Infants and toddlers in diapers often get rashes-everything from tiny red bumps to more irritated tender areas.
Why do babies get rashes? One or more conditions can cause a diaper rash. The enzymes that help digest food can be irritating when they come out with feces (poop) into the diaper. Wet diapers can cause irritation where they are in contact with the skin. This is more likely to occur where the diaper rubs the creases of the upper thighs. Yeast growing in the warm, wet diaper areas can be another cause of diaper rash.
Some tips to help prevent diaper rashes are:
Change diapers often. Changing a diaper before it gets very wet and as soon after a child has a bowel movement helps. Prolonged contact of the skin with moisture from pee and/or feces irritates the skin.
Avoid irritating soaps and wipes. Use unscented and alcohol-free diaper wipes or just water rather than other skin cleaning products. Scented soaps and wipes that have alcohol in them can irritate a baby's bottom. The ingredients in many soaps remove the skin's natural oils. Without these normal oils on the skin, skin irritation is more likely.
If the diaper area is red and irritated, clean the skin by patting it with a diaper wipe, with cotton balls soaked in warm water or with freshly laundered, well-rinsed, soft, washcloths wet with water. Avoid rubbing the skin. Always use a fresh wipe, or different wet wash cloth each time you swipe. Once soiled, store reusable cloths in a washable, plastic-lined, tightly covered receptacle until they can be laundered.
Consider use of a barrier product . Ask the family to discuss with the child's health care professional the use of a barrier product if an infant has ongoing difficulty with diaper rash. Barrier diaper creams or ointments can help protect the skin from irritation caused by rubbing on the moist and/or soiled surface of a diaper. They are over-the-counter products that contain petroleum or zinc oxide. If the child has had a problem with diaper rash that requires use of a barrier medication, the program should have instructions from the child's health care provider and permission from the child's parent to use it. The product's container should have the child's name and instructions for use too. Put 2 or 3 tablespoons of the barrier cream on a facial tissue and bring it that way to the diaper changing surface. (Do not bring any of the containers of supplies to the diapering surface. Everything on the diapering surface will need to be disinfected after the diaper change.)
Apply the barrier in a thick layer, spreading it gently and smoothly across the diaper area. Be sure to cover the creases of the upper thighs under the edge of the diaper. When cleaning the child, remove only the soiled barrier product. Rubbing to remove the unsoiled lower layer of barrier product will irritate the skin.
The recommended medication administration and diaper changing procedures are in Caring for Our Children, (CFOC3) Standards 188.8.131.52 and 184.108.40.206 for medication administration and Standard 220.127.116.11 for the diaper changing procedure. Access these standards at www.nrckids.org.
Follow the instructions from the child's health care provider and the CFOC3 recommended procedures when using any diaper cream. Some diaper creams contain active ingredients that are not for prolonged use. Documentation of the product applications can be as simple as having a check mark in a diaper cream column on a diaper change log sheet. Note the date and time of the diaper changes there. This lets families know about the frequency of diaper changes and use of recommended medication.
If a diaper rash is bleeding, seems very sore to the child, or lasts more than a few days, be sure to seek guidance from the child's health care provider and check the procedures being used by anyone who is changing the child's diaper.
Contributed by Sarah Macdonald, MD, FAAP, CHOP Care Network High Point