Time for a Change

Detecting and Treating Diaper Rash By Lisa Marie Metzler

It is estimated that a baby will use six to 10 diapers each day. This translates to 2,000 to 3,000 diapers each year. With all these changes, your baby's tender skin needs special care.

What Kind of Rash Is It?
Diaper rash is caused from urine and stool contact with the skin. It's not usually painful to a baby, but it can look a little scary to a parent. However, if the rash isn't treated, it can become raw and painful for your baby and even become infected. If a rash persists after initial treatment or starts bleeding, oozing or blistering, then it’s time to call your physician.

"It may be difficult to distinguish between a ‘normal’ diaper rash (irritant) and a yeast (candidal) infection," says Dr. Pamela Phillips, a pediatrician at Columbia-Presbyterian Eastside, Manhattan, N.Y. "Irritant diaper rash usually involves the buttocks, lower abdomen and upper thighs. Candidal infections tend to be bright red with sharp borders and satellite papules and often involve the areas within the folds."

According to Dr. Phillips, a diaper rash that lasts more than four to five days despite treatment is usually a yeast infection.

When Joyce Steel's baby girl was 18 months old, she developed a rash. Steel, who lives in Ramsey, N.J., treated the rash, but it seemed to only become worse and more painful, so she called her pediatrician. "It turned out she had a yeast infection," says Steel. "It surprised me because I had no idea babies were susceptible to yeast infections." Her pediatrician prescribed Nystatin cream (an antifungal medication), and within a week, the yeast infection was gone. Steel's pediatrician says yeast infections are not uncommon, and because Steel's baby had spent a lot of time in the pool the constant moisture level created a good breeding ground for the yeast.

"The most important thing is good diaper hygiene," says Dr. Phillips. "Change diapers frequently, use a soft cloth and water to cleanse the diaper area and apply a barrier ointment such as Desitin or Balmex. Keep the area open to air for short periods when possible.”

The candida albicans is an organism that lives on the skin of many healthy people. But under the right conditions, a yeast infection will result. Yeast infections thrive in the moist environment of the diaper area, especially if there is already an irritation there.

Sometimes babies will get a yeast infection if they have been taking antibiotics, too. Babies can also be susceptible to yeast infection if the baby is breastfed and the mother is taking antibiotics.

Some breastfed babies who develop a yeast infection may also have thrush. Thrush is the oral form of the candidal infection. Symptoms of thrush in a baby are white cottage cheese-like patches on the tongue and side of the mouth. Symptoms of thrush in the mother include the onset of persistently sore nipples and shooting pains in the breast during or just after feeding. "The mother needs to treat her nipples with a prescription antifungal cream," says Dr. Phillips. "However, if the infant only has a diaper rash without thrush, no treatment of the mother is typically needed."

Diarrhea also can result in a contact dermatitis rash. "This is common with diarrhea, and it needs lots of air," says Dr. Cathryn Tobin, pediatrician and author of The Parent's Problem Solver (Three Rivers Press, 2002). "I often find cornstarch, frequent diaper changes and a dab of polysporin ointment on open sores will settle this kind of rash."

Diaper Rash Remedies
Every little bottom is different. While some babies will respond well to a particular cream, another baby's rash may only become more irritated. Ellen Snook of San Francisco, Calif., battled diaper rash with both her children, especially after weaning from breast milk and introducing new foods. On the recommendation of her pediatrician, Snook tried Flander's Buttocks Ointment.

"It's far more effective than standard diaper rash cream," says Snook. "The magic ingredient seems to be Peruvian balsam." On another occasion when the diaper rash caused open sores, Snook's pediatrician said to make a paste of Mylanta and cornstarch. This formula worked well for the Snook babies.

Sarah Dycus, a mom of four from Streamwood, Ill., recommends vinegar to heal diaper rashes. "The first thing I do is give a bath, and I add some vinegar," says Dycus. "I usually add about 1 cup if bathing the baby in the sink or 2 to 3 cups if bathing in the tub. I rarely use any type of diaper rash ointment. Vinegar works quick too; usually in a day or two the rash is gone."

Local whole food stores often have remedies like calendula, also called pot marigold. A cream with a blend of althaea and ulmus (bark from the elm tree family) can bring soothing relief, too. Another effective remedy is Therapeutic Botanicals Baby Cream, which consists of zinc oxide, tea tree oil, calendula and comfrey, or the BabySpa BabyBottoms Cure, which can be found at www.organicbebe.com.

Want to see more?

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• Diaper Rash Discussion Board
• Newborn Worries: Your Top 10 Questions – Answered!
• Talk about it!