Module 7: Diaper Rashes
With diapers come diaper rashes! These are very common in the newborn and infant stage, and can get severe. The trick is identifying them and treating them early, so they don’t evolve.
What Causes Diaper Rash?
When urine and stool are in contact with the skin for a prolonged period of time, the combination of moisture and bacteria causes skin irritation and breakdown. This shows up as redness and discomfort. While all infants will inevitably get a diaper rash, it’s more likely to occur with infrequent diaper changes or active diarrheal illnesses.
How Do I Prevent Diaper Rash?
The easiest way to prevent diaper rash is to change diapers as soon as you realize that they are dirty (usually every 2-3 hours for newborns) and clean the skin thoroughly with non-scented and alcohol-free wipes between changes (Water Wipes are a great option, if you’re stuck). Sometimes, it may help to add an ointment like Aquaphor Baby Healing Ointment as part of your diaper change routine at the end if your child has sensitive skin and gets frequent rashes. If that isn’t the case for your child, no ointment is needed for a routine diaper change if there’s no rash.
How Do I Treat Diaper Rash?
Once the rash has appeared, it's time to nip it in the bud! This requires a barrier cream, which forms a separation between the baby’s skin and any urine or stool in the diaper, preventing skin breakdown and bacterial or fungal infection. There are different types of barrier creams: Petrolatum (like you'd find in Vaseline) and Zinc Oxide (usually two different strengths, 14% or 40%). All diaper rash creams are a variant of these two active ingredients.
Ointment Options: Some examples of barrier creams are Triple Paste, Aquaphor 3-In-1 Baby Ointment (or their Healing Ointment), Desitin Maximum Strength (40% Zinc Oxide). All skin types are different, so find one that works for your infant and stick with it.
How To Apply: Cleanse the diaper area. If your child can't tolerate wipes due to pain from the rash, use a spray bottle with room temperature water or a wet washcloth instead. Next, allow the area to air dry, pat it dry with a washcloth, or use a hair dryer on the lowest (i.e., cool) setting. It's important to let the area fully dry, since moisture feeds diaper rashes! Then, add the cream liberally (there's no such thing as too much!), after which you can apply a clean diaper loosely or allow for diaper-free time.
Product Recommendations:
Help! The Rash Isn’t Healing!
A diaper rash should heal within 5-7 days with the above treatment (including increasing to a 40% Zinc Oxide ointment and maximizing diaper-free time). Sometimes, it can last longer or worsen if bacteria or fungus infect the broken-down skin. This requires prescription medication.
Nystatin: Ointment for yeast infections (these have a classic appearance with “satellite lesions,” which are red, speckled dots trailing outwards into the thighs and buttocks).
Mupirocin: Ointment for bacterial infections.
Hydrocortisone: Steroid cream or ointment that helps calm inflammation in severe rashes. This is typically only used at a low dose and for up to 1 week at a time.
Apply the medication first to optimize absorption, then the barrier cream to form a separation between the skin and any urine or stool that may arise. If you apply the medication second, it may have trouble penetrating the barrier cream, and is less likely to get absorbed into the skin.
Note: In some cases, there can be an allergy to the diaper or ingredients in wipes or diaper creams, which causes rashes that never seem to fully go away. Always make sure you're using non-scented, alcohol-free, and preservative-free products, and see your doctor if in spite of this a diaper rash doesn’t fully disappear.
When Should I See The Doctor?
If there are blisters, pimples, pustules, or ulcers, or if the rash isn’t improving after 3-5 days of home management, to make sure that prescription medications aren’t necessary.
If the diaper area is swollen, warm, and extremely tender, this can indicate an infection that has gone deeper into the skin and requires oral antibiotics.
If your child has fever in addition to the rash. This can mean the rash is causing more serious complications, or that there's another illness entirely that needs evaluation.
Additional Diaper Rash Tips:
Diarrheal Illnesses: If there’s diarrhea, I recommend adding a preventative barrier ointment (like the Aquaphor Baby Healing) after fully cleaning and drying the diaper area, since there’s a higher risk of rashes forming due to the more frequent and looser stools.
Front To Back: When wiping during diaper changes, always go from front to back (rather than back to front), especially in females, since it lowers risk of urinary tract infections.
Powders: In general, powders such as cornstarch are not recommended, since they retain moisture and keep it close to the skin, which can further irritate already broken-down skin.
Cloth Diapers: While environmentally-friendly and OK to use when your infant doesn’t have a rash if you’re comfortable with the laundering involved, I advise ditching them during diaper rashes, since they don’t absorb as much moisture from urine and stool as disposable ones.
