The diaper area is a perfect environment for rashes to develop — moist, dark, and inundated by a never ending supply of pee and poop. But the causes of a diaper rash vary, and when parents don’t know the exact cause, treatments can fail.
Typical causes of diaper rashes include:
- Simple irritation. The moisture and ammonia in the urine and stool and the rubbing against the diaper material can irritate your baby’s skin and cause it to look very red. If the diaper area is red, but the folds of the skin (which are more protected) are not red, you’ve got simple irritation.
- Yeast infection. Yeast loves the moist, dark diaper area and can cause a bright red rash, often with small red ‘satellite’ pimples radiating from the border of the rash. You can differentiate a yeast infection from irritation because, unlike simple irritation, yeast causes redness in the folds and creases of baby’s skin.
- Bacterial infection. Look for yellowish, fluid-filled bumps (“pustules”) and honey-colored, crusty areas, which are symptomatic of a bacterial infection (like staph or strep) and require antibiotic treatment.
- Seborrhea ( cradle cap). Sometimes a diaper rash is part of a more generalized rash, such as one due to cradle cap, where there are red scaly, waxy patches on other parts of baby’s body and scalp.
Tips for Treating a Diaper Rash Caused by Simple Irritation
- Check the diaper frequently, and change it when wet.
- Use a gentle perfume-free soap or even just plain water when cleaning the area. Make sure the diaper area is quite dry before putting on a fresh diaper.
- Avoid wipes, especially those with fragrance or alcohol.
- Let your baby’s bottom “hang in the breeze.” There is nothing better to dry out the area than taking the diaper off for a while whenever the coast is clear (e.g., right after cleaning off a bowel movement).
- Consider changing the brand or type of diaper. Cloth diapers tend to cause fewer rashes because they don’t hold in the liquid as well. And some parents have better luck with one brand of disposable diaper over another.
- Keep the diapers a bit loose so some air can come in and the area can “breathe.” Avoid plastic pants, which hold the moisture in.
- When washing cloth diapers, put a half cup of vinegar in the rinse cycle to help get rid of alkaline irritants.
- Use a protective barrier cream or ointment on the area after each diaper change. In general, those with zinc oxide give the best protection from irritation (but are a bit stickier). But often the less sticky petroleum products work just fine.
- Consider an over-the-counter steroid cream to decrease redness and inflammation (but consult your pediatrician before using them).
Avoid corn starch, which yeast loves to eat, and talcum powder, which can cause trouble if inhaled into the lungs.
Tips for Treating a Diaper Rash Caused by Yeast
- Apply an anti-yeast cream to the area as directed by your baby’s doctor.
- Check if there is also a yeast infection in the mouth.
- Look for milky crusts on the tongue or gums that, unlike milk, cannot be scraped off.
- You may need to boil your baby’s bottles and their nipples to get rid of the yeast on them. Hot water dishwashers work fine for this.
- If there is yeast in baby’s mouth, it usually needs to be treated as well, using prescription anti-yeast drops.
When to Worry About Diaper Rash
Your pediatrician should check out the rash if it:
- doesn’t not respond to the above measures after 3-5 days.
- has yellow fluid-filled bumps (pustules) in it. This could signal a bacterial infection requiring immediate antibiotic treatment.
- is getting worse, not better.
- is associated with other symptoms, like fever or lethargy.