Definition

• Any rash on the skin covered by a diaper
• Diaper-wearing age group (birth to 3 years)

Health Information

Symptoms

• Mild rashes just have areas of pink dry skin.
• Severe rashes have areas of red skin. In some areas, the skin may become raw or even bleed.
• Yeast infections are bright red. The borders are very sharp. Small red bumps or even pimples may occur just beyond the border. Yeast rashes usually cover large areas.
• Pink rashes are not painful, but raw ones can be very painful. This can lead crying and poor sleep.

Cause

• Mild rashes can be caused by the drying effect of soaps.
• Stool and urine left on skin can combine to make ammonia. Ammonia can cause a mild chemical burn.
• Stools left on the skin can be very irritating because they contain bacteria. Urine alone has no germs in it and usually doesn’t irritate the skin.
• Rashes around the anus are common during bouts of diarrhea.
• Rashes from irritants can get a secondary infection with yeast. Less commonly it can happen with bacteria.

Prevention of Recurrent Diaper Rash

• Change diapers more often. Especially try to prevent skin contact with stool.
• Rinse the baby’s skin with lots of warm water when cleaning off stool. Don’t depend on diaper wipes alone
• Be sure to clean stool off all the skin folds. Cleaning the scrotum can be a challenge.

Care Advice

1. Overview:
   • Diaper rashes are very common in babies.
   • Often caused by not cleaning stool off the skin soon enough.
   • Here’s some care advice that should help.
2. Change More Often:
   • Change diapers more often to prevent skin contact with stool.
   • You may want to get up once during the night to change the diaper. Do this until the rash is under control.
3. Rinse with Warm Water:
   • Rinse the baby’s skin with lots of warm water after cleaning off stool.
   • Wash with a mild soap (such as Dove) only after stools. Reason: Using soap often can slow healing.
   • Do not depend on diaper wipes alone for removing stool. Reason: They leave a film of bacteria on the skin.
4. Leave the Bottom Open to Air:
   • Expose the bottom to air as much as possible.
   • Attach the diaper loosely at the waist to help with air exposure.
   • When napping, take the diaper off and lay your child on a towel. Reason: Dryness reduces the risk of yeast infections.
5. Anti-Yeast Cream:
   • Most diaper rashes respond to 3 days of warm water cleansing and air exposure. If you’ve tried this or the rash is bright red, suspect a yeast infection.
   • Buy an anti-yeast cream such as Lotrimin. No prescription is needed.
   • Use Lotrimin cream 2 times per day.
6. Raw Skin:
   • If the bottom is very raw, soak in warm water for 10 minutes. Add 2 tablespoons (30 ml) of baking soda to the tub of warm water.
   • Do this 2 times per day for a few days.
   • Then, put Lotrimin cream on the rash.
7. Sore or Scab on End of the Penis:
   • Use an antibiotic ointment such as Polysporin. No prescription is needed.
   • Do this 3 times per day.
   • Reason: The sore is a bacterial infection that can cause painful urination.
8. Diarrhea Rash:
   • If your child has diarrhea and an anal rash, use a protective ointment. Examples are petroleum jelly, A&D or Desitin.
   • This forms a barrier between the skin and the stool.
   • Otherwise, these generally are not needed.
   • Caution: Wash off the skin before putting the ointment on.
9. What to Expect:
   • With proper treatment, most diaper rashes are better in 3 days.
   • If the rash does not respond, a yeast infection has probably occurred. If so, start an anti-yeast cream.
10. Return to Child Care:
    • Diaper rashes cannot be spread to others. Yeast ones do not spread. Bacterial ones have a small risk until they are on an antibiotic ointment.
    • Your child does not need to miss any child care.

Call Your Doctor If

• Rash isn’t much better after 3 days of using anti-yeast cream
• It starts to look infected (with sores and scabs)
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC