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Diaper Rash

Overview

Diaper rash is a red rash that develops on the skin under a baby's diaper. Most babies get diaper rash, and those with sensitive skin may develop a chronic or recurring rash.

Diaper rash can range from mild skin irritation to a more severe rash with open sores. A diaper rash most often affects the skin on the groin, in the folds of skin between the legs, and on the buttocks. Typically, babies develop diaper rash between the ages of 4 and 15 months. Sometimes a diaper rash appears when the baby begins to eat solid food.

Diaper rash has many causes, such as a yeast infection, acid in the baby's stool or diarrhea, ammonia in the baby's urine, or use of diapers that are too tight or are not changed frequently enough.

Treatment for diaper rash includes keeping the area dry and clean, using a diaper rash cream, and letting your baby go without a diaper when possible. A mild diaper rash usually heals with 3 to 4 days of treatment. If the diaper rash is caused by an infection, we may treat the infection with a medicated cream. 

Causes

A common cause of diaper rash is infection by a fungus or yeast called Candida. Candida grows best in a warm, moist environment, such as under a diaper. A diaper rash caused by Candida may also result when an infant or a nursing mother is taking antibiotics, when the baby has diarrhea, or when the area under the diaper is not kept dry and clean.

Other causes for diaper rash may be bowel movements that contain too much acid (especially with diarrhea) or urine that contains too much ammonia, which can occur when bacteria break down the urine.

Diaper rash can also be a result of an allergic reaction to soap and other products used to clean the diapers. Sometimes, diaper rash is a result of the diaper being too tight and rubbing on the skin. A rash also can develop when moisture gets trapped under the diaper.

Symptoms

Diaper rash usually appears on the groin, buttocks, and the folds of your baby's skin on the upper thighs or between the legs. You may first notice a red rash when you change your baby's diaper. The rash may develop on separate areas of your baby's bottom and then spread into one big rash.

On boys, a bright red rash may appear on the scrotum and penis and become scaly. In girls, the bright red rash may appear around the vagina and labia. If the rash worsens, you may also see bumps, pimples, and even pus-filled or open sores. Babies who are old enough may grab at or try to scratch at their bottom when you remove their diaper.

If you're not sure if the rash is a diaper rash, check the location of the rash. Diaper rashes do not spread beyond the area covered by the diaper.

Diagnosis

We usually diagnose a diaper rash by its appearance and location. If we need to identify a specific type of infection (fungus or yeast) to prescribe the proper medication, we may carefully take a small sample to send to the laboratory for testing.

Prevention

The best way to prevent diaper rash is to keep the area of skin beneath the diaper dry and clean. Change your baby's diaper often and be sure your baby's care providers do the same. Avoid scrubbing or rubbing the skin beneath the diaper. Use lukewarm water and a cotton ball or soft washcloth to gently wipe your baby's bottom when changing the diaper. If a diaper rash develops, you can use a squirt bottle to clean the area to avoid rubbing sensitive skin and making it worse.

Do not use wipes that contain alcohol or perfume, as they may irritate your baby's skin. Avoid using cornstarch or talcum powder on your baby's bottom, which can worsen a diaper rash that is caused by a yeast infection.

When possible, lay your baby on a towel or blanket and let him or her go without a diaper. "Airing" your baby's bottom allows it to heal more quickly. You may go through a few towels if your baby urinates or has a bowel movement without a diaper. Be sure to clean your baby right away and then place them on a clean towel or blanket.

Make sure you are not using plastic or rubber pants over a cloth diaper. The plastic traps the moisture under the diaper and puts your baby at higher risk for developing a diaper rash. Instead, use highly absorbent diapers that pull moisture away from your baby's bottom.

If you use cloth diapers, avoid using dryer sheets, as they can irritate your baby's skin. Be sure to run the diapers through several rinse cycles in the washing machine to ensure that all soap is removed.

Finally, make sure to thoroughly wash your hands before and after each diaper change.

Treatments

If your baby's diaper rash is mild, home treatment is usually all that is needed. Keep the area clean and dry and remove the diaper for a few hours a day until the diaper rash heals, usually within 2 to 3 days. If the rash spreads or worsens, your baby may need additional treatment.

Nonprescription diaper rash cream. Apply a thick layer of a cream that contains zinc oxide (such as Desitin) or petroleum jelly (such as Original A&D ointment) to keep moisture away and protect the skin. You can use one of the nonprescription diaper rash creams, such as Butt Paste, Triple Paste, Zinc Oxide, or Acid Mantle. Lanolin ointment (such as Lansinoh) may soothe your baby's tender skin. Make sure the baby's bottom is completely dry before you apply a diaper cream.

It is not necessary to remove all of the diaper rash cream or petroleum jelly each time you change a diaper. Just pat the area clean after a diaper change. Reapply the cream, ointment, or petroleum jelly as needed.

Prescription diaper rash cream. If the diaper rash is a result of a fungal or yeast infection, we may recommend an antifungal cream or ointment until the rash heals. Examples of antifungal creams include miconazole, nystatin, clotrimazole, econazole, and ketaconazole.

If the diaper rash is severe, we may prescribe a corticosteroid cream to reduce inflammation. Do not use a nonprescription corticosteroid cream (contains hydrocortisone) unless we recommend it. Doing so can cause long-term damage to your baby's skin.

When to Call Us

Please call the Appointment and Advice line if your baby's rash doesn't respond to treatment or doesn't heal when expected. The rash should usually improve within 2 to 3 days.

We also recommend that you call us if any of the following occur:

• The rash spreads to the back, legs, abdomen, arms, or face.
  
• The rash appears to be getting worse (blisters, large bumps, or pus-filled sores develop).
  
• Your baby develops a fever of 100.4°F or above.
  
• Your baby is less than 6 weeks old and develops a diaper rash.
  
• Your baby is taking antibiotics (or if you are a nursing mother taking antibiotics). 
  

Your Child's Care with Me

If you are concerned about your child’s symptoms, and your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

Depending on your child’s symptoms and medical history and your preferences, the nurse may:

• Provide advice about how to care for your child at home.
• Send me a message so I can follow up with you directly.
• Offer you a telephone appointment with me or a trusted colleague.
• Make an appointment for your child to be seen in person.

Whether by phone or in person, we will discuss your child’s symptoms and medical history, and address your concerns. Together we will create a treatment plan to help your child feel better.

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).

Related Health Tools:

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.