In some shape or form, diapers are pretty much universal in most cultures, so it’s wise to have diaper rash on your parental radar. A little knowledge will allow you to reduce the chances of this happening and troubleshoot the early signs of problems.

One-quarter of infants who wear diapers will have diaper rash at some point. The condition is even more common in babies who wear cloth diapers.

Why do we even have diapers, and how did we manage before they came into the picture? No one wants poop on their cream-colored carpet. (What parent has cream-colored carpets anyway?) Historically, people have used leaf wraps, animal skins, and even moss as diapers. Cloth diapers in 15th-century England were not changed for several days. (Eww!) In tropical climates, some infants simply go nude. Modern-day diapers actually reduce the chance of diaper rash as they absorb urine, reducing skin contact time.

What is diaper rash?

Think of the skin as a barrier. The rash kicks off due to a disruption to this barrier, resulting in irritation and inflammation. Diaper rash is most commonly a form of contact dermatitis. This can then become vulnerable to secondary infection, most commonly with yeasts or candida. Sometimes, the primary trigger for the rash is yeast or bacterial infection.

What causes diaper rash in babies?

Diaper rash has a range of triggers. The primary issue is the need for babies to wear diapers all day and skin coming into contact with urine and feces, which are irritants. The longer the contact, the higher the chance of problems arising.

Other triggers include detergents, fabric softeners, and fragranced products.

Dyes and preservatives in diapers or wet wipes can cause problems, too.

Diaper elastic chafing and rubbing on the skin can also contribute to disrupting the skin barrier.

Antibiotics can temporarily destroy the “good” bacteria we need on our skin, leading to overgrowth of yeasts and certain forms of diaper rash. Episodes of diarrhea can also pave the way for diaper rash due to increased contact of the skin with feces.

Diaper rash is more common as babies start weaning because certain foods will lower the pH of stool. If your baby is getting frequent diaper rash at this time, the trigger may be acidic foods such as oranges, grapes, and apples, including juice. Tomatoes and tomato-based foods (for example, sauces) are also common culprits. Starchy, more digestible foods, like pasta or bread, may be less likely to cause diaper rash in infants whose skin is more sensitive to acidic foods.

Hot weather is also problematic. Allowing babies to spend extra time with their diapers off to allow air circulation can help prevent diaper rash. Some lighter diaper brands which allow more skin exposure are available for hot weather wear.

What does diaper rash look like?

Red, inflamed skin around the genitals is your warning sign of diaper rash. Sometimes, there may only be a few spots, or there may be scattered spots around an area of redness. Skin creases in the groin are usually not affected.

Common types of diaper rash

Diaper rash is usually a form of irritant dermatitis, meaning the skin has become red and inflamed following contact with one or more of the triggers discussed above.

Yeast infection is also very common, often brought about by antibiotics. It occurs frequently as a secondary infection after disruption of the skin barrier due to irritant dermatitis.

Various other possibilities exist but are less common. Occasionally, bacteria can enter the skin. Yellow crusting, weeping, or skin redness that feels warmer than usual are all warning signs. Product allergies will show up as a nettle-type rash after exposure to the particular trigger.

Finally, other types of common skin afflictions in babies, such as seborrheic dermatitis or eczema, can also show up in the diaper area.

The parent website of the American Academy of Pediatrics has some images of different types of diaper rash.

What should I do if my baby has diaper rash?

Confident parents can manage early signs of diaper rash. If you notice that your baby’s diaper area is starting to look a little sore or has a few red spots, it’s time to review your regime. If weaning, look for the potential triggers mentioned above. Make sure you are applying a zinc-based barrier cream regularly. Allow your baby to spend as long as feasible without wearing a diaper. At least 10 minutes 3 times a day following a diaper change is a good start.

When it comes to bathing, a daily bath in warm or lukewarm water without soap or shampoo is best. Pat the skin dry gently, don’t rub.

Consider using a slightly larger diaper temporarily to reduce the chance of the leg elastic rubbing against irritated skin.

Mild diaper rash should start getting better within 3 to 4 days.

When should I see the doctor?

Do check with your doctor if you’re unsure what you are dealing with or are worried.

Reasons to seek a consult include:

• Diaper rash not responding to home measures mentioned above
• Rash that appears particularly angry, red, or widespread
• Swelling of the skin, pus spots, or ulceration—a rash that feels hot may indicate bacterial infection and also needs prompt attention.
• An irritable, unhappy, or feverish baby
• Your instinct telling you to see a doctor

Many more persistent cases will need anti-yeast or very mild steroid creams added in after an examination by your doctor. Occasionally, other skin issues may need other treatments or referral to a dermatologist. Severe diaper rash may take up to a week to start improving. Check with your doctor what to expect when embarking on prescription treatments.

Preventing diaper rash in babies

Prevent diaper rash by changing the diapers as soon as they are dirty. More absorbent varieties will reduce the amount of urine in contact with the skin. Larger-size diapers may also be less likely to rub.

Make sure to use a barrier cream on the diaper area. Effective barrier creams contain zinc oxide. Common examples include Aquaphor 3-in-1 diaper rash cream or Desitin. A thin layer is enough; smooth cream on gently as opposed to rubbing it in, which can cause irritation.

For those committed to cloth diapers, change regularly as soon as they get soiled. Cloth diapers need a thorough rinse in the laundry to remove any detergent. Plastic over-pants may be required on occasion, but they can create a “greenhouse effect” that promotes the growth of infections.

When it comes to skin cleaning, look for water-based wipes without preservatives. Even better, use just cotton wool or a soft cloth and warm water. Allowing babies to spend some time roaming around diaper-free is really helpful, particularly if they do have diaper rash.

The market for baby bath products is pretty saturated with items appealing to your parental heart, but all that babies really need is warm water, nothing fancier than that.

What about natural remedies?

The internet is literally exploding with advice on natural remedies. It would be impossible to comment on the safety or reliability of most of these. Coconut oil is a safe product to put on babies’ skin.

Calendula-based creams (derived from marigold plants) for diaper rash seem to be popular among some parents, as are aloe vera creams. It’s important to be aware that alternative remedies are often backed by little research if any at all.

Sometimes diaper rash will happen despite your best efforts. Most cases will clear up pretty quickly with treatment. Diapers are just a fact of life, so keep changing them regularly, use a barrier cream, and go gently when it comes to baby skin.