Dr. MJ Bazos MD, Patient Handout
Diaper Rash

Guidelines for Parents

Diaper rash affects most babies, but it is usually not serious. This brochure explains the causes of diaper rash, steps you can take to help prevent it, and how to treat it if it develops.

What is diaper rash?
Diaper rash can be any rash that develops inside the diaper area. In mild cases, the skin might be red. In more severe cases, there may be painful open sores. You will usually see a rash around the abdomen, genitalia, and inside the skin folds of the thighs and buttocks. Mild cases clear up within 3 to 4 days without any treatment. If a rash persists or develops again after treatment, consult your pediatrician.

What causes diaper rash?
Over the years diaper rash has been blamed on various causes, such as teething, diet, and ammonia in the urine.
However, medical experts now believe it is caused by any of the following:

• Too much moisture
• Chafing or rubbing
• Prolonged contact of the skin with urine, feces, or both
• Yeast infection
• Bacterial infection
• Allergic reaction to diaper material

When skin stays wet for too long, the layers that protect it start to break down. When wet skin is rubbed, it also damages more easily. Moisture from a soiled diaper can harm your baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop. Further rubbing between the moist folds of the skin only makes the rash worse. This is why diaper rash often forms in the skin folds of the groin and upper thighs.

More than half of babies between 4 months and 15 months of age develop diaper rash at least once in a 2- month period. Diaper rash occurs more often in the following instances:

• As infants get older — mostly between 8 to 10 months of age
• If babies are not kept clean and dry
• In babies who have frequent stools, especially when the stools stay in their diapers overnight
• When babies begin to eat solid foods
• When babies are taking antibiotics, or in nursing babies whose mothers are taking antibiotics

Infants taking antibiotics are more likely to get diaper rashes caused by yeast infections. Yeast infects the weakened skin and causes a bright red rash with red spots at its edges. You can treat this with over-the-counter antifungal medications. If you see these symptoms, you may wish to consult with your pediatrician.

What can I do to prevent diaper rash?
To help prevent diaper rash from developing, you should:

• Change the diaper promptly after your child wets or has a bowel movement. This limits moisture on the skin. Do not put the diaper on airtight, especially overnight. Keep the diaper loose so that the wet and soiled parts do not rub against the skin as much.
• Gently clean the diaper area with water. You do not need to use soap with every diaper change or after every bowel movement. (Breastfed infants may stool as many as 8 times a day.) Use soap only when the stool does not come off easily.
• Do not use talcum or baby powder because they could cause breathing problems in your infant.
• Avoid over-cleansing with wipes that can dry out the skin. The alcohol or perfume in these products may irritate some babies’ skin.

What can I do if my baby gets diaper rash?
If diaper rash develops despite your best efforts to prevent it, try the following:

• Change wet or soiled diapers often.
• Use clear water to cleanse the diaper area with each diaper change. Using water in a squirt bottle lets you clean and rinse without rubbing.
• Pat dry; do not rub. Allow the area to air dry fully.
• Apply a thick layer of protective ointment or cream (such as one that contains zinc oxide or petrolatum) to form a protective coating on the skin. These ointments are usually thick and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or rubbing will only damage the skin more.
• Check with your pediatrician if the rash:

- Has blisters or pus-filled sores

- Does not go away within 48 to 72 hours

- Gets worse

• Use creams with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful.

Which type of diaper should I use?
There are many different brands of diapers. Diapers are made of cloth or disposable materials. After they get soiled, you can wash cloth diapers and use them again and you throw away disposable diapers.

Research suggests that diaper rash is less common with the use of disposable diapers. In child care settings, children who wear super-absorbent disposable diapers tend to have lower rates of diaper rash. Regardless of which type of diaper you use, diaper rash occurs less often and is less severe when you change diapers often.
If you use a cloth diaper, you can use a stay-dry liner inside it to keep your baby drier.
If you choose not to wash cloth diapers yourself, you can have a diaper service clean them. If you do your own washing, you will need to presoak heavily soiled diapers. Keep and wash soiled diapers separate from other clothes. Use hot water and double-rinse each wash. Do not use fabric softeners or antistatic products on the diapers because they may cause rashes in young, sensitive skin. Whether you use cloth diapers, disposables, or both, always change diapers as needed to keep your baby clean, dry, and healthy.

Remember — never leave your baby alone on the changing table or on any other surface above the floor. Even a newborn can make a sudden turn and fall to the floor.

Diaper rash is usually not serious, but it can cause your child discomfort. Follow the steps in this brochure to help prevent and treat diaper rash. Discuss any questions you have about these steps with your pediatrician.