As Smooth as a Baby’s Bottom: Everything You Never Wanted to Know About Diaper Rash

DiapersParenting

Aug 22

You’ve heard the expression, ‘as smooth as a baby’s bottom’? A baby’s bottom is indeed supposed to be smooth, healthy, and perfect. But often our poor little ones are afflicted with unhappy, irritated skin in the diaper area. So what can we do to prevent this, and if it happens anyway, what can we do to help?

First, the basics.

Baby skin is perfect. If there is no rash, you generally don’t need to use any products. In fact, many oils and creams and lotions can interfere with the baby’s self-regulating skin, and can actually cause problems. If your baby’s bottom looks smooth and healthy, then all is well. The best approach is to leave well enough alone and don’t apply anything during diaper changes, unless there is evidence of a rash.

Preventing Diaper Rash

There are a few things you can do regularly to lower the risk of diaper rash, and to keep your baby’s perfect bottom perfect. These are the “basic bottom care” steps.

The meconium protocol
One exception to the ‘use no products’ guideline is during the first few days, when your baby is clearing meconium out of their system. Meconium is known as a baby’s first poop, and it is thick and sticky, and can be hard to clean. Some people use coconut oil or olive oil as a prophylactic. This is safe for your brand new baby’s skin, and can be applied as a preventative, or a shield, until the meconium phase has passed, which is usually just a few days.
After the meconium has faded from black to green to yellow, you can stop using the coconut oil, and simply rely on good diaper hygiene to help keep your little one’s skin healthy and happy. What is good diaper hygiene? Read on.
Maintain good diaper hygiene
Change your baby’s diaper often: every time they pee or poop. The main cause of common diaper rash comes from prolonged exposure to irritants in urine or faeces. Every single time your baby poops or even pees, it is a good idea to change their diaper. Otherwise, the urine (and hence the ammonia), remains in contact with your baby’s tender skin for long periods of time, which causes irritation, which in turn will cause a rash. Once the skin is broken and rashy, the ammonia creates further damage by irritating and stinging all the abrasions in your baby’s tender skin. This common rash can turn from mild to nasty very quickly if the baby’s bottom soaks in urine for any length of time.
Today’s disposable diapers are so absorbent that we tend to leave them on too long. It is hard to see a need to replace them when they still feel so dry. But remember that it is not the wetness, but the ammonia, that causes the rash. So even though a diaper seems barely used, any amount of urine can irritate the baby’s sensitive skin if left in contact for a long time. Cloth diapers feel far more wet, which makes us want to change them more often. The soaked feeling they get gives us more of a sense of how much urine our baby is actually sitting in. Any kind of diaper is fine, we just have to remember to change disposables as often as we would change cloth. Ideally, change your baby’s diaper after every single pee.
Water and dry
Wash your baby’s bottom thoroughly with water at all diaper changes. If you are at home, a small cloth soaked in plain tap water is the best tool. Use lots of water, and thoroughly dab all over the diaper area to wash the ammonia away. Do this several times, so that the whole area is thoroughly soaked. If possible, be cautious with wipes as many of them have chemicals or fragrances that can add further irritation to baby’s skin. Even the ones that are chemical free merely wipe the baby off without truly cleaning the ammonia away. Water is your best bet.
Once the diaper area is all washed, dry the baby thoroughly. You can pat the area dry with a dry baby cloth. Just pat. Wiping can be too abrasive on the baby’s delicate skin. Or you can use a hair dryer on a low temperature. Most babies love the feeling of warm air. It’s like a baby spa treatment! Or if it’s a warm day, you can air dry your baby, by leaving your baby bare until their bottom has thoroughly dried. Don’t put the diaper on until your baby is all dry, because the damp skin can invite a rash.
Avoid products
If your baby’s skin is looking good–smooth, healthy perfection–avoid creams, oils, lotions, powders, and all other products. Your baby’s skin is more ingestive than adult skin, and absorbs chemicals in ways that are not safe. Baby skin is perfect and as long as we keep it healthy, it doesn’t benefit from any additional products which can undermine or interfere with the skin’s natural ability to self cleanse and self regulate.
If you’re up for the adventure, the Diaper Free Approach, or “Elimination Communication”, is another approach to limiting diaper rashes. This approach involves watching your baby to learn to identify signals that they are about to pee or poop, and then holding them over a toilet or basin so they can eliminate without diapers. Some people go all in with this method, and some use it in conjunction with diapers. It definitely involves a lot of misses, but also means your baby will spend less time stewing in their own waste.

Types of Diaper Rash

However, diaper rashes are common!

Even if we do everything right, the very fact of diapers increases the likelihood of diaper rash despite our best intentions and efforts. So what do we do if (or more likely, when) our baby gets a rash?

There are several kinds of standard diaper rash, but the first one, “common diaper rash”, is by far the most prevalent. Most parents will encounter it at least once or twice during their baby’s infancy.

Common Diaper Rash
The most frequent type of diaper rash is caused by overexposure to irritants, typically urine & faeces. This kind of rash looks red and is widespread on the surface but not so much in the creases.
Acidic Rash
This type of rash often happens when you first introduce solid foods, and can be caused by any new foods, especially acidic foods. Usually you see a very red anus, but not much rash elsewhere.
Candida
This is caused by yeast. You see redness in creases, often not limited to the diaper area, but elsewhere too. This is common if you have thrush, or if either you or your baby have been on antibiotics, including during labour (such as for Group B Strep).
Chemical Rash
This type of rash is caused by a reaction to chemicals, such as the ones in disposable diapers, wipes, fragrances, lotions, creams, or any other products.
Heat Rash
This kind of rash is bumpy, and can look almost like hives. It can be all over, or anywhere the baby was overheated, not just the diaper area. It is caused by the baby being too hot.

common types of diaper rash info graphic — *Types of Diaper Rash*

If you can’t tell what kind of rash it is, don’t worry! The remedies are mostly the same regardless of what’s causing it.

Treating Diaper Rash

To a certain extent, the cure is the same as prevention, except we need to be more vigilant, and more consistent. These are the steps to take if your baby has a diaper rash.

Wash all urine and poop off the affected area immediately, but gently. If your baby’s skin is already abrased, these irritants will be very uncomfortable for your poor baby, and they will cause further damage. So change your baby’s diaper right away, every single time they pee or poop, so that the irritants don’t cause extended discomfort.
Use water. You have to get all the ammonia off the diaper area, so use water liberally and gently to cleanse your baby’s bottom at every diaper change. Dab and blot, don’t wipe.
Air dry. The more time your baby can spend out of a diaper the better. Your ability to do this will depend on the season, and your living arrangements, and the age of your baby. If your baby is really young (pre-rolling), you can just place them on a water-proof mat on the floor, or on a bed (if you’re supervising) for some diaper-free time. If your baby is crawling, you can let them crawl outside in the summer, if you have a safe space for them to do so. Otherwise, get creative! A playpen with a waterproof mat maybe.
This is the one that’s different: Use a barrier cream. If your baby already has a rash, then applying a barrier cream to a totally clean, dry bottom can help protect their sensitive skin from further damage. Be careful to avoid products that could further irritate your baby’s skin. Avoid talc always, as it can harm the baby’s lungs. Avoid mineral oils always (vaseline, baby oil), as these are not safe for newborns. Avoid anything with chemicals, dyes, or artificial fragrances. Safe products include coconut oil, zinc oxide, or any barrier creams your care provider recommends. But when the rash is all healed, you can stop using it.
Here’s a cool one: Use your own milk on it! Really. Truly. Your own human milk is a dynamic, living, reactive substance that will become whatever medicine your baby needs. Breast/Chestfeeding your baby also helps because it provides your baby with tailor-made-to-order, customised medicines to cure the rash. Your lactation system is your baby’s external immune system, and your milk will design a targeted remedy to help cure anything that ails your baby. And once your baby’s bottom is clean and dry, you can apply the milk topically to both soothe the skin and promote healing. Human milk is a panacea for almost all baby ailments.
Note the type of rash. Most diaper rashes are the Common Diaper Rash, caused by prolonged contact with urine or faeces against your baby’s delicate skin. But if you suspect it’s a different kind of rash, you can take slightly different steps:

Acidic Rash: If you think a new food is causing this rash, stop offering it for a few weeks before trying again. Usually babies just outgrow this reaction as their digestive system matures.
Candida: You can try all the above approaches, especially air-drying and coconut oil, and you can try taking probiotics, but if it persists or gets worse, consult your doctor or midwife. You might need a prescription antifungal cream.
Chemical Rash: Stop using whatever might be causing it, such as disposable diapers, a lotion or product, chemicals, fragrances, a soap or bath product, or wipes.
Heat Rash: Dress your baby less. Babies don’t have the same kind of sweat glands we do so they are prone to heat rashes. Just dress them cooler and it will go away, with no treatment necessary.

Any rash that does not seem to be healing, or that seems to be getting worse, deserves a quick peek from your healthcare provider. There are less common causes such as infections and allergies that might require treatment. But rest assured, the vast majority of diaper rashes are simply the ones listed above, most often the common rash, caused by prolonged exposure to normal baby pee & baby poop.

The bottom line on a baby’s bottom is that babies are born with perfect skin, and we can do our best to help keep their skin perfect with just a few straightforward steps. Diaper rashes are common-extremely common!--and almost everyone has to contend with them now and again, so please don’t feel bad if your baby has one. It’s totally normal, and most people experience diaper rashes several times until their baby is beyond diapers.

Just follow these simple steps, and know that like all babyhood challenges, this is not forever. Your baby’s bottom will soon be as smooth as a baby’s bottom once again. And better yet, as your children grow up, they eventually take over all responsibility for their own bottoms.