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楼主: livlov

[成长烦恼] 13个月宝宝湿疹大爆发,请有经验的妈妈给些建议?谢谢

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辅政大臣赐尚方宝剑

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发表于 2017-1-25 08:59:38 | 显示全部楼层

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本帖最后由 anncmy 于 2017-01-25 09:22 编辑

好像看到了我家老大小时候的影子啊。那个时候他脸上2个嘴角边,和大腿上一块,从3个月开始发,一直到一岁多才好。
建议你看看我3年前写的 一个湿疹帖子:
http://www.powerapple.com/bbs/topics/2454802
我家娃现在快4岁了,湿疹就只有1个月前给他milk challenge 到 fresh milk 后复发了。激素涂了一个礼拜就全恢复了。现在还是不能喝fresh milk,但 boiled milk可以喝喝停停了。其他奶酪啥的都可以吃了。我都不记得再上次发湿疹是啥时候了。

你家孩子超过1岁了,可以不用喝奶粉什么了。他的主要营养来源应该是三餐食物。喝奶只是保证钙来源的一个途径。 羊奶不推荐,因为蛋白质成分和牛乳非常接近。 不过你要试的话,我建议你超市里买新鲜的羊奶,可以先从羊奶酸奶开始。酸奶分子更小,容易被身体接受。 St Helen's farm 家的,各大超市应该都有,通常就在鲜奶/酸奶柜台边上。 羊奶酸奶 成分很简单,没有普通酸奶常有的各种凝固剂增稠剂的。

我家是确诊有过敏的,GP直接就给开的Nutramigen AA (就是和 Neocate一样性质的,不同厂家和牌子罢了) 是 氨基酸 粉。 (那个 AA 代表 Amino Acid)  不是水解奶粉。  这个就算现在医生再开给你们也没什么意义,因为里面钙含量对这个年龄段的孩子来说太少了,只有一半的量。  而且吃口非常难喝。 我家孩子4个月大就开始喝,他习惯那个口味,所以也没什么,但到12个月时候营养师也是建议慢慢换到其他牛乳替代品:oat drink / coconut drink   我还给孩子试了 good hemp milk,他也能喝。 soy 也是不建议的。 因为它的蛋白质分子和牛乳也是很接近的。大多数对牛乳过敏的,对豆奶也是过敏的。

coconut 是fruit,不是nut。我家孩子到现在还常上面几个轮流喝。牛奶一星期只喝个3-4次吧。
现在市面上有 coconut 做的酸奶。但注意, Alpro 家的 coconut 酸奶,里头还是有豆奶的,不是纯的coconut.  
纯的椰奶做的牌子我忘记了,价格相比普通酸奶贵很多很多(一小罐应该在3镑左右)相信你家托儿所给孩子喝的coconut yoghurt肯定不是这个。


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辅政大臣赐尚方宝剑

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发表于 2017-1-25 09:12:37 | 显示全部楼层
再给你推荐个 无激素的 药膏,叫 Dermalex Eczema for babies and children。 boots 和各大药房都有卖的。 现在可能改包装了。不便宜,我都是乘buy one get 2nd half price时候多屯些。 要不就boots的点圈积分时候多买一些。 我家孩子持续用了5-6罐100克的下去之后很有效果。又把它做普通保湿的用了一段时间后才转回只用aveeno cream + hydromol ointment 做保湿(是的,两个叠加用,先涂aveeno,再上hydromol油膏。当然这个你们得自己摸索最适合你家孩子的保湿膏/霜/乳)
.
Dermalex用的时候不要吝啬,要抹的厚点效果比较好。 这个可以安全的用在脸部(眼皮上我家也用过)。
贴个 lloyds 药房的连接:
http://www.lloydspharmacy.com/en/dermalex-eczema-for-babies-30g
保湿必须坚持再坚持。 托儿所阿姨让他们每次换尿布的时候就给孩子擦保湿药膏。脸的比较难处理,尤其孩子出牙齿,口水多的时候,口水是刺激物,很容易就搞糟糕了。所以清洁也是非常非常重要的。
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辅政大臣赐尚方宝剑

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发表于 2017-1-25 09:36:06 | 显示全部楼层
激素的话,1%的hydrocortison 都是很弱很弱的了。这个是第一级的激素。GP都是比较谨慎的。
我家那个时候2.5%的 Eumovate都用了很久。连着用1-2个月的-_-  (这个GP是说只能用2周。皮肤科专家医生说有必要就可以用)eumovate是属于第二级的激素。
到最后我家还用了一个更凶的,名字我都忘了。是第三级的。 这个第三级的激素药膏是皮肤科专家给的,强调每次不能超过10天,然后必须停用至少1个月后才能再次使用。
后面还有2个等级的激素可以用。不过副作用就开始大了。对小孩子不建议。

希望你家孩子也能快快好起来。湿疹是个持久战。不停的观察,护理,得用月,用年来算。 只有靠家长多用心了。
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 楼主| 发表于 2017-1-25 23:05:35 | 显示全部楼层
anncmy 发表于 2017-01-25 08:59
本帖最后由 anncmy 于 2017-01-25 09:22 编辑

好像看到了我家老大...

谢谢MM这么详细的分享。我记得你的帖子。我就是看了你的帖子才买的dermlex,在这次湿疹大爆发之前,这个cream一直都很有效,我们也用了有5-6支,但现在就好像完全失效了。所有他用的cream,ointment都失效了。所以我现在开使了发掘新cream的路程。

我已经开始给佑佑吃羊奶粉了,Nannycare的牌子,对比了他跟mutramigen LGG的成分,维生素,钙等都基本一样,但甜很多,味道很好。我会按照你的建议慢慢过渡到新鲜的羊奶。这个奶粉不便宜,一桶要23镑。

soya过敏我没想过,因为觉得我们是中国人,应该在进化过程中完全接受了soya。看来我的想法太幼稚。他吃的酸奶就是soya based或是和coconut混在一起的alpro牌子,还好还有羊酸奶。谢谢你提供这么多有用的信息。
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军机大臣

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 楼主| 发表于 2017-1-25 23:09:53 | 显示全部楼层
anncmy 发表于 2017-01-25 09:12
再给你推荐个 无激素的 药膏,叫 Dermalex Eczema for babies and...

是的,他现在teething很严重,口水一直流,所以下巴也有一块红的。幼儿园阿姨至少图2-3次,这10天太严重了,他们都坚持涂5次,记录在他的本子上,但成效不大,我估计他们涂得量不够,还有就是他皮肤估计现在很脆弱,抹了cream后他会觉得痛,老是用手背搓和蹭在大人肩膀上搓,所以只有在家,我们一直盯着,才会控制比较好。所以周五到周日刚刚养好一些,周一去幼儿园回来就不行了。
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军机大臣

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 楼主| 发表于 2017-1-25 23:12:40 | 显示全部楼层
anncmy 发表于 2017-01-25 09:36
激素的话,1%的hydrocortison 都是很弱很弱的了。这个是第一级的激素。GP都是比较...

是的,激素也失灵了,也是1%的,ointment。2.5%我们用过几天,但儿科医生严重不同意,我们就停了。估计我得找GP开一个,2.5%的激素是不是只有cream没有ointment?我看的有关湿疹的书说尽可能用ointment
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辅政大臣赐尚方宝剑

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发表于 2017-1-26 05:28:19 | 显示全部楼层
livlov 发表于 2017-01-25 23:12

是的,激素也失灵了,也是1%的,ointment。2.5%我们用过几天,但儿科医生严重不同...

2.5% 浓度的激素,hydrocortison 和 euvomate 都有。 但euvomate要比hydrocortison 强劲很多,是第二级别的。
Euvomate 我家只开到过ointment.  估计Cream 也应该是有的。
给我们看的那个皮肤Consultant是说干的湿疹用Ointment.
出水的,有水泡的湿疹得用cream.

你家孩子可以试试用 Dermol 500 做洗面奶 给他清洗面部,然后再上激素,再上保湿。保湿可以用 dermalex. 大爆发的时候光靠Dermalex 是挡不住的,只有上激素。

还有过敏的问题,只能一个个排除,不能想当然的。 我家娃后来还查出来花生(是legume,不算坚果) 和 核桃 (tree nut, 这个问题比较严重) 过敏。 我和老公家两边都没有听说过谁有这些过敏的。 花生核桃哪个中国家庭少接触了,所以现在都非常注意了。回国都不敢出去吃饭就怕人家用的花生油炒菜啥的
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辅政大臣赐尚方宝剑

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发表于 2017-1-26 05:38:49 | 显示全部楼层
livlov 发表于 2017-01-25 23:09

是的,他现在teething很严重,口水一直流,所以下巴也有一块红的。幼儿园阿姨至少图2-...

总是搓啊蹭的,应该是痒。 如果是痛的话,他不会去碰这块地方的。
实在痒的厉害时候,可以上 antihistamine. 我家是 2mg/5ml chlorphenamine Maleate 长备的。

还有,开春要小心水痘。 我家娃得水痘时候湿疹也爆发了。而且因为水痘,激素保湿都不能上,全靠antihistamine 和一个水痘着哩熬过来的。。。。
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发表于 2017-1-26 17:07:12 | 显示全部楼层
本帖最后由 yvette-yq 于 2017-01-27 01:07 编辑
livlov 发表于 2017-01-25 07:23


Hi Yvette, to answer your question, initially...

Well, cheer up. My son is allergic to milk (cow's, sheep's, goat's, oat's, etc.) wheat, gluten, nuts, eggs, sesame, coconut, legumes (including soya, chickpeas, lentils, and some other peas and beans), and even tested positive for beef. We suspect he has enteropathies of infancy and childhood. So, he is on Neocate Advance trial at the moment.
Nevertheless, he is still a happy, intelligent child despite of all kinds of troubles he has with his nutrition intake and when playing with other kids. He counted to ten last night repeatedly on his own, in fact, at 20-months old. One kid had cheese for lunch in the nursery the other day, and touched him in the afternoon. He ended up with eczema flare-up and swollen face. But he was calm, and didn't even cry. If not because the nursery staff got panic and called us (French people really don't know allergies), we would have thought it was just another normal flare-up.
For messy-play, use pastas, noodles, rice, green vegetables, carrots, and etc. As long as they are not covered by acidic sauce, he will be fine. Puffed rice is useful to train his little hands, too. My son was BLW, so he starts playing with his food from 5/6 months. He was totally fine as long as the food is carefully chosen.
I remember we only got the final blood test results (as scores) when we were in the UK.  And it was quite general, e.g. egg, peanut, and ect. We had a lot more tests done in France, which shows us what type of protein he is allergic to. e.g. under milk category, there are two main types of proteins (and even more categories at the next levels, but not very important here). Casein can cause more serious, and persistent allergies, while Whey protein normally is not as persistent. Most importantly, casein is very thermal-stable, and is very difficult to be degraded/denatured. Even hydrolysed milk proteins can have traces of casein residual. That's why some CMA sufferers can still react to hydrolysed formula. For them, it is worth trying to avoid milk products completely. Alternative, you can try amino acid formula. Neocate Active and Nutramigen AA are both suitable, but they do taste horrendous! Your son might be too old to start taking amino acid formula, because his taste buds have developed.
@anncmy is right. After 1 year of age, what they need mainly from cow's milk is calcium. If you don't want him to try amino acid formula, you can give alternative milk. e.g. oat's milk since he is not allergic to gluten, rice milk, coconut milk, hemp milk. Remember it needs to be one of those calcium fortified ones. In addition, the alternative milk can be very low in proteins. So if you have decided to give alternative milk, you may need to add some more protein-rich food in his diet, i.e. legumes, meat, fish, and etc. Let's just hope your son is one of those lucky ones to be free from goat's milk allergy.
If hydrocotisone not working, it may be worth trying other type of steroid. Steroid is like ointment, you got to find THE one. When we were in the UK, we tried a few different types of steroid. Eumovate (clobetasone butyrate) was not very useful. Synalar Cream (Fluocinolone acetonide) was thought to be quite effective. At the moment, we use a cream called Locatop prescribed by a French dermatologist. It is Desonide based, and is also quite effective.
Though you have to be very careful when using on face (definitely need to consult a doctor before using anything higher than the common hydrocortisone one). And you got to use enough. We are all very cautious so we put as little as possible. But not enough steroid just means the eczema flare-ups last longer, and we use steroid for longer, which is even worse. Do avoid eyes! Even the mildest steroid can cause eye blood pressure changes.
If the eczema is caused by allergies, the priority is to exclude all allergens, possibly including in his environment. Research shows proteins, such as egg and milk proteins exist extensively in our living environment. Depends on the severity of the reactions, allergens in house dusts may cause some troubles. We have no food that contains allergens for my son (listed above) in our house. We eat the same food as he does. And since we do so, his eczema has gone from wild to controllable, and he can sleep through the night very well (compared to woken up by itchiness at least 3 time every night).
Some of above information and measurements maybe too extreme. In your case, your son’s eczema shouldn’t be too difficult to manage once allergens are confirmed. At least he can still eat his food (though his skins don’t agree completely). It is just a piece of information for anyone that maybe interested in.
Please also share your information. Much appreciated.
And good luck.

@anncmy Thanks for the information. I am aware the heavy metal concentration in rice, but I certainly didn't know NHS has recommendations against it. Rice milk is my least favorite alternative milk, partly because nutrition-wise, it is not as good as others. And partly because my son only has rice, corn, and potatoes as main sources of carbohydrates, I really don't want him to have too much rice, also due to the heavy metal concentration concerns. To add to that point, I do give my son organic rice milk when it is necessary. And to anyone planning to give rice milk, I would recommend organic rice milk if possible.

点评

Yvette 写的很好。不过纠正一点: 5岁以下小孩子别给他们喝 rice milk. 大米由于种植方法的缘故,砷 (Arsenic) 含量相对高。 对于成人而言 rice milk里的砷在可接受的范围。 对于小孩子来说就太高了。 尤其是如果把rice milk当牛奶替代品,会引起中毒的。 所以千万别给小孩子喝rice milk. NHS 也是这么警告的。  发表于 2017-1-26 23:46
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辅政大臣赐尚方宝剑

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发表于 2017-1-27 04:58:59 | 显示全部楼层
yvette-yq 发表于 2017-01-26 17:07
本帖最后由 yvette-yq 于 2017-01-27 01:07 编辑


Well...

yvette 你误解我的意思了。
大米里 砷含量高,和是不是有机种植没有关系。
Do organic foods have less arsenic than non-organic foods?
Because arsenic is naturally found in the soil and water, it is absorbed by plants regardless of whether they are grown under conventional or organic farming practices. The FDA is unaware of any data that show a difference in the amount of arsenic found in organic rice versus conventionally grown rice.  (摘自:http://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm319948.htm)

有机种植就是不使用化学肥料/杀虫剂。  大米里砷含量高,是因为水稻的种植方式(水田)以及水稻本身比起其他植物更会吸收土壤中的砷。

有机的饮料你也要注意看nutrition list/ingredients list.  我家孩子的营养师特意提醒过  不要买organic 的,因为里面没有添加钙。 我自己只注意过oatly家的 organic oat drinks,的确是没有添加钙。  rice 的没有关心过,因为医院给的小册子里也是说不能给5岁以下孩子rice drink.
NHS的 和 uk food standards agency 的官方网站里都有提到:https://www.food.gov.uk/science/arsenic-in-rice
NHS的在最后倒数第二段最后一句话。http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/solid-foods-weaning.aspx
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