Advice about illness please!!

Hi,

I asked a parent to collect a child today, as when I was doing his nappy his bottom was completely covered in an ulcer-type rash, which looked EXTREMELY sore and quite weepy. He also had a red blotchy rash under his armpit and around one nipple.

I advised the parent to take him to the doctor or walk-in centre to get a diagnosis and to check if it was contagious. I also advised that if they prescribed medicine I would not be able to have him back tomorrow in case there was any side effect/allergic reaction etc. Mum was fine about this when I spoke to her.

However, she has text to say it is a fungal illness and she has been given some cream which needs to be applied 3 times a day for the next 7 days - Metanium. She said he has had this cream before, and anyone can buy it over the counter.

I have asked have they said anything more specific about the fungal illness, but the answer is no.

But I have no idea whether to let him back tomorrow or not. I don't know if the illness is contagious. The cream is not prescribed by a doctor/nurse etc, so according to my policy I should not apply it; but I do have a bit saying: "However some forms of pain and fever relief or teething gel may be provided by the parent". Parents sign a form to say that I can administer sunblock, nappy cream that they have provided.

But my worry is that as she has had medical advice, and a form of diagnosis, shouldn't the cream really have been prescribed? And it is not just a general use cream such as sudocrem, as far as I know.

I have tried the NCMA legal advice line, but there is no answer as usual!

Any help and advice would be greatly received!!!! HELP!!!!!

With fungal infections there should be minimal risk to other mindees as long as it is covered and you are careful about hygeine. Metanium will be to dry up the weepiness on his bottom but isnt a fungal medication - she needs to see the doctor for that if she hasnt already. you can get over the counter antifungals such as daktarin but im not sure if they are suitable for babies.
As for administering medicine it depends on your policy , but I would give cream or medicine both prescribed or on the advice of a pharmacist as long as mum signs the relevant medicine forms.

My sons got horrendous nappy rash due to eczema, and the doctor prescribed them Metanium, which gets absolutely everywhere, but is a miracle cure! If she has been 'given' the cream, then it may have been prescribed for her, but, as it's available in the same bit of a chemists as sudocreme and cammillosan I can't see a problem with you being able to apply it as it's basically a nappy rash cream.

If the child has a fungal infection you just need to be hot on your infection control procedures, gloves, wiping down changing tables and ensuring soiled nappies are well wrapped up. It does seem odd that if the child has a fungal infection they haven't given the mum an anti fungal though.

The cream she is talking about can be brought from any pharmacy and is used to treat bad nappy rash (which sounds like what you described).

I happily apply it to my LO here as she gets an awful sore bottom when she is teething in particular.

All I can say is get mum/dad to sign each day for it and also make sure whatever baby is on does not matter if it gets stained as this is yellow, thick and stains.

Lisa x

Thank you all for the replies! NCMA advice line did actually ring me back, so just had a long chat with them - their advice was err on the side of caution if there was not enough information , but also to ring the NHS for some general advice.

So, I have managed to speak to a nurse as well, and they said that yes, fungal infections are contagious. And also that Metanium isn't a fungal infection treatment?!!?

I have just looked on the Metanium website under the section: 'When it is NOT nappy rash' and it specifically says 'A Fungal Infection' - so I am still confused as to why she has been told it is a fungal infection and then told to get Metanium?!?

But have decided to go with the information that I have - that as it has been diagnosed as a fungal infection, then it is contagious. Metanium is NOT an anti-fungal treatment, nor has it been officially prescribed by a healthcare professional.

Therefore, the cream will not necessarily clear up the diagnosed infection, so further healthcare advice needs to be sought by parent to ensure correct treatment.

So I am about to ring her and tell her that after getting advice, that I won't be having him back tomorrow :( Feel very bad about it, but there is just too much doubt over it for me to be confident that he would be ok to be back in tomorrow. So wish me luck!!

Just to let you know that mum was absolutely fine about him not coming tomorrow, and she is not convinced by the walk-in centre diagnosis anyway, as they did not even remove the nappy cream I had put on him to check him over anyway!!

So she is going to book a proper doctor's appt tomorrow to get another opinion.

But again, thanks for the advice :)