Recurrent Vulva Infection

[susyp]

I've just noticed that my daughter seems to have an infection down below for the third time since late July. The last two times we have been to the doctor they have said to put on cream + given antibiotics. The antibiotics need to be taken for 2+ weeks, 4 times a day (an hour before food which I have found impossible but may be easier with school routine), taste horrible though.

I was really worried why this had come back again - this time she is just a little red, and a little smelly, no pain or discharge - I looked it up and read that some sites said it could be home treated by not using bubble baths and putting half a cup of white vinegar into a bath instead.

I was going to give her a bath first thing tomorrow like this and then again before bed - and then see how she is on Monday morning before deciding whether to go to the doctor (who will no doubt prescribe another round of antibiotics).

Also she is still wearing nappies at night which are very wet in the morning- should I perhaps be bathing her in the morning before school as well?

She barely drinks anything and can go the entire day until around 5pm (as I force her to drink lots after school) without weeing - could this be another cause?

any advice from parents who have encountered this would be very gratefully received - it's only been 2 weeks since we stopped the last round of antibiotics.

thank you

Susypx

[Fuschia]

Is it a bacterial infection, as opposed to thrush? Only antibiotics might well encourage thrush.

I would have thought drinking plenty of water and avoiding juice and sugary drinks would be of benefit whichever it is... Avoiding tights, trousers, man made fibres, bubble bath, soap, and rinsing washing very thoroughly withit fabric conditioner.

If the gp suggests another rounded ntibiitics, ask for a swab, to make sure the right ones are prescribed?

Live yoghurt is good from a probiotic point of view

[Fuschia]

Though this says that thrush is rare in children

http://www.anzvs.org/docs/ANZVS-PedVulva.pdf

All looks like good advice there...

Sounds potentially quite nasty, I would definitely see the gp again...

This confirms the vinegar idea

http://www.rch.org.au/kidsinfo/fact_sheets/Vulval_skin_care_for_girls/

I can help worrying it might sting though!

[susyp]

It's not thrush, I think it is bacterial - looking online - when she had it very badly the first time the discharge was yellowy/green and I think thrush is more cottage cheesy.......! She hasn;t had a discharge since hte first time as I am quite quick at noticing - so there wouldnt be anything to take a swab of? I check her nightly now. She has a red ring around her vulva. Each time she has had a stomach ache for about a week beforehand, which doesn't really come up very often on the sites I have read about it, but I have found it a couple of times. It stung once this week when she weed - but again I do wonder whether her wee is so strong due to not going all day.

I will see the doctor, but just want to give it a couple of days perhaps to see if ditching the bubbles and trying vinegar instead gets rid of it. They keep saying it's a hygiene thing but I have been watching her and her wiping seems fine to me. So maybe it's a bubbles thing. Apparently oestrogen levels are lowest between 3-8?

Happy to report she is much better at the doctors now - I posted before about the horrendous experience i had the first time I took her when they had to examine her down below! Also noticed on cbeebies there is a doctors show starting on monday at 4pm - we shall be glued to the set!

susypx

[Fuschia]

I wonder whether after the third bout, it's something she should be referred for? I also wonder whether stomach pain makes it more akin to cystitis... Surely if it was he vulva only, it would be more localised pain? Poor little lamb. It's horrible when they have something going on and you can't get to the bottom of it.

Peeing in the shower is a good option if it's stinging a lot

[susyp]

Yes I was wondering about asking to be referred. Especially because of the stomach pain which is what worries me the most. It's not stinging at all at the moment, she hasn't complained at all the last few days, I just happened to notice tonight that it was a bit red and smelly.

will try the vinegar thing and also visit doctor on monday - I hate taking her out of school when she is so new to it but sure she'll not be bothered about missing an hour.

The medicine has to be given 4 times a day so I guess at least once at school and ideally twice - it would work well at break times as actually would be an hour before food and I could give it through the fence - do schools approve this or does it have to be given by the nurse? Just thought it would be less hassle for me to pop up with it than her having to be taken to the nurse (the playground is alongside the road). I appreciate the school would have to ok it and inform the playground attendants of course!!

susypx

[Fuschia]

Don't know about that, lol!

I would probably see the gp, enquire about a swab (there doesn't need to be visible discharge afaik) and then have a chat with the school.

[susyp]

thank you fuschia you are a legend!

xxx

[Fuschia]

Just far too much experience of the sort of medical issues that drag on and on until when you look back, you think, why did I put up with that? Since one of my twins had a really serious urine infection that went undiagnosed for over a week and ended up with her fitting and needing a lumbar puncture, I am now mrs well informed mother, polite but firm!

Don't you think sometimes when you are back and forth to the gp, often seeing a different one each time, they often don't seem to take proper account of the history and treat each new visit as if it were the first? ThAts where problems creep in, I think.

[sillywoman]

Susyp, I don't know about the recurrent infections, but you mentioned that her nappies are very wet at night & this tip might be useful: once mine reached about 18 months, when their nappies began to be over-full at night someone told me that if you put two nappies on it helps. The idea is that you tear a hole in the outside underneath of the first nappy, put the second nappy over the top, then all the urine filters down into the second nappy, keeping the acidity (mostly) away from their skin - which is encased in the first nappy - overnight.

As I said, I just thought it might be helpful. Good luck with getting to the source of the infection problem.

SW

[espelli]

Susyp, I've nothing to add about the infection, which sounds horrible - poor little thing, but if she needs prescribed medication at school you won't need to give it through the fence! The school will either request you come in to give it to her or ask you for written permission for a member of staff to give it to her. I hope you manage to find out the cause of it.

[susyp]

thank you all - it looks fine today - and i gave her a bath with white vinegar added first thing which was ok. But she has a bad tummy ache which seems to be linked so I will probably visit the GP tomorrow - going to try and see the same one !

In terms of the nappy - she is 4 so I really need to persuade her out of them at night - I really don't think she will become dry naturally - but figure starting school is enough for the time being - maybe in the spring. May try and give her a quick (vinegar)bath in the morning to make sure no urine clinging . I wonder if it is the bubble bath - we use a very gentle one (santex) but my sister had a of skin allergies.

She doesn't seem to smelly too vinegary anyway! I only added half a cup!

susypx

[Saffron]

OMG, feel your pain -- and your daughter's pain -- literally. So much personal experience with this as a child and an adult!!

I've looked into the bubble bath issue, and it seems the jury is still out. Evidence I read seemed to suggest that rinsing thoroughly after a bubble bath was the key.

Re hygiene, you need to get the nurse or doctor to define specifically what includes "hygiene" b/c different clinicians include different issues in this unbrella term. Personally, I don't find that blaming it on hygiene is very helpful anyway, b/c plenty of children (and adults!) whose hygiene is good still have problems with the urogenital tract.

Although it may be true that candidiasis of the vagina is not common in children, fungal infection of the external genitals (vulva and vestibule) is not at all uncommon. Unfortunately, fungal infection and bacterial urinary infection can sometimes occur together or within a short time of each other. Agree with Fuschia, you need to have swabs, make sure you're getting the right antibiotic, and try not to work at crossed-purposes with antibiotics leading on to an outbreak of thrush in the vulva.

The fact that she doesn't drink much all day, and can go for long periods of the day without urinating is very problematic for 2 reasons. (1) Retaining urine for extended periods of time is thought to allow bacteria to build-up in the bladder, leading to infection. Regularly emptying the bladder completely would help to expell bacteria from the urinary tract, thus keeping their numbers within a normal range. (2) Retaining urine can lead to "sterile inflammation". Retaining urine for excessive periods of time strains the bladder and can cause symptoms of inflammtion when no bacterial infection is present.

Could you liaise with your daughter's teacher and school nurse to ensure she takes a certain amount of fluid at a certain and is offered frequent, schedules toilet breaks? I think you need to address the fluid intake and scheduling of toilet breaks as if it were a prescription, if you see what I mean. It may take a while for your daughter to adjust. Essentially, her toilet habit during the day needs to be retrained, so that she's relaxed and comfortable urinating several times a day.

And definitely talk to your GP about a referral or further investigation. It would be good to rule out something more serious from early on, like issues with the kidneys. xx

[susyp]

Yes I think I will try and ask the teacher to get her to drink more and go to the toilet more. As the last week specifically she has not been at all at school and this has been the week her tummy ache has got worse. I also tend to give her a lot of juice as she will drink that - so am cutting that right out now. Very hard getting her to drink so I may have to be imaginative and design some sort of reward chart. But although the doctor says it is not linked to these infections I am definitely noticing that the times that she doesn't drink enough are linked to these infections.

I will see a doctor tomorrow and ask for a swab and a referral. How invasive would a kidney test be? She's had tummy ache on and off for a good 6 months I would say. It's hard to know how much of it is real and how much of it something she has twigged she can say. As you would never think watching her play etc that there was anything wrong.

I have a morbid fear of hospitals so need to try and address this - I didn't take her one night when she couldn't breathe with croup and only found out afterwards how dangerous that was - so this forum is very helpful in giving me a balanced opinion - as not only am i totally neurotic about health issues - I also find it very hard to take her to see anyone at hospital - weird combination! so thank you so much for advice, it is very gratefully received

susypx

[Saffron]

Ultrasound of the kidneys would not be at all invasive. They might also want to take bloods to check markers of general inflammation. Then again, you may find that you're able to sort it all with the GP just getting the right antibiotics at the right time... you'll really have to discuss the details with the GP to know for sure.

I would totally cut out juice. That may sound controversial, but IME it's better to drink 3oz of water than 6oz of juice when it comes to uirinary problems. I think the fluid intake issue is HUGE. I don't understand why your GP has a different opinion. I think you need to discuss that further. From personal experience, after several rounds of UTIs and candidiasis, I got so hypersensitive that even when I didn't have an infection, urinating was painful when the urine was concentrated even w/o an infection. So from that pov only, it's important to keep drinking lots of fluids! This has happened to me both as an adult and a child. Stress can bring it on or make it worse.

What are the toilets like at your daughter's school? The toilets at my school were awful when I was a child. The locks on half the stalls never worked, and the loo paper was frequently empty. When the teacher would take the class to the lavatories it was always too busy and loud. I would get so anxious waiting in the queue for the toilet, that by the time I got there (and the stall doors wouldn't shut and there was no loo roll anyway!) I was too anxious to wee :( . So just from a practical pov, it's worth a check that children's toilet are in good condition. Plus maybe send your daughter to school with a little packet of tissues in pocket to boost her confidence and help her remember to take toilet breaks? :)

[susyp]

Yes that's a good idea about checking the toilets. I'll ask her about it, she normally tells me if something worries her. She has dones well on her reward chart so far today and has drunk a glass about every 2 hours and also had a wee each time.

I'll give her a ribena carton tomorrow instead of oj in her lunch - we stupidly only have one beaker so she has one out on the classroom side so i need to buy another one to go in her lunch box. She has squash in it - and will have water at breaktimes. Depends what I worry about - I giver her oj with calcium added to boost her calcium intake as she is dairy allergic - but she could probably just drink more oatmilk instead.

the toilets in her nursery were awful for sure - everytime I went in they all seemed to have a poo in too!

susypx