If you have a baby, you know about diaper rash. While it’s a common problem, even a mild case can upset you — and irritate your little one.
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When you’re changing a diaper and find a red, painful-looking bottom, it’s important not only to know how to treat it, but also how to avoid recurrence. Often, this involves basic care adjustments, but sometimes, it can be harder to pinpoint the source of the problem, especially if it’s related to food or skin allergies.
Pediatrician James Mandelik, MD, explains what to watch for, how to head off trouble and when you should suspect that allergies are involved.
Deciphering the diaper rash: first steps
According to the American Academy of Pediatrics, more than half of all babies between 4 months and 15 months of age will develop diaper rash at least once in a two-month period. So you’re not alone if you’re occasionally struggling with an outbreak.
“It’s a quality-of-life issue for the child who is miserable, and for the parents who want to help but are not getting any sleep,” Dr. Mandelik says.
He says to first look for the most common cause of diaper rash, which is a baby wearing a wet or soiled diaper for too long. So it’s important to pay attention to a few diapering basics before looking for other causes.
Basic care tips: Research suggests that diaper rash is less common with disposable diapers, but what’s more important than the type of diaper is how often you change it.
Before you consider allergies as a culprit, check to see if you are doing the following:
- Always change your baby’s wet or soiled diaper as soon as possible. That’s the best strategy to prevent diaper rash, Dr. Mandelik says. Be especially vigilant if your child has diarrhea or is taking an antibiotic (or if you’re a nursing mother taking an antibiotic). Antibiotics can cause loose stools and extra irritation.
- Apply a protective ointment or cream. Look for products containing zinc oxide or petroleum jelly to use and apply when changing a diaper.
- Let your baby go without a diaper at home whenever possible. This exposes his or her bottom to fresh air.
Watch for allergies and other factors
Besides the most obvious, there are several other factors that may leave your baby with a red bottom:
1. Disagreeable diapers or wipes. A certain brand of disposable diaper or baby wipe could irritate the skin.
Tip: “While they may outgrow the irritant, the best thing is to try a different product,” Dr. Mandelik says. “The simplest strategy is trial and error — eliminate one variable at a time.”
2. Disturbing detergent. The laundry detergent used to wash cloth diapers is sometimes the culprit, but if this is the case, your child is likely to have a rash elsewhere on the body as well.
Tip: Use detergents labeled scent/fragrance-free and dye-free to wash your baby’s diapers and clothes. Stick with one brand if you suspect soap is irritating your child’s skin.
3. Harmful heat. Hot, humid weather or overdressing a child for the weather can cause a heat rash in the groin area. However, as with detergent, the rash is likely to also show up elsewhere, particularly on the neck, armpits and elbow creases.
Tip: Of course you want to keep your baby warm enough, but it’s possible to overdo it.
In cold weather, check on your baby and loosen clothing as needed when you’re moving from your car to stores or restaurants and back. In hot weather, a diaper is often enough, but use sunscreen and shade when you’re outside. And bring an outfit for air-conditioned spaces.
4. Unfriendly food. Your child may have a food sensitivity or allergy, but other symptoms besides diaper rash are also likely in this case.
For instance, a child having an adverse reaction to cow’s milk is likely to also have blood in the stool, hives, swollen lips and/or wheezing, says Dr. Mandelik, who completed his fellowship in allergies.
Tip: To prevent food allergies, doctors recommend that children avoid milk before age 1 and eggs before age 2.
Know when to call for help
Despite all your best efforts, a child can still develop a diaper rash, either gradually or suddenly. If that happens, clean the area gently with soap and a soft cloth. Avoid rubbing and pat the area dry. Follow the basic care tips, above.
Call the doctor if the rash:
- Persists for three days or gets worse.
- Is more red-dotted than solid red, indicating a possible yeast infection.
- Contains skin that is breaking down and not intact.
- Is accompanied by a fever.
“If there’s any question in your mind, bring them in to see their pediatrician,” says Dr. Mandelik, adding, “I tell my parents that about anything.”