I recently wrote about gastroenteritis, so it is a natural progression to talk about diaper rash. It’s a pretty common complaint in a diapered child. I would venture to say it is the most common type of rash in infants and toddlers. I will also say, diaper rash is miserable for babies and parents. Trying to smear paste onto a raw butt with one hand and hold two feet and two hands of a screaming infant with the other is akin to digging an elephant’s grave with a teaspoon.
The skin is our body’s first line of defense. A diaper rash is a break in the skin’s barrier function. It breaks down because of the excess moisture, friction, pH changes, and enzymatic activity.
Let me explain:
- Extra moisture from poo and pee is locked against the skin by the diaper. Whether it’s cloth or disposable diapers, the moisture is there. The skin softens and starts to break down, or macerate (kind of the same process as putting sugar on strawberries, but way grosser).
- Friction damages the skin even more because macerated skin is fragile skin.
- The skin is naturally acidic, which keeps water and germs out of the body. When poo, pee, and moisture sit on the skin, all kinds of chemical reactions happen and the skin’s pH goes up. A higher pH changes the skin’s microbiome (fancy name for the skin’s good bacteria), too.
- The higher skin pH activates poo enzymes, which break down the skin even more.
The skin’s physical and chemical barriers break down, which allows germs like Staph and Candida to go crazy. The way to fix the problem is the prevent it. Protect the skin barrier, and the skin barrier will protect your baby’s bum.
Diaper area skin care:
Increase the diaper-changing frequency. If the poo and pee doesn’t sit on the skin, the skin doesn’t have time to break down. I also recommend increasing baby’s “air time.” This one is kind of an “idealist” recommendation. I don’t know about you, but the last thing I want when my infant has watery diarrhea is for him to be crawling around my house without a diaper…so, yeah. Do what you can to keep the booty dry, but don’t beat yourself up.
Even wiping a dirty bum with a baby wipe is friction. Instead, try to rinse with warm water or a soothing bottom spray, and then dab with a dry cloth. Just don’t rub. Anything that is stuck on there should easily come off with a cotton ball soaked in mineral oil.
Baby wipes, disposable diapers, and cloth diapers washed in standard detergents all have added preservatives, chemicals, and other irritants. You may need to do a little trial and error to see what works for your child’s bum. There is one chemical, MIT (methylisothiazolinone), that is particularly infamous for irritating skin, and it’s often found in baby wipes. It’s a preservative to keep the wet wipes from molding, but it’s hard on the skin. Avoid it if you can.
When prevention isn’t enough:
There are all kinds of products on the market for diaper rash. Ultimately, you want something that is thick, and white or clear, without fragrance or other additives. Ointments are better than creams are better than lotions. Basically, you want to create a booty barrier so the irritants can’t touch the skin. Slather a thick layer, and don’t rub it in. Don’t worry about trying to wipe it off every diaper change, either. I heard one dermatologist relate it to frosting a cupcake: gently wipe off the top so you don’t break the cupcake, and then add another thick layer of “icing.”
Sometimes antifungal, antibacterial, and anti-inflammatory creams are necessary to treat secondary infections. An irritant diaper rash is diffusely red, warm, and generally flat. A fungal diaper rash usually has raised, red bumps, in addition to general redness. Don’t hesitate to have your child’s diaper rash checked if it’s just not getting better. A general rule of thumb is, if it’s not better in 2 weeks, it’s not just a diaper rash. We are always happy to see your infant or toddler if you are concerned about the rash. Of course, you should try to see your pediatrician for this first.