Diaper Rash

A diaper rash is any rash on the skin area covered by a diaper. Almost every child gets diaper rashes. Most of them are due to prolonged contact with moisture, bacteria, and ammonia. The ammonia and other skin irritants are made by the reaction of bacteria from bowel movements to certain chemicals in the urine. Bouts of diarrhea cause rashes in most children. Diaper rashes occur less frequently with disposable diapers.

With proper treatment these rashes are usually better in 3 days. If the rash does not improve with treatment, then your child probably has a yeast infection (Candida). If your child has a yeast infection, then the rash becomes bright red and raw, covers a large area, and is surrounded by red dots. You will need a special cream for yeast infections.

• Change diapers frequently 
  The key to successful treatment is keeping the area dry and clean so 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.
   
• Rinse the skin with warm water 
  Do not wash the skin with soap after every diaper change because it can damage the skin. Use a mild soap (like Dove) only after bowel movements. The soap will remove the film of bacteria left on the skin. Diaper wipes are inadequate for cleaning off poop. They commonly leave a film of bacteria 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 a day.
   
• Nighttime care 
  At night use disposable diapers that lock wetness inside the diaper and away from the skin. Avoid plastic pants at night. Until the rash is better, awaken your baby once during the night to change the diaper.
   
• Creams and ointments 
  Most babies don't need any diaper cream. However, if your baby's skin is dry and cracked, apply an ointment to protect the skin after you wash off each bowel movement. A barrier ointment is also needed whenever your child has diarrhea.
   

  Your baby's ointment is ___________________________.

  Cornstarch reduces friction and can be used to prevent future diaper rashes after this one is healed. Recent studies showed 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 start getting better after 3 days of warm water cleaning and air exposure, your child probably has a yeast infection. Apply Lotrimin cream (no prescription necessary) four times a day or after each bottom rinse for BMs.

Changing the diaper right 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, 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.

If you feel that your child needs immediate medical care.

• The rash looks infected (pimples, blisters, boils, sores). 
• Your child starts acting very sick.

• The rash isn't much better in 3 days. 
• The diaper rash becomes bright red or raw. 
• You have other concerns or questions.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.