Q&A: diaper rash problem

Lihpovela, who titled her email "long time listener, first time caller" (heh), writes:

"My sister has a baby who is 11 months old and has very sensitive skin and absolutely terrible diaper rash--to the extent that the poor little guy cries when you lay him down for a change because he knows what is coming.  My mother and I have tried to convince my sister to switch to cloth diapers to alleviate this problem, but she does not want to (too yucky!).  She seems instead to want to just grit it out. While I'd love to hear ideas about how to convince her to switch, if you think that would help his buns, I'm equally interested in other ideas about treating the rash.  She uses wet wipes with every change, even if there is only pee.  Is this gratuitous? (I don't do this myself with my cloth diapered 10-month old, I use some baby oil every change and a wet rag if there is an actually mess that needs cleaning). How about zinc oxide- every time? How to know if you need something stronger?"

"Grit it out"? Easy for her to say when it's not her butt on fire! I can't recall having a diaper rash, but I imagine it feeling about as uncomfortable as a yeast infection. She definitely needs to make some changes. (I don't want to make alarmist predictions, but she really needs to get this fixed before he starts holding in his pee and poop because he's afraid of the feeling. She could be causing a huge, I've-been-in-therapy-for-12-years-about-this, ostracized-at-summer-camp problem by not taking this seriously.)

My husband calls me the Forensic Poopologist, and the further into the game of dealing with other people's butts I go, the more I learn than less is more. Instead of going with something stronger, I'd actually back up and see if removing things from her routine will cause less irritation.

The very first thing I'd do in her situation is give him 2-3 regularly scheduled air baths a day. Put him on a waterproof pad or take him outside and let him go diaperless and pantless for 10-15 minutes to let his poor butt air out.

Then I'd take a look at their diaper situation. (Has she read about how easy and non-yucky it is to use cloth diapers? Plus it saves a bundle of money.) While switching to cloth diapers can eliminate or ease diaper rash for many babies, if your sister's not willing to try that she can still go with less irritating diapers. If she's using national brand diapers with scents or lotions or "rash-guard" or a whole bunch of bells and whistles, she should switch to a brand with the least technology possible. She could try the Seventh Generation diapers with no bleach (they do have the absorbant polymer things) and see if that helps alleviate the problem. She could also try Tushies, which use cotton as the absorbant layer.

If she uses wipes with each change, that could be making the problem worse by irritating his sensitive skin. Even the ones that claim to be "natural" or for sensitive skin often contain alcohol or sodium laureth sulfate or other things that are flaming her son's tush. She could switch to a non-irritating brand like Seventh Generation, or, even better, go to washcloths or unbleached paper  towels with plain water or a homemade wipe mix. With my first son I wiped at each change (even just pee), and we used our own mix of water, aloe gel, and a few drops of tea tree oil. (Readers, feel free to leave your recipe for wipe solution in the comments.) With my second son I only wipe after poop or if the diaper seems wet to the touch.

I would NOT use zinc oxide cream at each change, and would consider switching away from zinc oxide cream altogether. ("Harmful if absorbed through skin. Causes irritation. Prolonged skin contact can cause dermatitis called oxide pox.") If you walk into your local health food store and go into the baby care aisle there will be several good zinc oxide-free choices. I'd look for one that contains calendula, but I'm sure someone will make a specific brand recommendation in the comments.

Now once she's giving air baths, has switched to the lowest-tech diaper she can find, has ditched the irritating wipes, and has gotten rid of the zinc oxide, she may need to try to figure out what's causing the rash in the first place (if it's not as simple as a contact allergy or irritation to the diaper, wipes, or cream). Teething often causes diaper rash either by causing a rash to appear directly (some kids get a rash around their mouths, some get a rash around their anuses, and some get both) or by making the poop so acidic that it causes a rash as it comes out. There's nothing to be done about teething rash except to change a diaper as soon as the baby poops and to allow him more time to air out during periods of heavy teething.

Some babies get rashes when they eat certain foods that make their poop almost seem to burn their skin. Common foods that cause this problem are acidic foods like citrus, citrus juices (although I can't imagine an 11-month-old is drinking orange juice anyway), and tomato products, and sometimes grapes. She should think about his diet and observe to see if the rash gets any worse when he eats certain foods.

It's also possible that he has a fungal infection instead of a straight-up rash. A fungal infection rash looks like burn marks on the skin--red patches that are slightly raised that may have kind of oozy-looking centers. The only way to get rid of a fungal rash is to treat it with anti-fungal cream (sold OTC for athlete's foot as Lotrimin).

If she eliminates everything else and he's still got a nasty rash, she'll need to go to the pediatrician and see if it's a problem that could be resolved by hydrocortizone cream. I'd never advise that as a first-line strategy (if only because even if it resolved the immediate problem, if she's still using irritating products the rash is bound to return), but if nothing else is contributing to the rash and it still won't resolve, it might be what finally knocks it out.

I hope you can get her to pay more attention to this problem. Her poor baby! Imagine how you'd feel if your butt and crotch hurt all the time. Maybe you and your mom can give her painful wedgies until she agrees to try to figure out the problem and fix it.

Comments

[kelly jeanie]

I'm looking forward to hear your readers' suggestions as well, Moxie. Thanks for another great post. My son also has sensitive skin. When he was just a week or two old we had gotten some prescription cream from the doctor to clear up the nasty rash he had on his tush, but it didn't seem to be working. Being the clueless mom I am, I was cycling through all the wipes we had acquired before he was born and when we hit the Pampers Sensitive it cleared right up. Good thing too; this was long before I came across your site, and my doctor is the type to throw prescriptions at that type of problem. In hindsight, the best thing to do would have been to go with plain cloth and water. We have since tried other commercial wipes labeled "sensitive" and, as you might expect, his poor skin would get inflamed again until we switched back to the Pampers. I did try the Target equivalent this month (he's now 13 months old) and those don't seem to bother him, but those are the first generic alternative I've seen to those specific wipes. Since that first rash, we've rarely seen anything that didn't clear up within a day, excepting when he had diarrhea. I don't use cream every change, only if he seems a bit inflamed, and things seem to clear within the next couple of changes.

[jesse]

I saw an article about the healing properties of breast milk in a recent Mothering magazine article-- for example putting a few drops of BM in a toddler's nose to fight a cold. I have been looking at homemade recipes for diaper cream online and someone said the breast milk can clear a rash. Maybe your reader can try 1/2 an ounce of breastmilk on her baby's bottom-- perhaps a couple doses, letting it air dry? FYI, if people are interested in a more technical description of the powerful immune properties of breast milk, Jack Newman, the breast feeding guru, has a great brief on his website. Just google "Jack Newman breastfeeding".

[Ally]

Ow, poor baby. Jamie had a chronic problem with diaper rash until we switched to cloth. Not as bad as this poor guy, but that is probably because we use target's sensitive skin wipes and kept on top of it with either lotrimin if it was yeast, or a 1:1 mixture of aquaphor and maaloxx(sp?) for everything else.

We recently had to switch back to sposies for a couple of weeks and by the end of that period his butt was a raw, red mess. Four days back into cloth full-time with liberal applications of aquaphor and it is once again beautifully clear.

[kate]

I'm so upset reading that this mom is trying to "grit it out". Ugh, poor baby.

Naked bum time is the best. Neosporin helps too.

[gretchen]

Maybe he has a yeast infection. My daughter had what I thought was a stubborn diaper rash, turns out it was a yeast infection. Doctor had me apply Lotrimin(anti-fungual foot cream) at each change and it cleared up in days. I would tell your sister to ask her doctor about the possibility of a yeast infection.

[Tabetha]

All (3 so far) of my babies had major diaper rashes when they were teething. They would get it so bad that their bottoms would be bleeding when I changed them even though I changed them immediately. Here is some advice if the child is teething.

If the description above sounds like your baby, it is probably a yeast rash. Yeast is always in poop, but when a child is teething, his body puts out more yeast, which can cause horrible diaper rashes. The doctor prescribed Nystatin for it, but the nystatin did not seem to work (at least not fast enough for me). After trying over and over to give my baby relief, I tried this, and it worked!!! I put constarch baby powder on the bottom first, then a layer of desitin on top, then a layer of vaseline on top of that. The three will get mixed together as you are putting it on and will form a paste. I did this, and my son's bleeding rash was gone in a day or 2.

It is important to use a wash cloth rather than wipes during this time b/c the wipes irritate and burn the rash. Also, do not give him fruit or juice or anything acidic until the rash is gone.

Good luck!!

[charissa]

My daughter (now 2) has had a few diaper rashes in her time. The things that helped were rinsing out the wipes before using them (this amounts to the same thing as a cloth and water, but if that seems like too much work, just rinsing the wipe under running water will help), and using pure aloe vera gel. The gel stings at the very first, but it worked pretty quickly for us, so I didn't need to apply it more than a couple times. Naked time is good, too, and making sure the boy is good and dry before putting a new diaper on (especially if she's using wipes with each and every diaper change). For this, I put the blow drier by the changing table and just used the "cool air" setting to make sure my daugher's bum was thoroughly dry. It was good amusement for her, too.

[Brooke]

I had what was essentially diaper rash last year. It was very, very horrible. It turned out to be a yeast infection (which is a pretty common form of diaper rash I guess), so if it is that bad, checking to see if he has a yeast infection would be a good thing. I have nothing but sympathy for the poor kiddo.

Since my daughter has super super sensitive skin, we only use cloth wipes, although the 7th Generation disposable things work well. California Baby makes a diaper rash solution which you can dilute to make a wipes solution. It seems to work really well. Better even than plain water. It's also really easy which is a plus.

[Katie]

None of the OTC meds works for us and ended up having to go and get perscription cortizone for his bum and it healed back up. Now anytime it starts up I put a little bit on and it's no problem. I use disp. diapers and wipes. The meds worked perfect for him.

[erin]

Our now 4 month old had an awful diaper rash while in cloth diapers. We switched to disposables for a while (7th gen) and stopped wiping with every pee. (we use cut-up wash clothes in water that we keep in a warmer- pampered tush!) Someone told me that the baby's urine can help prevent rash if it dries on the skin. Since it worked, I didn't investigate further, but I'd be curious to know if there is any science behind it!

[Em]

I second what you say about zinc oxide creams. My daughter had awful diaper rash. I tried everything ... until I finally worked out that the zinc oxide creams I was using were the the cause - they irritated her skin dreadfully. I now use a zinc free cream (here's a link - I'm not sure if is available in the US -http://www.onlyoz.com.au/prod1821.htm ) but rarely need to use it as she doesn't get a rash anymore.

[J]

I agree with what others have said about the possibility that it is a yeast rash. My daughter was prone to getting that, and once she'd get it, nothing would take care of it except prescription Nystatin (Lotrimin and clotrimazole burned her bottom--horrible!). A layer of that with some pure corn starch on top, and then a diaper cream to seal it in. The baby might also be having a reaction to the zinc oxide. She should definitely try to switch creams. Finally, tiny washcloths wet with plain water are much better than wipes, especially if it is yeast. Most wipes have alcohol in them, which makes yeast that much worse.

[Amy]

Good tips above. In addition, I highly recommend Aquaphor, if she hasn't tried it. Much better than any of the zinc oxide creams, and in my experience it heals any irritation rash.

If she tries the Aquaphor and it still doesn't clear up after a day or two, its likely a yeast or fungal infection, and should be seen by a ped.

Also, I saw above that someone recommended Neosporin -- PSA alert, but close to 50% of the population is allergic to one of the ingredients in Neosporin. We learned this the hard way with my son. If you want to use an anitbiotic ointment on a child, best to use Bacitracin or get a prescription for Bactroban. I absolutely would not put Neosporin on a terrible diaper rash as if the child is reactive to it, the rash will get much worse, and can make it even harder to figure out the cause.

[Amy]

Also, tell her to skip the wipes and try using Cetaphil or plain water to clean his skin.

[Lee]

I, too, have had terrific results with Zinc Oxide and will even go as far as to recommend the generic K-Mart version as it's (a) stronger and (b) cheaper than the name brands.

And unlike the CVS generic brand (which I find to be too thick to even get out of the tube), the K-Mart version is soft and squeeze-able.

[Lee again]

You know, I started my post with "I, too", but just realized that I don't think anyone mentioned it. sorry.

[Janie]

Aw, poor baby. That has to be constantly painful. My son had a horrible horrible rash due to acidic diarrhea back in February because he developed a lactose intolerance (thanks Moxie and readers for your help back then!).

The rash was worse to him than the diarrhea because it was so sore. We switched immediately to soft, damp paper towels kept in an old wipes box, and - very important! - we would BLOT, not wipe, his bottom. Blot gently until clean - wiping would tear his poor sensitive skin. After that, as much "air time" as you can handle is wonderful. I spread out sheets and towels on the floor to catch errant spurts and let him go. Also at night I would let him sleep on his belly on a pad and scrunch his knees under him so that his bum was up in the air for a few hours.

Those things helped the most. I did use several different creams - from Aquaphor to Maalox-mixes, to Boudreaux's, and the only thing that helped was the full-strength original Desitin. I used it long enough to let the raw areas heal and redness subside, then I used A&D ointment without zinc oxide.

This was by far the worst ordeal I've gone through as a new mom - the raw bottom and the crying as soon as a bm or pee happened was heartbreaking. He also would not sit on his bottom, he would prop up on his legs so his bottom had no pressure on it. So sad.

I had no idea acidic diarrhea could cause so much damage so quickly. Now at the first sign of loose bowels I immediately use ointment or Aquaphor as a barrier.

Sorry for the long comment, but I hope this helps.

[Gretchen]

Since no one has mentioned it yet, I'll throw in my "product of choice" - Triple Paste. It's a mixture of Desitin, corn starch and lanolin, I think, sold at pharmacies or available online at http://www.sumlab.com/shop/trip.asp and just about every other online pharmacy.

My daughter had hideous, long-term, occasionally bleeding diaper rash that got worse (!) over a weekend when our pediatrician was out of town. I had read about Triple Paste on some of the mommy web sites, and I was lucky enough to find some at CVS. I applied some Sunday night before bed; by Monday morning all the hideousness was gone and the area was only slightly pink. My daughter stopped screaming every time she peed, too, which was what I was hoping for.

Now we switch to the Triple Paste anytime it looks like there's any diaper rash starting, and it usually wipes it out (haha) in a day or less.