The diaper area can be so confusing, especially for newborn parents. As a pediatrician, I want you to not just know how to prevent a diaper rash, but understand the reasons behind the correct care and treatments.
Diaper rash can be such a black box for especially new parents, and for good reason I think the term diaper rash is too simplistic and too vague for all the things going on in that area. So today let’s break it all down to what we usually mean by diaper rash.
How do you prevent it? What’s the right way to take care of the diaper area? a couple words about diaper choices, What does allergy versus irritation look like? When do we need to see a doctor and it needs treatment, and a few other conditions to look out for.
What is diaper rash?
The term is used loosely for a variety of things that happen in the diaper area and we’ll go over each of them. but it’s important to think about why do any of these conditions start, and unfortunately this is an area where our culture and nature are not quite in sync. Because you see it’s hard for our skin, any part of our skin to be constantly in a closed off especially moist and wet environment. So in a way babies are not meant to wear diapers because we’re meant to roam around in the wild, but our culture and the world being the way it is many of us live in areas where we simply need to diaper the baby.
How to Care for Skin in Diaper Area?
The important things to keep in mind when taking care of the area is to keep it as clean as possible, and as dry as possible.
- Frequently Change
The first thing is frequent change. Of course you don’t have to change every five minutes, but in general every couple hours, depending on how old the baby is. For newborn babies, they most likely need a change at least every three hours, so the less time we can have that skin sitting in a closed off wet environment the better it is. And of course there are conditions like if they’re sick and they have diarrhea where we might need to change a little more often. So as you get to know your baby, you’ll get to know their patterns for when they pee, and poop and how often you should change them.
- Diaper Creams
When you do change them, you’re cleaning the area and trying to let it dry out and air out as much as possible, and then after the area is clean there’s one important ingredient that we have to remember in protecting the skin.
Now the market for baby creams is crazy. There’s so many out there but the actual active ingredient meaning the part that’s actually doing something is just one thing, and it’s zinc. One standard diaper cream you might be already using is boudreaux’s butt paste, and this one has 16% zinc and it lists active ingredient zinc oxide. That’s what you’re looking for. I believe Decitan has about 13%. It’s not that important to keep it exact but we want at least 10% zinc oxide. There are also companies that focus on making the cream more organic and natural, and one example is the Honest company diaper cream and it has 14% zinc oxide.
Now they call it diaper rash cream, but it’s really a diaper rash prevention cream. So zinc just acts as the barrier, it sits on top of the skin and tries to protect the skin from the moisture around it. So hopefully if you change the diaper frequently and use zinc oxide each time to protect the skin you will never actually have a diaper rash to deal with, but of course if it does happen, it doesn’t mean that you did something wrong. Sometimes they have diarrhea, and it’s impossible to keep the skin dry, other times everybody’s skin is a bit different, but in general I would say the universal way to take care of the skin is to keep it dry as much as possible and use zinc oxide.
- Diaper Choices
We have our good old-fashioned paper diapers, and one thing that’s becoming quite popular lately is cloth diapers. The inside tends to be pretty soft cotton, and again huge variations between the different brands. It’s up to you to choose cloth diapers or other material diapers. There are many dimensions in this decision, such as cost and convenience. With a non-disposable cloth diaper, you have to find a way to clean them, versus having somebody pick them up and clean them which can be very costly. There’s the eco-friendly aspect of having disposable diapers that get thrown away, versus the water it takes to wash non-disposable diapers. That’s where you might have to do a little bit of digging into the company that you’re buying from, and then lastly how it affects the skin. There’s no conclusive rule to say which one reacts better with the baby’s skin, and I’ve seen both sides of the spectrum. So sometimes it can take a little bit of trial and error to find a diaper that your baby’s skin seems to react the best with or not react from, and there are also other options for potentially more sensitive skin.
so companies like the Honest company or Huggies or companies using bamboo and experimenting with other materials that might react better with your baby’s skin, but again your baby’s unique, so it’s hard to say what would be conclusively best for you, this is not really a comprehensive diaper review, I just wanted to present to you that there are many choices out there and as you try different things.
Types of Diaper Rash
One particular type of diaper rash I want you to be on the lookout for is:
1.Allergy (Contact Dermatitis)
An allergy is a little bit different from the irritation based diaper rashes which just react to the material of the diaper. Now with an allergy you’re going to see pretty sharply demarcated lines, and the skin in contact with the diaper is red and just looks angry. And especially with diaper rash, if they go up to the tummy with diaper ends on the tummy and also around the back, the parts of the skin which are not usually in contact with the wet part of the diaper. If that’s also red, and irritated, that’s a good sign to you that the diaper itself might be the problem, so definitely try another material.
Now this is in contrast to the more common type of diaper rash which is irritation based. Again, even if you’re doing everything correctly with changing, bathing, keeping dry, zinc oxide, you can still have some episodes of diaper rash just because the skin can chafe from being in that environment.
2.Irritation ( Irritant Dermatitis)
So with irritation you’ll probably notice it in areas that are more wet first, so around the anus all the way coming up to the front that area that is constantly wet. you’ll probably start to notice increasing irritation. Now at the irritation stage the skin should still be intact, it’s not going to be super red and blistery looking, but it will look kind of irritated and pink, and irritation usually spares the skin folds, if you open them, the skin inside should not be irritated, so look for areas of high friction and high amounts of moisture.
And as for the treatment, there’s not a good medical treatment for this. If you haven’t been using zinc, definitely start to use that. If you have an environment where the baby can go diaper free for a little bit, even a little bit of time diaper free can really help that skin, just air out and dry up. There are some natural substances that you can try to help with the healing of the skin, things like aloe vera, or witch hazel, some people use olive oil, or beeswax, but again I want to stress that we’re trying to keep the skin dry so you can apply those things but give it some time to then air dry.
There are some diaper creams out there especially to try to soothe the skin that’s already irritated, these don’t have zinc. So again you shouldn’t use them alone, but if you’re already using zinc to protect the skin, it’s still irritating, you just want to help with the inflammation, there are creams of mostly the natural substances we talked about that you can try. One is the Earth Mama Diaper Cream that’s all organic, another similar one I’ve been having success with lately is called the Ambiba, it’s the diaper and all over cream, so you can actually use it on any parts of the skin that’s irritated, comes in a stick which is like a glue stick that you can push up.
These herbal creams can do a lot to just allow the area to calm down a little bit, but again they do not replace zinc’s protection for the skin at baseline, if you can use these in conjunction with some diaper free time, some air out time, that would be even better.
3.Fungal (Candida Dermatitis)
If the irritation doesn’t clear up and the skin continues to be stressed by this environment, the next thing that can happen is a candida or yeast infection. In fact when we say diaper rash this is what most people are referring to. A yeast infection is something that we need medical treatment for. You have to see the doctor and get an antifungal cream. And a lot of times you might need help recognizing the difference between straight irritation, and a yeast infection. So if you’re not sure, always call your pediatrician.
For my patients, I have parents send me pictures or I hop on to zoom with them and we look together at the skin, to look for a couple things. Are the areas more red and angry instead of just pink and irritated? When we open the skin folds, is that area also involved? Because with yeast infections the skin folds will often also have the same lesions, a lot of times around the red areas, you can see what we call satellite lesions. They look like little dots, and that’s definitely a good sign for a candida infection. As it gets more severe, the top layer of skin might come off or break, and the area will be tender, and just overall looks a lot more angry. if we get to this point this is where we do need a prescription strength anti-fungal, so i don’t recommend just doing over-the-counter antifungal. get the real prescription strength medicine so you can really kill off the fungal infection.
Another area that can get the same kind of candida or diaper rash funnily enough in babies is in their neck folds. Because if you think about it, babies have no neck, it’s really short, so their chin is sitting right on their chest and as they’re feeding, they all drool, so the milk draws into that neck fold, it sits there, it’s always wet and it can be hard to remember to open that and look in there. So sometimes babies actually develop the same Candida, they will have to use the anti-fungal cream. So you see the skin and lots of parts of the body actually follow the same rules. That’s why I want you to understand the reasons behind the things that we do and the reason behind our care measures, so you can know what the best thing is for your baby.
4.Impetigo (Bacterial Infection)
Lastly, a couple more serious conditions you need to know and be on the lookout for. One is called impetigo, which is where anytime our skin breaks down, it can turn into a bacterial infection.
You get sort of a honey crusty, kind of drainage, the area will be red, and warm and tender, so it can hurt to touch, it can be warm when you put your hands on it, that’s definitely a sign to call your doctor because you might need antibiotic cream.
5.Eczema (Atopic Dermatitis)
There is a very common baby skin condition eczema, which can confuse things a little bit. Eczema is in the atopic family of conditions like allergies, and asthma in skin. It makes the skin thicker, rougher, itchy, and irritated, and sometimes it can flare that looks red like a rash. So definitely if your baby has eczema on other parts of their body. Sometimes that can actually be found in the diaper area.
But just know that if your baby does have eczema and you’re looking at something red, and irritated like a rash in the diaper. Eczema can also be on the list.