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Why Does Diaper Rash Happen?
Clues in Appearance of the Rash
Preventing Diaper Rash
Diapers: Cloth vs. Disposable
Treatment of Diaper Rash
When to Call Your Pediatrician
 
 

For most babies, diaper rash is a fact of life. I would like to share some information from my experience as a general pediatrician on how to prevent and treat most diaper rashes, and when to consult your own pediatrician about this problem.
 

Why Does Diaper Rash Happen?

Diaper rash is well named, since it is rare to see rashes on babies’ buttocks and genital areas in parts of the world where diapers are not worn. Infants have sensitive skin, and contact with several different irritants in the diaper area may cause rashes. These irritants include urine, which is wet and acidic, and stool, which contains bacteria and digestive enzymes. These substances may be even more irritating when diapers are left on too long, if you use plastic pants or disposable diapers that are fastened tightly, or when your baby has diarrhea.

Irritated skin is also fertile ground for the growth of a yeast called Candida. This is the same yeast that causes infections in babies’ mouths (sometimes called thrush) and vaginal infections in mature women. Candida is present in everyone’s intestines and skin, but is usually held in check by friendly bacteria. Although Candida diaper rash occurs frequently in infants, there is a special risk if your baby is taking an antibiotic. These medications kill friendly bacteria in the gastrointestinal tract and allow overgrowth of the yeast. However, even without antibiotics, any rash that has been present for more than a few days is likely to have Candida present.

Skin bacteria may also cause diaper rash. One particularly dangerous rash is caused by a certain strain of staphylococcus bacteria. It is called scalded skin syndrome because it looks like a bad burn. This rash needs immediate medical attention. Another bacterial diaper rash is caused by streptococcus—the same bug that causes strep throat in older children. Strep may cause a bright red rash in the area around the anus. This also needs medical attention.
 

Clues in Appearance of the Rash

The first sign of irritant diaper rash may be redness or small bumps on the lower abdomen, buttocks, genitals, or thigh folds. These early findings may be the result of prolonged contact with urine and stool. Candida rashes, found near skin folds, are typically solid red and surrounded by bright red spots. Bacterial rashes are more serious—if you see pimples with pus, or a bright red rash that looks like a burn, especially if your baby has a fever, call your pediatrician immediately.
 

Preventing Diaper Rash

With proper care, many diaper rashes can be prevented. Here are some ways to help reduce the risk of diaper rashes in your baby:

• Change your baby’s diaper frequently to reduce exposure to irritating urine and stool.
• Use plain water with a soft cloth to wipe your baby’s bottom. Avoid wipes with chemicals, perfumes, or alcohol.
• Apply petroleum jelly or barrier ointment (such as Desitin, A & D, or zinc oxide) after cleaning with a moist cloth to protect your infant’s skin.
• Avoid talc. If your baby breathes it in, this powder irritates the lungs and may cause pneumonia.
• Cornstarch should also be avoided, since it may increase the growth of yeast.
• Expose your baby’s bottom to air whenever possible.
• Avoid tight fitting disposable diapers or plastic pants over cloth diapers.
• Avoid unnecessary antibiotics. Let your pediatrician know that you only want antibiotics if they are really needed. Overuse of antibiotics may lead not only to diaper rashes, but to other complications, such as diarrhea, more drug-resistant “superbugs,” and other serious problems.

Diapers: Cloth vs. Disposable

Many parents are confused about whether to use cloth or disposable diapers. There is no right answer. Although the convenience of disposables makes them the more popular choice, there are many parents who are choosing cloth diapers, and most locations have services available to clean and deliver cloth diapers on a regular basis. Whichever you choose, be aware that babies average about 10 diapers per day, and may use even more on some days.

Advantages of cloth diapers:

• Cloth diapers are usually cheaper, even after laundering costs.
• They are softer and trap less moisture, so the risk of rash may be reduced.
• They are made of natural cotton so they may reduce the risk of allergic skin rashes.
• Cloth diapers are generally more ecological, as they can be recycled instead of accumulating in landfills.

• The main disadvantage of cloth diapers is the extra work in cleaning them. Many services are available to clean and deliver fresh diapers. If you decide to wash your own, you should dispose of solid waste separately in the toilet. Diapers should be washed with soap, not with detergent, fabric softeners, or antistatic products. Use hot water and double rinse each wash.
• Another disadvantage of cloth diapers is that they may be more inconvenient to use when traveling away from home. You may want a few disposables for travel to avoid inconvenience. Some people use tight plastic pants over cloth diapers when they travel, but this may lead to more rashes.
• Finally, the resources used in laundering cloth diapers cancel out some of the ecological advantages of cloth diapers.

• The chief advantage of disposable diapers is convenience. They are generally more absorbent than cloth diapers, but leaving them on longer leads to diaper rashes, so this is not really an advantage.

• Disposables trap more moisture and may increase the risk of rashes.
• The new superabsorbent types may be left on too long.
• The cost of disposable diapers is higher than cloth.
• Disposal of disposables is a major environmental challenge, since they are not biodegradable. They are a major factor in the growth of garbage landfills.
• There is a potential health risk associated with leaving waste (stool) inside.

Treatment of Diaper Rash

Most mild diaper rashes may be managed at home. But don’t wait: damaged skin is more likely to become infected with bacteria and yeast than healthy skin. Here are some important pointers:

• Have your baby go diaperless when possible, especially after a bowel movement. During naps, you may try putting a diaper or towel under the baby.
• Rinse the skin with warm running water.
• Adding some baking soda to the cleansing water may help neutralize acidity: one-half teaspoon of baking soda per cup of warm water. This is especially helpful with a yeast diaper rash.
• For flat red rashes or rashes with red spots on the surrounding margins (probable yeast), you may try treating the skin with an antiyeast cream, applied after each diaper change. Clotrimazole is an antiyeast cream that is available without a prescription. Nystatin is a common prescription antiyeast cream.
• Some pediatricians may also recommend using one percent hydrocortisone cream (available over the counter) at the same time as the antiyeast cream. Other doctors feel though that the hydrocortisone may make the yeast worse. So talk with your doctor about this option, and see what he or she recommends.
• For simple irritant diaper rashes, one percent hydrocortisone cream applied with each diaper change may help. Never use stronger steroids without consulting a physician.
• Antibiotics (ointments or oral) should never be used for diaper rashes without seeing a doctor.

When to Call Your Pediatrician

Observe your baby and his or her rash carefully, and call your doctor in the following circumstances:

• If you see pustules (pus-filled pimples)
• For any open or weeping blisters or sores
• If your baby has a fever or is acting very sick
• For any raw, bleeding areas
• If you think your baby has pain interfering with sleep
• If there is swelling on the tip of his penis
• If the rash is flaming red and looks like a burn
• If your baby’s rash is not improving after two days of home therapy
• If you have any other questions