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Diaper Rash

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Definition

  • Any rash on the skin covered by a diaper
  • Limited to diaper-wearing age group (birth to 3 years)

Cause 

  • A chemical irritation of the skin from a mixture of stool and urine being left on it
  • Worse during bouts of diarrhea

Main Complication 

  • Secondary infection by yeast or bacteria

When to Call Your Doctor for Diaper Rash

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Bright red skin that peels off in sheets
  • Large red area with a fever
  • Age under 1 month old with tiny water blisters or pimples (like chickenpox) in a cluster
  • Age under 1 month old and looks or acts abnormal in any way
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Pimples, blisters, open weeping sores, boils, yellow crusts, red streaks
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Rash is very raw or bleeds
  • Has spread beyond the diaper area
  • Rash is not improved after 3 days of treatment for yeast
 

Parent Care at Home If

  • Mild diaper rash and you don't think your child needs to be seen
 

Home Care Advice for Diaper Rash

  1. Change Frequently: Change diapers frequently to prevent skin contact with stool. It may be necessary to get up once during the night to change the diaper.
  2. Rinse with Warm Water: Rinse the baby's skin with lots of warm water during each diaper change. Wash with a mild soap (such as Dove) only after stools. (Reason: Frequent use of soap can interfere with healing). Avoid diaper wipes. (Reason: They leave a film of bacteria on the skin).
  3. Increase Air Exposure: Expose the bottom to air as much as possible. Attach the diaper loosely at the waist to help with air circulation. When napping, take the diaper off and lay your child on a towel. (Reason: Dryness reduces the risk of yeast infections).
  4. Anti-Yeast Cream: If the rash is bright red or does not respond to 3 days of warm water cleansing and air exposure, suspect a yeast infection. Apply Lotrimin cream (no prescription needed) 3 times per day.
  5. Raw Skin: If the bottom is very raw, soak in warm water for 10 minutes 3 times per day. Add 2 tablespoons (30 ml) of baking soda to the tub of warm water. Then apply Lotrimin cream.
  6. Sore or Scab on End of the Penis: Apply an antibiotic ointment such as Polysporin (no prescription needed) 3 times per day. (Reason: a bacterial infection that can cause painful urination).
  7. Diarrhea Rash: If your child has diarrhea and a severe rash around the anus, use a protective ointment (barrier ointment) such as petroleum jelly, A&D or Desitin. Otherwise these are not needed. Caution: Wash off the skin before applying.
  8. Expected Course: With proper treatment these rashes are usually better in 3 days. If they do not respond, a yeast infection has probably occurred.
  9. Call Your Doctor If:
    • Rash isn't much better in 3 days on treatment for yeast
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Arnsmeier SL and Paller AS. Getting to the bottom of diaper dermatitis. Contemp Pediatr. 1997;14(11):115-111.
  2. Boiko S. Making rash decisions in the diaper area. Pediatr Ann. 2000;29:50-56.
  3. Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal intertrigo: an underrecognized condition in children. Pediatrics. 2003; 112(6):1427-1429.
  4. Kazaks EL and Lane AT. Diaper dermatitis. Pediatr Clin North Am. 2000; 47: 909-920.
  5. Schuman AJ. Disposable diapers? Definitely! Contemp Pediatr. 1997;14(11)131-139.
  6. Singalavanija S and Frieden IJ. Diaper dermatitis. Pediatr Rev. 1995;16:142-147.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/14/2010 12:39:46 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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