From one desperate mother to another, I would like to share my story with you on chronic diaper rash. I’ve been there done that, and now want to give you the knowledge I’ve gained from spending countless hours on the computer and in my pediatrician’s office searching for explanations, remedies, solutions and preventions. If I could remember every source I received this information from I’d share that too, but I cannot. However, Dr. John Mersch, MD, FAAP, does a good job of summarizing diaper rash from a medical professional perspective supporting my information to follow. Additional sources have been sited at the end of this commentary that I’ve found to help me though these bouts of baby agony. What I share with you now is not just what I’ve learned from the professionals, but what I’ve had to instinctively learn from on hands experience (and a little advice from my own mom) to get through the baby bottom blues.
I would never wish a chronic diaper rash scenario on any baby, or their mother. I have had my fair share of screaming, whimpering and red-faced pleading from my little girl on the changing table from this plaguing affair. Even worse are the open sores that ooze as a result of her skin literally being burnt off her bottom. The end of potty training cannot come fast enough in my house.
While in my case it is inevitable that another episode of diaper rash will strike at any time, it helps being knowledgeable about what I’m up against so I can try to prevent it. And once it does occur, I am better armed to nip this thing in the bud and give my baby the much needed comfort she deserves.
If this sounds too close to home for you, read on.
Why Babies Are Prone to Diaper Rash
Trapped Moisture
Any type of skin that is subject to continuous dampness for extended periods of time is bound to get irritated. A snug fitting diaper, especially one that’s been soiled, becomes a breeding ground for such an instance. The sooner you can change you baby’s diaper once it becomes wet or dirty the better chance you have at keeping diaper rash at bay.
Infrequent Diaper Changes
Let’s face it, sometimes baby sits in a soiled diaper and we don’t know it. Whether we are shopping, in the car, at a party or even while they sleep, your baby is going to sit in a dirty diaper at some point of their pre-potty existence. In other instances, daycares and home care givers have their hands full and usually cannot give the full attention to your baby’s bottom that you do. The result is extended time spent in a wet or dirty diaper. I’ve learned to coat my baby’s bottom with a top notch barrier cream before I drop her off at her sitters. While I know that doesn’t help for the whole day, it will at least help through the first change she gets.
Reaction to Food
A baby’s digestive system is not as mature as adults, or older toddlers for that matter. Some babies will take on new and edgy foods with ease. Others will be more sensitive possibly resulting in an allergic reaction. If you notice a skin irritation in the diaper area after a particular new food is introduced, you will need to be on guard. If you notice a diaper rash that will not go away, despite all your best efforts and that of your doctor’s, you will need to monitor which foods you baby is currently eating to weed out the suspected culprit that is causing the unwanted irritation. It’s not fun or easy, I know because I’ve been there, in fact I am still there!
Sensitive Skin
Typically all new babies have delicate skin. As they grow older and dairy is introduced, a baby’s skin will toughen. A few however, as in the case of my baby girl, will be known throughout her life as having sensitive skin. Any minor abruption to the surface results in a big, red blotch at the site of occurrence. Take that to the trapped diaper area and we’ve got ourselves a good game of hot potato! How fast we can get a soiled diaper changed in our house is a necessity, not a casual matter. If an infection or diarrhea occurs we are in for a long hull.
Types of Diaper Rash
Simple Irritation or Contact Rash aka Dermatitis
Most babies only get a mild irritation in the diaper area which again, cannot be helped when their little bottoms are trapped in a snug diaper all day, every day. Simple airing it out and perhaps a light barrier cream will clear it up anywhere from within the next diaper change to a day or two. The diaper area may look like it has a soft redness to it and could even be mistaken for a tight fitted diaper. Basically, you see the rash outlined at the area of where the diaper resides on your baby’s bottom, thus a contact rash (where the diaper is in contact with the skin). If this occurs often, you may also need to change the size or even type of diaper you use to be sure your baby is not reacting to the diaper itself. May sound crazy, but it can happen. When the area becomes bright red, warm to the touch and even raised or inflamed, you have something a little more than just a simple irritated rash. Keep reading!
Skin Infections
Most other forms of diaper rash will be either the result of a yeast infection or a bacterial infection. Both yeast and bacteria reside in the intestines and carry over into the stool. As this gets exposed to the skin, an infection can occur, especially in cases of sensitive skin or if a minor irritation was already in place. If you are not able to clear up an ailing bottom within 7 days or if your baby develops a fever, you need to call your pediatrician for a diagnosis, treatment and a possible prescription cream or ointment. Here’s how you can tell what you’re dealing with…
Yeast Infection or Candida
Typically this type of diaper rash infection will have little red or puss-looking satellite spots throughout the infected area. Most times this will be predominate in the area that surrounds the anus and connecting creases of the bottom, including up near the groin. Moisture is a breading ground for yeast so do your best to get these areas fully dry before putting on another diaper. What I found to be a challenge to decipher this type of rash is when the rash first occurs, the entire area on my daughter would be bright red and inflamed. I would have to get the inflammation under control before I could accurately access what I was dealing with. At one point we were prescribed a hydrocortisone cream which I now use at the onset of a rash like the one just described. It helps to take out the sting and the inflammation. But it is meant to be used only up to 2 days or else it adds to the problem. A little Tylenol helps too. Usually the next day after a good soaking bath and excessive airing out, I can start to see the satellite spots take form. If you cannot get this under control with your own barrier cream within one week, see your doctor for a prescription cream.
Bacterial Infection or Impetigo
A bacterial infection diaper rash is different from a yeast infection because the area of irritation is basically a blanket of redness, but can also develop small blisters that result in open sores. There will be no satellite spots with this virus. Just as with a yeast infection, keep your baby’s bottom as dry as possible with frequent diaper changes and get the area completely dry before putting on another diaper. If the area feels dry but is still sticky to the touch… it is not completely dry! I’ve blown on the infected area, waved it with another clean diaper, used mini fans and finished it all off with a heating lamp (more on that below) to get the job done. The effort will be worth it because you are helping the rash to heal quicker. Again, if it does not clear up within one week, see your pediatrician.
Treatment for Diaper Rash
On one occasion, my poor husband thought he was doing the best thing for our daughter’s excessive rash when he diapered her without a barrier cream aka diaper cream. That’s because he knows that her bottom needed to air out. Thankfully I changed her relatively quickly to discover she had a diaper on without barrier cream. While airing out is absolutely essential, it needs to happen without a diaper on. A diaper will inevitably trap in moisture should your baby urinate or even worse, have a bowel movement. For this reason, any time your baby has on a diaper with a rash, she needs to have on some kind of barrier cream to protect her skin from the stinging acid of her excretions. That’s the point of a barrier cream… to keep a barrier between your baby’s skin and intestinal ailments.
Diaper Creams
Not all creams are created equal. Some are creamy like A&D; or Desitin (a benefit to wipe it off easier), others are more like paste such as Aveeno (it will stay on to protect your baby’s bottom even if they urinate). Some have only 15-20% zinc oxide (the healing agent for typical diaper rashes), while others will have a concentration as high as 40% like Desitin Maximum Strength. Still, other creams are medicated, such as Triple Paste, sometimes alleviating the need for a prescription cream. Then there are the petroleum based ointments that will basically help to heal dry or chaffed skin as a result of a skin irritation. A&D; and Desitin both have an ointment solution. Now you want me to tell you exactly what cream to buy so you can get your baby’s little bum back on track… only problem is you will have to figure that out on your own. I’ve read through suggestions and reviews till the cows come home to get the best for my baby’s bottom. And I’ve tried every imaginable cream out there… Boudreaux’s Butt Paste, Balmex, bag balm, cornstarch, Maylox… you name it, I’ve tried it! What I found out in the end is that a cream that works for one baby with the same condition, may not work for my baby. That is frustrating! I will tell you my favorites, however, and what has worked for my daughter in the end… I love A&D; ointment for when she is without bottom trauma. We use it daily! Now when a flare up occurs, we settle on Desitin Maximum Strength which has 40% zinc oxide concentration and the consistency of a paste so it stays on her bottom. Between the two, if I can’t get the rash under control, I need to switch to the prescription stuff.
Baking Soda Bath
Ooooh, Ahhhh, OUCH! A nice soothing bath should feel nice on an irritated bottom right? Not always. Hopefully for your baby, she does not have open sores and this will be a nice treat for her bum. Otherwise you may be bathing your screaming child in your arms as she clings to you in desperation to take her away from the stinging water. With that said, a fresh water bath 2-3 times a day with 2 tablespoons of baking soda added is the best thing you can do to really clean out the infected area. Try to avoid soap, especially ones with fragrance. This only adds to the irritation. Most times it will only be the initial bath that is such a horror, since you’ll be taking all precautions to get the area completely dry so it can heal quickly. In our house, the baking soda resides next to the shampoo (and of course the turtle, the crab and the seahorse).
Buff is Best
In the end, my husband hit the nail right on the head. Let your baby go at it in the buff. Air is the best cure (besides a prescription cream if you’re dealing with a known infection) to help heal that little bum. As scary as it is for your floors, let her run around for a short while without a diaper on. Especially if you have a little one who will not sit still long enough for you to get her bottom completely dry. I’ve also let my daughter take naps without a diaper. It’s a mess when she wakes up, but that’s what washing machines are for. Then we go straight to the tub.
No More Wipes
Most wipes, even the sensitive ones, have alcohol or some cleaning agent in them. Do you remember the enthusiasm you had with an open wound trying to clean it with alcohol? Talk about a sting! No wonder your little one screams when you try to clean her little bum. Instead, use a warm moist cloth. I’ve also used moistened cotton balls (however I find these leave a cotton residue) and tissues. I keep a squirt bottle of water on the changing table that I drizzle over her bottom after every cleaning. I find that patting it dry with a tissue helps to dry it faster than any wipe can do.
Heat Lamp
This has been a lifesaver for my baby doll! After I get her all cleaned up and air dried, I hold a simple desk lamp over her wounds. This helps to dry out the rash and any open sores she has. I’ve spent up to 15 minutes (each changing!) holding this light over her bottom just to get the oozing sores to dry up before putting on diaper cream. The patience with this procedure has healed her bottom in record time. Of course, my daughter loves books, so it’s easy for me to give her a few reads to flip through that will keep her still for that amount of time. If you have a little squirm muffin, you may need to let your baby nap in the buff and hold the light on her when she’s sleeping (a little trick my mother gave me).
What’s on the Dinner Plate?
Some foods have a higher acid content and can actually contribute to an already flared up situation as well as strong flavored foods. Tomatoes, citric fruits, juices, garlic, onions and peppers are a few main culprits in my house. Go easy on the dairy too since this can give a softer mucus texture to your baby’s stool. Trying to keep a balance between a hard and soft stool can be challenging and demanding, but the payoff will be relieving. The goal here is not to have a runny stool in order to keep the moisture at bay, but also not to create constipation.
Life After Diaper Rash
Despite the horror we’ve had in our house with bouts of chronic diaper rash, my little sweet pea is still out there running and playing as if nothing bothers her. My own mother tells me stories of how she would stand over my crib day after day with a heat lamp to get my open sore, bloody bottom under control and I think to myself, wow… maybe I do have a little greatness of my mom in me. I would stand over my baby girl for months if I had to. And I am!
