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Dr. Navitsky
Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1036
Experience:  US Pediatrician licensed in California living abroad.
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My 11 month old has had musousy diarrhea for 7 days now. All

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My 11 month old has had musousy diarrhea for 7 days now. All stool cultures and rotavirus are negative. She has no s/sx of dehydration. The rash on her bottom is soooo bad, looks like raw hamburger meat and I pamper her bottom. She is stooling up to 15 times a day!!! Been to the doctor twice this week. He just switched her formula to Nutrimagen from Enfamil Gentelease. She has always been on Gentlease and he says could be teething or lactose intolerance. But intolerance now at 11 months old? She has only had 2 bottles so far of the new formula. Been on brat diet for a week now. Now just for a background....she has had diarrhea off and on with the bad diaper rash since she was a week old, usually clears in a day or two then the cycle starts again in about 3-4 weeks or less sometimes. Doctors were never concerned to change her formula. She is 11 months old and 19.5 pounds and she has always been a peanut as the doctor says but now I'm wondering could she of always been allergic to milk maybe and has been suffering from malnutrition this entire time? She is only working on her 2nd tooth.
Submitted: 2 years ago.
Category: Pediatrics
Expert:  Dr. Su S. replied 2 years ago.
Greetings,

In diarrhea, there can be transient lactose intolerance. It may take time to return to normal after the diarrhea has improved. In milk allergy, infection or diarrheal attack, intestinal villi or absorptive surface can be destroyed which may take time to heal up even the cause is removed. In some cases, milk may not be absorbed at that time. After an episode of viral diarrhea there can be lactose intolerance for several weeks. If the diarrhea persists, she can be tested again whether there is any milk allergy or intolerance. Reducing substance in the stool can be positive if there is lactose or sugar in the stool. Repeated passage of stool can keep the area moist & make diaper rash worse. There can be a fungal infection too. Destin is good. You can also try A D cream, vaseline. In fungal infection, nystatin, miconazole or clotrimazole creams can be helpful. If possible, you can try to keep the area open to make it dry.

Any query, please feel free to ask.
It will be my privilege to assist you.
Regards.
Customer: replied 2 years ago.
Relist: Other.
Is exactly
What my pediatrician has said to me
Customer: replied 2 years ago.
Relist: Other.
Already knew that
Expert:  Dr. Navitsky replied 2 years ago.
Hi good morning: As you have re-listed your question I can try to help you. So after only 7 days of diarrhea the likely culprit is still a viral illness...and really for another few days up to possibly 2 weeks I would consider the same. There are so many viruses that can affect the GI tract we can only test for a few including rotavirus which is common.....Other stool cultures that your pedi has tested for probably include different bacterial infections, we can also test for some protozoan infections that are even more rare. In short there are so many things we can't culture.....I am assuming based on your description of mucousy diarrhea that there is no blood in the stool. What the prior expert and your pediatrician have mentioned are entirely correct and I do agree with their thoughts. However transient lactose intolerance doesn't develop in a day....after a week or 10days or so of diarrhea ok it can happen. All of a sudden lactose intolerance in an 11 month old is very unusual but there can be other intolerances such as fructose etc that can pop up but really I don't consider these until a few weeks have gone by....Has she been cranky or had any other symptoms that are unusual for her? Runny nose, decrease appetite, rumbling intestinal sounds? Is her stool stinky? The diaper rash I'll address in another post following this one as I see you are still on line and perhaps I can get some more information from you. In addition I'm going to give you my recommendations so hold on..
Expert:  Dr. Navitsky replied 2 years ago.
So what I would do is actually give a regular diet as well as she can tolerate it. The brat diet has little scientific evidence to back it up while a return to a regular diet can (maybe with the exception of milk....definitely with the exception of juice). Also feeding a brat diet can result in rebound constipation when she finally improves...In addition I would start a probiotic (also supported by most recent evidence...you can buy culturelle Jr over the counter although it is pricey and give a capsule a day....or whatever product you find as a pediatric probiotic....the brand does matter as you want to make sure that they have the amount of active cultures they say they do and culturelle is an accepted and widely used brand. If you don't have access to a probiotic you can approximate it with lots of yogurt, or kefir, etc....There is no exact count of the cultures in active yogurt so it is not as scientific but active cultures are good gut bacteria that help to repopulate the intestinal wall that has been kind of hosed off from her enormous stool flow. Choose organic yogurts as they have less sugar and more cultures than the average yoplait.

Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1036
Experience: US Pediatrician licensed in California living abroad.
Dr. Navitsky and 2 other Pediatrics Specialists are ready to help you
Expert:  Dr. Navitsky replied 2 years ago.
The diaper rash is obviously from her increased stooling and I know how bad it can get. The nystatin is only for yeast infection and as it looks like raw hamburger poor kid....it is not a bad idea to use but only 4x a day. The most important thing however is the barrier cream you are using. I have never used resinol but it is OK (it has a topical anesthetic and vaseline) however it doesn't have any zinc oxide in it which is what she needs. The desitin original has the highest amount of any product OTC and works really well as a barrier cream....not letting the stool touch her skin. I would slather a thick covering of this with each diaper change and when she stools just gently wipe off what has stool in it and leave the rest. The amount of air time she gets is another key. She needs to be without a diaper as much as humanly possible and whenever you can ensure she won't stool on you.....you can also kind of place a towel under her where ever she goes and try to catch a stool here is one comes out....I also like triple paste (OTC) but rarely does the purple original desitin fail me and it is cheaper.
Expert:  Dr. Navitsky replied 2 years ago.
Sorry but I have a bit more to add...feel free to respond whenever although you have already accepted. I don't think she has had a milk allergy all this time no. These kids usually present as babies when using a milk based formula like Gentlease with diarrhea that doesn't stop and often results in poor weight gain and with mixed in blood. At 11 months old and 19.5# XXXXX weight is fine (I don't know her height) but even if she is skinny as long as she is gaining at her physicals and growing she is fine. Her weight is on the 25% for her age and unless she has been falling off a previously higher curve she is fine! Otherwise babies and kids can have loose stools once in a while...depending on what they eat and how they digest it etc...as long as it doesn't last I don't worry. The last thing is that it isn't her teeth! Teething causes pain, crankiness, poor sleep and poor appetite maybe low grade temperature but not 7 days of really bad loose stools! If you need to get back to me later with other thoughts please feel free to respond. Thanks!
Customer: replied 2 years ago.
Thank you so much. U have made me feel better. I do also have triple paste. I will switch to that for
now. She has always been growing and gaining steadily at all of her physicals. She is my little angel and my heart breaks every time I have to change her, which is a lot!!! Other than diaper changes, she is acting very normal and no s/sx of dehydration. I am an RN but not to pediatrics and it's always different when it's your child. Thank you for your expertise.
Expert:  Dr. Navitsky replied 2 years ago.
You are welcome. Remember to smooth on enough to frost a cake!! Even if she is not acting differently and has no other symptoms that you can tell she still statistically speaking is most likely to have a virus. After about 2 weeks is when I start considering other things so keep your fingers crossed... If her growth has been good and steady then she is unlikely to have had any chronic thing up to now resulting in malabsorption. You can also try wetting Viva paper towels (they are extra thick) instead of wipes to clean her as the chemicals even in the sensitive ones can sometimes burn. The off diaper thing is always what has helped me the most as both of my little angels have had their shares of hamburger style rashes!! I'll cross my fingers that she improves in the next few days. Good luck!
Customer: replied 2 years ago.
Oh yeah one more thing. I forgot to mention that my baby girl was also born to my sister who was and is still a heroin addict. The baby was born with opioids in her system but no affects to keep her hospitalized at birth. My sister probably did a ton of other drugs and drinking too but def a lot of heroin. All of baby girls development has been normal our only issue is the on and off diarrhea, mostly on...since BIRTH!!! Could this be something more serious???
Customer: replied 2 years ago.
Could she possibly be missing an enzyme or something that aids in digestion?
Expert:  Dr. Navitsky replied 2 years ago.
This is possible but less likely....the most common one is lactose also fructose....there are of course MANY other enzymes in digestion starting in the stomach and all the way down to the intestine that could present with diarrhea/poor absorption....but I wouldn't expect an acute course of diarrhea such as your daughter has been having for the last 7 days (mucus by the way is common in rapid transit)even if she has had the history of a day or so once in a while of loose stools since birth. Stools that are my definition on diarrhea are really runny, leaking out of the diaper and persistent over a few days not just once in a while like one a day. IF her pedi had not been previously concerned about the prior loose stools and she is growing it would be something to keep in the back of my mind but not necessarily meaning something is wrong. Effects of poly-drug abuse besides the initial withdrawl from opoids at birth and maybe having some growth retardation at the onset, really I would expect to come later on in terms of behavior and development.....Make sure she has been tested for blood borne infectious diseases like HIV and Hep B and C although I expect this would have been done if the use was known prenatally! She is lucky to have you now as a Mom! With enzyme deficiency I would expect more of an indolent history of chronic loose stools, gassiness or flatulence, and not so great growth. Many of the super rare ones are not recognized until a child really starts to eat solids and and starts with symptoms. Right now I would just concentrate on curing her bottom, giving her a probiotic, and waiting, Having 15 stools a day for the last 7 days is such a large amount that infection is still #1, #2, and all the way down to #10 on my list....it is just too much output for some type of digestive deficiency. I would expect the amount out will slow down over the next few days (hopefully) and you should start to see an improvement with the dietary suggestions I made and the probiotics. Let me know how she does if things are not better!

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