Diaper rash

It seems like you just got that diaper rash cleared up and now it's back, looking red and angry, making changing time a misery for you and your baby. Diaper rash is a common ailment, but are some babies more prone to it than others?

“I don’t think there’s data that this is the case,” says Elena Pope, a paediatric dermatologist at Toronto’s Hospital for Sick Children. “But I certainly see parents who say one baby is more prone than his siblings.” Pope speculates that some babies develop rashes more easily because the superficial layers of the skin are thinner or a bit more permeable. What’s the rash?

Diaper rash can range from mild redness to open sores. Most cases are what Pope calls irritant diaper dermatitis, a rash caused by irritation either from the enzymes in urine and feces or from chemicals in detergent or fabric softener, baby wipes, soaps, lotions or the diaper itself.

Sarah Masterson’s* three-month-old son, Jacob, had a persistent rash that went away when, on the advice of her doctor, she eliminated certain foods from her diet. A breastfed baby with an allergy to something in his mother’s diet can develop a rash that typically begins around the anus and spreads across the buttocks. Older babies who’ve started eating table foods can also develop an allergic rash to something they’ve eaten. A process of eliminating foods is usually the best way to home in on the offending food, but your doctor will be able to advise you.

Yeast or bacteria can also be the culprit. These bugs tend to thrive in the warm, moist diaper environment, says Pope. If the rash has red bumps with white centres, it’s probably yeast; your baby should see a doctor who may prescribe an antifungal or corticosteroid cream, says Pope, adding, “A rash caused by yeast doesn’t indicate any problem with the baby’s immune system as is sometimes thought.”

*Names changed by request.

Prevention & treatment

Here are Pope’s ABCDs of preventing and treating diaper rash for babies who seem particularly prone:

A is for air. “Leave the diaper off and the rash will improve,” says Pope. After diaper changes, let your baby lie on a towel or pad for a bit while you play with her.

B is for barrier. The most important thing you can do is prevent contact with poo and pee, says Pope. She recommends very liberal applications of a paste like zinc oxide. “The thicker the better — enough that it hides the skin,” she says. Pope’s not keen on petroleum jelly for kids who are prone to rash since it can melt away in a warm diaper, offering little protection. But try putting the petroleum jelly on top of the paste, so that the diaper won’t stick.

C is for cleansing. If the rash is mild, clean your baby’s skin carefully with warm water — just rinsing rather than using a washcloth. If your baby’s bottom is really sore and you’re applying a paste, try using mineral oil to remove waste from the skin, bearing in mind that you don’t have to scrub away all of the paste, says Pope. Some wipes, especially if they contain fragrance or alcohol, can irritate a baby’s skin. Remember that keeping the bottom dry is key. Pope recommends using a hair dryer on the low setting. Or you can gently pat dry, taking special care along creases and folds.

D is for diaper. Diapers should be changed as soon as they’re wet or soiled. Pope favours disposable diapers for kids who are prone to diaper rash, citing a significant drop in the number of rashes she’s seen since the use of disposables became widespread. But brands vary, so if your baby is rashy, try switching brands, says Pope. Some parents, however, swear that switching to cloth helped them clear up a rash. You may need to experiment a bit. If your baby’s in cloth, the problem may your laundry routine. Bleach, borax or fragrance in detergents can linger in diapers and cause irritation. Try adding a quarter to half cup of vinegar to the rinse cycle to neutralize any ammonia that might linger in the diapers, causing a rash.

If your baby’s rash is getting worse or isn’t clearing up within a few days despite careful home treatment, see the doctor.