Newborn skin can be exceptionally sensitive to irritants in the environment. It is not unusual for infants to develop intermittent diaper rashes, and we often see families in the office to assess and advise on diaper rashes. Below we offer some helpful tips and tricks to try before giving the office a call.
Change diapers often. A baby’s skin can get irritated when a diaper is left on for too long and the urine or stool is in close contact with the skin for prolonged periods of time, so check your baby every hour or two to see if they are wet or soiled. Even if you are vigilant with diaper changes, it is not uncommon to see diaper rashes in specific situations, such as when a baby has a diarrheal illness or is taking antibiotics for a bacterial infection. With more severe or extensive rashes, we will sometimes recommend giving your baby as much time as possible WITHOUT a diaper, on a waterproof sheet or towel, to let the skin “breathe”.
Avoid other irritants. Aside from urine or stool, baby wipes themselves can be irritating due to the fragrances, alcohol, and other chemicals that they may contain. Look for a fragrance-free baby wipe, and for a severe diaper rash switch to using a clean washcloth and warm water ONLY to wipe. If your baby tends to have especially sensitive skin or gets frequent diaper rashes, try switching your baby’s soap, lotion, and detergent (especially important if laundering cloth diapers) to fragrance-free varieties as well, and consider dye-free diapers.
Wipe gently. If diaper cream was applied with the last diaper change (see below), there is no need to remove all of the diaper cream. The purpose of diaper cream is to create a barrier to protect the skin from urine and stool. Once you wipe away visible stool, if diaper cream is still present on the skin, leave it there! It’s doing its job, and you will only retraumatize the skin if you wipe all of the cream away. As you will see in the next step, you are simply going to add fresh diaper cream on top of the old layer.
Apply a thick layer of diaper cream to perfectly dry buttocks. Pat your baby dry with a clean cloth or soft toilet paper–avoid rubbing–then apply diaper cream to the affected area like you are frosting a cake. If there is diaper cream still adherent to the skin from the last diaper change, apply a fresh thick layer on top of whatever cream is left on the skin. A common mistake is using too thin a layer of barrier cream to protect the vulnerable skin. You can use a cotton makeup pad to apply the cream and then leave the makeup pad in the diaper to prevent the cream from rubbing off onto the diaper.
Recommended diaper creams include:
Petroleum-based: Vaseline, Aquaphor, A&D Ointment
Zinc-oxide based: Desitin, Boudreaux’s Butt Paste, Triple Paste
Once your baby’s diaper rash has resolved, you can prevent future diaper rashes by applying a thin layer of any of these with each diaper change.
Most routine diaper rashes will clear up within a few days of the above routine. Because the diaper is a wet, dark environment, sometimes the rash can become superinfected with yeast or bacteria. Therefore, if the rash does not resolve in 2-3 days with these recommendations, or if you notice skin breakdown or sores, drainage/pus, fever, fussiness, or any other new or concerning symptoms, please call our office to discuss additional interventions or schedule an office visit. Depending on what type of rash your baby has, we may recommend adding an antifungal cream, antibiotic cream, and/or mild steroid ointment.
Additional resources:
Seattle Children’s Handout on Diaper Rashes
KidsHealth Parent Handout on Diaper Rashes
First Aid: Diaper Rash
Diapering Your Baby
