for pain

teething gels - local anaesthetic or mild antiseptic

example - bonjela (without choline salicylate), dentinox

avoid choline salicylate = can cause Reye’s syndrome (brain disorder)
avoid Ashton & Parsons Powder

Question 12

What are non-medicinal treatment options for teething?

Answer 12

rubbing their gums lightly

teething rings - chilled
chilled fruit or vegetables

avoid teething biscuits - high sugar content

Question 13

How to identify nappy rash?

Answer 13

common condition
happens to up to a third of nappy wearing babies

usually develops when the baby is between 9 and 12 months

Question 14

What are symptoms of mild nappy rash?

Answer 14

small part of their nappy area will be covered in a pink or red rash usually made up small spots or blotches
= can look shiny

stinging sensation when passing urine or faeces

other areas of the body will not be involved

Question 15

What are symptoms of severe nappy rash?

Answer 15

more advanced and painful symptoms
bright red spots
dry, cracked and broken skin
swellings, ulcers and blisters on the skin

will cover a larger part of the nappy area and may spread down the legs or up the abdomen

weeping and yellow crusting = bacterial infection

satellite papules (small dark red lesions near the perimeter of the area) = secondary fungal infection due to candida

Question 16

What kind of infection can a nappy rash progress into?

Answer 16

bacterial infection
- weeping and yellow crusts

secondly fungal infection

• satellite papules = small dark red lesions
• due to candida

Question 17

What causes nappy rash?

Answer 17

skin comes into contact with urine and faeces

ammonia

• nappy does absorbs all the urine and faeces
• they can turn into the chemical ammonia
• ammonia can irritate the skin and cause it to become inflamed and sore

fungal infection

• if the skin is warm and damp for long periods of time it can allow fungus to grow
• candida can irritate the skin

Question 18

What conditions appear similar to nappy rash?

Answer 18

eczema
psoriasis
infections

Question 19

What are non-medicinal treatments to nappy rash?

Answer 19

mild nappy rash typically does not need medication

leave the nappy off for as long as possible
avoid using soaps to clean the baby’s skin
apply a barrier cream each time between changes
change the baby’s nappy each time frequently
recommend changing the type of nappy used
avoid plastic tight fitting pants

Question 20

What are medicinal treatments to nappy rash?

Answer 20

emollient preparations
- dimeticone = water repellent
- zinc = soothing agent
- castor oil = water resistant layer (normally with zinc)
- lanolin = hydrates the skin but can cause sensitivity reactions
Dexpanthenol 5% ointment

canesten clotrimazole - better for severe nappy rash with fungal infection

• use 2-3 per day
• use 7-10 days after healing

Question 21

What are medicinal treatments to nappy rash?

fungal

Answer 21

topical anticandidals
- treats fungal infections

does not need a prescription
canesten - clotrimazole
- apply two to three times a day
- used for 7 - 10 days after it has healed to ensure the infection has been treated completely