Diaper Rash

What is it?

Diaper rash is a red, irritated area of skin in the groin, buttocks, and other skin that lies under a baby’s diaper. Almost every baby gets diaper rash at some point. Diaper rash has several different causes, but they all have the same root – delicate skin and moisture. Babies have soft and delicate skin that is easy to damage, and the diaper area is often moist, especially during diarrhea. Moisture on the skin weakens its structure and reduces its normal protective coating of oil. Germs from the skin surface or from stool grow very fast in this environment. Some germs, like candida (yeast) can actually start growing on the skin. Other germs, like bacteria, produce by-products that are harmful to the skin. Either way, the thin, delicate skin in the diaper area begins to break down, and the baby’s body may produce inflammation to try to heal the area. Inflammation causes redness, pain, and tenderness. Sometimes the skin can even break or peel, which is quite painful, especially when urine touches it. Diaper rash is more common during diarrhea, and the frequent diaper changes make it even more uncomfortable for the child.

The biggest concern in diaper rash is usually the baby’s comfort. Diaper rash probably feels a little like chafing skin or chapped lips – it is irritating all the time and worse when you move or touch the area. Diaper rash is almost never dangerous or serious, but it can be very annoying to the baby. Babies with diaper rash are often fussy, cranky, and can’t spend as much time being fun and cuddly as they want to be, and as you want them to be. If the home is already stressful for other reasons, a fussy, cranky baby with diaper rash can feel like the last straw. Unfortunately, diaper rash and crying push some people over the edge into hurting their babies. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.

Fortunately, diaper rash is usually easy to treat. Since moisture and soiling are the biggest causes, the solution is to keep the area as dry and clean as possible. The first step is to check the diaper frequently and change it if it is even a little wet. This can be inconvenient, but it is better than having the rash get worse. If you use baby wipes with diaper changes, be watchful and see if your baby seems to be in pain when you use the wipe. Most wipes today have skin softeners in them, but they may contain fragrances or other chemicals that sting on open skin. If the baby fusses, switch to using just plain warm water and the softest cloth you can find. Pat the skin dry rather than wiping it. It is generally a good idea to avoid using any soap at all on broken skin in the diaper area – especially avoid using strong adult deodorant soaps. These are very drying to the skin. Whenever possible, try to leave the diaper off of your baby, or at least leave it open over the area of the worst rash. Usually the only time you can do that is when the baby sleeps.

After each diaper change, you can apply a petrolatum-based ointment or jelly, such as Vaseline® A & D ointment, zinc oxide, Desitin® and others. These oil-based products "waterproof" the skin and keep moisture off of it. They also give the skin a chance to recover some of its own oil and to heal. You can use the least expensive version of these "barrier" ointments, and apply large amounts that you can drop onto the skin and smear around. That way you don’t have to try to apply small amounts of medicine in the sore, painful area. Both you and your baby will appreciate this. Please check the labels carefully, and avoid using creams or lotions unless your doctor specifically recommends them. These are water-based products and do not provide nearly as much protection.

Diaper rashes that are caused by yeast can be especially troubling. They produce a red rash that is raised and bumpy – it can sometimes be scaly. Yeast rashes can spread beyond the diaper area – you may see small red spots near the main rash. If your doctor feels your baby has a yeast rash, s/he will prescribe an anti-fungal ointment such as nystatin, mycostatin, or clotrimazole (Lotrimin® and others). Use this after each diaper change and before you apply the Vaseline® or A&D Ointment. Most doctors recommend continuing to use these medications for about three days after the last signs of rash disappear.

Sometimes doctors recommend using a mild steroid cream like hydrocortisone 0.5% if the rash is very inflamed. Please check with your doctor before using any steroid medication. Some steroid creams and ointments can cause changes in skin color or other properties.

Most diaper rashes clear up readily with careful attention to keeping the area clean and dry, with additional use of any needed medicines. Some things that can happen along with a diaper rash that you should look out for are:

• Spreading of the rash beyond the diaper area
• Blistering or breaking of the skin
• Fever
• Changes in appetite
• White flat patches in the mouth or on the tongue – these can be signs of oral thrush and need a different kind of treatment

If any of these things happen, please check with your doctor.

One more very important point: diaper rash, just like colic or other conditions that cause babies to cry a lot, can make parents frantic. Parents who already have a lot going on and who feel stressed sometimes just can’t take a crying baby - all parents feel this way from time to time. If you find that you are beginning to feel that way, please call a friend, a relative, or someone else who can watch the baby for a while so you can get some rest, go shopping, or just relax for an hour or so. It is normal to feel angry and frustrated with a crying baby. Sadly, anger and frustration can lead to injuring a baby, which is never normal. NEVER SHAKE A BABY.

When yeast is the cause of diaper rash, it very often infects the baby’s mouth as well. This is called oral thrush. We treat thrush with anti-fungal medications just like the diaper rash, but in an oral form. Some doctors automatically start oral medicine when they are treating a yeast diaper rash. You may also want to read our Aftercare Instructions on Thrush.

Some diaper rashes, especially yeast ones, can cause a lot of redness and swelling of the skin around the baby’s genitals. This can be frightening to look at, especially in boys. Sometimes the rash causes a dramatic swelling and redness of the head or shaft of the penis. This is called balanitis or posthitis. These conditions get better as the diaper rash improves. Please read our Aftercare Instructions on Balanitis and Posthitis.

Most of the time a rash under the baby’s diaper is simply a diaper rash. In summer babies can sweat in the diaper area and develop a pink or red rash like tiny goose bumps. Some people call this "prickly heat" or a heat rash. Generally this goes away with a cool bath.

Infections of the skin are rare in younger babies, but occasionally toddlers who are still in diapers can develop a skin infection called "impetigo." Impetigo usually breaks out in more exposed areas but sometimes it occurs in the diaper area. You can also read our Aftercare Instructions on Impetigo.

In rare cases, severe nutritional deficiencies can cause skin rashes, especially cracked or peeling skin. Deficiencies of zinc and some of the B-vitamins can cause this kind of skin change. Seborrhea, a condition in which there is too much oil in the skin, can also cause a scaly or bumpy rash in the diaper area. Even the germs that we usually think of causing strep throat can cause infections of the vagina or anus. These infections can spread onto the skin around the area and cause redness and pain.

Sadly, sometimes people who are angry at babies hurt them on purpose. Most doctors have seen at least one baby who has had cigarette burns or other injuries in their diaper areas. Burns are usually perfectly circular and just a little bigger around than a cigarette. They may have raised edges and be dark red, purple, or black in the center. A form of impetigo called "bullous impetigo" can make sores that look a bit like cigarette burns, but the sores are usually not all of exactly the same size. If you have any doubt at all, please take your child to your doctor right away, and do not let anyone else care for him or her until the doctor has seen the rash.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.