Addressing BCG Scar Issues and Nutritional Concerns in Toddlers

BCG scar and milk supply (complementary foods)

Hello, doctor.
My daughter just turned one year old.
The healing period for the BCG vaccine is typically 2-3 months, but it took nearly 5 months for her to heal completely, during which she had no discomfort.
Recently, I've noticed that the BCG scar seems to be itchy, and she keeps scratching it until it breaks the skin.
Additionally, the scar turns red whenever it comes into contact with warm water.
Should I take her to the hospital for an examination?
Also, her total milk intake is about 600 to 750 ml per day, and she doesn't eat much solid food.
During mealtime, she sometimes strongly resists feeding, as if she isn't hungry at all.
She would rather drink water than milk (she can drink 120 ml of water in one go).
Her limbs are quite thin, and I'm concerned about her nutritional balance.
Could you provide some suggestions on how to improve this? Thank you, doctor.

Lilly, 30~39 year old female. Ask Date: 2021/08/26

Dr. Xiao Kaiwen reply Pediatrics

It is advisable to have a pediatrician personally examine the BCG vaccine scar at the hospital.
One-year-old infants are typically at the peak of their aversion to milk and food.
As long as they are not ill, such as with gastroenteritis or herpetic pharyngitis, have normal urine output, are not consuming excessive snacks at the expense of regular meals, and their growth curve for height and weight is normal (which may require measurement by a pediatrician), and they are receiving necessary nutrients (grains, root vegetables, fruits, proteins, and fats), this can be considered a benign phase of food aversion.
Observation is sufficient, and it may be helpful to try different food options, such as substituting rice with noodles or dumplings.
The key is not to force-feed, as this can prolong the duration of food aversion.

Reply Date: 2021/08/26

More Info

Addressing the concerns regarding BCG scar issues and nutritional needs in toddlers is crucial for ensuring the overall health and well-being of your child. Let's break down the two main issues you've raised: the BCG scar and nutritional concerns.

BCG Scar Issues
The BCG vaccine, which is administered to protect against tuberculosis, can leave a scar that may itch or become red when exposed to water. It is not uncommon for the scar to become itchy as it heals, and some redness can occur when the area is exposed to warmth or moisture. However, if your child is scratching the scar to the point of breaking the skin, it is important to monitor this closely.
1. When to Seek Medical Attention: If the scar continues to itch excessively, becomes increasingly red, or shows signs of infection (such as pus, increased warmth, or swelling), it would be advisable to return to your healthcare provider for an evaluation. They can assess whether there is an infection or if the scar is healing normally.

2. Management at Home: In the meantime, you can try to keep the area clean and avoid letting your child scratch it. Applying a gentle, fragrance-free moisturizer may help alleviate some of the itching. If the itching persists, consult your pediatrician about potential topical treatments that are safe for toddlers.

Nutritional Concerns
Regarding your child's nutritional intake, it is concerning that she is consuming only 600 to 750 ml of milk daily and is resistant to solid foods. Adequate nutrition is vital for growth and development, especially in the first few years of life.

1. Assessing Nutritional Intake: At one year old, toddlers typically require a balanced diet that includes a variety of foods from all food groups: fruits, vegetables, grains, protein sources (like meat, fish, eggs, beans), and dairy. If she is not consuming enough solid foods, it may lead to nutritional deficiencies.

2. Encouraging Solid Food Intake:
- Offer Variety: Introduce a variety of textures and flavors. Sometimes, toddlers may refuse foods simply because they are not familiar with them.
- Make Meals Fun: Use fun shapes or colors to make meals more appealing. Involve her in meal preparation to pique her interest.

- Regular Meal Times: Establish a routine for meals and snacks. Offer food at regular intervals, and try to minimize distractions during meal times.

- Limit Milk Intake: While milk is an important source of calcium and vitamin D, too much can fill her up and reduce her appetite for solid foods. Consider limiting milk to about 400-500 ml per day, allowing her to feel hungrier for meals.

3. Hydration: It’s good that she is drinking water, but ensure that it does not replace her milk or solid food intake. Water should complement her diet, not substitute it.

4. Consulting a Pediatrician or Nutritionist: If her eating habits do not improve or if you continue to have concerns about her growth and nutritional status, it may be beneficial to consult a pediatrician or a pediatric nutritionist. They can provide tailored advice and may suggest a nutritional assessment to ensure she is meeting her developmental milestones.

Conclusion
In summary, while the BCG scar may require monitoring, your child's nutritional intake is equally important. Encouraging a balanced diet and addressing any feeding challenges will help ensure she receives the nutrients necessary for her growth and development. If you have ongoing concerns, do not hesitate to reach out to your healthcare provider for further guidance.

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