Transcript Stress Management

ATOPIC DERMATITIS
Definition
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Atopic dermatitis is a very common,
often chronic (long-lasting) skin
disease that affects a large
percentage of the world's population.
It is also called eczema, dermatitis,
or atopy. Most commonly, it may be
thought of as a type of skin allergy
or sensitivity.
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The atopic dermatitis triad includes
asthma, allergies (hay fever), and
eczema. There is a known hereditary
component of the disease, and it is
seen more in some families. The
hallmarks of the disease include skin
rashes and itching.
ATOPIC DERMATITIS
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The skin of a patient with atopic dermatitis
reacts abnormally and easily to irritants,
food, and environmental allergens and
becomes red, flaky and very itchy. It also
becomes vulnerable to surface infections
caused by bacteria. The skin on the
flexural surfaces of the joints (for example
inner sides of elbows and knees) are the
most commonly affected regions in
people.
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The word "dermatitis" means inflammation
of the skin. "Atopic" refers to diseases that
are hereditary, tend to run in families, and
often occur together. In atopic dermatitis,
the skin becomes extremely itchy and
inflamed, causing redness, swelling,
cracking, weeping, crusting, and scaling.
Dry skin is a very common complaint and
an underlying cause of some of the typical
rash symptoms.
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Although atopic dermatitis can occur in any age,
most often it affects infants and young children.
In some instances, it may persist into adulthood
or actually first show up later in life. A large
number of patients tend to have a long-term
course with various ups and downs. In most
cases, there are periods of time when the disease
is worse, called exacerbations or flares, which are
followed by periods when the skin improves or
clears up entirely, called remissions. Many
children with atopic dermatitis enter into a
permanent remission of the disease when they
get older, although their skin may remain
somewhat dry and easily irritated.
Triggers
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Multiple factors can trigger or worsen
atopic dermatitis, including dry skin,
seasonal allergies, exposure to harsh
soaps and detergents, new skin
products or creams, and cold
weather. Environmental factors can
activate symptoms of atopic
dermatitis at any time in the lives of
individuals who have inherited the
atopic disease trait.
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Scientists estimate that 65% of patients
develop symptoms in the first year of life,
and 90% develop symptoms before the
age of 5. Onset after age 30 is less
common and often occurs after exposure
of the skin to harsh conditions. People
who live in urban areas and in climates
with low humidity seem to be at an
increased risk for developing atopic
dermatitis.
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About 10% of all infants and young
children experience symptoms of the
disease. Roughly 60% of these
infants continue to have one or more
symptoms of atopic dermatitis even
after they reach adulthood.
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The itchy feeling is an important factor in
atopic dermatitis, because scratching and
rubbing in response to itching worsen the
skin inflammation that is characteristic of
this disease. People with atopic dermatitis
seem to be more sensitive to itching and
feel the need to scratch longer in
response. They develop what is referred to
as the "itch-scratch" cycle. The extreme
itchiness of the skin causes the person to
scratch, which in turn worsens the itch,
and so on.
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Itching is particularly a problem during
sleep, when conscious control of
scratching decreases and the absence of
other outside stimuli makes the itchiness
more noticeable. Many patients also notice
worsening of their itch in the early
evening when they get home from work or
school when there are less external stimuli
to keep them occupied. When things at
home sort of quiet down, the itching
seems to become more noticeable.
Major and minor features of
atopic dermatitis
Major features
 Itching
 Characteristic rash in locations typical
of the disease (arm folds and behind
knees)
 Chronic or repeatedly occurring
symptoms
 Personal or family history of atopic
disorders (eczema, hay fever,
asthma)
Some minor features
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Early age of onset
Dry, rough skin
High levels of immunoglobulin E (IgE), an
antibody, in the blood
Ichthyosis
Hyper linear palms
Keratosis pilaris
Hand or foot dermatitis
Cheilitis (dry or irritated lips)
Nipple eczema
Susceptibility to skin infection
Positive allergy skin tests
Conditions aggravating AD
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Many factors or conditions can intensify the
symptoms of atopic dermatitis, including dry
skin, winter or cold weather, wool cloths, and
other irritating skin conditions. These factors may
further trigger the itch-scratch cycle, further
stimulating the many times already overactive
immune system in the skin. Repeated
aggravation and activation of the itch-scratch
cycle may cause further skin damage and barrier
breakdown. These exacerbating elements can be
broken down into two main categories: irritants
and allergens. Emotional factors and some
infections can also influence atopic dermatitis.
Management
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Although there is no cure for atopic
eczema, and its cause is not well
understood, it can be treated very
effectively in the short term through
a combination of prevention
(learning what triggers the allergic
reactions) and drug therapy.
Management
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Most patients can be successfully
managed with proper skin care and
lifestyle changes and do not require
the more intensive treatments
discussed. Much of the improvement
comes from homework, including
lubricating generously especially
right after showers or baths.
Management
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The doctor should have three main goals in treating atopic
dermatitis:
healing the skin and keeping it healthy
preventing flares, and
treating symptoms when they do occur.
Much of caring for the skin involves developing skin-care
routines, identifying exacerbating factors, and avoiding
circumstances that stimulate the skin's immune system and
the itch-scratch cycle. It is important for the patient and
family members to note any changes in skin condition in
response to treatment and to be persistent in identifying
the most effective treatment strategy.
Management
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A simple and basic regimen is key.
Staying with one recommended
soap and one moisturizer is very
important. Using multiple soaps,
lotions, fragrances, and mixes of
products may cause further issues
and skin sensitivity.
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Healing the skin and keeping it healthy
are of primary importance both in
preventing further damage and enhancing
the patient's quality of life. Developing
and following a daily skin care routine is
critical to preventing recurrent episodes of
symptoms. Key factors are proper bathing
and the application of lubricants, such as
creams or ointments, within three minutes
of bathing.
Management
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People with atopic dermatitis should
avoid hot or long (more than 10 to
15 minutes) baths and showers. A
lukewarm bath helps to cleanse and
moisturize the skin without drying it
excessively. Bath oils are not usually
helpful.
Management
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Once the bath is finished, the patient should airdry the skin or pat it dry gently (avoiding rubbing
or brisk drying) and apply a lubricant
immediately. Lubrication restores the skin's
moisture, increases the rate of healing, and
establishes a barrier against further drying and
irritation. Several kinds of lubricants can be used.
Lotions generally are not the best choice because
they have a high water or alcohol content and
evaporate quickly. Creams and ointments work
better at healing the skin. Tar preparations can
be very helpful in healing very dry, lichenified
areas. Whatever preparation is chosen, it should
be as free of fragrances and chemicals as
possible.
Management
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Another key to protecting and restoring the skin
is taking steps to avoid repeated skin infections.
Although it may not be possible to avoid
infections altogether, the effects of an infection
may be minimized if they are identified and
treated early. Patients and their families should
learn to recognize the signs of skin infections,
including tiny pustules (pus-filled bumps) on the
arms and legs, appearance of oozing areas, or
crusty yellow blisters. If symptoms of a skin
infection develop, the doctor should be consulted
to begin treatment as soon as possible.
Treating atopic dermatitis in
infants and children
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Give brief, lukewarm baths.
Apply lubricant immediately following the bath.
Keep a child's fingernails filed short.
Select soft cotton fabrics when choosing clothing.
Consider using antihistamines to reduce scratching
at night.
Keep the child cool; avoid situations where
overheating occurs.
Learn to recognize skin infections and seek treatment
promptly.
Attempt to distract the child with activities to keep
him or her from scratching.
Controlling atopic dermatitis
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Lubricate the skin frequently.
Avoid harsh soaps and cleansers.
Prevent scratching or rubbing
whenever possible.
Protect skin from excessive moisture,
irritants, and rough clothing.
Maintain a cool, stable temperature
and consistent humidity levels.
Limit exposure to dust, cigarette
smoke, pollens, and animal dander.
Recognize and limit emotional stress.
Prevention
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Since there is no cure for atopic eczema,
treatment should mainly involve discovering the
triggers of allergic reactions and learning to avoid
them.
Diet: Originally controversial, the association of
food allergy with atopic dermatitis has now been
clearly demonstrated. Many common food
allergens can trigger an allergic reaction: such as
milk, nuts, cheese, tomatoes, wheat, yeast, soy,
and corn. Many of these allergens are common
ingredients in grocery store products (especially
corn syrup, which is a sugar substitute).
Prevention
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Specialty health food stores often
carry products that do not contain
common allergens. If a child avoids
these allergens early on, the
frequency of reactions to these later
in life is decreased significantly.
Breastfeeding is the best way to
avoid these problems, but if that is
unavailable, then hydrolyzed
formulas are preferred to cow's milk.
Prevention
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Environment and Lifestyle: Since dust is a
very common allergen and irritant, adults
with atopic eczema should likely avoid
smoking, as well as the inhalation of dust
in general. The dander from the fur of
dogs and cats may also trigger an
inflammatory response. It is a common
misconception that simply removing an
animal from a room will prevent an
allergic reaction from occurring.
Prevention
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A room must be completely free of
animal dander in order to prevent an
allergic reaction. Anger, stress, and
lack of sleep are also factors that are
known to aggravate eczema.
Excessive heat (especially with
humidity) and coldness are known to
provoke outbreaks, as well as
sudden and extreme temperature
swings.
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The Scratch Test: An allergy skin-patch or
"scratch" test, given by an allergist, can
often pinpoint the triggers of allergic
reactions. Once the causes of the allergic
reactions are discovered, the allergens
should be eliminated from the diet,
lifestyle, and/or environment. If the
eczema is severe, it may take some time
(days to weeks depending on the severity)
for the body's immune system to begin to
settle down after the irritants are
withdrawn.
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The primary treatment involves
prevention, includes avoiding or
minimizing contact with (or intake
of) known allergens. Once that has
been established, topical treatments
can be used. Topical treatments
focus on reducing both the dryness
and inflammation of the skin.
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To combat the severe dryness associated
with eczema, a high-quality, dermatologist
approved moisturizer should be used
daily. Moisturizers should not have any
ingredients that may further aggravate
the condition. Moisturizers are especially
effective if applied within 5–10 minutes
after bathing. A doctor might also
prescribe lotion containing sodium
hyaluronate to improve skin dryness
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Most commercial soaps wash away
all the oils produced by the skin that
normally serve to prevent drying.
Using a soap substitute such as
aqueous cream helps keep the skin
moisturized. A non-soap cleanser can
be purchased usually at a local drug
store. Showers should be kept short
and at a lukewarm/moderate
temperature.
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If moisturizers on their own don't
help and the eczema is severe, a
doctor may prescribe topical
corticosteroid ointments, creams, or
injections. Corticosteroids have
traditionally been considered the
most effective method of treating
severe eczema.
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Disadvantages of using steroid creams
include stretch marks and thinning of the
skin. Higher-potency steroid creams must
not be used on the face or other areas
where the skin is naturally thin; usually a
lower-potency steroid is prescribed for
sensitive areas. If the eczema is especially
severe, a doctor may prescribe prednisone
or administer a shot of cortisone or
triamcinolone If complications include
infections (often of Staphylococcus
aureus), antibiotics may be employed.
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A more novel form of treatment involves
exposure to broad or narrow-band ultraviolet
light. UV radiation exposure has been found to
have a localized immunomodulatory effect on
affected tissues, and may be used to decrease
the severity and frequency of flares. The usage of
UVA1 is more effective in treating acute flares,
whereas narrow-band UVB is more effective in
long-term management scenarios.However, UV
radiation has also been implicated in various
types of skin cancer,and thus UV treatment is not
without risk.
Lifestyle and home remedies
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To help reduce itching and soothe
inflamed skin, try these self-care
measures:
Try to identify and avoid triggers that
worsen the inflammation. Rapid
changes of temperature, sweating
and stress can worsen the condition.
Avoid direct contact with wool
products, such as rugs, bedding and
clothes, as well as harsh soaps and
detergents.
Lifestyle and home remedies
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Apply an anti-itch cream or calamine lotion
to the affected area. A nonprescription
hydrocortisone cream, containing at least 1
percent hydrocortisone, can temporarily
relieve the itch. A nonprescription oral
antihistamine, such as diphenhydramine
(Benadryl, others), may be helpful if itching
is severe.
Avoid scratching whenever possible. Cover
the itchy area if you can't keep from
scratching it. Trim nails and wear gloves at
night.
Lifestyle and home remedies
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Apply cool, wet compresses. Covering the
affected area with bandages and dressings
can help protect the skin and prevent
scratching.
Take a warm bath. Sprinkle the bath water
with baking soda, uncooked oatmeal or
colloidal oatmeal — a finely ground oatmeal
that is made for the bathtub (Aveeno,
others). Or, add 1/2 cup (118 milliliters) of
bleach to a 40 gallon (151 liter) bathtub
filled with warm water. The diluted bleach
bath is thought to kill bacteria that grow on
the skin.
Lifestyle and home remedies
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Choose mild soaps without dyes or perfumes. Be sure
to rinse the soap completely off your body.
Moisturize your skin. Use an oil or cream to seal in
moisture while your skin is still damp from a bath or
shower. Pay special attention to your legs, arms,
back and the sides of your body. If your skin is
already dry, consider using a lubricating cream.
Wear cool, smooth-textured cotton clothing. Avoid
clothing that's rough, tight, scratchy or made from
wool. This will help you avoid irritation. Also, wear
appropriate clothing in hot weather or during
exercise to prevent excessive sweating.
Factors that worsen atopic dermatitis
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Long, hot baths or showers
Dry skin
Stress
Sweating
Rapid changes in temperature
Low humidity
Solvents, cleaners, soaps or detergents
Wool or man-made fabrics or clothing
Dust or sand
Atopic Dermatitis At A Glance
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Atopic dermatitis is a type of eczema.
The skin sensitivity of this disease may be
inherited and genetically determined.
The patient's skin may be "super sensitive"
to many irritants.
Dry scaly patches develop in a characteristic
distribution.
Itching varies but may be intense and
scratching hard to resist.
Scratching can cause skin thickening and
darkening and lead to further complications,
including bacterial infection.
Atopic Dermatitis At A Glance
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Extremely dry skin can break down and ooze or
weep.
If the itch can be controlled, the rash (which is
aggravated by vigorous scratching) may be more
readily contained.
Treatment of atopic dermatitis is centered around
rehydrating the skin with rich moisturizers like
Vaseline and cautious use of topical steroids to
reduce inflammation and itching.
Oral antihistamines are often necessary to break the
"itch-scratch" cycle.
Since secondary infections can aggravate the rash,
topical or oral antibiotics may also be occasionally
indicated.
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Researchers have discovered a very effective and low-tech
means of managing eczema. It’s called household bleach.
The bleach study, published in the journal Pediatrics, found
that giving diluted bleach baths to children with moderate
or severe eczema (atopic dermatitis) reduced signs of
infection and reduced the severity and extent of the
eczema on their bodies.
Dr. Amy Paller and researchers treated 31 patients (6
months to 17 years old) who had eczema and a bacterial
staph infection for 14 days with oral antibiotics. Half of the
patients received bleach in their bath water (half a cup per
full standard tub), while the other half received a lookalike placebo. All were instructed to bathe in the bleach
twice a week, and soak for five to 10 minutes for three
months.
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The research team saw such rapid
improvement in the kids taking the real
bleach baths that they terminated the study
early because they wanted the children
getting the placebo to get the same relief.
"The eczema kept getting better and better
with the bleach baths and these baths
prevented it from flaring again," Paller said.
"We presume the bleach has antibacterial
properties and decreased the number of
bacteria on the skin, which is one of the
drivers of flares."
Myths and Facts
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Myth: Keep Bathing to a Minimum
It is a common misconception that bathing dries the skin and
should be kept to a bare minimum.
What dermatologists recommend: People with atopic
dermatitis tend to have excessively dry skin. To hydrate the skin,
take a short, daily bath(s) in warm — not hot — water. A mild,
non-irritating soap should be used only when needed.
The facts: Daily bathing as recommended by a dermatologist
helps to hydrate the skin, which can reduce flare-ups and relieve
discomfort when moisturizers also are used as directed.
For severe atopic dermatitis, a dermatologist may recommend up
to 3 short baths a day. Even patients who avoid water because
getting wet can be painful tend to get relief after some initial
discomfort.
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Myth: Moisturizers Add Moisture to the Skin
The word “moisturizer” causes a great deal of confusion.
People often think that a moisturizer adds moisture to the
skin and can be applied any time.
What dermatologists recommend: Apply moisturizer
within 3 minutes of bathing. This will trap moisture in the
skin. Continue to apply moisturizer throughout the day to
very dry areas.
The facts: A moisturizer cannot add moisture to the skin.
Moisturizer seals in the water from the bath, preventing
water from evaporating. This is why moisturizer is most
effective when applied within 3 minutes of bathing.
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To apply a moisturizer after bathing:
Gently pat the skin partially dry.
Apply medication directly on the lesions.
Apply moisturizer on top of the medication and to the rest
of the skin. For best results, dermatologists recommend
using a thick, oily moisturizer and applying it in the same
way that you would apply icing to a cake.
Applying moisturizer within 3 minutes of bathing and
frequently throughout the day will help the skin to retain
moisture from bathing. This, in turn, helps prevent dryness
and cracking, which is especially important when the air is
dry. With regular use, moisturizer can help to reduce
discomfort and flare-ups as well as decrease the need for
medication.
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Myth: Identify and Avoid Allergens to Prevent Flare-ups
Dermatologists often hear their patients and caregivers say that if only a
patient’s allergies could be identified, then the patient could avoid these
and prevent atopic dermatitis flares.
What dermatologists recommend: No one thing — not even allergen
(substance to which the patient is allergic) avoidance — can control atopic
dermatitis. Successfully managing this complex condition requires a multifaceted approach. Proper skin care, using medication as directed, and
avoiding one’s personal triggers all play a role. A trigger is anything that
irritates the skin. A trigger need not be an allergen.
The facts: Laundry detergents, soaps, smoke, skin care products that
contain alcohol or fragrance, and rough-textured clothing such as wool are
common triggers that cause atopic dermatitis to flare. Triggers vary from
person to person though, so it is important to learn what irritates the skin
and avoid contact with individual triggers.
Preventing Flare-Ups
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Lifestyle modifications are the first line of
defense in controlling eczema, regardless
of whether the eczema is mild, moderate,
or severe. Recommended by
dermatologists, the following guidelines
can help reduce the severity and
frequency of flare-ups, which also may
decrease the need for anti-inflammatory
medicine. Continuing to follow these
guidelines once the signs and symptoms
clear can help prevent further outbreaks:
Preventing Flare-Ups
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1. Moisturize, moisturize, moisturize. Eczema
is usually dry and itchy, so applying moisturizers
as needed to keep the skin moist is part of an
effective treatment plan. Frequent moisturizing
locks in the skin’s own moisture to prevent
dryness and cracking.
One of the best ways to lock in moisture is to
apply moisturizer after bathing. When bathing,
care must be taken to avoid irritating the skin.
For tips on how to bathe and moisturize to help
alleviate eczema,
Preventing Flare-Ups
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2. Limit contact with anything that irritates the skin.
Soaps, bubble bath, perfumes, cosmetics, laundry
detergents, household cleaners, too much time spent in
water, finger paints, gasoline, turpentine, wool, a pet’s fur,
juices from meats and fruits, plants, jewelry, and even
lotions can irritate sensitive skin. Know what irritates your
skin and limit contact with all that does. Avoiding personalcare products that contain alcohol and not washing hands
too frequently also will help reduce irritation.
3. Avoid sweating and overheating. The most common
triggers of the scratch/itch cycle are sweating and
overheating. It is essential to prevent these situations
whenever possible.
Preventing Flare-Ups
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4. Avoid sudden changes in temperature and
humidity. A sudden rise in temperature can cause
overheating and sweating. A drop in humidity can dry skin
and lead to a flare-up.
5. Grab a cold compress to curb the itch. Scratching
makes the condition worse and may puncture skin allowing
bacteria to enter and cause an infection. Gently applying a
cold compress to the area that itches can reduce
inflammation and lessen the desire to scratch.
6. Keep fingernails short. Short nails decrease the
likelihood that scratching will puncture the skin. Keeping
nails short and wearing cotton gloves at night may help
prevent scratching that punctures the skin while asleep.
Preventing Flare-Ups
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7. Dress in loose-fitting cotton clothes. Synthetic
fabrics, wool, and other materials that feel rough to the
touch often irritate the skin and trigger a flare-up. Cotton
and cotton-blend clothes usually make skin feel better.
8. Double rinse clothes, and wash new clothes before
wearing. Laundry detergents can trigger flare-ups. Using a
fragrance-free, neutral pH detergent and double rinsing
clothes can help prevent flare-ups caused by laundry
detergent. It also may be helpful to wash new clothes
before they are worn as washing removes excess dyes and
fabric finishers, which can irritate the skin. Tags should be
removed, too, as these can rub the skin, causing irritation.
Preventing Flare-Ups
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9. Reduce stress. Stress reduction plays
a key role in preventing eczema flares. In
today’s fast-paced world, reducing stress
can be challenging; however, there are
ways to effectively reduce stress.
10. Follow a prescribed treatment
regimen. Moisturizing and using
medications as directed by a
dermatologist go a long way toward
keeping flare-ups at bay.
Stress Reduction Techniques
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Reducing stress makes controlling eczema much easier. In fact,
studies show that keeping calm and having a positive outlook may
be the best ways to keep eczema under control. However, in
today’s fast-paced world, managing stress can be a challenge
even for children. Here are some time-tested techniques that can
help effectively manage the stress of everyday life:
Maintain your treatment regimen. When life becomes
especially hectic, it is important to comply with your treatment
regimen to help avoid a flare-up.
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Don’t skimp on sleep. Adequate sleep reduces stress and gives
skin time to rejuvenate.
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Pace yourself.
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Think calm. Take a minute or two to think calming thoughts
when under stress.
Stress Reduction Techniques
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Free your mind with a relaxation technique. Deep breathing,
progressive relaxation, visualization, yoga, meditation, or listening to a
relaxation CD can help.
Write away your worries. Research shows that taking 15 minutes each
day to write down your concerns is an effective stress management
technique. Ripping up the paper after you finish writing also helps relieve
stress.
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Participate in a hobby. Doing something you enjoy can enhance your
mental, emotional, and physical well-being.
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Get a pet. Pets reduce stress for many.
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Make time for yourself everyday. Create a list of things you enjoy.
Maybe a walk, catching a favorite TV show, or curling up with a book are
on your list. Find time everyday to do something you enjoy.
Join a support group. Some find comfort and a feeling of well being
when they talk with others who have eczema.
Around the Home
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Indoor allergens and irritants can trigger the signs and symptoms
of atopic dermatitis, a type of eczema that occurs when there is a
genetic predisposition to atopic conditions, such as asthma and
hay fever. Taking some precautions around the home can help
prevent flare-ups:
1. Control Dust Mites. Some studies suggest that reducing dust
mites can reduce symptoms; other studies show no effect. For the
most part, only children have shown improvement when dust
mites were controlled. This is what can be done to control dust
mites in a child’s room:
Eliminate carpeting, rugs and blinds.
Limit upholstered furniture. The only upholstered item in the
bedroom should be the bed.
Cover box spring and mattress in plastic zippered covers and wipe
off covers weekly.
Keep furnishings to a minimum. Only items made of wood,
rubber, metal, or plastic should be used. That goes for toys, too.
Around the Home
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Use a pillow and mattress pad made of
Dacron®.
Clean the room thoroughly each week.
This should include wiping the floor,
furniture, tops of doors, window frames,
and sills with a damp cloth or oil mop.
Wash all bed clothes and curtains at least
once a week in water that is 130° F or
hotter.
Air the room thoroughly after cleaning.
Keep all animals with fur or feathers out.
Around the Home
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2. Keep home’s humidity level between 45% and 55%.
Dehumidifiers and humidifiers can keep humidity levels between 45% and
55%. Use a hygrometer, a device that measures humidity, to monitor the
amount of moisture in the air. Hygrometers are available in places where
thermometers are sold, such as a local hardware store.
3. Avoid contact with pets that have fur or feathers. When fur and
feathers come into contact with skin, they can cause a flare-up. Pet
dander is another common trigger. Be sure to keep pets with fur or
feathers out of the bedroom.
4. Avoid contact with harsh dish-washing products and household
cleaners. Look for natural alternatives to bleaches and other cleaners
that contain harsh chemicals. If you must use such cleansers, wear
protective gloves. Wearing cotton gloves under rubber gloves can help
prevent a flare-up if you have an allergy to latex.
5. Cover up in the yard. If plants or other things in the yard trigger a
flare-up, wearing gloves and long pants and sleeves may help prevent a
flare-up.
Homeopathic treatment
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Duration of treatment:
The total length of treatment varies form case to case,
depending of the following factors:
Duration of Atopic Dermatitis
Areas affected
Extent of spread
Previous medication (Extensive use of oral or local
cortisone)
One may expect a definite change in about three to five
months, depending on the extent. The total length of
medication may be anything between six months to two
years or longer.
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Mother’s History during pregnancy
The baby’s constitution
Activity status
Thermal status of the baby
Sleep position of the baby
Fears of the baby- approaching
people, downward motion
Common remedies coming up
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Belladonna
Calc carb
Stramonium
Sulphur
Chamomilla
Rheum
Calc Phos
Tub
Cup met
Common constitutional symptoms
of babies
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Desire to be carried
Biting
Spitting
Pulling hair
Restlessness
Violent
Fear of dark
Clinging
Aversion to be touched or looked at