The toddler wriggled across the exam table, laughing as he crinkled its paper covering. His grandmother JoAnne scooped him onto her lap, rubbing his back as he sucked his thumb. She lifted his hospital gown and unfastened his diaper, showing us the raw skin beneath. Teary-eyed, she told me and another pediatrician the story of his rash.
About a year earlier, JoAnne had received full custody of 2-year-old Calvin when his parents, struggling with drug addiction, could no longer adequately care for him. The child seemed healthy, just “hard-headed” and prone to tantrums, JoAnne said. Though tight on money, the grandmother was determined to be a good surrogate parent.
Three months after JoAnne received custody, scaly red patches appeared on Calvin’s groin. A primary care doctor prescribed an antifungal ointment. For a month, JoAnne lathered it on with every diaper change, but the rash got redder and rawer. She returned to the doctor, who advised a stronger antifungal cream and a topical antibiotic. But there was no relief, and the rash spread to Calvin’s face, inner thighs and lower back. He scratched constantly, crying himself to sleep each night.
