Most newborns and infants will have a diaper rash some time in their life. Although the word “diaper” is included in the name, it is usually the conditions associated with wearing diapers—and not the diaper itself—that cause the majority of diaper rashes. These conditions include (1) prolonged exposure to alkaline urine, which disrupts the skin barrier and encourages overgrowth of microbes; (2) friction; and (3) irritation from poop. Most mild diaper rashes can be cleared with more frequent diaper changes, gentle cleansing, and using a thick diaper cream multiple times a day. However, sometimes diaper rashes can be extra difficult to control and this blog contains my favorite tips for preventing and clearing up diaper rashes (diaper dermatitis).

1. Prevent exposure to too much moisture and rubbing:

• • If you are using cloth diapers, you may need to temporarily change to disposable, superabsorbent, and breathable diapers for a few weeks. I do not have a favorite brand but tend to suggest diapers made of materials that are stretchy and fit your baby comfortably, so a poor fit doesn’t cause extra friction.
  • Don’t be in too much of a hurry when changing diapers. If there is any moisture left behind from moisture or your baby wipes, allow the skin to air dry or gently pat the area dry with a towel before applying any creams or closing the diaper. Don’t close the diaper before the skin is dry! And do not scrub or rub! Friction from scrubbing can cause additional irritation on sensitive skin. My favorite drying cloths are Viva Signature Cloth Choose-A-Sheet Paper Towels or (if you can’t find Viva Paper Towels) soft cotton nail polish remover wipes.

2. Prevent irritation from feces:

• • Use lots of barrier ointment. With every diaper change, you should apply additional diaper cream so that there is always a cake frosting thick layer of barrier ointment on the entire bottom of your baby. Many dermatologists prefer Desitin extra strength (zinc oxide 40%), Vanicream moisturizing ointment (a non-petrolatum based ointment with wax), or Triple Paste (a combination of Vaseline, cornstarch, and lanolin). You can cover the paste with an additional layer of Vaseline (petrolatum ointment) to make poop easier to remove during diaper changes.
  • Maintain an acidic environment in the diaper area. Most of the enzymes found in stool are activated by an alkaline environment, causing further irritation. Use baby wipes that are pH balanced to maintain a slight acidity. WaterWipes Baby Wipes, Seventh Generation Original Soft & Gentle Baby Wipes, and Babyganics Face Hand & Baby Wipes Fragrance Free are three good choices.
  • If your baby is having lots of loose stools, and it is hard to keep up with diaper changes, Mylanta or Maalox can be sprinkled (a very small amount) on top of the diaper ointment to bind irritating bile acids. For extra irritated bottoms, Nexcare No Sting Liquid Bandage can be used to create a clear barrier on the skin that will stay in place for days and help keep your baby comfortable.

3. Avoid the temptation to remove all the protective ointment:

• • When you change your baby’s diaper and cream is still there and not soiled by stool, don’t wipe it all away. Just apply more barrier ointment on top. If the cream is soiled by stool, then gently wipe it away with mineral oil on a cotton ball followed by gently cleaning the skin with a soft wipe and warm water.

4. Make sure you are using a protective barrier cream:

• • A good diaper cream, paste, or ointment should protect the skin from urine and feces. You can test it out by applying the diaper cream to your hand and then washing your hand. You should notice the water beading up and not getting into your skin. This is a good sign that the diaper cream will protect your baby’s bottom from urine, stool, or anything else that makes its way into the diaper.

5. Bathe your baby’s bottom daily:

• • Daily bathing in lukewarm water can help prevent skin breakdown. Use gentle cleansers that are allergen and fragrance free. My favorite gentle baby cleansers that are extra allergy-free are:
    • Aveeno Baby Cleansing Therapy Moisturizing Wash Fragrance Free
    • Babyganics Shampoo & Body Wash Fragrance Free
    • Burt’s Bees Baby Bee Shampoo & Wash Fragrance Free
    • California Baby Super Sensitive Shampoo & Bodywash No Fragrance
    • CeraVe Baby Wash & Shampoo
    • Oh my devita Baby Bubbly Babies Bodywash and Shampoo Fragrance Free
    • SheaMoisture Baby Wash & Shampoo Fragrance Free
    • Tom’s of Maine Baby Shampoo & Wash Fragrance Free

6. Avoid allergens and irritants:

• • Wipes and diaper products should be free of alcohol, essential oils, soap, and sodium lauryl sulfate. Sometimes baby products can contain additives that might cause allergy problems. If your baby’s diaper rash keeps coming back despite all your efforts, it may be due to a contact allergy. The most common ingredients that cause allergies in infants are Balsam of Peru (also called Myroxylon Balsamum), methylisothiazolinone, methylchloroisothiazolinone, bronopol, and iodopropynyl butylcarbamate.
  • Below are my favorite “allergy-free” baby products. Make sure you look for these exact products, and double-check ingredients lists, as manufacturers may change their ingredients without changing labels:
    • Fragrance and Allergen-free Diaper creams and ointments:
      • Aquaphor Baby Diaper Rash Cream
      • Attitude Little Ones Baby Diaper Cream Zinc Fragrance Free
      • Avalon Organics Protective Zinc Diaper Balm
      • Babo Botanicals Soothing Diaper Cream
      • Babyganics Diaper Rash Cream
      • Butt Naked Baby Protective Diaper Balm
      • CeraVe Baby Diaper Rash Cream
      • Little Twig Organic Diaper Cream Extra-Mild Unscented
      • Motherlove Diaper Rash & Thrush
      • Oh my devita Baby Butter Cheeks Diaper Balm
      • Tom’s of Maine Baby Diaper Cream Fragrance Free
      • Vanicream Diaper Rash Ointment
    • Fragrance and Allergen-free Baby wipes:
      • Babyganics Flushable Wipes
      • Babyganics Face Hand & Baby Wipes Fragrance Free
      • Dr. Brown’s Nose & Face Wipes Naturally Soothing with Calendula
      • Earth’s Best Tender Care Chlorine Free Baby Wipes
      • Seventh Generation Original Soft & Gentle Baby Wipes 5 pk Free & Clear
      • Seventh Generation Thick n’Strong Baby Wipes
      • WaterWipes Baby Wipes Value Pack 4 pk

7. Look for signs that you may have something more than just a diaper rash:

• • Rarely, diaper rashes can be a sign of a more serious underlying condition. If your baby has any of these signs, you should see your pediatrician or pediatric dermatologist:
    • The diaper rash does not improve after several days of carefully following the above instructions
    • You see blisters, pus bumps, or open sores
    • There are bruises or evidence of bleeding in the diaper area
    • Your baby seems to be in significant discomfort
    • The rash spreads to other parts of the body
    • Your baby is losing weight, has a fever, or appears sick

Our younger readers may not be changing diapers, but should understand the importance of Water, Sanitation, and Hygiene (WASH) in our lives and the health of our communities. The United Nations has featured several books for young readers that teach young children about the importance of water and sanitation in health, poverty reduction, economic growth, and environmental sustainability. You can access the book club at: https://www.un.org/sustainabledevelopment/sdgbookclub-6archive/

Teenagers can learn about WASH by visiting www.worldwaterday.org. They can also join an international conversation on the value of water by sharing posts on social media that answer the question “What does water mean to you?” Tag your posts with #Water2me and your voice will be used to shape a United Nations campaign on the “Valuing Water” being held on World Water Day 2021 (Monday, March 22, 2021).