For parents of the children with atopic dermatitis

Some of my blog readers might be a father or a mother whose child suffers from eczema. They might be puzzled with the problem whether they should use TS or not. Otherwise they might have already decided never to use them.
This blog will not offer any answer to the question. I have never recommended to use or not to use TS because I myself don’t have an obvious answer which is scientifically persuading .
However, if my child were a patient with eczema, I never use TS because I have seen too many patients with TSA. But it is also a truth that most of patients with eczema will be healed as they grow even if they are treated with TS.

Here I will address some information for the parents who decided not to use TS for their children.

First of all, you had better look for any doctor who will accept your intension that you wouldn’t like to use TS to your children. It might be difficult. But what I’d like to emphasize is that nourishing an atopic child without TS is sometimes misunderstood and regarded as medical abandonment or abuse to the child. You had better visit any doctor only for the counterargument against somebody’s blame to you in advance. I dare say the ability of the doctor is not important for that purpose. The fact that you visited any doctor periodically is important.

You must become an instant doctor also. Especially, you should know the signs of dehydration and sepsis.
http://www.babycenter.com/0_dehydration_11527.bc
http://kidshealth.org/parent/pregnancy_center/newborn_health_conditions/sepsis.html

There is no evidence that infantile patients with atopic dermatitis without using TS tend to develop dehydration or sepsis more easily than patients using TS.
However, parents who chose the way without TS tend to become reluctant to visit any hospital because they think doctors will blame them for non-use of TS. So the initial treatment for the patients who developed dehydration or sepsis can be delayed.

Parents must be smart and persevering. If your baby developed dehydration or sepsis and the doctor in charge told you should use TS, obey his instruction temporarily.
The doctor might even make threats that he can’t guarantee your baby’s life if you don’t agree to use TS. He is wrong medically. Any dehydration or sepsis can be treated ordinarily without TS. Glucocorticoids are only required systemically in such a case that the baby fell into septic shock and catecholamine became ineffective for rising blood pressure. The reason why the doctor wishes to use TS is that it is just easier to manage the patient at least temporarily (viz while the doctor is in charge). It is such a thing. Non-use of TS itself is never life-threatening from the viewpoint of emergency medicine.

But never discuss the matter with the doctor in charge. Only obey his instruction and agree to use TS. you can stop it afterwards. The situation can become life-threatening if other treatments are delayed. It is not the time of discussion.

Only endure even if the doctor blamed you for the former non-use of TS. He is only very sensitive in front of an infantile patient with dehydration or sepsis.

After discharging from hospital, you can stop TS again. You might have a psychological trauma due to the blame from the doctor. Forget it.
     
Anyway, never hesitate to visit hospital once you find any sign of dehydration or sepsis. That is the most important. Using TS temporarily or not makes no sense. You should give priority to the treatment of dehydration or sepsis.  

I am writing this blog under a certain ground. I am a skilled doctor of emergency medicine also. I am an ACLS experienced provider, a PALS provider, an ALSO provider and a FCCS provider still at present and formerly was an ACLS instructor and a JATEC (=ATLS) instructor.
As I had such a background, I might have been able to see severe TSW patients. I had a self-confidence that I could save the patients whatever emergent situations they dropped to.
I saved the patients with dehydration or sepsis many times without using TS. I declare that there is no life-threatening situation that absolutely requires TS application.

Another point to which the parents of atopic infants should be careful is nutrition.

 

The above chart is a growth chart of an infantile patient. The red curve means his body weight.
His parents stopped TS at the time of the top of the curve. The patient developed rebound and his serum protein and body weight decreased because of much exudation. The parents tried a kind of folk therapy but failed to maintain his body weight. He developed diarrhea and admitted to a hospital. The doctor in charge was my friend and treated without using any steroids. She examined his food allergy and looked for materials which are eatable for him and his body weight began to increase again.

As a result, what this baby needed was the examination of food allergy and nourishment by the eatable meal.
The patient had been fed by breast. Food allergens transfer from mother to baby by breast feeding. If the patient had been fed by artificial allergy-free bottle, he wouldn't have needed so much TS and wouldn’t have developed rebound. The crime of steroids exists in that they cover eczema and make the cause search difficult too.

Psychological care for the children is also important.
Smile always in front of your baby. Never look at the skin too much but look at the eyes of your baby.

Always be bright and cheerful. If you feel sad, your child will feel guilty.
You might be afraid that the child would ask of you why he or she suffers from eczema. But the child will say one day  to you “I am sorry for my suffering from eczema.” At that time, you would first recognize how your attitudes distressed your child.

Never discuss emotionally with the other parent in front of the child about his or her eczema. Smile always and keep strength as a parent of your precious child.

・・Sorry, I was not a good father. It was so hard for me to say the above phrases even if they are absolutely right. I always felt myself hypocritical.

One day when I told the above routine phrases to the parents of a patient, I suddenly become very very sad and really dropped tears. They never stopped. I couldn’t continue the out-patient work on the day.
After a while, I submitted my resignation to the hospital. I couldn’t continue my work anymore. It was my threshold.

I think you, parents of atopic children have threshold too. OK, I am also not so strong in fact. Anyway, let's start from what we can do. So I am now writing this blog. You too smile to your baby.

  

Sorry, the comment column is not available now. But the author believes readers can find some hints to overcome their own situations by the previous comments.