What Is Diaper Rash?

You go to change your baby's dirty 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).

All infants develop a diaper rash at some time or another; some even arrive home from the hospital with a slight rash. Still, 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 are seen most frequently in babies around 9 to 12 months old.

Diaper rash can alarm parents and annoy babies, but most cases usually disappear after a few days with simple home treatments.

Children's Health Center Dermatitis

Signs and Symptoms

Diaper rash is characterized by reddish, puffy and perhaps slightly warmer skin in the diaper region — buttocks, thighs and genitals. You may notice that your baby seems more uncomfortable than usual, especially during diaper changing. A baby with a diaper rash will usually fuss or cry when the diaper area is washed or touched.

Causes

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. Diaper rash is more common in babies who have frequent stools, especially when the stools stay in the diaper overnight. The reason: Feces irritate the skin more than urine does. When babies have diarrhea, the stool's acid-base content is unbalanced, resulting in more skin irritation.
  
  
• Introduction of solid foods. As babies between the ages of 4 months and 12 months start to eat solid foods, the acid-base content of their stool changes, increasing the likelihood of diaper rash. Changes in your baby's diet also can increase the frequency of stools, which can lead to diaper rashes.
  
  
• Irritation from a new product. Disposable wipes, a new brand of disposable diaper, or a detergent, bleach or fabric softener used to launder diapers can have an irritating effect when in contact with your baby's bottom. Other substances that can add to the problem include the ingredients found in some baby lotions, powders and oils.
  
  
• Bacterial or yeast infection. What begins as a simple local infection may spread to the surrounding region. The region covered by a diaper — buttocks, thighs and genitals — is especially vulnerable to this tendency.
  
  
• Sensitive skin. Babies with skin conditions such as atopic dermatitis or eczema are more prone to diaper rashes.
  
  
• Chafing or rubbing. Tight-fitting diapers or clothing that rubs against the skin can lead to a rash.
  
  
• Use of antibiotics. Diaper rash can result when either babies or the mothers of breast-feeding babies are taking antibiotics. These medications kill bacteria and may result in an overgrowth of yeast (fungi) normally found on the skin. Yeast grows well in the warm, moist diaper region and can cause a rash.

Your baby's skin: Not always flawless Dermatitis

When to Seek Medical Advice

Diaper rash is easily treated in most cases and improves within several days after starting home treatment. If standard treatments such as frequent diaper changes and over-the-counter ointments don't bring improvement after a few days, consult your doctor. In some cases diaper rash can lead to secondary infections that may require prescription medications. Have your child examined if the rash is severe, worsens despite home treatment or occurs along with any of the following:

• Fever
  
  
• Blisters or boils
  
  
• Bleeding
  
  
• Crusty areas
  
  
• Bright red spots that together form a solid red area with a scalloped border
  
  
• Pus or weeping discharge

Fever

Treatment

The most important factor in treating diaper rash is to keep your baby's skin as clean and dry as possible. Until the rash clears, however, you'll want to take steps to ease your baby's discomfort. If your baby's diaper rash persists during home treatment, your doctor may prescribe an antifungal cream and possibly a mild hydrocortisone cream. Diaper rashes usually require several days to improve and can continue for weeks. If the rash persists beyond prescription treatment, however, your doctor may recommend that your baby see a dermatologist.

Use creams with steroids only if your baby's pediatrician or dermatologist recommends them — strong steroids or frequent use can lead to additional problems.

Prevention

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 can also aid in cleaning the skin.
  
  
• Pat your baby dry with a clean towel. Don't scrub your baby's bottom. Scrubbing can lead to further skin breakdown.
  
  
• Don't dry your baby with a blow dryer. Hot air from a blow dryer can cause skin to shrink and crack.
  
  
• Don't over-tighten diapers or use diapers with elastic edges. Both prevent airflow into the diaper region, setting up a moist environment favorable to diaper rashes. Tight-fitting 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 bare bottomed. 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.
  
  
• Use a mild detergent to wash diapers. Double rinse them if your child already has a diaper rash or is prone to rashes.
  
  
• Presoak heavily soiled diapers separate from other clothes. If you choose not to wash cloth diapers yourself, you can have a diaper service professionally clean them.
  
  
• Don't use fabric softeners or antistatic sheets on diapers. These products can cause irritation and rashes on young, sensitive skin.
  
  
• Use diaper liners. If you use cloth diapers, you can also add a stay-dry liner to keep your baby drier.
  
  
• Use breathable diaper covers. Instead of using plastic or rubber pants over cloth diapers, opt for more breathable diaper covers.
  
  
• If your baby is especially prone to diaper rash, apply an ointment with each diaper change to prevent further skin irritation. Petroleum jelly and zinc oxide are the time-proven ingredients included in many prepared diaper ointments. Use these products on clear skin to help 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. Disposable diapers labeled as "super-absorbent" offer little advantage in preventing diaper rash from bowel movements because these diapers absorb urine, not feces.

There's no one best diaper — you'll just have to see what works best for your baby. If you have a problem with one brand of disposable diaper, try another. Whether you use cloth diapers, disposables or both, 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.

Self-Care

A variety of diaper rash medications are available without a prescription. Consult with your doctor or pharmacist for specific recommendations. The most popular over-the-counter products are Desitin, Balmex, and A and D ointments. Many diaper rash creams contain the active ingredient zinc oxide. These products typically are applied, in a thin layer, to the irritated region several times throughout the day to soothe and protect your baby's skin.

Ointments or creams are usually less irritating than lotions or liquid solutions. Yet ointments completely cover the skin and don't allow it to receive air. Creams dry on the skin and allow air to come through. Your doctor can tell you whether a cream or ointment would be better for your child's particular rash. As a general rule, stick with products designed specifically for babies. Don't use products developed to treat chafing or rashes experienced by adults or by animals.

To aid the healing of diaper rash, do what you can to increase airflow to the diaper region. These simple suggestions may help:

• Let your child go without a diaper for short periods of time.
  
  
• Avoid using plastic or tight-fitting diaper covers.
  
  
• Use larger-sized diapers until the rash goes away.

While your baby has a diaper rash, avoid washing the affected area with soaps and disposable, scented wipes. Alcohol and perfumes in these products can irritate your baby's skin and aggravate or prolong the rash.

In the past, it was common to use talcum powder or cornstarch to protect a baby's skin and absorb excess moisture. However, inhaled talcum powder can be intensely irritating to a baby's lungs. An infant can suddenly grab the bottle of powder and pull it toward his or her face if you're not careful. Cornstarch use presents another problem because it has been found to be an excellent food for bacteria. When it's allowed to collect in the skin creases of the diaper area, it can assist in the formation of bacterial infection. For these reasons, don't use powders and cornstarch.

— July 11, 2002 —