Dealing with diaper rash is part and parcel of childcare, especially in the first year or so of your child’s life. It is not an indication of being a negligent parent in any way.
No parent is unfamiliar with the dreaded condition. If your child’s diaper area looks disturbingly red and irritated, chances are its diaper rash. The skin may also be a little puffy and warm to the touch. If you’re lucky, the rash may be mild – a few red spots in a small area. Otherwise, it could be extensive, with tender red bumps that spread to the tummy and thighs.
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How does a child get diaper rash?
Diaper rash can be caused by anything from a new food to your child’s own urine. Here are the most common causes of diaper rash:
Exposure to wetness.
No matter how absorbent a diaper seems to be, it will still leave traces of moisture on your child’s skin. Urine, especially when it mixes with bacteria from your child’s stool, breaks down and forms ammonia. Most babies’ skin cannot tolerate the harshness of ammonia on their skin. This is one of the reasons why a child with frequent bowel movements or diarrhoea seems more prone to diaper rash.
Although a child left in a dirty diaper for too long is more likely to develop diaper rash, any child with sensitive skin can still get a rash.
Chafing / chemical sensitivity.
Your child’s diaper rash may be the result of his diaper rubbing against his skin, especially if he’s particularly sensitive to chemicals like the fragrances in a disposable diaper or the detergents used to wash a cloth diaper. It could also be that a lotion, cream or talc you’re using at diaper time doesn’t agree with your child’s skin.
The introduction of new foods.
It’s common for children to get diaper rash when they start eating solid foods or are introduced to a new food. Any new food changes the composition of the stool. The acids in certain foods, such as strawberries and fruit juices, can be culprits when it comes to diaper rash. A new food might increase the frequency of your child’s bowel movements as well
Bacterial or yeast (fungal) infection.
The area covered by a diaper – buttocks, thighs and genitals – is especially vulnerable because it’s warm and moist. This makes the area a perfect breeding ground for bacteria and yeast, so what may seem like a simple skin infection to begin with may spread to the surrounding region. These rashes generally start within the creases of the skin, and red dots may form around the creases.
Irritation from a new product.
Disposable wipes, a new brand of disposable diaper, detergents, bleach or fabric softener used to launder cloth diapers are all capable of irritating a baby’s delicate nappy area. Other substances that can add to the problem include ingredients found in some baby toiletries.
Use of antibiotics.
Antibiotics kill bacteria – both bad and good ones. Without the right balance of good bacteria, yeast infections may occur. This can happen when babies take antibiotics themselves or when breast-feeding mothers take antibiotics.
Infection.
The diaper area is warm and moist, which is practically a playground for bacteria and yeast. So it’s easy for a bacterial or yeast infection to flourish there and cause a rash, especially in the cracks and folds of your child’s skin.
Sensitive skin.
Babies with skin conditions, such as atopic dermatitis or eczema, may be more likely to develop diaper rashes. However, itself eczema tend to affect areas other than the diaper area including the face, neck and arms.
Diaper rash is characterised by the following:
Physical signs on the skin.
Diaper rash is marked by red, angry – and vulnerable – looking skin in the diaper region – buttocks, thighs and genitals.
Extra fussiness due to discomfort.
A baby with diaper rash would appear to be uncomfortable, fussy and irritable. This would appear especially so during nappy – changing times, when the diaper area is tender and sensitive to water and to touch.
More common with disposables.
Diaper rash is more common in children who wear disposable diapers. They’re more common in babies during their first 15 months, especially between 8 and 10 months of age.
When to see a doctor
Diaper rash is usually easily treated at home and improves within a few days. However, if diaper rash persists, it may lead to secondary infection. If your baby’s skin doesn’t improve after a few days of home treatment efforts with over-the-counter ointment and more frequent diaper changes, it’s time to check with your doctor.
Your child should be examined if:
- The rash is severe
- The rash worsens despite home treatment
Be sure to inform your doctor if the rash occurs along with any of the following:
- Fever
- Blisters or boils
- A rash that extends beyond the diaper area
- Pus or weeping discharge from the rash area
At The Doctors
Useful information you can provide the doctor with:
- Your baby’s signs and symptoms. Also disclose how long your baby has had these symptoms.
- List all products used on your baby’s skin. Include brand of diapers, laundry detergent, soaps, lotions, powders and oils you use for your baby in this piece of information. If you suspect one or more products may be causing your baby’s diaper rash, it would be a good idea to bring them to the appointment so your doctor can read the label/labels.
- Write down all that you need to ask your doctor. Prepare your list of questions in advance to help you make the most of your time with your doctor.
- Your baby’s key medical background and vital information.These should include all the conditions your baby has been treated for and all medications, either prescribed or over-the-counter which was taken. If your baby is breast-fed, state any medications you have taken recently.
Questions for your doctor that may help you.
What is the most likely cause of my baby’s rash?
What diaper ointments or creams would you recommend for my baby?
When should I use an ointment instead of a cream, and vice versa?
Are there any products or ingredients that I should avoid using with my baby?
Are there any foods I should avoid giving my baby, either through breast milk or through my baby’s diet?
How soon can I expect improvement?
What can I do to help my baby’s skin heal?
What can I do to prevent this condition from recurring?
What you can do in the meantime
The best treatment for diaper rash is to keep your baby’s skin as clean and dry as possible. Give your baby as much diaper-free time as possible. This gives the skin a chance to start healing. When you do use diapers, change them frequently and apply a diaper rash cream or ointment to act as a barrier between your baby’s skin and a dirty diaper. Prior to the appointment with your baby’s doctor, avoid products that seem to trigger your baby’s rash. Wash your baby’s bottom with water after each diaper change, and avoid soaps and wipes, especially those containing alcohol or fragrance.
Only by recommendation.
If your baby’s diaper rash persists during home treatment, your doctor may prescribe an antifungal cream or a mild hydrocortisone cream. Use creams or ointments with steroids only if your baby’s paediatrician or dermatologist recommends them.
Worst-case scenario.
Diaper rashes usually require several days to improve but, in some cases, might persist for weeks. If the rash persists despite prescription treatment, your doctor may recommend that your baby see a dermatologist.
Over-the-counter products
- Various diaper-rash medications are available without a prescription. Ask a pharmacist for recommendations.
- Zinc oxide is the active ingredient in most diaper-rash creams. Diaper-rash creams are usually spread out in a thin layer to the irritated region and re-applied throughout the day to soothe and protect a baby’s skin. Zinc oxide based baby creams may also be used to prevent diaper rash on normal, healthy skin.
- Ointments or creams may be more effective than lotions or liquid solutions. However, ointments might also create a barrier over the skin, making it difficult for it to breathe. Creams dry on the skin and allow air through. Ask your doctor 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.
More airflow for that little butt
To aid the healing of diaper rash, do what you can to increase airflow to the diaper region. These simple suggestions may help:
- Now and then let your child go diaper-less.
- Avoid using ill-fitting diapers
- Avoid plastic diaper covers.
- If possible, use cloth diapers until the rash goes away.
- Avoid washing the affected area with soaps or scented wipes. Alcohol and perfumes in these products can irritate your baby’s skin and aggravate or prolong the rash.
Simple but effective strategies
- Don’t leave soiled diapers. Remove/change dirty diapers promptly.
- Alert your daycare staff. If your child is in day care, alert the staff of your baby’s condition and ask them to take extra care by changing dirty diapers promptly.
- Use lots of clean water. Rinse your baby’s bottom with water during each diaper change. If you are not using the sink or tub, moist washcloths and cotton balls also can aid in cleaning the skin. Don’t use wipes that contain alcohol or fragrance.
- Gently does it. Pat dry the affected area gently with a clean towel. Don’t rub your baby’s bottom. Rubbing can further irritate the skin.
- No tight-fitting diapers. Diapers that are too tight prevent airflow into the diaper region, setting up a warm and moist environment favourable to diaper rashes. Tight-fitting diapers can also cause chafing at the waist or thighs.
- 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, even ones made specially for baby’s laundry because they may still 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 the diaper service takes these steps as well.
- Cream up regularly. If your baby gets rashes often, apply baby cream during each diaper change to prevent skin irritation. Using a good baby cream even on problem-free skin helps keep it in good condition.
- Keep your hands clean. Hand washing can prevent the spread of bacteria or yeast to other parts of your baby’s body, to yourself or to other children.
- Give your baby’s bottom more “air-time” without a diaper. 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.
