Any rash in the skin area covered by a diaper
Almost every child gets diaper rashes. Most are due to prolonged contact with moisture, bacteria, and ammonia. The skin irritants are made by the action of bacteria from bowel movements on certain chemicals in the urine. Bouts of diarrhea cause rashes in most children. Diaper rashes occur equally with cloth and disposable diapers.
With proper treatment these rashes are usually better in 3 days. If they do not respond, a yeast infection (Candida) has probably occurred. Suspect this if the rash becomes bright red and raw, covers a large area, and is surrounded by red dots. You will need a special cream for a yeast infection.
Change Diapers Frequently. The key to successful treatment is keeping the area dry and clean so that it can heal itself. Check the diapers about every hour, and if they are wet or soiled, change them immediately. Exposure to stools causes most of the skin damage. Make sure that your baby's bottom is completely dry before closing up the fresh diaper.
Increase Air Exposure. Leave your baby's bottom exposed to the air as much as possible each day. Practical times are during naps or after bowel movements. Put a towel or diaper under your baby. When the diaper is on, fasten it loosely so that air can circulate between it and the skin. Avoid airtight plastic pants for a few days. If you use disposable diapers, punch holes in them to let air in.
Rinse the Skin with Warm Water. Washing the skin with soap after every diaper change will damage the skin. Use a mild soap (such as Dove) only after bowel movements. The soap will remove the film of bacteria left on the skin. After using a soap, rinse well. If the diaper rash is quite raw, use warm water soaks for 15 minutes three times every day.
Nighttime Care. At night use the new disposable diapers that are made with materials that lock wetness inside the diaper and away from the skin. Avoid plastic pants at night. Until the rash is better, awaken once during the night to change your baby's diaper.
Creams and Ointments. Most babies don't need any diaper creams or powders. If your baby's skin is dry and cracked, however, apply an ointment to protect the skin after washing off each bowel movement. A barrier ointment is also needed whenever your child has diarrhea.
Cornstarch reduces friction and can be used to prevent future diaper rashes after this one is healed. Studies show that cornstarch does not encourage yeast infections. Avoid talcum powder because of the risk of pneumonia if your baby inhales it.
Yeast Infections. If the rash is bright red or does not respond to 3 days of warm water cleansing and air exposure, suspect a yeast infection. Apply Lotrimin cream (no prescription necessary) 4 times per day or after each bottom rinse for bowel movements.
Prevention of Diaper Rash. Changing the diaper immediately after your child has a bowel movement and rinsing the skin with warm water are the most effective things you can do to prevent diaper rash.
If you use cloth diapers and wash them yourself, you will need to use bleach (such as Clorox, Borax, or Purex) to sterilize them. During the regular cycle, use any detergent. Then refill the washer with warm water, add 1 cup of bleach, and run a second cycle. Unlike bleach, vinegar is not effective in killing germs.
CALL OUR OFFICE
- It looks infected (yellow pus, pimples, blisters, spreading redness, red streaks).
- Your child starts acting very sick.
During regular hours if
- The rash isn't much better in 3 days.
- You have other concerns or questions.
Instructions for Pediatric Patients, 2nd Edition, ©1999 by WB Saunders Company.
Written by Barton D. Schmitt, MD, pediatrician and author of Your Child’s Health, Bantam Books, a book for parents.