Diaper rash

Signs and symptoms of diaper rash include:

• Inflamed skin in the diaper area — buttocks, thighs and genitals
• Itchy, tender skin in the diaper area
• Sores in the diaper area
• Discomfort, fussiness or crying, especially during diaper changes

When to see a doctor

If your baby's skin doesn't improve after a few days of home treatment, talk with your health care provider. You may need a prescription medication to treat diaper rash, or the rash may have another cause, such as zinc nutritional deficiency.

Take your child to your health care provider for:

• A rash with a fever
• A rash that's severe or unusual
• A rash that persists or gets worse despite home treatment
• A rash that bleeds, itches or oozes
• A rash that causes burning or pain when your baby urinates or has a bowel movement

Diaper rash may be caused by:

• Leaving on wet or soiled diapers too long. The tender skin of babies can develop a rash if wet or soiled diapers are left on too long. Babies may be more prone to diaper rash if they're experiencing frequent bowel movements or diarrhea.
• Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.
• Using a new product. Your baby's skin may react to a new brand of baby wipes, diapers or a detergent, bleach or fabric softener used to launder cloth diapers. Ingredients in lotions, powders and oils might add to the problem.
• Developing a bacterial or yeast (fungal) infection. What begins as a simple infection may spread to the surrounding skin. The area covered by a diaper is at risk because it's warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes can be found within the creases of the skin. And you might notice red dots scattered around the creases.
• Introducing new foods. As babies start to eat solid foods, the content of their stool changes. This increases the likelihood of diaper rash. Changes in your baby's diet can also increase the frequency of stools, which can lead to diaper rash. Breastfed babies might develop diaper rash in response to something the mother has eaten.
• Having sensitive skin. Babies with skin conditions, such as atopic dermatitis (eczema) or seborrheic dermatitis, may be more likely to develop diaper rash. The irritated skin of atopic dermatitis is usually in areas not covered by a diaper.
• Using antibiotics. Antibiotics can contribute to a rash by killing bacteria that keep yeast growth in check. Antibiotic use also increases the risk of diarrhea. Breastfed babies whose mothers take antibiotics are also at increased risk of diaper rash.

• Changes in skin color. In babies with brown and Black skin, diaper rash might cause the affected area to lighten (post-inflammatory hypopigmentation). Mild hypopigmentation usually clears up in a few weeks. Severe cases might take months or years to return to the usual skin color.
• Infection. Diaper rash can develop into a severe infection that doesn't respond to treatment.

The best way to prevent diaper rash is to keep the diaper area clean and dry. A few simple strategies can help decrease the likelihood of diaper rash developing on your baby's skin.

• Change diapers often. Remove wet or dirty diapers promptly. If your child is in child care, ask staff members to do the same. Disposable diapers that contain an absorbent gel are effective because they draw wetness away from the skin.
• Rinse your baby's bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls and baby wipes can aid in cleaning the skin. Be gentle. Use wipes that don't contain alcohol or fragrance. Or use a mild soap or a gentle nonsoap cleanser.
• Gently pat the skin dry with a clean towel or let it air dry. Don't scrub your baby's bottom. Don't use talcum powder.
• Apply cream, paste or ointment regularly. If your baby gets rashes often, apply a cream, paste or ointment during each diaper change. Petroleum jelly and zinc oxide are the time-proven ingredients in many diaper rash products. If the product you applied at the previous diaper change is clean, leave it in place and add another layer on top of it.
• After changing diapers, wash your hands well. Hand-washing can prevent the spread of bacteria or yeast to other parts of your baby's body, to you or to other children.
• Fasten diapers securely but not too tight. A diaper that allows some airflow helps prevent diaper rashes. Too-tight diapers can rub the skin. Take a break from plastic or tightfitting diaper covers.
• Give your baby's bottom more time without a diaper. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your bare-bottomed baby on a large towel and engage in some playtime.

The best treatment for diaper rash is to keep your baby's skin as clean and dry as possible. If the rash doesn't go away with home treatment, your health care provider might suggest:

• A mild (0.5% to 1%) hydrocortisone (steroid) cream twice a day for 3 to 5 days
• An antifungal cream, if your baby has a fungal infection
• Antibiotic medicine taken by mouth, if your baby has a bacterial infection

A diaper rash might take several days to improve, depending on how severe it is. A rash may come back again and again. If a rash persists even with prescription products, your health care provider may recommend that your baby see a specialist in skin conditions (dermatologist).

Generally, a diaper rash can be treated successfully at home with these practices:

• Keep the diaper area clean and dry. The best way to keep your baby's diaper area clean and dry is by changing diapers promptly after they are wet or soiled. Until the rash is better, this may mean getting up during the night to change the diaper. Try using disposable diapers that contain an absorbent gel. They draw wetness away from the skin.
• Rinse your baby's bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls and baby wipes can aid in cleaning the skin. Be gentle. Use wipes that don't contain alcohol or fragrance. Or use a mild soap or a gentle nonsoap cleanser.
• Gently pat the skin dry with a clean towel or let it air dry. Don't scrub your baby's bottom. Don't use talcum powder.

• Apply cream, paste or ointment. After you've gently cleaned and dried the skin, apply a cream, paste or ointment. If the product you applied at the previous diaper change is clean, leave it in place and add another layer on top of it. If you do want to remove it, try using mineral oil on a cotton ball.

  Products with a high percentage of zinc oxide or petroleum jelly work well to protect the skin from moisture. Various diaper rash medications are available without a prescription. Talk to your health care provider or pharmacist for specific recommendations. Some popular products include A + D, Balmex, Desitin, Triple Paste and Lotrimin (for yeast infections).

  Zinc oxide is the active ingredient in many diaper rash products. Such products are usually applied to the rash throughout the day to soothe and protect babies' skin. It doesn't take much – a thin covering will do. The product can be applied over medicated creams, such as an antifungal or a steroid, when needed. You could also apply petroleum jelly on top, which helps keep the diaper from sticking to the paste, ointment or cream.

  Ointments, pastes or creams may be less irritating than lotions. But ointments and pastes create a barrier over the skin and don't allow it to receive air. Creams dry on the skin and allow air through.

  As a general rule, stick with products designed for babies. Avoid items containing baking soda, boric acid, camphor, phenol, benzocaine, diphenhydramine or salicylates. These ingredients can be toxic for babies.

• Increase airflow. To aid the healing of diaper rash, do what you can to increase air exposure to the diaper region. These tips may help:
  • Let your baby go without a diaper and ointment for short periods of time, such as during naps.
  • Take a break from plastic or tightfitting diaper covers.
  • Use diapers that are larger than usual until the rash goes away.
• Bathe your baby daily. Until the rash clears up, give your baby a bath each day. Use warm water with mild, fragrance-free soap or a gentle nonsoap cleanser.
• Stop using products that seem to trigger your baby's rash. Try a different brand of baby wipe, disposable diaper, laundry soap or whatever other product you suspect.

The following alternative treatments have worked for some people:

• Witch hazel (winter bloom), a flowering plant. A study showed that applying an ointment made with witch hazel to diaper rash helped. The study included 309 children.

• Human breast milk. Results are mixed on whether human breast milk applied to diaper rash is better than other treatments. One study showed that applying breast milk to diaper rash is an effective and safe treatment. Infants with diaper rash were treated with either 1% hydrocortisone ointment or breast milk. The study included 141 infants. Treatment with breast milk was as effective as the ointment alone.

  Another study compared human breast milk with a cream made from zinc oxide and cod liver oil. Newborns with diaper rash were treated with the cream or the breast milk. The study included 63 babies. Treatment with the cream was more effective.

• Shampoo clay (bentonite). A study showed that shampoo clay was effective in healing diaper rash and that it worked faster than calendula. The study included 60 infants.
• Other substances. Other natural remedies have been tried, including aloe vera, calendula, bee pollen, beeswax and cod liver oil. Further study is needed to prove their effectiveness for treating diaper rash. Some of these substances may promote bacterial growth.

Generally, diaper rash can be treated successfully at home. Make an appointment with your baby's health care provider if the rash gets worse despite several days of home treatment, is severe or occurs along with a fever.

Here's some information to help you get ready for your appointment.

What you can do

• List your baby's signs and symptoms, and for how long your baby has had them.
• List key information about your baby's medical conditions and food intake. For example, has your baby been treated for any illness or given any medications recently? Has the baby's diet changed? If your baby is breastfed also note any medications that might reach the baby through breast milk. Also note changes in the mother's diet, such as an increase in tomato-based foods.
• List all products that come into contact with your baby's skin. Your baby's health care provider will want to know what brand of wipes, diapers, laundry detergent, soaps, lotions, powders and oils you use for your baby. If you suspect that one or more products may be causing your baby's diaper rash, you may wish to bring them to the appointment so your health care provider can read the label.
• List questions to ask your health care provider. Creating your list of questions in advance can help you make the most of your time with your health care provider.

Below are some basic questions to ask your health care provider about diaper rash.

• What is the most likely cause of my baby's rash?
• What are other possible causes?
• What can I do to help my baby's skin heal?
• What diaper ointments, pastes, creams or lotions would you recommend for my baby?
• When should I use an ointment or paste instead of a cream or lotion?
• Do you suggest any other treatments?
• What products or ingredients should I avoid using with my baby?
• Should I avoid exposing my baby to certain foods, either through breast milk or through my baby's diet?
• How soon do you expect my baby's symptoms to improve?
• What can I do to prevent this condition from recurring?
• Is the rash a sign of some other internal problem?

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your health care provider may ask:

• When did you first notice your baby's signs and symptoms?
• What type of diaper does your baby typically wear?
• How often do you or your baby's child care provider change your baby's diaper?
• What types of soap and wipes do you use to clean your baby?
• Do you apply any skin care products to your baby, such as lotions, powders, creams and oils?
• Is the baby breastfed? If so, is the mother taking antibiotics? Are there any changes to the mother's own diet?
• Have you introduced your baby to solid foods?
• What treatments have you tried so far for your baby's rash? Has anything helped?
• Has your baby recently had any other medical conditions, including any illness that caused diarrhea?
• Has your baby recently taken any new medications?