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Diaper
Rash: Tips on Prevention and Treatment
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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