Diaper Rash

Diaper rash usually begins as a solid patch of red, thickened skin (often around the anus) and can spread to cover the entire groin and lower buttocks. The same moist, warm, closed-off conditions causing the original rash also can lead to infection by bacteria or yeast. An infected rash can become a group of separate round spots with oozing, crusting, and surrounding redness and swelling. While many factors can cause diaper rash, it’s your infant’s very thin, delicate skin which makes him or her so susceptible to this common problem.

Causes of Diaper Rash

  • Moisture
  • Prolonged contact with urine or feces
  • Chemical irritation
  • Chafing
  • Occlusion (poor skin/air contact)

Breast-fed babies have less diaper rash, probably because they urinate less often and their urine and stool are chemically different from bottle-fed babies. High-protein foods raise acid levels in urine and stool, promoting diaper rash.

Of course, keeping the area dry is the most important thing you can do to prevent the rash. Many diaper comparison studies have been done, and the results show a slight advantage to the newer gel-type ("super absorbent") disposable diapers compared to cloth and the older cellulous-type disposable. Gel-type diapers simply keep the area drier.

Prickly Heat

Many confuse prickly heat (miliaria) with diaper rash. Prickly heat is caused by blocked sweat glands which often occur in the diaper area. It looks like small red spots all over, some with tiny blisters at the top. Prickly heat spots are usually only a few millimeters (1/8-1/4") wide, whereas diaper rash occurs in much larger patches. Prickly heat goes away by itself, but you can help by airing out the diaper area as much as possible. Keeping your baby cool and dry when it’s hot out also helps prevent this rash.

There are only two basic prevention techniques. Always remember:

  1. Keep the area dry.
  2. Don’t irritate the skin.

See the box for practical diapering tips based upon these two guiding principles.

Diapering Tips

  • Change your baby’s diapers often (especially when soiled instead of just wet).
  • Don’t wipe your baby with a "clean" part of the used diaper. This spreads bacteria and yeast. Used diapers are microscopically dirty everywhere, not just on the obviously wet or soiled parts.
  • Use hypoallergenic, unscented wipes or plain water. Harsh chemicals and perfumes from disposable wipe solutions are a major cause of diaper rash.
  • Fasten your child’s diapers loosely to prevent chafing and promote air circulation.
  • Try to let your baby "air dry" for at least a few minutes before putting on a fresh diaper.
  • Corn starch or talc helps keep the skin dry.

There are dozens of home remedies and commercial OTC products available for diaper rash, but most lack scientific evidence for effectiveness. However, both zinc oxide ointments and white petrolatum are proven effective agents for treating diaper rash. They block irritants from contacting the skin, promote healing, and minimize chances of infection.

White petrolatum can block the skin too much and cause prickly heat or a skin break down, so we recommend zinc oxide combinations only. Corn starch/talc and zinc oxide combination powders are an excellent way to keep the rash from returning once it’s gone.

Many parents assume as diaper rash worsens (or those round blisters pop up) that some type of anti-infection cream should be used. This is a big mistake. The FDA has ruled infections in the diaper area shouldn’t be treated by OTC medications, and for good reason: you can’t tell at home what kind of infection is present. If you even suspect infection, take your child to a doctor. Testing is crucial to determine whether yeast or bacteria are present, because treatment is different for each.

Rashes are always hard for parents to figure out. If the above suggestions and products don’t clear up the diaper rash within one week, see your doctor. And of course if there are any signs of infection on your child (pus, crusting and oozing rash, large or round "spots" of diaper rash, or strong odor from the skin), see your doctor right away.

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