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The dreaded diaper rash: A pediatrician's advice for preventing and treating an angry bottom

Diapers in New York, May 18, 2018. (Tony Cenicola/Copyright 2018 The New York Times)

Your child will likely spend two to three years in diapers. Regardless of the type of diaper you choose, you can expect to battle at least a few diaper rashes. They are common and rarely dangerous, but with these prevention and treatment pointers, you should be better equipped to handle and conquer even the angriest of diaper rashes.

Most diaper rashes are caused when a baby's sensitive skin comes into contact with urine and stool. Pediatricians call this diaper dermatitis, which literally means skin irritation from the diaper. This can generally be prevented with a simple coat of clear petroleum or non-petroleum jelly, or ointment applied to the skin of the diaper area. The ointment creates a barrier to protect the skin and makes it easier to wipe clean the sticky meconium stools babies pass in the first week after birth.

Despite your best attempts to prevent contact, with newborns stooling as many as 10 times a day, and/or when your baby has diarrhea, it's often difficult to keep the skin from looking red and irritated. When a rash does appear in the diaper area, it can be helpful to use a white barrier cream or ointment with zinc oxide to coat your baby's bottom. The more intense the rash, the higher the percentage of zinc oxide is often needed. Many over-the-counter options are available that contain between 10 and 40 percent zinc oxide. Make sure the area is completely dry before you apply your barrier cream. You can fan the area with a diaper or let your infant or toddler go diaper-free for a short while (depending on how risk-averse you are) to allow the area to dry on its own. Once completely dry, apply a generous layer of your favorite cream. It's important to do this during every diaper change.

It's also important to change your baby's diaper frequently - as soon as you realize it's wet or dirty - to minimize the contact and irritation that creates the rash in the first place. Wiping with a warm, soft washcloth or a dampened soft paper towel is often less irritating than prepackaged wipes, which may contain alcohol or other irritants. Or look for wipes that contain fewer ingredients or only water. In cases in which the skin is so irritated that it's breaking down or even bleeding, use a squirt bottle to spray and gently rinse away the mess over the sink or bathtub. This can be much less painful than wiping the affected area. Some babies may have discomfort from simply being in bath water when skin is very irritated or broken down. An oatmeal powder, made for diaper rashes or skin irritation, in the bath water can help soothe the irritation and make bath time more enjoyable.

Although most diaper rashes are not dangerous, as with all skin conditions in little ones, it's important to know the signs of something more serious. Always call or see your pediatrician if:

  • The rash isn't gradually improving after a few days.
  • You notice red, raised bumps that are not responding to treatment. This may be a sign of a fungal/yeast diaper rash, which needs to be a treated with an antifungal cream. In such cases, your pediatrician may recommend an antifungal that also has zinc oxide to provide double duty treating the infection and protecting the skin.
  • The skin underneath the redness seems tender, abnormally hard, you see an obvious swelling forming, or your baby has a fever or looks sick. This could be a sign of a skin infection or abscess requiring antibiotics.

Once your child is potty-trained, you can pat yourself on the back for conquering a huge parenting milestone. But even potty-trained kids can get diaper-type rashes and bottom irritation. Sometimes this may be confused for a urinary tract infection because children will say it hurts when they pee, but the discomfort is from the urine running over irritated skin (as opposed to pain from a true urinary tract infection). In such cases, the urine will usually look normal and the skin will appear red and irritated. This occurs because young kids often can't properly wipe and clean themselves (or don't, because they are rushing to get back to play). To heal the skin and treat discomfort in this age group, try cleaning the area with mild soap and soaking in plain bath water with ½ cup of Epsom salt for 15 minutes at night. Then apply your favorite diaper cream (yes, diaper cream even though your child may no longer wear diapers) to the area. In addition, help your child wipe and reinforce proper hygiene. If your child stays dry at night, it can also be helpful to have them sleep without underwear or in loosefitting shorts to allow the area to dry out, heal and avoid further irritation.

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This article was written by Tanya Altmann and Tiffany Fischman, a reporter for The Washington Post.

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