Diaper Rash

Diaper rash is a common condition that can make a baby’s skin sore, red, scaly, and tender. Most cases will clear up up with simple changes in diapering.

Causes

Usually, diaper rash is the result of an irritation, infection, or allergy.

• Irritation. A baby’s skin can get irritated when a diaper is left on for too long and poop (or the diaper itself) rubs against the skin repeatedly.
• Infection. Urine (pee) changes the skin’s pH levels, and that lets bacteria and fungi grow more easily. The substances that stop diapers from leaking also prevent air circulation, creating a warm, moist environment where bacteria and fungi can thrive, causing a rash.
• Allergies. Babies with sensitive skin also can develop rashes. Certain types of detergent, soaps, diapers (or dyes from diapers), or baby wipes can affect sensitive skin, causing a rash.

Also, starting new foods can change the content and frequency of a baby’s poop, which can sometimes lead to a diaper rash. And diarrhea can make an existing case of diaper rash worse.

Diaper rash that lasts for more than a few days, even with changes to the diapering routine, might be caused by a yeast called Candida albicans (a type of fungus). This form of the rash is usually red, slightly raised, and has small red dots extending beyond the main part of the rash. It often starts in the deep creases of skin and can spread to skin on the front and back of the baby. Antibiotics given to a baby or a breastfeeding mom can cause this, as they kill off the “good” bacteria that keep Candida from growing.

Prevention

To prevent diaper rash, keep your baby’s skin as dry and clean as possible and change diapers often so that poop and pee don’t irritate the skin.

Try these tips:

• change your baby’s soiled or wet diapers as soon as possible and clean the area thoroughly
• occasionally soak your baby’s bottom between diaper changes with warm water; you can gently scoop the water over your baby’s bottom with your hand or squeeze it from a plastic bottle
• allow your baby’s skin to dry completely before you put on another diaper
• pat the skin gently with a soft cloth when drying it — rubbing can irritate skin
• put the diaper on loosely to prevent chafing
• change diapers often — ideally every 2 hours or so — and after every poop
• applying diaper cream or ointment with each diaper change can help some babies with sensitive skin, but not all babies need this

If you use cloth diapers, check the manufacturer’s directions on how to best clean them. Only use detergents in the amount recommended, and run an extra rinse cycle after washing to remove traces of soap or detergent that can irritate your baby’s skin. Avoid using fabric softeners and dryer sheets — even these can irritate skin.

Some babies get a rash after switching to a new type of diaper. While experts don’t recommend any particular brand, if your child is sensitive you can look for diapers free of dyes or fragrances. Some babies are sensitive to baby wipes; water and a washcloth work just as well and may be a gentler option.

Treatment

To help clear up diaper rash, check your baby’s diaper often and change it as soon as it’s wet or soiled. Gently cleanse the diaper area with soap and water and pat dry. Creams and ointments containing zinc oxide or petroleum help to soothe skin and protect it from moisture. They should be smeared on thickly (like cake icing) at each diaper change.

Some experts suggest letting your baby go without diapers for several hours each day to give irritated skin a chance to dry and “breathe.” This is easiest if you place your baby in a crib with waterproof sheets or on a large towel on the floor.

Diaper rash usually goes away within 2 to 3 days with home care, although it can last longer.

When to Talk to the Doctor

If the rash doesn’t go away, gets worse, or if sores appear on your baby’s skin, talk to your doctor. Also seek medical care if your baby has a fever, pus is draining from the rash, or if your child is fussier than usual.

Depending on what type of rash your baby has, the doctor may choose to use an antifungal cream or an antibiotic cream, or may recommend other changes to your diapering routine. Sometimes, if those changes don’t help a rash caused by an allergic reaction, the doctor may prescribe a mild steroid cream for a few days until the rash goes away.