Preventing and Treating Diaper Rash

Seeing a rash when you change your baby’s diaper can be concerning. Amy L. Silverio, DO, a pediatrician in Primary Care Pediatrics at Lurie Children’s, explains what causes diaper rash and what you can do to prevent and treat it. 

What is infant diaper rash?

Diaper rash is a common condition in babies and toddlers who wear diapers. Skin in the area covered by the diaper becomes red and sore (inflamed). The rash can also cause breaks in the skin.

Do all babies get diaper rash?

About half of all babies will get diaper rash at least once — it’s most common when babies are between 9 and 12 months old. “Diaper rashes can develop at any point, but they’re more common as babies get older and tend to be in their diapers longer,” Dr. Silverio says. “Newborns are frequent feeders, and parents usually change diapers with each feeding.”

Diaper Rash Causes

Diaper rash occurs for different reasons, and there are different types of diaper rash. Your baby may have:

Contact Diaper Dermatitis 

Contact diaper rash, or irritant diaper dermatitis, is the most common type. It happens when a wet or soiled diaper touches your baby’s skin for too long. Substances in pee (urine) and poop (stool) can cause your baby’s skin to become irritated.

Skin irritation can also happen when diapers:

• Don’t absorb well enough
• Fit too tightly

Some babies get irritant diaper rash when they begin eating solid foods. Changes in their diet may cause more frequent bowel movements. Your baby’s diet can also cause their poop to become more acidic and more likely to irritate their skin.

Bacteria Diaper Rash 

Some babies get a diaper rash that worsens when it becomes infected by bacteria. When a baby’s skin becomes irritated, it creates opportunities for bacterial infection, says Dr. Silverio. “Bacteria live on our skin normally. Sometimes, bacteria colonize and infect the area where skin has broken.” 

Yeast Diaper Rash 

Yeast (fungal) diaper rashes may occur when babies take antibiotic medication for illnesses or infections or the person breastfeeding them is taking antibiotics. Antibiotics can kill bacteria that help control growth of a fungus called candida. When too much candida grows, your baby may get yeast diaper rash. Fungal rashes can also occur when natural fungi on your baby’s skin or in their digestive tract grow more than they should.

What are the signs of diaper rash?

All diaper rashes cause skin irritation. But symptoms may look different depending on the diaper rash type.

Contact Diaper Rash Symptoms

You may notice that your baby is fussy or uncomfortable during diaper changes. Babies with contact diaper rash typically have very pink or red skin in areas that come in contact with their diaper. However, symptoms usually go away after two to three days of at-home treatment.

Bacteria Diaper Rash Symptoms

Bacteria diaper rash causes different symptoms than contact diaper rash. Babies with bacterial infections may have:

• Bright red skin in their diaper area
• Little pimples (pustules) or blisters
• Yellow-looking liquid (pus) that drains from the blisters, yellow crusting or both pus and crusting

“You may see bright red skin around the anus or scattered blisters or pustules within the diaper area,” Dr. Silverio says. “These symptoms may indicate a bacterial infection.”

Yeast Diaper Rash Symptoms

Yeast diaper rash symptoms may spread beyond the area that comes in contact with the diaper. You may see well-defined bright red patches in the skin folds of your baby’s groin area. You may also see little pimples that spread out from the red area and have white patches on top. 

How To Treat Diaper Rash

Begin diaper rash treatment at the first sign of irritation in your baby’s skin. It’s important to keep their skin clean and dry. You should:

Change Diapers Often

Change your baby’s diaper right away when they poop. Change diapers at every feeding for babies who aren’t eating solid food yet. Check diapers frequently for older babies and change them whenever you see they’ve urinated.

Clean Your Baby’s Skin

Gently clean your baby with:

• Mild cleanser
• Fragrance-free baby wipes that don’t contain alcohol
• Spray bottle filled with warm water

Use a gentle patting motion and don’t rub the skin. It may help to sit your baby in a lukewarm bath to clean them if their skin is very irritated. But never leave your baby unattended in the bathtub.

Let Skin Dry Thoroughly

Pat your baby’s skin gently with a soft cloth after cleaning. Let the skin air dry for a while, if possible.

Apply Cream or Ointment

Use an ointment (emollient) or cream that contains zinc oxide to help protect the skin. “Certain creams and ointments work as a barrier so that even if there is moisture, it protects the skin and avoids direct contact with urine or stool,” Dr. Silverio says. Talk with your pediatrician before you try any natural remedies for diaper rash that you may have heard or read about.

Use Loose-Fitting Diapers

Dress your baby in an absorbent diaper that’s a little baggy. “Make sure diapers aren’t so well fitted that they have direct contact with your baby’s skin,” Dr. Silverio says. “You want the diaper to fit around the waist and legs but not be too close to the baby’s skin.”

This is especially important overnight, she says. When your baby urinates during the night, the diaper becomes more and more moist. If it’s in contact with their skin, it can cause irritation and lead to diaper rash. 

Is there a way to prevent diaper rash?

You can help keep your baby from getting diaper rash with the same steps used to treat diaper rash. Keep your baby clean and dry as much as possible and apply barrier creams. “These creams aren’t harmful,” Dr. Silverio says. “Even using petroleum jelly can be a good preventive strategy so they don’t develop diaper rashes.”

Let your baby spend some time out of a diaper on a rubber sheet or waterproof mat if you can. This helps increase airflow to the diaper area and allows the skin to dry fully.

Do cloth diapers cause diaper rash?

Cloth diapers can be less absorbent and can trap moisture against your baby’s skin. Make sure you get the most absorbent cloth diapers you can and change your baby often. 

Do allergies cause diaper rash?

Some babies may be allergic to certain fragrances in creams, diapers or wipes. Consider changing brands if you notice skin irritation after using certain products. Typically, an allergic rash will appear wherever the product has touched your baby’s skin.

Are there complications from diaper rash?

Always call your pediatrician if you have any concerns or questions, says Dr. Silverio. Some babies who have bacterial diaper rash, fungal diaper rash or a worsening contact diaper rash may need treatment with:

• Antibacterial medication
• Antifungal medication
• Topical steroids to reduce inflammation

Does my baby need to see a pediatrician for a diaper rash? 

Call your pediatrician right away if your baby has a diaper rash and:

• Develops a fever
• Has a rash with pimples or white patches or that seems to be spreading beyond their diaper area
• Is 4 months old or younger
• Seems to be in significant discomfort or pain

Most diaper rashes are treatable at home. But if a rash doesn’t go away after two to three days of at-home treatment, check in with your pediatrician.

Learn more about primary care pediatrics at Lurie Children’s

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