Ask the Experts: First steps for treating diaper rash

Q: What should I do at the first sign of diaper rash on my infant’s bottom?

A: Diaper rashes are common, but they can be one of the most frustrating problems to treat in a pediatrician’s office. That’s because they are often caused by a combination of factors, so fixing one problem at a time doesn’t always do the trick.

At the first sign of diaper rash, soak your baby in a warm bath of clear water (no soap). Gently clean the diaper area using a soft cloth or your hand. After the bath, dry your baby gently, but do not replace the diaper right away. Allow her skin to become fully dry before you use any creams or ointments. This is the most common mistake parents make when treating diaper rash.

Once your baby’s skin is completely dry, cover it generously with a water-repelling barrier cream. Most over-the-counter creams are water-repelling, and they don’t need to be expensive. Many brand-name products also contain anti-inflammatories, anti-fungals or vitamins to encourage skin healing. I tell parents to apply the cream “like spreading icing on a cake.” In other words, go thick! There is no danger of overdoing it. After that, watch your baby carefully. Change her diaper immediately when it is wet or soiled. Although you may see some improvement right away, it can take several days to heal entirely.

A new diaper rash is often triggered by chemical irritation. Chemicals can be artificial, such as those in baby wipes, or natural, like urine. Disposable diapers contain chemicals that may irritate babies’ skin, and detergent residue in cloth diapers can be a factor, too. Chemical irritation leads to inflammation, and inflammation can persist long after the chemical is removed. In these cases, a mild anti-inflammatory cream, such as 1 percent hydrocortisone, may be helpful in older babies.

Microorganisms play a role as well. Yeast is common in our intestinal tract and is in poop. It grows well on warm, moist skin. For that reason, an anti-fungal cream might also be helpful for difficult rashes.

Babies have sensitive skin to begin with, and diapers make the problem worse by keeping the area humid. Allowing your baby to have some diaper-free time is often the best trick to healing a stubborn rash. If that doesn’t work, it’s time to talk to your pediatrician.

—Kerry McGee, MD, private practice pediatrician in Pittsburgh, Pennsylvania