Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION

• any rash on the skin area covered by a diaper.

CAUSES

Almost every child gets diaper rashes. Most of them are due to prolonged contact with moisture, bacteria, and ammonia. The ammonia and other skin irritants are made by the reaction of bacteria from bowel movements to certain chemicals in the urine. Bouts of diarrhea cause rashes in most children. Diaper rashes occur equally with cloth diapers and disposable diapers.

EXPECTED COURSE

With proper treatment these rashes are usually better in 3 days. If they do not respond to the initial treatment, a yeast infection (Candida) has probably occurred. Suspect this if the rash becomes bright red and raw, covers a large area, and is surrounded by red dots. You will need a special cream for yeast infections.

HOME CARE

1. Change diapers frequently

   The key to successful treatment is keeping the area dry and clean so it can heal itself. Check the diapers about every hour, and if they are wet or soiled, change them immediately. Exposure to stools causes most of the skin damage. Make sure that your baby's bottom is completely dry before closing up the fresh diaper.

2. Increase air exposure

   Leave your baby's bottom exposed to the air as much as possible each day. Practical times are during naps or after bowel movements. Put a towel or diaper under your baby. When the diaper is on, fasten it loosely so that air can circulate between it and the skin. Avoid airtight plastic pants for a few days. If you use disposable diapers, punch holes in them to let air in.

3. Rinse the skin with warm water

   Washing the skin with soap after every diaper change will damage the skin. Use a mild soap (like Dove) only after bowel movements. The soap will remove the film of bacteria left on the skin. After using a soap, rinse well. If the diaper rash is quite raw, use warm water soaks for 15 minutes three times a day.

4. Nighttime care

   At night use the new disposable diapers that are made with materials that lock wetness inside the diaper and away from the skin. Avoid plastic pants at night. Until the rash is better, awaken your baby once during the night to change the diaper.

5. Creams and ointments

   Most babies don't need any diaper cream. However, if your baby's skin is dry and cracked, apply an ointment to protect the skin after you wash off each bowel movement. A barrier ointment is also needed whenever your child has diarrhea.

   Cornstarch reduces friction and can be used to prevent future diaper rashes after this one is healed. Recent studies showed that cornstarch does not encourage yeast infections. Avoid talcum powder because of the risk of pneumonia if your baby inhales it.

6. Yeast infections

   If the rash is bright red or does not start getting better after 3 days of warm water cleaning and air exposure, your child probably has a yeast infection. Apply Lotrimin cream (no prescription necessary) four times a day or after each bottom rinse for BMs.

7. Prevention of diaper rash

   Changing the diaper immediately after your child has a bowel movement and rinsing the skin with warm water are the most effective things you can do to prevent diaper rash.

   If you use cloth diapers and wash them yourself, you will need to use bleach (such as Clorox, Borax, or Purex) to sterilize them. During the regular cycle, use any detergent. Then refill the washer with warm water, add 1 cup of bleach, and run a second cycle. Unlike bleach, vinegar is not effective in killing germs.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• The rash looks infected (pimples, blisters, boils, sores).
• Your child starts acting very sick.

CALL YOUR CHILD'S PHYSICIAN WITHIN 24 HOURS IF:

• The rash isn't much better in 3 days.
• The diaper rash becomes bright red or raw.
• You have other concerns or questions.