Nappy rash

**mumofone** · 05-01-2016, 09:30 AM

I look after a baby who always has nappy rash around the front of her bottom and looks painful and sore. I feel like the wipes parents give me aren't sensitive enough and am considering buying my own for her. Should I bring this up with parents or what would you do, I hate changing her cod it looks painful but at the same time don't want to look like I'm judging them etc.

**loocyloo** · 05-01-2016, 10:17 AM

I use cotton wool and warm water to clean nappy rash.

Have the parents provided any creams for the nappy rash? If it's been ongoing, I would suggest the parents visit dr/health visitor for advice.

I would just make a note in child's daily diary that I was using warm water/sensitive wipes/whatever to clean child's sore bottom.

**redtiger21** · 05-01-2016, 12:10 PM

Same as loocyloo, cotton wool and warm water, and dry it thoroughly. Only use cream if they provide it, don't use your own in case of reaction. Then note in diary, and if it persists suggest gp/hv visit or phonecall x

**moggy** · 05-01-2016, 01:29 PM

A baby shouldn't 'always' have nappy rash- it could be a skin-reaction to something, could be thrush, could be some kind of infection. I would be asking them to get it checked out. GP can prescribe a suitable cream. If you have any concerns it is being caused by infrequent nappy changes or any other cause for concern, or feel the parents are not seeking medical advise as needed, then make sure you note it.

**mumofone** · 05-01-2016, 01:54 PM

Originally Posted by moggy

A baby shouldn't 'always' have nappy rash- it could be a skin-reaction to something, could be thrush, could be some kind of infection. I would be asking them to get it checked out. GP can prescribe a suitable cream. If you have any concerns it is being caused by infrequent nappy changes or any other cause for concern, or feel the parents are not seeking medical advise as needed, then make sure you note it.

Thanks moggy, I guess this is my underlying concern if I'm honest. I just don't really know how or where to document it.
Child doesn't have a daily diary...

**moggy** · 05-01-2016, 02:39 PM

Originally Posted by mumofone

Thanks moggy, I guess this is my underlying concern if I'm honest. I just don't really know how or where to document it.
Child doesn't have a daily diary...

It should be recorded as 'a concern'- Pacey 'Accident, Incident and Medication folder' includes a section for recording 'concerns'- child's details, dates, details of concerns, details of conversations with dates. It needs to be kept confidential and away in the child's individual file as you would a medical record.

But first thing is to have a straight talk to parents- be clear, ask/tell them to take child to the GP. No need to make any 'allegations' that might upset them at this stage, say you are 'worried it could be thrush' (very common in little ones, easily treated with special cream) and suggest they get an appointment this week. Add this to your record. Note what happens next.

Do you feel they are 'not coping'? or finding parenthood a struggle? are they just new parents who have no idea how often a nappy should be changed? You are in a position where you can offer some advise in a friendly manner, maybe ask your CFC if they have any support for new parents which you could let the parents know about...?

**halor** · 05-01-2016, 10:04 PM

I have a little one with nearly constant nappy rash. A lot of the time she has open sores and today it has bled. The poor poppet is in such a state. The parents are at a loss and the doctors just keep saying they are doing everything right and there's nothing they can do apart from try some antibiotic cream which didn't work. I make sure I note nappy changes down and describe state of her bottom and sometimes I will also text parent to keep them informed how she is during the day.

**mumofone** · 05-01-2016, 10:11 PM

Originally Posted by moggy

It should be recorded as 'a concern'- Pacey 'Accident, Incident and Medication folder' includes a section for recording 'concerns'- child's details, dates, details of concerns, details of conversations with dates. It needs to be kept confidential and away in the child's individual file as you would a medical record.

But first thing is to have a straight talk to parents- be clear, ask/tell them to take child to the GP. No need to make any 'allegations' that might upset them at this stage, say you are 'worried it could be thrush' (very common in little ones, easily treated with special cream) and suggest they get an appointment this week. Add this to your record. Note what happens next.

Do you feel they are 'not coping'? or finding parenthood a struggle? are they just new parents who have no idea how often a nappy should be changed? You are in a position where you can offer some advise in a friendly manner, maybe ask your CFC if they have any support for new parents which you could let the parents know about...?

Thanks Moggy, ive got a concern form drawn up somewhere, i'll get it out and take a look. Does this stay private from the parents? Who would ever see it? Just in the case of any allegations and stuff?

I mentioned to mum that the wipes maybe disagreeing with the baby and she said that she's always used them...I'll keep monitoring it, they send sudocreme so I will apply that too.

**mumofone** · 05-01-2016, 10:13 PM

Originally Posted by moggy

It should be recorded as 'a concern'- Pacey 'Accident, Incident and Medication folder' includes a section for recording 'concerns'- child's details, dates, details of concerns, details of conversations with dates. It needs to be kept confidential and away in the child's individual file as you would a medical record.

But first thing is to have a straight talk to parents- be clear, ask/tell them to take child to the GP. No need to make any 'allegations' that might upset them at this stage, say you are 'worried it could be thrush' (very common in little ones, easily treated with special cream) and suggest they get an appointment this week. Add this to your record. Note what happens next.

Do you feel they are 'not coping'? or finding parenthood a struggle? are they just new parents who have no idea how often a nappy should be changed? You are in a position where you can offer some advise in a friendly manner, maybe ask your CFC if they have any support for new parents which you could let the parents know about...?

I think my guess is just not frequent enough nappy changes with different people looking after the baby, I almost wish i had baby full time so i could sort it out (or try). x

**halor** · 05-01-2016, 10:17 PM

Originally Posted by mumofone

I think my guess is just not frequent enough nappy changes with different people looking after the baby, I almost wish i had baby full time so i could sort it out (or try). x

Have you asked if they have spoken to a doctor?

**mumofone** · 05-01-2016, 10:37 PM

Originally Posted by halor

Have you asked if they have spoken to a doctor?

No and I'm reluctant to because my guess is that they haven't and then I'm worried they will feel like I'm judging them :-(

**halor** · 05-01-2016, 10:40 PM

Really you need to speak to them first, at least you will have a better idea of what they are doing at home. Don't shoot me down but it's a little unfair to presume things without gaining a little more information.

The little one I have had terrible problems. I have seen her arrive with a clear bum and go home with terrible sores and that's with me immediately changing her. She is an extreme case though.

**halor** · 05-01-2016, 10:44 PM

I would definitely speak to them though as they may appreciate any advice you can give them x

Simona · 06-01-2016, 11:10 AM

Is it not part of the initial interview and so on to discuss what parents wish us to use at nappy change as we record the 'all about me' details?

Usually cms ask for parents to provide their own brand of nappy wipes ...but I have come across parents totally against them or even using cotton wool....be aware.

Make sure that part of the 'physical care' is covered and recorded in the child's notes...well worth it....but I would never change or use an alternative without 'parental permission'.

**Maza** · 06-01-2016, 02:13 PM

If you feel uncomfortable discussing it you could always make up a little white lie - tell them that you noticed the rash and that it reminds you of a time when your own child had it - you took your child to the GP and they prescribed some great cream etc etc. You shouldn't feel bad. Many times I have been chatting to friends/relatives and they will say things like "The childminder/nanny/teacher/playgroup leader etc noticed xyz and suggested that I get it checked out, and I'm glad I did..."

When one of my mindees had it I obviously wasn't comfortable with her wandering around without a nappy in my home (like you would if it was your own child) but I used to keep her on the changing mat for an extra couple of minutes without a nappy and we would sing interactive songs/rhymes while she was there. I think every bit of fresh air helps! Obviously it's harder to manage if you have several toddlers on that day who need you.

Simona · 06-01-2016, 05:01 PM

I like your advice Maza...a bit of fresh air can help!

Nappy rash is also caused by the fact urine has ammonia and that causes the reaction....the level of ammonia can differ in each child and in some cases nappy changes have to be very frequent.
Maybe parents can be given something to read and help them make a decision

This may help

Caring And Protecting Against Nappy Rash | JOHNSON

**mumofone** · 13-01-2016, 11:42 AM

Thanks everyone for your responses, parents said they will take baby to the doctor.
Is this an example of working in partnership with parents to benefit the child would you say?

**moggy** · 13-01-2016, 01:54 PM

Originally Posted by mumofone

Thanks everyone for your responses, parents said they will take baby to the doctor.
Is this an example of working in partnership with parents to benefit the child would you say?

Absolutely, write this up for evidence of 'working together' for your CPD folder.