Diaper rash is marked by red, angry and vulnerable-looking skin in the diaper region – buttocks, thighs and genitals. A baby with diaper rash would appear to be uncomfortable, fussy and irritable. This would appear especially so during nappy changing times; the diaper area is tender and sensitive to water and to touch.  Diaper rashes can occur intermittently and is more common in children who wear disposable diapers. They’re more common in babies during their first 15 months, especially between 8 and 10 months of age.  

The causes of diaper rash

Causes of diaper rash can be traced to a number of sources, including:

• Irritation from stool and urine. Prolonged exposure to urine or feces can irritate a baby’s sensitive skin. Your baby may be more prone to diaper rash if he or she is experiencing frequent bowel movements, because feces irritates the skin more than urine.
• Introduction of new foods. When a baby is six to twelve months old and is on solid food, the content of their stool changes, increasing the likelihood of diaper rash. Changes in your baby’s diet can also increase the frequency of stools, which can lead to diaper rash. If you’re breastfeeding, your baby may develop diaper rash in response to something you’ve eaten, such as foods with acidic content.
• Irritation from a new product. Disposable wipes, a new brand of disposable diaper, or a detergent, bleach or fabric softener used to launder cloth diapers are all capable of irritating a baby’s delicate nappy area. Other substances that can add to the problem include ingredients found in some baby toiletries.
• Bacterial or yeast (fungal) infection. The area covered by a diaper – buttocks, thighs and genitals – is especially vulnerable because it’s warm and moist. This makes the area a perfect breeding ground for bacteria and yeast, so what may seem like a simple skin infection to begin with may spread to the surrounding region. These rashes generally start within the creases of the skin, and red dots may form around the creases.
• Sensitive skin. Babies with skin conditions, such as atopic dermatitis or eczema, may be more likely to develop diaper rashes. However, atopic dermatitis and eczema tend to affect areas other than the diaper area including the face, neck and arms.
• Skin chafing/rubbing. Tight or ill-fitting diapers or clothing that rubs unnecessarily against the skin can lead to a rash.
• Use of antibiotics. Antibiotics kill bacteria – both bad and good ones. Without the right balance of good bacteria, yeast infections may occur. This can happen when babies are given antibiotics or when breastfeeding mothers take antibiotics.

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When to see a doctor

Most cases of diaper rash are easily treated and improve within a few days after starting home treatment. If your baby’s skin doesn’t improve after a few days of home treatment with over-the-counter ointment and more frequent diaper changes, talk to your doctor. Sometimes, diaper rash leads to secondary infections that may require a visit to the doctor for prescription medications. Take your child to visit a doctor if:

• The rash is severe
• The rash worsens despite home treatmentAlso see your child’s doctor if the rash occurs along with any of the following:
• Fever
• Blisters or boils
• A rash that extends beyond the diaper area
• Pus or weeping discharge from the rash areaUseful information you can provide the doctor with:
• All your baby’s signs and symptoms – Include the duration i.e. how long your baby has had these symptoms.
• Your baby’s key medical background and vital information –These should include all the conditions your baby has been treated for and all medications, either prescribed or over-the-counter which was taken. If your baby is breast-fed, state any medications you have taken recently.
• List all products used on your baby’s skin. Include brand of diapers, laundry detergent, soaps, lotions, powders and oils you use for your baby in this piece of information. If you suspect one or more products may be causing your baby’s diaper rash, it would be a good idea to bring them to the appointment so your doctor can read the label/labels.
• Write down all that you need to ask your doctor –  Prepare your list of questions in advance to help you make the most of your time with your doctor.Below are some basic questions to ask your doctor about.
• What is the most likely cause of my baby’s rash?
• What can I do to help my baby’s skin heal?
• What diaper ointments or creams would you recommend for my baby?
• When should I use an ointment instead of a cream, and vice versa?
• Are there any other treatments?QAre there any products or ingredients that I should avoid using?
• Should I avoid exposing my baby to any kind of foods, either through breast milk or through my baby’s diet?
• How soon can I expect my baby’s symptoms to improve?
• What can I do to prevent this condition from recurring?If any additional questions occur to you during your visit, don’t hesitate to ask.

What you can do

In the time prior to the appointment with your baby’s doctor, avoid products that seem to trigger your baby’s rash. Wash your baby’s bottom with water after each diaper change, and avoid soaps and wipes, especially those containing alcohol or fragrances. Give your baby as much diaper-free time as possible. This gives the skin a chance to start healing. When you do use diapers, change them frequently and apply a diaper rash cream or ointment to act as a barrier between your baby’s skin and a dirty diaper. The best treatment for diaper rash is to keep your baby’s skin as clean and dry as possible. If your baby’s diaper rash persists during home treatment, your doctor may prescribe

• An antifungal cream
• A mild hydrocortisone creamUse creams or ointments with steroids only if your baby’s pediatrician or dermatologist recommends them.Diaper rashes usually require several days to improve but in some cases, it might last for weeks. If the rash persists despite prescription treatment, your doctor may recommend that your baby see  a dermatologist.

Lifestyle and home remedies

• Over-the-counter products. Various diaper rash medications are available without a prescription. Talk to your doctor or ask your pharmacist for recommendations.Zinc oxide is the active ingredient in most diaper rash creams. Diaper rash creams are usually spread out in a thin layer to the irritated region and re-applied throughout the day to soothe and protect a baby’s skin. Zinc oxide-based baby creams may also be used to prevent diaper rash on normal, healthy skin.Ointments or creams may be less irritating than lotions or liquid solutions. However, ointments might also create a barrier over the skin, making it difficult for it to breathe. Creams dry on the skin and allow air through. Ask your doctor whether a cream or ointment would be better for your child’s particular rash. As a general rule, stick with products designed specifically for babies.