Diaper rash: Solved!

Q: Why is diaper rash so common? 

A: Skin in the diaper area spends much of the day in contact with two very irritating substances — urine and stool. If your child has diarrhea or is teething (meaning extra saliva is passing through the gut), the chance of diaper rash increases. 

Q: How do I prevent and treat diaper rash? 

A: In general, use strategies to minimize the contact of urine and stool with the skin: 

  • Change diapers frequently. This gives the skin more “dry” time so it can heal.
  • Coat the skin with a thick layer of paste. The brand is less important than the ingredients. Zinc oxide and petrolatum are both good choices, and fragrance-free products are best. Think of diaper paste as a shield that sits between the skin and the contents of the diaper. If the paste isn’t soiled, there’s no need to rub it off during changes: Simply add more paste on top. In general, there’s no such thing as too much paste. I like to tell parents to apply it like they’re icing a cupcake!
  • Consider your choice of diapers. Diapers vary considerably with respect to their cost to your bank account and to the environment, but when it comes to the health of the skin in the diaper area, the more absorbent the diaper, the better job it does of wicking moisture. Cloth diapers tend to be less absorbent than most disposable brands. 
  • Clean the skin gently during changes. Disposable wipes, which have shown to be safe and effective, work for many parents. I recommend alcohol- and fragrance-free wipes. You can also cleanse the skin with water and a non-soap/gentle cleanser, which might feel more comfortable than a moistened wipe if the skin is irritated. 

Q: Could my child have a yeast infection?

A: Another cause of diaper rash is a yeast infection caused by a common yeast called Candida albicans. Infants harbor this yeast in their digestive tracts, and in small amounts it’s a normal and healthy part of the diaper environment. 

However, it can overgrow and cause problematic rashes. Clues to a yeast infection include a rash that is worse in the groin folds and the presence of little pink bumps or pimples scattered throughout the diaper area. Talk to your health care provider if you suspect your child has a yeast infection, since a prescription might be needed. 

Q: Could my baby be allergic to his diaper? 

A: True diaper allergies are actually very rare, so it’s a better idea to first try the strategies above than to frantically start switching brands of products. Clues to this problem are rashes that are limited to the area of contact and a rash that doesn’t clear until the culprit is eliminated. In rare cases, the dyes and colorings on printed diapers are a potential source
of irritation or allergy.

Dr. Ingrid C. Polcari is an assistant professor at the University of Minnesota Medical School. She subspecializes in pediatric dermatology and practices at the University of Minnesota Health Pediatric Dermatology Clinic at the Masonic Children’s Hospital.