So many viruses! Winter Update

Many years ago, I had a patient with a terrible diaper rash — open, raw skin that looked painful enough to make everyone cringe at diaper changes. The family had used every cream known to man. Fancy creams, prescription creams, zinc creams, all the creams. Nothing was working. Finally, desperate, I sent the baby to dermatology. The dermatologist took one look and said: “Stop everything. Just use Vaseline.” Ever since then, Vaseline has been my go-to treatment for most diaper rashes. The other big lesson I learned is this: when the skin is really irritated, stop wiping. Even “gentle” sensitive wipes will wipe away the new skin cells trying to grow and heal the rash. Instead, use water. You can use a spray bottle, hold the baby under a faucet, or use a handheld showerhead. (Just be careful with flailing little arms and legs — nobody wants an accidental hot-water burn while cleaning baby!) For many babies, severe diaper rash improves with three simple things: * Gentle cleaning with water only * Thick barrier protection * Avoiding friction from wipes The one diaper rash that usually will not improve with just Vaseline is a yeast diaper rash. What Causes Diaper Rash? Diaper rash happens when the skin becomes irritated from moisture, urine, stool, friction, yeast, or bacteria. Some diaper rashes are mild and red, while others become raw, painful, or peely. Different diaper rashes need different treatments. Types of Diaper Rash 1. Smooth Red Diaper Rash (Irritant Diaper Rash) - This is the most common diaper rash. It happens because urine and stool irritate and essentially “burn” the skin. Symptoms include: * Smooth red skin * Tenderness * Irritation in areas touching the diaper Best Treatment for Irritant Diaper Rash Treatment options include: * Vaseline * Desitin * Butt Paste * Zinc oxide diaper creams * Over-the-counter hydrocortisone cream * Prescription hydrocortisone if needed If using hydrocortisone: * Use twice daily for 5 days * Then once daily for another week if needed For many babies, a VERY thick layer of Vaseline works surprisingly well and is all that is needed. 2. Yeast Diaper Rash A yeast diaper rash looks different from a standard diaper rash. It is often: * Dotty * Peely * Bright red * Surrounded by small “satellite” spots Yeast thrives in warm, wet environments, and a diaper is essentially a warm, damp plastic bag — the perfect setup for fungus to grow. Best Treatment for Yeast Diaper Rash Yeast diaper rashes need antifungal treatment, such as: * Lotrimin * Lamisil * Prescription Nystatin These should be applied 3–4 times daily and continued for one full week after the rash appears gone. Many pediatricians feel that if a diaper rash has lasted longer than 3 days, yeast may be contributing and an antifungal cream should be added. 3. Severe Raw Diaper Rash (Erosive Diaper Dermatitis) This is the diaper rash parents dread. The skin becomes: * Raw * Open * Eroded This happens when urine, stool, moisture, and digestive enzymes break down the skin barrier over time. These severe diaper rashes can take several weeks to fully heal. They look terribly painful, but most young babies act normal while they have the rash. Best Treatment for Severe Raw Diaper Rash The goal is to create a barrier so urine and stool cannot touch the damaged skin. This is where Vaseline often works best. And the key is using a VERY thick layer. Other barrier treatments include: * Corona ointment * Xeroform * Phytoplex Z-Guard paste * Cavilon spray * Coloplast barrier cream * Ilex barrier cream * Stomahesive powder mixed with diaper rash ointment Home Remedies for Diaper Rash Some families also find these soothing treatments helpful: * Baking soda baths * Domeboro soaks * Freshly pumped breast milk applied to the skin * Liquid Maalox dabbed on the rash and allowed to dry * Gentian Violet for raw, weepy rashes Gentian Violet can help dry the skin and may help with both yeast and mild bacterial infection. Fair warning: it stains everything purple. Stop Using Baby Wipes on Raw Skin One of the most important diaper rash tips is this: When the skin is raw, stop rubbing it. Even sensitive baby wipes can worsen severe diaper rash. Instead: * Use plain water * Use a spray bottle or rinse the baby under running water * Dab gently instead of wiping * Allow diaper-free time whenever possible Reducing friction is often one of the fastest ways to help the skin heal. When to See a Doctor for Diaper Rash Parents should contact their pediatrician if: * The diaper rash is worsening * The rash is not improving within a few days * The child develops a fever * The rash becomes blistered, crusted, or rapidly spreading A diaper rash with fever may indicate a bacterial infection and should be evaluated promptly. Final Thoughts on Treating Diaper Rash Parents are often surprised that the best diaper rash treatment is sometimes the simplest one. For many babies, the combination of: * Water instead of wipes * Thick Vaseline * Time out of diapers works better than a cabinet full of medicated creams. And if the rash looks dotty and peely instead of smooth and red, think yeast.

Traveling with a Baby or Toddler: Safety Tips for Flying, Sun Protection, Swimming, and International Travel Planning a vacation with a baby or toddler can feel overwhelming, but with the right preparation, family travel can be safe, enjoyable, and memorable. Whether you are flying with an infant, heading to the beach, or traveling internationally, understanding child travel safety is essential. This guide covers important tips for sun safety, airplane travel, water safety, and travel vaccines for babies and young children. Sun Safety for Babies and Toddlers Protecting babies and toddlers from the sun is especially important because young children have sensitive skin that burns easily. Choosing a Safe Sunscreen for Babies Sunscreen can be used at any age, including babies under 6 months old, as long as you choose a mineral or barrier sunscreen that primarily contains zinc oxide. Mineral sunscreens sit on top of the skin rather than being absorbed. When selecting sunscreen for children: Choose products with mostly zinc oxide Avoid oxybenzone, which may disrupt hormones Avoid retinyl palmitate, a form of vitamin A that may increase sun sensitivity Avoid spray sunscreens to prevent inhalation Parents can research sunscreen ingredients and safety ratings through resources such as EWG Skin Deep Cosmetics Database and look for products with a hazard score under 4. Safe Sun Exposure for Infants Even with sunscreen, babies should not spend long periods in direct midday sunlight. Safer sun habits include: Keeping babies and toddlers out of direct midday sun Allowing limited early morning or late afternoon sun exposure Using hats, rash guards, and shade whenever possible Short periods of sun exposure very early or very late in the day may be reasonable without sunscreen, but prolonged exposure should always be avoided. Flying with a Baby or Toddler Air travel with children requires planning, especially when it comes to safety and comfort. The Safest Way for Babies to Fly Although airlines allow children under age 2 to sit on a parent’s lap, the American Academy of Pediatrics recommends that infants travel in an FAA-approved car seat. Many car seats are approved for both motor vehicles and aircraft. Check: The sticker on the side of the car seat Your car seat manual Your airline’s measurement and seating requirements Older children may be able to use the CARES harness system on airplanes. Traveling with Car Seats If you are bringing a car seat to your destination: Ask your airline whether car seats count toward baggage limits Many airlines check car seats for free Car seats used on the plane with a purchased seat usually do not count as carry-on luggage Helping Babies with Ear Pressure on Airplanes Changes in cabin pressure can cause ear discomfort during takeoff and landing. To help reduce ear pain: Nurse, bottle-feed, or offer a pacifier during ascent and descent Older children can suck on lollipops If your child recently had diagnosed middle ear fluid or an ear infection, you can give ibuprofen about 30 min before take off. If more than 6 hours has passed, you can give a second dose 30 min before landing. Preventing Illness While Flying Airplane travel itself is generally safe for babies, but crowded public spaces can spread germs. Helpful travel hygiene tips include: Wash or sanitize your hands frequently Clean your hands before touching your baby Wipe down commonly touched surfaces if desired Can Benadryl Help Kids Sleep on Flights? Some parents consider using Benadryl during flights. However, children can occasionally have the opposite reaction and become hyperactive or irritable. If you want to try it: Test it at home first during nap time Be aware that effects may last about 6 hours Avoid routine use Entertainment Tips for Long Flights with Toddlers Older babies and toddlers can quickly become bored during travel. Helpful ideas include: Bring a bag of small toys your child has never seen before Borrow toys from friends specifically for travel Introduce a new activity or toy every 15 to 30 minutes And remember: if your child cries or fusses on the plane, most passengers understand. Many are parents themselves. Water Safety for Babies and Toddlers Pools, lakes, oceans, and bathtubs all require constant supervision around young children. Never Leave Children Alone Near Water Children can drown quickly and silently, even in small amounts of water. Important safety rules include: Never leave a child alone near pools, lakes, oceans, bathtubs, or buckets of water An adult who can swim should always remain within arm’s reach of infants and toddlers Supervision from a distance is not enough Water Safety and Alcohol Adults supervising children around water should avoid alcohol or other substances that impair judgment or slow reaction time. If it's a party, please arrange for a LIFEGUARD! Ocean Safety for Young Children If visiting the beach with babies or toddlers: Watch tide conditions carefully Stay alert for strong waves Learn how to recognize rip currents Keep young children at arm's length closeness to an adult at all times in the water Travel Vaccines and Medications for International Travel Families traveling internationally may need additional vaccines or medications depending on the destination. Please write on the portal to check in before international travel. Early Measles vaccine If your child is 6 months to 11 months, it is recommended by the American Academy of Pediatrics to get a measles vaccine prior to international travel. There is no specific recommendation for an early measles shot for travel within the US, but if you know you are going to a "measles hot spot," we DO recommend an early MMR. The measles vaccine given UNDER one year old does NOT count for the one year old vaccine, and it will need to be repeated. If your child already had their 1 year old measles vaccine, but has not yet had their 4 year old measles vaccine, you can get an early second MMR-V. This WILL count as the 4 year old vaccine and does NOT need to be repeated. Book a medical assistant visit to get this vaccine! Oral Typhoid Vaccine (Vivotif) Vivotif is approved for children ages 6 and older. Look at the CDC travel site for your destination to see if you need it. If you do, please book an appointment. If you have a recent weight, we can do that as a televist. Typical dosing instructions include: Take 1 capsule by mouth on days 1, 3, 5, and 7 Take capsules 1 hour before meals with a cold or lukewarm drink Complete the series at least one week before exposure Malaria Prevention with Malarone Malarone may be prescribed for travel to malaria-endemic regions. Look on the CDC travel site for your destination to see if you need it. Typical dosing recommendations: Start 1 to 2 days before entering the area Continue daily during travel Continue for 7 days after returning home Weight-based dosing: 11 to 20 kg: 1 pediatric tablet daily 21 to 30 kg: 2 pediatric tablets daily 31 to 40 kg: 3 pediatric tablets daily Over 40 kg: 1 adult tablet daily Book an appointment to get this prescribed. If you have a recent weight, we can do it as a telehealth visit. Travel Vaccine Clinics in Philadelphia Families in the Philadelphia area may consider the following travel medicine resources. General pediatricians cannot give Yellow Fever vaccine or injected Typhoid vaccine. Pennsylvania Hospital Travel Medicine Penn Presbyterian Medical Center Travel Medicine Passport Health Final Thoughts on Traveling with Young Children Traveling with babies and toddlers requires preparation, flexibility, and patience. Prioritizing sun protection, car seat safety, water supervision, and proper travel health precautions can help make your family vacation safer and less stressful. With thoughtful planning, traveling with young children can create wonderful family memories while keeping everyone healthy and safe.