You start to change your baby’s diaper, and there it is a patchwork of bright red skin on your baby’s bottom. Don’t panic. What you’re seeing is most likely diaper rash, a common form of inflamed skin (dermatitis).
Most infants develop a diaper rash at some time or another; some even arrive home from the hospital with a slight rash. Diaper rash may be more common after solid foods are added to your baby’s diet or when your baby is taking antibiotics. Other factors that can lead to diaper rash include continuously wet or infrequently changed diapers, diarrhea and the use of plastic pants to cover a diaper. Diaper rashes can occur intermittently, anytime while your child wears diapers, but they’re more common in babies during their first 15 months, especially between 8 and 10 months of age.
Diaper rash can alarm parents and annoy babies, but fortunately most cases disappear after a few days with simple home treatments.
SIGNS AND SYMPTOMS
Diaper rash is characterized by red, puffy and perhaps slightly warmer skin in the diaper region � buttocks, thighs and genitals. You may notice your baby seems more uncomfortable than usual, especially during diaper changes. A baby with a diaper rash often fusses or cries when the diaper area is washed or touched.
Diaper rash can be traced to a number of causes, including:
- Irritation from stool and urine. Prolonged exposure to urine or feces can irritate a baby’s sensitive skin. Your baby may be more prone to diaper rash if he or she is experiencing frequent bowel movements, because feces are more irritating than urine.
- Introduction of new foods. As babies start to eat solid foods, generally when they’re between 4 and 12 months old, the content of their stool changes, increasing the likelihood of diaper rash. Changes in your baby’s diet can also increase the frequency of stools, which can lead to diaper rash. If you’re breast-feeding, your baby may develop diaper rash in response to something you’ve eaten, such as tomato-based foods.
- Irritation from a new product. Disposable wipes, a new brand of disposable diaper, or a detergent, bleach or fabric softener used to launder cloth diapers can all irritate your baby’s delicate bottom. Other substances that can add to the problem include ingredients found in some baby lotions, powders and oils.
- Bacterial or yeast (fungi) infection. What begins as a simple skin infection may spread to the surrounding region. The area covered by a diaper buttocks, thighs and genitals is especially vulnerable to this tendency because it’s warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes generally start within the creases of the skin, and there may be red dots scattered around the creases.
- Sensitive skin. Babies with skin conditions, such as atopic dermatitis or eczema, may be more likely to develop diaper rashes. However, the irritated skin of atopic dermatitis and eczema commonly affects more than just the diaper area.
- Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.
- Use of antibiotics. Antibiotics kill bacteria both bad and good. Without the right balance of good bacteria, however, yeast infections can occur. This can happen when babies take antibiotics or when mothers, who are breast-feeding their infants, are taking antibiotics.
A few simple strategies can help decrease the likelihood of diaper rash developing on your baby’s skin:
- Change diapers often. Remove dirty diapers promptly. If your child is in child care, ask staff members to do the same.
- Rinse your baby’s bottom with water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths and cotton balls also can aid in cleaning the skin. Don’t use wipes that contain alcohol or fragrance.
- Pat your baby dry with a clean towel. Don’t scrub your baby’s bottom. Scrubbing can further irritate the skin.
- Don’t overtighten diapers or use diapers with elastic edges. Both prevent airflow into the diaper region, setting up a moist environment favorable to diaper rashes. Tightfitting diapers can also cause chafing at the waist or thighs.
- Give your baby’s bottom a little breathing room. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your baby on a large towel and engage in some playtime while he or she is bare-bottomed.
- Wash cloth diapers carefully. Pre-soak heavily soiled cloth diapers and use hot water to wash them. Use a mild detergent and skip the fabric softeners and dryer sheets because they can contain fragrances that may irritate your baby’s skin. Double rinse your baby’s diapers if your child already has a diaper rash or is prone to developing diaper rash. If you use a diaper service to clean your baby’s diapers, make sure it takes these steps as well.
- Try diaper liners and breathable diaper covers. Diaper liners in cloth diapers may help keep your baby’s skin drier. Choose breathable diaper covers instead of plastic or rubber pants over cloth diapers because they let air circulate.
- Consider using ointment regularly. If your baby gets rashes often, apply a barrier ointment during each diaper change to prevent skin irritation. Petroleum jelly and zinc oxide are the time-proven ingredients included in many prepared diaper ointments. Using these products on clear skin helps keep it in good condition.
- After changing diapers, wash your hands well. Hand washing can prevent the spread of bacteria or yeast to other parts of your baby’s body, to you or to other children.
Many parents worry about what kind of diapers to use. When it comes to preventing diaper rash, there’s no compelling evidence that cloth diapers are better than disposable diapers or vice versa, though disposables may keep baby’s skin slightly drier. Since there’s no one best diaper use whatever works best for you and your baby. If one brand of disposable diaper irritates your baby’s skin, try another.
Whether you use cloth diapers, disposables or both kinds, always change your baby as soon as possible after he or she soils the diaper to keep the bottom as clean and dry as possible.
ALL BABIES HAVE DIAPER RASH!
There are many misconceptions about a baby’s bottom:
- It is supposed to be perfectly smooth and rash-free
- Diaper rash is abnormal
- Diaper rash is a sign of food or formula allergies
- Diaper rash means the baby has bad diarrhea or a yeast infection
Having a diaper rash is a normal part of being a baby. There are many ways you can limit the amount of rash, but from time to time it will flare up again.
WHY BABIES GET DIAPER RASH
Start with ultra sensitive skin, add the chemicals and moisture of urine and stools, cover the area with a diaper that rubs back and forth, and you have diaper rash. This damaged skin is susceptible to the invasion of bacteria and yeast, which can make the rash worse.
WHAT CAN YOU DO ABOUT A DIAPER RASH?
Some babies only experience it once in a while, whereas others experience it time and again. No one knows the reason for these differences in the skin, but some babies just seem more sensitive than others.
The best way to treat an ordinary diaper rash, or diaper rash caused by a fungal infection, is to let it get some air. It is a good idea to leave the baby’s nappy off for about an hour a few times a day.
It also helps to change the baby’s nappy often. When the rash is at its worst, it may be necessary to change the nappy up to 12 times a day. Dry the baby’s bottom carefully after each change.
It is important to wash the baby’s bottom every time you change the nappy. If your baby has only wet their nappy, use warm water. If the baby has dirtied their nappy, use a little soap, but remember to always rinse in warm water to make sure there is no soap left on the baby’s skin.
Fixed faeces can be removed by using ordinary cooking oil on a wad of cotton wool. Do not use baby wipes, as they can sting and dry the skin out and the chemicals in them can make the rash worse.
If your baby has diaper rash or very sensitive skin it is a good idea to protect it with a thick barrier cream after every wash. To protect the red skin, you can use a zinc paste or barrier cream, which is available at the chemist: zinc forms a protective surface over the skin. Weak hydrocortisone creams (eg Dermacort) can be used for severe cases, but these should not be used without consulting your doctor first.
If using cloth nappies, try changing to disposable nappies as they absorb more fluid from the baby’s skin.
Try dressing the baby in woolen underwear on top of the nappy instead of plastic pants.
If using disposable nappies, try switching to cloth nappies. Sometimes changing to another type of nappy will help.
WHAT IF THE DIAPER RASH JUST GETS WORSE?
If the diaper rash does not get better in a few days, or gets worse, talk to your doctor or health visitor. If the baby’s skin turns even more red, warm and swollen, and the baby gets a temperature, you should also contact a doctor immediately as the diaper rash may be caused by a bacterial infection that requires medical treatment.
How to tell the differences between diaper rashes
- An ordinary diaper rash is very red, but not bright red. The baby feels well in general, only feeling a sting when they are wet, or dirty themselves. The redness does not reach into the folds of the skin and disappears a few days after giving their bottom some air, using zinc cream and frequently changing nappies. Get advice from a health visitor or doctor if the rash continues.
- A fungal infection is bright red. Check if the baby is red in the folds of the skin as well. The fungus can grow there too. Your baby will get very upset and cry when you change their nappy. The ordinary advice such as airing the bottom and frequent nappy changes is often not enough to improve the condition. If zinc paste for children does not help, contact a doctor.
- A bright red, very warm and swollen diaper rash may be caused by a bacterial infection. The baby may be in a bad mood and have a fever. If so, contact a doctor.
The cause of diaper rash is the skin being kept wet along with the chemical irritation of ammonia, produced by stale urine. This has the effect of breaking down the protective barrier normally formed by the skin, causing redness and rawness (inflammation) and allowing germs of various types to attack.
The most common infection to complicate the ammonia-like irritation is thrush (candida). In this event, the rash often has clusters or red spots around the margins of the main red area. Other germs (bacteria) can also infect the area.
It follows that the longer wet or soiled nappies are left in contact with the baby’s skin, the more likely diaper rash is to develop. Some babies’ skin is, however, much more sensitive than others. The problem is probably worse with old fashioned terry towelling nappies, especially if worn with waterproof pants. Modern disposable nappies, which are better at keeping the fluid away from the skin, are better in some respects.
SEVEN WAYS TO PREVENT OR MINIMIZE DIAPER RASH
If your baby does not have a problem with diaper rash, then you don’t need to be too strict with these preventative measures. However, if you are constantly battling rash, here are some helpful hints to minimize it:
- Change diapers frequently – at least every two hours in newborns. You can space this out as baby starts to urinate less often.
- Change poopy diapers right away – this is a lot of trouble at first since newborns often have small, frequent stools. This will slow down as baby grows.
- Try different brands – if using disposables, another brand may fit a little better and cause less friction.
- Rinse cloth diapers – add a half-cup of vinegar to the rinse cycle. This helps remove alkaline irritants. Your diaper service can also do this.
- Wipe well – be sure to wipe all the stool and urine away.
- Use unscented wipes or just plain water – these are less irritating. You can even rinse out the wipes with water, although this takes more time.
- Diaper rash cream – some lucky babies don’t need any. More sensitive bottoms need cream with each new diaper. There are two basic types of barrier creams:
- Petroleum ointment (Original A & D ointment) – this is an excellent preventative every-day ointment. It’s less sticky and less messy.
- White zinc oxide – this is thicker and may be better for babies who are more prone to rash.
FOUR WAYS TO TREAT DIAPER RASH FLARE-UPS
No matter how diligent you are with the above measures, your baby will still have a rash from time to time. Here are some tips to treating those rough spots:
- Wash off bottom with water – don’t wipe the sore areas. Instead, use a bulb syringe to gently wash baby’s diaper area.
- Gently dab or pat away any remaining stool. Blot baby’s bottom dry.
- Let it air out – leave the diaper off for a while, with no diaper cream on. Lay baby on a towel (with a waterproof pad underneath to catch accidents) with her bottom up. Do this as often as you can. This will help dry out the rash, which is important for the healing process.
- Diaper cream – when you do put the diaper back on, use generous amounts of cream. Here are some suggestions:
- Zinc oxide – for the moderate rash.
- Acid mantle – this is a brand name sold in stores. It is outstanding for moderate diaper rashes. Can be used with zinc oxide over it.
- Butt paste or Triple paste – there are a variety of creams that a pharmacist can mix up for you that contain a variety of ingredients. These are good for severe rashes. One brand that is already mixed is called Triple Paste. Ask your pharmacist for some. It is non-prescription. This cream may be difficult to find, but most pharmacies can order it from Summers Laboratories (1-800- 533-SKIN).
- Clotrimazole anti-fungal cream – for stubborn rashes, yeast may be involved (see below). You can add this over-the-counter cream to help.
- Hydrocortisone 1% cream – you can put this over-the-counter cream on twice a day beneath any of the other creams to help with severe rashes. It will help with the inflammation. Don’t use this for more than several days at a time as long-term use can damage the sensitive skin in the diaper area.
- Soothe and heal by Lansinoh. This pure lanolin ointment is excellent for soothing sore bottoms.
- Mix your own – if you can’t get a prescription, try mixing these together in the palm of your hand, then apply to baby’s bottom:
- Zinc oxide
- White petroleum ointment
- Acid mantle
- Aluminum acetate (Burrow’s solution)
- If you cant find Acid Mantle, then use Lansinoh (a lanolin ointment). It is available in the diaper cream section of drug stores.