Diaper rash is a common skin condition that affects infants, typically between 6-12 months old, and toddlers prior to potty training. The cause of diaper rash is a one-two punch: moisture and friction. The friction produced by the diaper as your baby moves causes the underlying moist skin to break down, which looks like redness and irritation in the diaper area and creases of the thighs. This can be very uncomfortable for your little one, and most babies are irritable when they have a diaper rash, particularly when you’re cleaning or changing their diaper. Additionally, a wet diaper provides a warm, moist environment in which bacteria and yeast thrive. Broken-down skin does not provide a very effective protective barrier, and essentially opens the door to infection.
Prevention is the best treatment. Follow the steps below to keep your baby’s bottom healthy:
Change dirty diapers frequently. Don’t wait to "really get your money’s worth" from each diaper. Changing diapers frequently, even if it’s just urine, reduces moisture on the skin that can cause skin breakdown.
Be gentle when cleaning the diaper area. Choose alcohol-free and fragrance-free baby wipes, or clean the area with plain water and a soft washcloth. Allow the area to air dry.
Apply a zinc oxide diaper cream. Create a protective barrier between your baby’s bottom and urine/stool by applying diaper cream "thick like cake frosting" after every diaper change, even when no signs of diaper rash are present. You should still see diaper cream on your baby at the next diaper change. There is no need to remove the cream entirely with each diaper change, just wipe up what is dirty and reapply a fresh layer.
Recipe for a "Happy Hiney." If simple hygiene and frequent application of zinc oxide is not effective, you can mix equal parts of over-the-counter hydrocortisone 1 percent ointment, antifungal cream (clotrimazole), and zinc oxide. Put a nickel-size amount of each cream in the palm of your hand and mix with your finger. Apply to the inflamed area twice daily.
See your pediatrician or family practice physician if your baby develops signs of a skin infection. Warnings signs include bright red round bumps or pus-filled areas at the outer margin of the rash ("satellite lesions" that can indicate presence of the yeast Candida albicans). Other red flags include a baby that is impossible to console, fever, blisters, draining pus or a rash that worsens or does not go away after three days of treatment.
Keep in mind that despite your best efforts, diaper rash may still occur. I’m a board-certified Dermatologist and even my toddler had diaper rash. Focusing on prevention, recognizing early signs and treating appropriately will help keep your baby’s bottom healthy today and every day.