Diaper Rash

Even if you change your baby's diaper religiously, most babies get at least one diaper rash between the ages of 4 and 15 months - it's just a fact of life when you spend it in a snug, damp diaper.

A generic diaper rash is caused by wetness and chaffing and will cause your baby's diaper area to become red and puffy. Even those expensive, super-absorbent diapers will leave a little moisture next to your baby's skin, and when bacteria from your baby's stool mixes with urine, it breaks down the chemicals in the urine, forming ammonia that can irritate your baby's delicate skin. Babies with sensitive skin are more prone to diaper rash, even with frequent changing; and if your baby is taking antibiotics, she may develop diarrhea, which can also cause diaper rash.

A yeast (Candida) infection can also cause a rash on your baby's diaper area, and appears as tiny red spots that multiply and mass into a raised, patchy bright or dark red rash with distinct borders. The affected area may be tender or painful and it can creep into the creases of skin around your baby's genitals and legs. You can differentiate a yeast infection from irritation because, unlike simple irritation, yeast causes redness in the folds and creases. A yeast infection can develop if your baby's skin is irritated (by wet diapers, for instance), which allows the yeast that is normally found in her body to get into the cracks in her skin and flourish. Babies who are on antibiotics are especially prone to yeast infections because the antibiotics kill healthy bacteria (which limit the amount of yeast in your baby's body) at the same time as the harmful bacteria. If your baby develops a yeast infection, you should take her to see the pediatrician, who will probably prescribe an anti-fungal medication.

A diaper rash may also be the result of a bacterial infection such as impetigo, which appears as yellowish, fluid-filled bumps and honey-colored, crusty areas. It may also be caused by seborrhea, which appears as red, scaly, waxy patches on your baby's abdomen and groin area.

The best way to prevent and treat diaper rash is to keep your baby's diaper area as clean and dry as possible by changing her frequently. And use a barrier ointment at every diaper change to form a protective layer on the skin. There are a variety of ointments on the market, such as petroleum jelly (which rubs off easily), A&D Ointment, white zinc oxide (a thicker cream which may be better for babies prone to rashes), and hydrocortisone 1% cream (put on twice a day under any of the other creams for severe rashes - but do not use for more than several consecutive days, as long-term use can damage sensitive diaper-area skin). Don't use talcum powder, which can irritate your baby's lungs if it is inhaled, or cornstarch, which may promote the growth of yeast and bacteria. Let your baby go diaper-free for as long as possible every day to let the diaper area dry out, and consider letting your baby sleep diaper-free - just be sure to use a plastic liner sheet to catch accidents. Make sure your baby's diapers aren't so tight that there's no room for air to circulate; and avoid airtight fabrics such as tight plastic pants.

If your baby has sensitive skin, avoid using commercial baby wipes that contain alcohol, fragrance, or other chemicals. Instead, use water with or without mild soap, and use a bulb syringe to gently wash baby's diaper area. If you use cloth diapers, don't use fabric softeners or wash them in detergents that contain fragrances, both of which may irritate your baby's skin. Wash them in hot water and try adding 1/2 cup of vinegar to the rinse cycle to eliminate alkaline irritants. If you are using disposable diapers, try switching brands to see if that eliminates the rash.

When your baby starts solid foods, introduce only one new item at a time, and wait a few days between introductions. This will make it easier to determine whether a diaper rash is the result of a food allergy, and you can identify which food caused the allergic reaction.

Breast milk lowers the ph of your baby's stool, making it more acidic, which will reduce its reaction with her urine, so breastfeed your baby as long as possible. Also, breastfeeding boosts your baby's resistance to infection, making her less likely to need antibiotics, which can contribute to diaper rash.

A mild case of diaper rash should clear up in a few days to a week, and you don't necessarily need to have your baby checked by a doctor. However, if you notice any of the following, call your pediatrician:

• The diaper rash occurs in the first 6 weeks of life


• Pimples, blisters, boils, or small ulcers form


• Pus or weeping discharge


• Your baby develops a fever


• Your baby loses weight or isn't eating as well as usual


• Large bumps or nodules appear


• The rash spreads to other areas, such as the arms, face or scalp


• The rash doesn't get better after one week with at-home treatment