Diapers cause skin rashes in the majority of infants and toddlers. Here are some pointers on how to prevent and protect infants from this painful affliction – K.P. Malini

For latter-day parents, disposable diapers offer great convenience. But they have their drawbacks. Diapers cause skin rashes in the majority of infants and toddlers wearing them. A recent survey titled Diaper Rash! The Bottom Line on Baby Bottoms conducted in the UK found that a third of all diaper-wearing infants have suffered a rash at some point in time.

Diaper rash is skin irritation in the covered area. The medical term for this common affliction is diaper dermatitis or chafing dermatitis, which is not limited to infants and can occur in persons of any age who wear diapers.

According to the Mayo Clinic, USA: “Diaper rash is often related to wet or infrequently changed diapers, skin sensitivity, and chafing.” The symptoms are usually reddening of the skin, and in some cases, erosions on the superficial skin layers. If left untreated, the rash may develop pustules or small blisters. “In newborns and infants, diaper rash is very common,” says Dr Sribiju, consultant dermatologist at the Kerala Government Health Services, Kozhikode. “The incidence of diaper dermatitis is estimated to be between 7-35 percent with peak incidence at 9-12 months of age,” he says. 

Causes of diaper rash

The common cause of the nappy rash is irritation or chafing due to friction of the diaper with the skin. It is triggered by a combination of factors, the most significant being prolonged contact with urine and faeces because of delay in changing diapers, skin maceration and in many cases, secondary infection with bacteria or candida albicans. “Nappy rash can be caused by a combination of wetness, frictional damage, impervious diaper coverings and increase in skin pH,” explains Dr Sribiju.

A 2017 study by the Tehran Medical Sciences Branch of the Islamic Azad University, Iran, indicates a link between breastfeeding and diaper rash. The study found that when breastfeeding stops, the chances of infants suffering nappy rash increase. Moreover, early introduction of cereals and diet changes in the first year of life tend to accelerate the incidence of rashes, reports the study.

Some research studies indicate that some commonly used baby care products can prompt skin irritation. A study published in the journal Paediatrics (January 2014) says that some children develop allergic contact dermatitis because of sensitivity to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), a combination preservative used in wet wipes. Therefore, using wet wipes to clean a baby’s tender bottom can be counter-productive in treating diaper rash. 

Other triggers include teething, diarrhoea, common colds, longer sleep periods at night, antibiotics, switching from breast milk to packaged baby foods, changing detergents and so on. For instance, some infants may be allergic to a new detergent used to wash cloth diapers triggering skin reactions. Infections, metabolic and nutritional deficiencies, and child abuse are other triggers. 

Types of diaper rash

Mild. You will see pink or red spots on the inner surfaces of the thighs, genitalia, buttocks and abdomen. Infants usually don’t show pain or discomfort at this stage.

Moderate to severe. Spots will be brighter red or the skin may be cracked, broken or blistered on the buttocks, lower abdomen and inner thighs. Infants will cry frequently and experience discomfort. 

Treatment 

According to the American Academy of Paediatrics, it is essential to change diapers immediately after a baby wets it or has a bowel movement. To prevent rashes, it’s advisable to apply a layer of ointment or cream containing zinc oxide or petrolatum, to form a protective coating on the skin. But it’s important to check with your paediatrician before doing so. 

Dr Sribiju advises parents to consult a dermatologist “as this is a multi-factorial condition”.  “Avoid treating it on your own. Parents should concentrate more on preventive aspects such as frequent change of diapers, using zinc oxide creams and good diaper hygiene. Diaper dermatitis is often recurrent. Therefore, the primary preventive practice is to keep your baby’s skin dry, protected and infection-free,” he says. 

Preventing diaper rash

According to the Mayo Clinic, USA, the best way to prevent diaper rash is to keep the genital and buttock areas clean and dry. Change diapers frequently. Before changing, either clean the diaper area with water-based wipes or wash with lukewarm water mixed with irritants and fragrance-free soap or cleanser. Dry gently and thoroughly. Do not rub vigorously. Don’t tie the diaper too tight and make sure to wash your hands after diaper changes.  Keep the infant diaper-free for as long as practical to allow sensitive skin to breathe. When the skin is covered, there is increased hydration, skin pH balance and friction, all of which could prompt diaper rash.  Bathe your baby daily but not more often than that. Dr. Sribiju says that cleaning the diaper area is necessary only when stool is present as over-washing leads to irritation.   Use soaps, bubble baths, lotions and talcum powder prudently. Contrary to popular belief, cornstarch is not beneficial for diaper rash. It worsens rashes because it contains fungus candida. Don’t use diaper wipes with fragrance or alcohol.  Increased aeration of the diaper area and the use of barrier cream reduces the incidence of nappy rash. Barrier creams should be applied after each diaper change and bathing.   Clothe babies in skin-friendly fabrics. Try to use cloth diapers washed with mild detergents. Once an infant is potty trained, the incidence of rashes will decrease.   Try to avoid or reduce the use of disposable diapers. Or use good quality diapers with absorbent gelling material that are more beneficial for diaper rash than conventional cellulose-core disposable diapers.