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TWO MAIN FACTORS
Diarrhea has been found to be the cause of diaper rash in 70-80% of cases. Liquid stool spreads over a wide area and is very irritating to the skin
Infrequent diaper changes make it difficult for the skin to protect itself from the many causes of irritation in the diaper area, including diarrhea and others listed below. Frequent changes will minimize the effects of all irritants.
OTHER FACTORS & TYPES OF RASH
Prolonged and/or frequent exposure to feces can cause rash. The mixture of urine and feces produces ammonia (high pH), which increases fecal enzyme activity, making the skin more susceptible to damage.
Hydration of skin – Urine alone does not generally damage skin, but if skin is allowed to become hydrated (filled with liquid), it is more easily damaged by irritants such as friction, chemicals or microbes. (i.e., bacteria or yeast).
Friction – When baby is mobile and the diaper rubs on wet skin, it will sometimes result in a rash. (Redness will be seen where chafing is greatest, but not in the baby’s skin folds).
Yeast or fungus infection – The main cause of severe diaper rash is infection of the skin with Candida, an organism found in feces of infants (this is more likely to happen if the child is taking antibiotics). This rash is bright red and tender, with distinct edges, and appears in the creases between the abdomen and thighs, with small red spots or pustules close to the large patches.
Heat inside the diaper may cause heat rash and may increase the growth of microbes such as yeast or bacteria. Some types of rash (e.g., impetigo) are most common in warm conditions.
Allergens and irritants – Some possible allergens and irritants are: baby wipes, plastic, chemicals, perfumes, perfumes, chlorine bleach, residues/ingredients in some detergents, fabric softeners, and paraben (a preservative in some creams and ointments).
Diet and age - Some studies have found less rash with breastfed babies than with formula-fed babies. Also, introduction of new foods can sometimes give feces higher pH and cause a rash (usually around the anus), which is possibly the reason the diaper rash peaks at 7 - 15 months.
Susceptibility - Some babies are simply more prone to rash than others.
Teething and the common cold have been reported to cause diaper rash.
Aggressive and/or frequent cleansing of the diaper area with soap or disposable baby wipes can damage skin. Insufficient cleaning can also contribute to rash.
Other forms of rash in the diaper area are: seborrheic dematitis (may be accompanied by "cradle cap" on the scalp), intertrigo (from skin rubbing on skin, in the creases), impetigo (caused by bacteria), psoriasis and scabies.
TO KEEP BABIES SKIN HEALTHY
On average, a baby’s diaper should be checked for wetness every hour. Newborn babies urinate 8 - 20 times a day (average 10 - 12). This gradually decreases to 7 - 10 times a day at 12 months of age and 5 - 8 times a day as they reach toilet-training age.
Gentle wiping of baby’s bottom with a clean, warm wet cloth is recommended at every diaper change for newborns, several times a day for older babies. Let baby’s skin dry before applying a clean diaper.
Creams and moisture barriers (e.g., petroleum jelly) need not be used with every diaper change. Generally, after the bath and/or before bed is sufficient. It is good to let skin "breathe." Skin must be clean before applying a moisture barrier. Powders and cornstarch can accidentally be inhaled by baby and probably should not be used.
PREVENTING DIAPER RASH
Diapers containing feces: Gently wipe feces off baby with the inside of the diaper (or stay-dry liner). Use toilet paper if necessary. Wipe girls from front to back to avoid vaginal infection. Wash baby’s bottom gently but thoroughly with warm water and a soft cloth (fold and use a clean part of the cloth each time you wipe). If you use soap, use a mild one and rinse it completely off.
If baby has diarrhea or a cold or is teething a moisture barrier (e.g., petroleum jelly) should be applied to the skin after cleaning and drying it well.
Diaper liners made of non-absorbent fabric such as polyester, will help keep wetness away from baby’s skin, and may reduce mixture of urine and feces.
Diaper Rash - Air baby’s bottom in a warm place after bathtime (or any convenient time). The use of plastic on the outside of the diaper tends to hide the evidence that a change is necessary, and tends to prevent evaporation and raise the temperature on baby’s skin.
This can cause general discomfort in warm conditions, and may increase growth of bacteria, fungi or yeast if present. The use of breathable waterproof diaper covers over cloth, may help prevent diaper rash, and is especially recommended if baby develops a yeast infection. Breathable waterproof covers do not necessarily reduce wetness on baby’s skin while the diaper is wet, but they do help prevent the build up of heat inside the diaper as well as aid in moisture evaporation.
For night diapering, ensure the diaper has adequate absorbency. Cloth diapers usually require the addition of an insert or two (or double diapering if using traditional flat diapers). Use of a non-absorbent inner liner next to baby’s skin is especially recommended for night. Apply a moisture barrier (e.g., petroleum jelly) to reduce hydration of the skin with urine during the night, and protect skin from irritants.
If baby’s skin is healthy, changing a wet diaper in the middle of the night is not generally necessary if the diaper is absorbent enough, as most of the moisture will be drawn away from the baby’s skin. Also as the baby is relatively immobile, there is not much friction on the skin.
If baby has a persistent rash, a 3 a.m. check may be advisable.
IF A RASH DEVELOPS
If diaper rash develops, let baby go without a diaper for one to three hours a day. For young babies, put them on the diaper Instead of in the diaper (make sure the room is warm). For older, more mobile babies, try to keep them in a non-carpeted area, or wait until nap time. (If urine gets in the carpet, baking soda or rug cleaning foam can be used to treat odors and stains). The next most airy option is to put baby into a cloth diaper alone (without a cover). Using a breathable waterproof cover over top is also an option that will allow some air in and out.
It is important to air baby’s bottom when a mild rash appears, to allow healing. Once skin becomes irritated, it is more susceptible to further irritation. Organisms that cause severe rash (e.g., yeast) do not generally infect healthy skin; however if present in the feces, they can infect damaged skin.
Avoid use of disposable baby wipes if baby has a rash. If allergies are suspected, eliminate possible allergens until the rash clears. Then introduce one possible allergen each week , so allergies can be detected. If in doubt, discuss this with your doctor.
Often a diaper rash cream or ointment will help clear up a rash within a day or two (consult with your pharmacist or health nurse for a recommended brand). If ointment is difficult to remove, use olive oil or baby oil on a cotton ball.
Consult a physician if a rash worsens or persists for more than three or four days, or if skin is broken or develops pimples, pustules or blisters. Prescription creams or medicine may be required to clear some types of rash (e.g., yeast infection)
IF A RASH PERSISTS
If a rash persists, or keeps coming back you may consider changing other things besides wet diapers. If your baby is under six months of age a regular detergent may be too harsh. Try a specially formulated detergent like Dreft or Ivory Snow. If your baby is older than six months try changing to a different detergent and/or add a cup of vinegar to the final rinse to lower the pH and help remove detergent residues if present.