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Diaper Rash: A Pain in the Rear

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Any baby who wears diapers (and what baby doesn't?) is prone to diaper rash. And while it may seem fairly innocuous, diaper rash may cause significant discomfort for your baby, making efforts at prevention and effective treatment very important.

  • Telltale Signs
  • When It's Not Diaper Rash
  • What Causes Diaper Rash?
  • Prevention and Treatment

Telltale Signs

You can easily recognize this common malady: Your baby's bottom is red and inflamed, with swollen bumps around the diaper area. If the rash also has reddish pink bumps surrounding a red patch in the diaper area or around your baby's mouth, it may have already advanced to a yeast rash, which needs to be treated with topical antifungal medication.

Since your baby cannot tell you in words exactly what's wrong, he may express his discomfort through crying and irritability, especially at diaper-changing times, and possibly by a loss of appetite.

When It's Not Diaper Rash

What you think is diaper rash on your child's bottom may very well be another mild childhood skin condition. For this reason, it's important to recognize the difference between diaper rashes and other common ailments so you can treat each one effectively. Impetigo, seborrheic dermatitis, and prickly heat are the conditions most commonly mistaken for diaper rash.


Impetigo is a contagious bacterial skin infection that shows up in the diaper area and on the face and hands, with pimples and scabby, honey-colored sores that blister and itch. Because this condition is contagious, all family members should wash their hands often with antibacterial soap to keep it from spreading. If you see this type of sore, call your pediatrician, who will likely prescribe an antibiotic cream or oral antibiotic.

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin condition that affects infants in their first year. You'll find raised, rough red patches covered with thick white or yellow scales on your baby's groin, genitals, and lower abdomen; when similar patches appear on the scalp, the condition is known as cradle cap. Try applying an over-the-counter cortisone or hydrocortisone ointment to the affected areas, and keep your baby clean and dry. If the condition doesn't clear up soon, see your pediatrician, who may prescribe a stronger cortisone cream.

Prickly Heat

Heat and humidity can lead to prickly heat, caused when perspiration builds up on the skin and is unable to evaporate. Less common after 3 months, this condition looks like an acne breakout, with very small pink bumps, and can show up in the skin folds in the diaper area, especially where the plastic lining of a diaper or diaper cover touches the skin. Moisture and humidity are the main causes of prickly heat, so make sure your child is not overdressed and that his skin remains dry. If prickly heat seems severe, it's time to contact your health care provider.

What Causes Diaper Rash?

Most cases of diaper rash are a result of skin irritation from moisture in the diaper area. Changes in skin pH, damage from proteins found in the stool, and secondary infection with bacteria or yeast are the main culprits. Here are some other common causes:

Not cleaning the diaper area properly. Since diaper rash is caused by pH changes that occur when stools and urine combine, you'll want to gently and thoroughly clean any waste from your baby's tender skin. Use a gentle alcohol-free baby wipe or a soft baby washcloth and warm water. Sensitive skin does best with plain water, while other bottoms may need a mild soap. Avoid scrubbing with coarse washcloths as this will only make the rash worse and your baby more uncomfortable. While most modern baby wipes do not contain alcohol, be sure to read the label and avoid using those which do, since this will sting and further irritate the rash.

Not changing diapers often enough. Studies have shown that infants who are changed at least eight times a day have diaper rash less often. Frequent diaper changes are important for two reasons: 1) prolonged wetness makes the skin fragile and prone to rashes; and 2) the more time urine and stools spend together, the longer the enzymes in the stool have to injure the baby's skin. Super-absorbent diapers can help by pulling urine away from the baby's skin and away from the baby's stools.

Yeast infections. Once your baby's skin has been wet for too long, it becomes susceptible to yeast rashes, the most persistent type of diaper rash. A course of antibiotics may cause diarrhea, which can set off a yeast rash. You'll recognize this type of rash by the raised reddish pink bumps or white pus bumps surrounding a red patch in the diaper area. Your baby may also have white patches in his mouth, and your breasts may become sore if you're nursing. Call your pediatrician as soon as possible for antifungal treatment if this condition persists.

Prevention and Treatment

Here's how you can prevent diaper rash from starting:

  • Make sure you change your baby's diapers as soon as possible after they become wet or soiled.
  • Clean your baby's genital area thoroughly after each bowel movement and allow the area to dry, being careful not to rub the skin too much or too harshly.
  • Coat your baby's bottom with a thin layer of protective ointment or petroleum jelly.
  • When putting on a fresh diaper, don't secure it too tightly, but rather allow some air to circulate.
  • Try using extra-absorbent diapers or those treated with petrolatum in the topsheet that touches your baby's skin.
  • Keep a close watch on the diaper area if your child is taking antibiotics, or otherwise has diarrhea, and change her diapers frequently.

Here are some tried and true methods for treating diaper rash once it exists:

  • Change your baby's diapers frequently to reduce moisture on the skin.
  • Air out the skin by letting your baby spend a little time each day without a diaper (though you might want to have a diaper or cloth handy in case of an accident).
  • After a bowel movement, clean your baby's bottom thoroughly and pat it dry before putting a diaper on.
  • Spread a thick layer of ointment containing zinc oxide or petroleum jelly, or one recommended by your baby's doctor, to prevent urine from reaching the irritated skin.
  • If all else fails, try a different brand of diapers, or a different detergent if your baby wears cloth diapers.
  • Consider using a disposable diaper with petrolatum in the topsheet.
  • Call your health care provider if the rash doesn't clear up after a few days, or if blisters or pus-filled bumps appear.

For more expert information, watch the diaper rash video featuring Dr. Mancini.


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