Diapering a Newborn: Dealing With Diaper Rash

By Jeannette Moninger
WebMD Feature

Is your baby bothered by diaper rash? There are lots of things you can do to prevent and treat this problem, says pediatrician Laura Jana, MD, co-author of Heading Home With Your Newborn: From Birth to Reality.

What causes diaper rash?

There are two main causes of diaper rash: contact irritation and yeast.

1. Contact irritation occurs when a wet or soiled diaper is left on for too long. You may notice redness or small bumps on your baby’s bottom, genitals, and creases near her thighs. Your baby’s skin also may be irritated by a certain brand of disposable diapers or baby wipes, or by detergents or fabric softeners used on cloth diapers.
2. Moisture that’s trapped in a soiled diaper is also a breeding ground for Candida albicans, a yeast that causes diaper rash. This rash often appears in skin creases, the thighs, and genitals (rarely on the buttocks).

Babies who are taking antibiotics (or whose breastfeeding moms are taking them) are more prone to this type of diaper rash because the medications kill good bacteria that keep yeast from growing. Plus, antibiotics can cause diarrhea, which irritates skin.

How can I prevent diaper rash?

Change your baby’s diaper as soon as you know it is wet or soiled. However, if your little one is napping and she doesn’t have sensitive skin that is prone to diaper rash, you can probably wait until she’s awake. That said, if you’re turning in for the night and you know that your baby has a soiled diaper, don’t let her sleep in it all night.

Some parents like to use baby powder to reduce moisture in the diaper area. Cornstarch may actually worsen a yeast diaper rash. If you want to use powder, make sure it doesn’t have talcum. Pour the powder carefully into your hands, away from your baby’s face, and then gently pat her bottom.

How do I get rid of my baby's diaper rash?

Frequent diaper changes are a must. At each changing, you should clean the diaper area with warm water and a soft washcloth or a baby wipe that doesn’t contain skin-irritating alcohol or fragrance.

Pat the skin dry with a clean, soft cloth, or if possible, let her bottom air dry. Then apply a thick layer of diaper cream ointment with zinc oxide or petroleum jelly to act as a waterproof barrier.  

When possible, keep the diaper loose so air can circulate, or let her go diaper-free for a while.  

Depending on the cause of the rash, your baby may need an antifungal cream, an antibiotic cream, or a mild steroid cream. [Drugstore] anti-inflammatory creams like hydrocortisone may help reduce redness and pain, but check with your pediatrician before using it. These types of steroid creams can worsen rashes caused by yeast if not used as directed. Yeast infections typically are treated with antifungal creams, [which may need a prescription].

Does diaper rash get worse when babies start solid foods?

Diaper rash is more common between months 8 and 10, when babies start to eat more solid foods. Various foods get passed in baby’s stool and can irritate the skin. Changes in diet also can affect the number of bowel movements and make diaper rash more likely.

Should I use cloth or disposable diapers?

The type of diaper isn’t as important.

Cloth diapers are not as absorbent as disposable diapers, so they can hold wetness against your baby’s skin. On the flip side, some disposable diapers are almost too absorbent, so [some] parents don’t change them as often as they should.

If you choose cloth diapers, be sure to change soiled diapers often and quickly. Rinse cloth diapers several times after washing to remove soap residue, and skip fabric softeners, which can inflame skin.

When should I call the doctor?

Call your pediatrician if:

• The rash isn’t improving or is worsening after two to three days of home treatment.
• There are blisters or pus-filled sores.
• Your baby has a fever.
• The rash seems to be causing a lot of pain.
• You think your baby may have a yeast infection.