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Diaper Rash: The Bottom Line
Have you heard the expression, “Skin as soft as a baby’s bottom?” Babies are widely praised for their smooth and delicate skin on their bottoms. But in fact, your baby’s bottom must be tough and resistant to withstand the continual exposure to urine, feces, germs, soaps, and diaper wipes. Unfortunately, the smooth skin on your baby’s bottom may break down at some time and develop a diaper rash. More than half of babies between 4 and 15 months of age get at least some trace of diaper rash at least once every two months. Let’s look at what you can do to try to prevent diaper rash, and to treat it promptly when it occurs.

Recognizing Diaper Rash
The earliest sign of a diaper rash is some redness of the skin in your baby’s diaper area. As the diaper rash progresses, the baby’s skin around the genitals, lower abdomen, thigh skin folds, upper thighs, and buttocks can become brighter red, swollen, shiny, and sensitive to touch. You may see a solid red rash or red spots. With a more severe diaper rash, the skin in the diaper area can develop blisters or open sores. Fortunately, most diaper rashes are mild, and with proper care will clear up within 3-4 days. But if the diaper rash does not clear up, you’ll need to contact your baby’s doctor for treatment.

The Causes of Diaper Rash
Your baby’s skin has natural layers of protection. However, the following things can break down the skin’s protection and cause a rash:

  • Urine and feces staying on the baby’s bottom for too long
  • Rubbing by the diaper or by too vigorous cleaning
  • Allergic reaction to chemicals in the diaper, diaper wipes or soap;
  • Infection with yeast or bacteria
  • The typical diaper rash starts when the skin on your baby’s bottom becomes irritated by urine or feces, rubbing, or an allergic reaction. Then, once the skin is vulnerable, an infection with yeast of bacteria can set in.

    Although babies can get diaper rash in the first few months of life, it is most common between 8 and 10 months of age. Diaper rash is more likely when:

  • Your baby begins to eat more solid food. This is thought to be due to the change in the acidity of babies’ urine and stool.
  • Your baby has diarrhea. This is because the frequent stools and cleaning can break down the skin.
  • Your baby takes antibiotics for an illness or when you’re taking antibiotics while breastfeeding your baby. This is because the antibiotics kill off the protective bacteria on the skin and allow an overgrowth of yeast infection. Your baby can also get a yeast infection (called “thrush”) in his mouth at the same time.

  • Preventing Diaper Rash
    The best way to prevent diaper rash is to try to minimize exposing your baby’s bottom to the things that can irritate the skin:

  • Change your baby’s diaper frequently to keep him as dry as possible. Cloth diapers tend to be less absorbent than disposable diapers and should be changed more frequently. Newborns pee and poop more frequently and may need to be changed every 1-2 hours; older infants and toddlers may need to be changed every 2-4 hours. Be sure to change your baby’s diaper as soon as possible after a bowel movement.

  • Clean your baby’s bottom gently. Generally, you need to clean your baby’s bottom only when she has a bowel movement. You can use a diaper wipe or a soft cloth moistened with water. If you have a baby girl, be sure to wipe from front to back to help prevent urinary tract infections.
  • You don’t need to use powder or cornstarch. They can cause breathing problems for some babies.
  • When you bathe your baby, use baby soap. Avoid adult soaps that have deodorants, perfumes, anti-perspirants, and other chemicals that can irritate your baby’s skin.

  • If Your Baby Gets Diaper Rash
    At the first sign of a diaper rash, try the following to help clear it up quickly:

  • Change your baby’s diaper more frequently. This helps protect your baby’s rash from further irritation by urine and stool. If possible, try leaving your baby without a diaper for periods of time to help dry her skin.
  • Don’t use scented diaper wipes. These may contain perfume, alcohol, and other chemicals that can irritate your baby’s skin. Look for “hypoallergenic” diaper wipes and consider pre-rinsing them in warm water to remove the chemicals so you can clean your baby with just a moist cloth.
  • If your baby’s bottom is tender, clean with water instead of diaper wipes. You can use a spray bottle with warm water, or rinse her bottom in the sink or tub.
  • Dry your baby as gently as possible. You can use a towel or washcloth and pat her dry (don’t rub); or use a blow dryer on the low or cool setting (to avoid burns).

  • Try using an over-the-counter protective ointment (e.g., with zinc oxide or petrolatum) on your baby’s diaper area. This can help protect the skin from irritation from urine and stool, and help it heal. You don’t need to rub off the ointment with each diaper change.
  • If your baby has a more severe diaper rash that has blisters, open sores, or doesn’t go away within 3-4 days, contact your baby’s doctor. Your baby may need an antifungal cream or powder for a yeast infection, or antibiotics for a bacterial infection of the diaper area.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician