Nurse Knowledge – Dealing With Diaper Rash

This past week both Eva and Marie suffered from a pretty painful bout of diaper rash because they had diarrhea for the past week from a stomach bug. I can’t tell you how many diapers I changed, but I know it was a lot.

Think almost hourly.

I’m so sick of diapers.

Anyway, Jarrett and I decided this would be a good topic to talk about for our nurse knowledge post this month since there are actually a lot of guidelines that you should follow which are outlined in the neonatal intensive care practice guidelines through Alberta Health Services.

Early Signs

I think the most important thing to strive for is prevention. Obviously, you can’t always stop a diaper rash but you can recognize the warning signs and try your best to prevent it from getting worse.

The main point that Alberta Health Services stresses for prevention is change diapers regularly. This way, you reduce the time of skin contact between the poop/pee and your baby’s bottom.

Obviously, I always change the girls whenever I can smell that they have pooped, but with the stomach bug the girls got, changing them when I smelled it was too late. If you see that your child’s poop is becoming different than what is ‘normal’ for them, then I would actually  recommend you be proactive and change them every hour or two, hopefully avoiding the diaper rash that is destined to come with diarrhea.

After the initial redness your baby may develop blisters, and excoriated areas that may appear slimy. This is severe diaper rash. If it gets to this point, refer to the treatment section of this page. You can also refer to your family physician or if you have it in your area, a nurse on call (such as health link in Alberta – 811)

Prevention

Now what? If you are starting to see a red bum when you are changing your child, they are on track for a diaper rash.  The Alberta Health Services guidelines suggest that you “cleanse the genital area gently and thoroughly, using non scented wipes, soft cloths, gauze, or cotton balls, moistened with water; avoid rubbing the skin”.

I have always just used wipes to rub away the poop on the bum, which may be why the girl’s diaper rash got so bad. Jarrett gave me these guidelines after the diaper rash was gone, so this is definitely something worth trying. Hopefully you can avoid the painful red sores that the girls got.

A suggestion to prevent diaper rash is to make sure your baby’s bum is completely dry before adding cream and covering them back up with a diaper. All of your baby’s folds can make that moisture stay and cause more redness and rashes. If you want to speed up the process, I found blowing on the bum helps.

The other suggestion that is made for prevention is to apply a zinc oxide cream to the bum to act as a barrier between the skin and the poop. Hopefully if you catch it early enough, you can stop the rash. Or at least minimize the effects. Things to remember with the diaper cream is  be sure to avoid anything with perfumes, dyes or preservatives. (Which you should avoid anyway to prevent irritating your child’s bum in general) And make sure you avoid rubbing the barrier off during cleansing – just dab.

What Cream Do I Use?

There are lots of creams out there right now that you can use, and ultimately it comes down to personal preference. It is NOT recommended to use baby powder because it does not act as a very good barrier, which is what you want for your baby when they have a diaper rash.

In the past 3 years of doing diapers, I have used Zincofax, Penaten and Baby Butz cream. Here are my personal opinion on these brands.

Zincofax –  I didn’t really like Zincofax as it wasn’t very thick and rubbed off really easily. This is what we had to use when the girls first started getting their diaper rash because we forgot our other cream at home. Their bums ended up getting very irritated and I had to move to treating the diaper rash instead of just preventing it. But that’s just my opinion.

Penaten – This is the first cream that I used with Jack and would be my cream of choice if I couldn’t get Baby Butz. I like that it goes on thick, creating a solid barrier between the rash and poop. I just found that it rubs off a little more easily than the other cream that I use. Definitely a great second option.

Baby Butz – I love this cream. It is thick, dries a little faster than Penaten, and I find that it stays on longer. It is a great cream and I go out of my way to buy this one (no one is paying me to say any of this, it is just my personal preference based on experience)

PRO TIP – Leave the diaper cream lid off so that the cream gets a little more dense. It sticks on the bum better and lasts longer too!

Treatment

There isn’t a whole lot you can do to treat your child’s diaper rash, but there are some things you can do.

First and foremost – use diaper cream. Always make sure when changing your baby to put diaper cream over the red areas and a little bit past to prevent the rash from getting any bigger. Make sure to try and dab off all the cream in between each diaper change, but if you can’t get it all off don’t obsess over it as it won’t hurt to leave the cream on for too long. Make sure to not rub.

Make sure to dry the diaper area completely in between each diaper change.If the rash is persisting and you use disposable diapers, try switching brands. If your child is constantly getting diaper rashes and you are using cloth diapers, it may be time to switch to disposable. My mom tried cloth with both my brother and I, and ended up switching to disposable to prevent constant diaper rashes.

Do not use perfumed wipes, soaps, fabric softeners as the fragrance may exacerbate the rash.

If the rash is bad, try and expose your baby’s diaper area for 10-15 minutes at least three times a day. I know that sounds like a challenge, especially because you KNOW that the baby is going to have an accident while you wait.  I recommend putting your child in an area it would be ok to have an accident. Maybe lay down a tarp with a blanket over it, so that if an accident does occur, it doesn’t damage your floor. Another option is just keep them on the change table for the 10 minutes, and keep your child distracted while you wait.

The most important thing to remember is to stay vigilant in changing their diapers. Be proactive and change the diaper every hour or so (especially if you are dealing with diarrhea). It sucks for you, but it keeps your baby happy. And it’s important to keep your baby happy.

According to Alberta Health Services, you should go see your baby’s doctor if there rash has not improved after 2 days of treatment or if the rash looks like a yeast infection (looks bright red like a burn, has red dots or bumps, the inside of your baby’s mouth has white spots or a white coating that can’t be wiped away with a cloth)

Eventually, it will get better. And you can learn from your own mistakes based on what works for your child. Hopefully you won’t have to deal with a bad case like I did with the girls, but if you do – you will know what works and what doesn’t for the next time!

Good luck!