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 3.6.3.1 and 3.6.3.2 for medication administration and Standard 3.2.1.4 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

Common diapering errors can often lead to cross contamination in the early learning environment. Addressing these 12 common errors properly will help reduce the spread of germs while diapering. Updated 4-2019

Click on the title for the link to download a fully Illustrated, step-by-step, up to date, tri-fold Diapering Poster. The poster shows the procedure for safe and sanitary diapering. The same steps apply to changing soiled underwear with the child lying down, a position that makes it easier to avoid contamination of the environment and proper cleaning of the child's skin. CCA Global created the poster with guidance from the staff of ECELS.   Reproduce and distribute the poster freely to child care professionals. Be sure to retain the citation and copyright. The poster may not be sold without permission from CCA Global. The source of the steps in the poster is the May 2013 updated online standards in Caring for Our Children, 3rd Edition, a publication of the American Academy of Pediatrics, American Public Health Association, and the National Resource Center for Health and Safety in Child Care and Early Education. Reviewed and reaffirmed 4/2018.

The attached ECELS Health and Safety Checklist includes references. It was updated December 2011 as Version 1.4. This tool guides the user to the appropriate national health and safety standard(s) and other related references for each item. Each item is cross-referenced with corresponding topics from: Caring for Our Children:  National Health and Safety Performance Standards, 3rd Edition, 2011 (CFOC) , the Environmental Rating Scales (ITERS-R, Infant/Toddler Environment Rating Scale - Revised Edition; ECERS-R, Early Childhood Environment Rating Scale - Revised Edition); and the Pennsylvania Child Care Facility Licensing Regulations. Reviewed and reaffirmed 6/2018.

The U.S Environmental Protection Agency (EPA) allows safer products to use the Design for the Environment (DfE) label on products that help protect the environment and are safer to use. The DfE scientific review team has screened each ingredient in these products for potential harmful effects on humans and the environment. Based on what is known, the product contains the least harmful ingredients among chemicals of the type used for the purpose for which the product is being sold. The EPA lists products on its website that have met the DfE criteria. 12/2012

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See Managing Infectious Diseases in Child Care and Schools, 4th Edition available at https://shop.aap.org or search www.healthychildren.org for more information. In PA, please send your health and safety request with your name and phone number to This email address is being protected from spambots. You need JavaScript enabled to view it..

Learn the latest on flu prevention.  This webinar was delivered by the National Center on Early Childhood Health and Wellness.   Flor Munoz, MD, MSc, FAAP and Timothy R. Shope, MD, MPH, FAAP presented the webinar in December 2018.  Click here to access the recorded webinar and handouts. Objectives for the webinar:

1. Update on recommendations for this influenza season.
2. Emphasize importance of universal immunization for everyone in child care and school settings.
3. Share strategies for use in early care and education settings to prevent or control the spread of influenza.

4. Review importance of influenza pandemic preparedness. 

View free, online demonstrations of step-by-step, easy ways to prepare foods for children's meals and snacks. Culinary Institute chefs show the proper techniques in 16 print and 51 brief video lessons. The foods are from the United States Department of Agriculture's collection of recipes for schools. The National Food Service Management Institute at the University of Mississippi hosts the website with this excellent professional development resource.

In addition to the videos and print lessons, the website offers six online courses that allow users to earn continuing education credits. The print and video lessons, online courses and USDA recipes are at http://nfsmi.org/Templates/TemplateDefault.aspx?qs=cElEPTIxNg.

Food-borne illness is very common. The risk of this type of illness increases in warm weather. Sending food from home and eating out-of-doors may allow perishable food to reach temperatures that foster bacterial growth. A 2011 study reported in the journal, Pediatrics measured temperatures of lunches that families packed and sent with their preschool children. The researchers found only 1.6% of lunches with perishable items were at safe temperature. The study was done in nine Texas child care centers and measured temperatures in the packed lunches of more than 700 preschoolers. Even when sent with ice packs, most of the lunches were at unsafe temperatures over an hour before the food was ready to be served. The message is clear: Early educators and families must adopt practices that ensure food is at a safe temperature before feeding it to children.