Q&A: diaper rash problem

Lihpovela, who titled her email "long time listener, first time caller" (heh), writes:

"My sister has a baby who is 11 months old and has very sensitive skin and absolutely terrible diaper rash--to the extent that the poor little guy cries when you lay him down for a change because he knows what is coming.  My mother and I have tried to convince my sister to switch to cloth diapers to alleviate this problem, but she does not want to (too yucky!).  She seems instead to want to just grit it out. While I'd love to hear ideas about how to convince her to switch, if you think that would help his buns, I'm equally interested in other ideas about treating the rash.  She uses wet wipes with every change, even if there is only pee.  Is this gratuitous? (I don't do this myself with my cloth diapered 10-month old, I use some baby oil every change and a wet rag if there is an actually mess that needs cleaning). How about zinc oxide- every time? How to know if you need something stronger?"

"Grit it out"? Easy for her to say when it's not her butt on fire! I can't recall having a diaper rash, but I imagine it feeling about as uncomfortable as a yeast infection. She definitely needs to make some changes. (I don't want to make alarmist predictions, but she really needs to get this fixed before he starts holding in his pee and poop because he's afraid of the feeling. She could be causing a huge, I've-been-in-therapy-for-12-years-about-this, ostracized-at-summer-camp problem by not taking this seriously.)

My husband calls me the Forensic Poopologist, and the further into the game of dealing with other people's butts I go, the more I learn than less is more. Instead of going with something stronger, I'd actually back up and see if removing things from her routine will cause less irritation.

The very first thing I'd do in her situation is give him 2-3 regularly scheduled air baths a day. Put him on a waterproof pad or take him outside and let him go diaperless and pantless for 10-15 minutes to let his poor butt air out.

Then I'd take a look at their diaper situation. (Has she read about how easy and non-yucky it is to use cloth diapers? Plus it saves a bundle of money.) While switching to cloth diapers can eliminate or ease diaper rash for many babies, if your sister's not willing to try that she can still go with less irritating diapers. If she's using national brand diapers with scents or lotions or "rash-guard" or a whole bunch of bells and whistles, she should switch to a brand with the least technology possible. She could try the Seventh Generation diapers with no bleach (they do have the absorbant polymer things) and see if that helps alleviate the problem. She could also try Tushies, which use cotton as the absorbant layer.

If she uses wipes with each change, that could be making the problem worse by irritating his sensitive skin. Even the ones that claim to be "natural" or for sensitive skin often contain alcohol or sodium laureth sulfate or other things that are flaming her son's tush. She could switch to a non-irritating brand like Seventh Generation, or, even better, go to washcloths or unbleached paper  towels with plain water or a homemade wipe mix. With my first son I wiped at each change (even just pee), and we used our own mix of water, aloe gel, and a few drops of tea tree oil. (Readers, feel free to leave your recipe for wipe solution in the comments.) With my second son I only wipe after poop or if the diaper seems wet to the touch.

I would NOT use zinc oxide cream at each change, and would consider switching away from zinc oxide cream altogether. ("Harmful if absorbed through skin. Causes irritation. Prolonged skin contact can cause dermatitis called oxide pox.") If you walk into your local health food store and go into the baby care aisle there will be several good zinc oxide-free choices. I'd look for one that contains calendula, but I'm sure someone will make a specific brand recommendation in the comments.

Now once she's giving air baths, has switched to the lowest-tech diaper she can find, has ditched the irritating wipes, and has gotten rid of the zinc oxide, she may need to try to figure out what's causing the rash in the first place (if it's not as simple as a contact allergy or irritation to the diaper, wipes, or cream). Teething often causes diaper rash either by causing a rash to appear directly (some kids get a rash around their mouths, some get a rash around their anuses, and some get both) or by making the poop so acidic that it causes a rash as it comes out. There's nothing to be done about teething rash except to change a diaper as soon as the baby poops and to allow him more time to air out during periods of heavy teething.

Some babies get rashes when they eat certain foods that make their poop almost seem to burn their skin. Common foods that cause this problem are acidic foods like citrus, citrus juices (although I can't imagine an 11-month-old is drinking orange juice anyway), and tomato products, and sometimes grapes. She should think about his diet and observe to see if the rash gets any worse when he eats certain foods.

It's also possible that he has a fungal infection instead of a straight-up rash. A fungal infection rash looks like burn marks on the skin--red patches that are slightly raised that may have kind of oozy-looking centers. The only way to get rid of a fungal rash is to treat it with anti-fungal cream (sold OTC for athlete's foot as Lotrimin).

If she eliminates everything else and he's still got a nasty rash, she'll need to go to the pediatrician and see if it's a problem that could be resolved by hydrocortizone cream. I'd never advise that as a first-line strategy (if only because even if it resolved the immediate problem, if she's still using irritating products the rash is bound to return), but if nothing else is contributing to the rash and it still won't resolve, it might be what finally knocks it out.

I hope you can get her to pay more attention to this problem. Her poor baby! Imagine how you'd feel if your butt and crotch hurt all the time. Maybe you and your mom can give her painful wedgies until she agrees to try to figure out the problem and fix it.