red and raw bottom

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Hi, I am in desperate need of advice. My client is a 5 yr old with many medical issues. Our current problem is that she is on total parenteral nutrition. She gets probiotics and prune juice when needed. Her stools are always liquid and she has frequent smears. Her bottom is absolutely raw. We use pink av diaper rash ointment and protective cream however it is not working. I keep her open to air as much as possible and encourage the other nurses and the parents to do so as well. I have also read that using liquid anti acid on the affected area can help so I am currently trying that. Does anyone else know of other tips or remedies that might help? I am posting this with moms permission. Any advice is greatly appreciated.

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Specializes in NICU, PICU, PCVICU and peds oncology.

I've seen Maalox applied topically to very excoriated buttocks before, with variable success. One compound I know for sure works is 20% sucralfate to 80% zinc oxide. We used it on a kiddo about 15 years ago with great success and it became one of our weapons against severe diaper rash. IT might be worth a try.

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Specializes in MICU, SICU, CICU.

For incontinence dermatitis, the manufacturer of calmoseptine ointment recommends cleansing with a gentle wound cleanser, pat dry, applying karaya powder to the denuded areas to help the calmoseptine to adhere and protect the skin. Use baby oil to remove it and only when necessary. This method does work.

If the patient is a child with severe ulcerative colitis the physician may recommend an ileostomy. That might be an improvement to her quality of life compared to having a PICC, TPN and severe diarrhea.

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Specializes in NICU, Trauma, Oncology.

*not a nurse, yet, but am a mom* the best diaper rash cream I have ever found is called Calazyme. Worked very well for when my LO had severe diaper rash

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Z-guard worked very well too in my experiences.

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Thank you for your replies.

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Specializes in CNS Pediatric Surgery, now retired.

The Calmoseptine ointment explained above by icuRNmaggie is good. Calmoseptine is OTC and available at most any Walgreen's.

Pediatric facilities often have a recipe for a "butt cream" - equal parts of nystatin ointment, Bacitracin ointment and zinc oxide mixed together. You can stir the ointments together with a tongue blade if you don't have a compounding pharmacy.

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At my facility we use calmoseptine and triad cream. I find triad works much better, but it is more expensive.

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Specializes in NICU, PICU, PACU.

We use Questerin paste, our pharmacy mixes it. Wonder if you can find somewhere to compound it. It really cuts the acid in the stool and used with other skin care products, it really works. Hope you find something, sore butts are the worst :(

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Aquaphor and Maalox mixed together.

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Specializes in ICU.

My son is 9 and has had problems with constipation and then it goes into severe diarrhea. His little butt gets so red sometimes. Here is what clears it up for me. First, I have him sit in a sitz bath for 15-20 min. Just about 2-3 inches of warm water, then I will put a preparation h cream on the red areas. Everytime I have done this, the red, raw areas are gone the next morning. Some days he could barely sit it hurt so bad. I have him lay on his stomach those nights to sleep and let his butt get some air.

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Specializes in Aged care, disability, community.

I've previously used a chux heavy duty dish cloth in the nappy, covered the child's butt in amolin (almond oil, calamine and zinc) nappy rash cream and when I've changed the nappy, blow dried before applying the cream with a hair dryer on cool. This has usually cleaned up the issues within 12 hrs. This included the chemical burns my son got from a different brand of disposable nappy.

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