Diaper rash: causes, treatment and prevention
Many factors can collide to cause diaper rash. Here’s what to do about it.
Your 1-year-old just tasted mandarin oranges for the first time and she gobbled them up! Great fun, until several hours later when she wakes from her nap screaming. When you check on her, you can tell she is in need of a diaper change. To your great surprise, when you change her soiled diaper you find an angry, red rash all over her bottom and she is letting you know, in no uncertain terms, that she is NOT happy.
Diaper rash pops up at some unexpected times, no matter how careful parents try to be. Don’t despair. These tips can help you deal with the discomfort, clear it up quickly and maybe even avoid it in the future.
What causes diaper rash?
Many factors can work together to make diapers a set-up for rash:
- Moisture from urine and stool, many times a day. No matter what diaper method (cloth or disposable) or brand you choose, none of them can keep all moisture away from your baby’s skin.
- Friction and occlusion. Those are fancy words to say that the diaper rubbing against the skin and that diaper’s great leak protection, keeping the area moist and humid, combine to make rash more likely.
- Diet. Breast-fed babies may have lower risk of diaper rash compared to formula-fed babies because of differences in stool pH. (Another reason to breast-feed.)
- Acidic foods, like mandarin oranges. These may may also change stool pH.
- Infections leading to diarrhea and causing skin irritation.
- Antibiotics. These may alter your baby’s gut bacteria and put your little one’s bottom at risk for a rash.
How should we treat a diaper rash?
Three words: Air. Air. Air.
Start at the beginning. Get a wet or soiled diaper off your baby as quickly as you can. When there’s a rash, you’ll want to change diapers more frequently than usual because a little bit of irritation can turn to a very angry rash quickly.
Clean the skin well. Wipes are OK for the mildest rash, but if your baby’s bottom is sore at all, please switch to plain, warm water. If the rash is mild you may be able to use a clean, wet washcloth to gently wipe the area. For moderate or severe irritation, I recommend using a little squirter bottle filled with warm water. Place a towel under your baby and gently squirt a little warm water over the irritated skin to wash away stool and urine. This may be gentler than wiping.
Then air. Take a few moments to allow the skin to dry. Fan the clean diaper over the skin or use a hairdryer on a low, slightly warm setting to gently dry the skin. The warmth of the hairdryer might increase circulation to the skin and aid with healing. Gentle cleaning and thorough airing may completely resolve your baby’s rash.
When should we use a diaper cream? And which one should we choose?
Products that are used in the diaper area include barrier creams and ointments, antibiotics, anti-fungals and anti-inflammatories. Here are descriptions and when and how you might want to use them and, importantly, not use them.
Barrier creams and ointments: These are great for coating clean, DRY skin to reduce exposure to urine and stool. Some ingredients help soothe irritation and heal the skin. Products in this category often contain petrolatum or zinc oxide as the active ingredients. Examples include the brands Vaseline, A&D, Balmex, Desitin and many, many others — I don’t have a favorite brand. The most important key to success is getting the skin thoroughly dry before you apply the product. These are moisture BARRIERS. If you put them on dry skin they’ll hold moisture out but if you put them on wet skin, they hold moisture in. They are good to prevent rashes, treat mild or moderate flat, red rashes and to be used on top other treatments to protect the skin.
Antibiotics: Over-the-counter antibiotics include products containing neomycin, polymyxin and others, e.g., brands like Neosporin or Polysporin. These are usually not helpful with diaper rashes. Infections in the diaper area are more often due to yeast than to bacteria. Your pediatrician may recommend an antibiotic in certain situations, but generally, I don’t suggest you start these on your own. They are not likely to help.
Anti-fungals: These are often helpful to treat the yeast infection that causes or accompanies a diaper rash. Over-the-counter products containing clotrimazole fall into this category as well as prescriptions containing nystatin. Yeast infections cause individual small, red bumps in the diaper area. Whenever the skin is red and irritated for longer than about three days, even if it started as just a smooth, flat red rash, yeast may take over and cause a secondary infection. So, for any rash lasting more than about three days, it’s reasonable to try an anti-fungal as part of your treatment.
Anti-inflammatories: Your pediatrician may recommend over-the-counter or stronger prescription topical steroids, such as cortisone and hydrocortisone, for inflammation or persistent irritation, but generally these are not something to use on your own. Steroids are absorbed through the skin in the diaper area much more than on other areas of the body, so we worry about side effects. Steer clear unless your doctor recommends them.
The BOTTOM (ahem) line for treating diaper rash
- Clean the skin.
- Dry it.
- Apply a yeast cream if concerned about yeast infection (rashes present for three or more days or rashes with individual raised, red bumps).
- Apply a thick layer of barrier ointment or cream on top.
- Repeat as needed.
- See your doctor if this does not help within a few days.
What about prevention?
Changing diapers frequently is a very important way to prevent diaper rash. What you do during the diaper change can also make a difference.
Diaper wipes and washcloths are necessarily damp to remove urine and stool from the skin. However, the moisture that remains on the skin can increase the risk of rash. Develop the habit of airing and drying the skin before putting on a fresh diaper. When my children were babies, I kept a little stack of clean clothes on the changing table. After wiping clean, I would pat the skin dry with a little cloth before fastening on the diaper, then toss the cloth into the laundry basket.
As soon as you see any redness, step up the frequency of diaper changes and add a little barrier cream to your regimen after drying the skin — I am really emphasizing that drying step. I like zinc oxide creams for this.
When introducing new foods to your baby, take it slowly with the obviously acidic foods. Don’t let her go overboard on the oranges no matter how much she likes them!
If your child needs to take an antibiotic, you might want to add in the zinc oxide cream right away in case of diarrhea. A nice, thick layer might prevent the skin from becoming irritated.
When should you see your pediatrician?
If your baby has a rash that doesn’t show signs of improvement within a week or is worsening after following these steps, you should schedule a visit to her doctor. If your child has very severe and recurrent diaper rashes, you should be sure to discuss this with your pediatrician. Some uncommon but serious health conditions may be associated with severe recurrent or persistent diaper rashes.
I hope these tips will help you avoid diaper rash altogether or at least clear up the misery as quickly as possible!
Rachel Lenox Mace, M.D., is a general pediatrician with the University Pediatrics practice at Vanderbilt Health at One Hundred Oaks. She is the mother of 3 children and enjoys cooking and reading.