infantile colic what to do ?

What advice should I give to the parents?

• Reassure the parents that their baby is well, they are not doing something wrong, the baby is not rejecting them, and that colic is common and is a phase that will pass within a few months.
• Holding the baby through the crying episode may be helpful. However, if there are times when the crying feels intolerable, it is best to put the baby down somewhere safe (e.g. their cot) and take a few minutes' 'time out'.
• Other strategies that may help to soothe a crying infant include:
• Gentle motion (e.g. pushing the pram or a ride in the car).
• 'White noise' (e.g. vacuum cleaner, hairdryer, running water).
• Bathing in a warm bath.
• Encourage parents to look after their own well-being:
• Ask family and friends for support — parents need to be able to take a break.
• Rest when the baby is asleep.
• Meet other parents with babies of the same age.

• When should treatment for infantile colic be considered, and with what?

  • The most useful intervention is support for parents and reassurance that infantile colic will resolve.
  • Only consider trying medical treatments if parents feel unable to cope despite advice and reassurance. The options for medical treatments are:
  • A 1-week trial of simeticone drops (breastfed or bottle-fed).
  • A 1-week trial of diet modification to exclude cow's milk protein:
  • Breastfed babies: dairy-free diet for the mother.
  • Bottle-fed babies: hypoallergenic formula.
  • A 1-week trial of lactase drops (breastfed or bottle-fed).
  • Only continue treatment if there is a response (i.e. the duration of crying shortens).
  • If there is no response to one medical treatment, consider trying another.
  • Breastfeeding mothers should take a calcium supplement if they are going to remain on a dairy-free diet long term.
  • If the baby does respond to lactase or hypoallergenic diet, reassure the parents that this does not necessarily mean that they are lactose intolerant or allergic to cow's milk. These are rare conditions that affect very few babies with infantile colic.

  When should I consider stopping treatment?

  • If there is no response to the trial of treatment stop it.
  • If there is a response to treatment: after the age of 3 months (and by 6 months of age at the latest), wean off treatment over a period of about 1 week.

diaper rash

 i saw this case  in my clinic
3 month old girl 2 days history of rash on buttocks area,no diarrhea

DIAPER RASH

Risk Factors

• Infrequent diaper changes
• Waterproof diapers
• Improper laundering
• Family history of dermatitis
• Hot, humid weather
• Recent treatment with oral antibiotics
• Diarrhea
• Dye allergy
  
  
  General Prevention
  Attention to hygiene during bouts of diarrhea

  
  

  Pathophysiology

  • Fecal proteases and lipases are irritants.
  • Fecal lipase and protease activity is increased by acceleration of GI transit; thus a higher incidence of irritant diaper dermatitis is observed in babies who have had diarrhea in the previous 48 h.
  • Once the skin is compromised, secondary infection by C. albicans is common. 40–75% of diaper rashes that last >3 days are colonized with C. albicans.
  • Bacteria may play a role in diaper dermatitis through reduction of fecal pH and resulting activation of enzymes.
  • Allergy is exceedingly rare as a cause in infants.

  Etiology

  • Irritation to skin from prolonged contact with urine or feces (2)
  • Some have raised the possibility of contact allergy from the dye in disposable diapers (3).
    History

    • Onset, duration, and change in the nature of the rash
    • Presence of rashes outside the diaper area
    • Associated scratching or crying
    • Contact with infants with a similar rash
    • Recent illness, diarrhea, or antibiotic use
    • Fever
    • Pustular drainage
    • Lymphangitis

    Physical Exam

    • Mild forms consist of shiny erythema ± scale.
    • Margins are not always evident.
    • Moderate cases have areas of papules, vesicles, and small superficial erosions.
    • It can progress to well-demarcated ulcerated nodules that measure a centimeter or more in diameter.
    • It is found on the prominent parts of the buttocks, medial thighs, mons pubis, and scrotum.
    • Skin folds are spared or involved last.
    • Tidemark dermatitis refers to the bandlike form of erythema of irritated diaper margins.
    • Diaper dermatitis can cause an id (autoeczematous) reaction outside the diaper area
      Treatment

      Medication

      First Line

      • For a pure contact dermatitis, a low-potency topical steroid (hydrocortisone 0.5–1% t.i.d.) and removal of the offending agent should suffice.
      • If candidiasis is suspected or diaper rash persists, use an antifungal such as miconazole nitrate 2% cream, miconazole powder, econazole (Spectazole), clotrimazole (Lotrimin), or ketoconazole (Nizoral) cream at each diaper change (2)[B].
      • If inflammation is prominent, consider a very low-potency steroid cream such as hydrocortisone 0.5–1% t.i.d. along with an antifungal cream ± a combination product such as clioquinol-hydrocor-tisone (Vioform–hydrocortisone) cream (2)[B].
      • If a secondary bacterial infection is suspected, use an antistaphylococcal oral antibiotic or mupirocin (Bactroban) ointment topically.
      • Precautions: Avoid high- or moderate-potency steroids often found in combination steroid antifungal mixtures (2)[B].

      Second Line

      Sucralfate paste for resistant cases

      Additional Treatment

      General Measures

      • Expose the buttocks to air as much as possible (2).
      • Avoid waterproof pants during treatment (day or night); they keep the skin wet and subject to rash or infection.
      • Change diapers frequently, even at night, if the rash is extensive (4).
      • Superabsorbable diapers are beneficial (2,4)[B].
      • Discontinue using baby lotion, powder, ointment, or baby oil (except zinc oxide).
      • Disposable baby wipes contain substances that induce contact or irritant dermatitis, such as fragrance, benzalkonium chloride, and isothiazolinone or alcohol.
      • Apply zinc oxide ointment or other barrier cream to the rash at the earliest sign and b.i.d. or t.i.d. (e.g., Desitin or Balmex). Thereafter, apply to clean, thoroughly dry skin (2).
      • Use mild soap, and pat dry.
      • Cornstarch can reduce friction. Talc powders that do not enhance the growth of yeast can provide protection against frictional injury in diaper dermatitis but do not form a continuous lipid barrier layer over the skin and obstruct the skin pores. These treatments are not recommended.