Diaper Rash

A variety of environmental factors and medical conditions can cause diaper rash.

Your infant or toddler may suffer from red, inflamed skin on the bottom, thighs, or genitals. This condition is commonly known as diaper rash, and its causes are many. For example, friction from diapers rubbing against skin and irritation from soaps and detergents can result in rashes. In addition, diapers trap heat and moisture and make the skin they cover ideal for fungal growth.

Diaper rashes are common, and most cases can be treated at home. Some severe and recurrent cases require more advanced medical care.

Irritation from Urine and Stool

Rashes are sometimes caused by infrequent diaper changes. Infants suffering from diarrhea are more susceptible to diaper rash because components of feces cause irritation. Changes in food consumption (such as discontinuing breastfeeding or starting solids) can change the stool and make rashes more likely.

Household and Personal Care Products

Infants and toddlers come into contact with potential irritants through use of disposable diapers and wipes, detergents, bath soaps, and lotions. These products may contain specific ingredients your child’s skin can’t tolerate. Overuse of products can also make the diaper area excessively moist, leading to irritation.

Rubbing and Chafing

If your child’s diaper is too small or is applied incorrectly, it may rub against his or her skin and cause a rash. The same effect can occur when overly tight clothing covering your child’s bottom causes his or her diaper to chafe.

Medical Conditions

Fungal (yeast) or bacterial infections frequently cause rashes in the diaper area. Infectious rashes are more common when your child is taking antibiotics. The antibiotics tend to kill the resident bacteria that keep infections from breaking out. Chronic skin conditions such as eczema may also be the culprit.

Infants and toddlers are at risk for diaper rash from birth to about 15 months of age. In rare cases, diaper rash may occur in older toddlers and preschoolers who wear diapers. Risk increases if the child is taking antibiotics, has a diagnosed skin condition, or has recently started eating solid foods.

Symptoms may vary depending on the cause and severity of the rash. Any of the following should be treated:

• red, puffy skin on your child’s buttocks, genitals, or thighs
• scales, pimples, blisters, or sores on or near the area covered by the diaper
• child scratches the area when the diaper is removed

Diaper rash is usually diagnosed by its appearance and location. If a yeast infection is suspected, skin cells may be scraped from the rash for testing. The scrapings are mixed with potassium hydroxide (KOH) and observed under a microscope for fungal cells. This is known as a KOH test.

The majority of diaper rash cases are treated at home with topical ointments that can be purchased over the counter. Follow these instructions for diaper changes:

• Change the diaper frequently, preferably every time your child urinates or has a bowel movement.
• Wash your hands with soap and warm water before changing your child’s diaper.
• Discontinue use of disposable wipes while the rash is visible. Instead, gently dab with moist cotton balls or rinse with a squirt bottle.
• Apply zinc oxide or petroleum jelly-based ointment to the affected area after it has completely dried.
• Apply diapers loosely.

If possible, allow your child to spend time with a bare bottom. This allows the area to dry and promotes healing. If you use cloth diapers, discontinue use of fragrant detergents. Run diapers through an extra rinse cycle to remove all soap residues. Avoid covering diapers with plastic pants.

Contact your child’s pediatrician if the rash worsens with treatment or does not clear up after several days. Your child’s doctor will examine him or her for signs of infection and may order a skin test. Depending on the diagnosis, your child may be prescribed antibiotic, antifungal, or steroid creams.

Most cases of diaper rash clear up after several days with home treatment. Some children have sensitive skin or chronic conditions that cause recurrent rashes. Severe rashes that require prescription-strength ointments usually clear up within a week after treatment begins. Secondary infections may occur when rashes are untreated.

Incorporating methods used to treat diaper rash as part of your regular diapering routine can prevent rashes. These include:

• frequent changes
• discontinuation of harsh wipes and detergents
• ensuring the bottom is completely dry before diapering
• more “naked bottom” time
• regular application of over-the-counter ointments