crying baby

Did you know there are approximately a bajillion types of rashes, each with a different cause? In my favorite health and healing manual for parents, Smart Medicine for a Healthier Child (available locally at BABS!), there is a chart of "Common Childhood Rashes" that takes up more than a full page!  Unless otherwise stated, I'm adapting information from that chart and other sections of the book.

For simplicity's sake, this post is going to focus on the two most common rashes in the diaper area and a "bonus" rash.  Ask your child's doctor or nurse to diagnose the rash to be sure you are treating it appropriately.

Diaper rash, also called "dermatitis" or "contact dermatitis"
This is kind of a catch-all for the diaper rash that so many babies get at least once.  It is an irritation caused by something touching the skin.  It occurs in the diaper area because that something is held against the skin by the diaper, and sometimes with very little air circulating.  That something could be simply your baby's urine, as it turns to ammonia.  Or it could be the interaction of your baby's urine with your detergent.  It could also be a sensitivity to the material against your baby's skin, whether that is the fabric in your cloth diapers or some element of a disposable.  Rashes can also be brought on by diarrhea.

The first goal in treating these rashes is easing the inflammation to soothe your baby's skin.  Zinc oxide ointment is often recommended, though these often contain ingredients that cause stink or absorbency problems with cloth diapers.  The Green Nursery carries diaper rash treatments that are soothing, safe for cloth diapers, and can be used as barriers against irritants to prevent future rashes.

Figuring out what is causing this kind of rash, if it recurs, can require a lot of trial and error and tweaking of a wash routine (or even changing diaper type entirely).

Fungal or yeast diaper rash (sometimes called thrush, though technically thrush is a yeast overgrowth in a baby's mouth)
According to Smart Medicine for a Healthier Child (pg. 243), "once a diaper rash has persisted for more than three days, there is an 80 percent chance that it involves fungal overgrowth." Athlete's foot, jock itch, vaginal yeast infections, and some diaper rashes can all be caused by the same fungus: candida albicans.  The chart says "fungal diaper rash is smooth, shiny, raised, and very red, and the skin appears raw and painful." (pg. 434).  One feature has been described by my kids' pediatric nurse practitioner as "satellite lesions" - there are well-defined edges to the rash, with a few scattered spots outside of it.

In treating it, there is a lot of overlap with the medications used to treat vaginal yeast infections - you can use over the counter treatments as diaper creams, or see your child's pediatrician for prescriptions for oral medications.  Other options include gentian violet painted on your child's diaper area (never put the q-tip into the bottle after it has touched the diaper area), or grapefruit seed extract (available at health food stores) diluted in water and sprayed or wiped onto the infected area.

Different strains of yeast respond differently to these treatments.  Plus, if you seem to be passing it from one family member to another and back again, you might want something that everyone takes by mouth. 

Yeast can be incredibly persistent.  It can live in your cloth diapers, hand and bath towels, breast pads, bras, etc.  Plus some of the creams can leave behind residue that will leave your cloth diapers stinking or repelling.  For all these reasons, I always suggest using disposable diapers and wipes when eradicating a yeast rash.  You can read a bit more about killing off yeast in cloth diapers here.

If your baby has a yeast rash and is eating solids, you will want to cut down on processed foods and especially sugars in his/her diet.  You can also give your baby probiotics - some moms break open an adult probiotic capsule and give their baby/toddler some of the powder inside.  Others purchase probiotic drops like these.  You can discuss options and brands with your child's pediatrician.  Yogurt is also a source of probiotics, but does not contain the diversity of good bacteria found in commercial options.

Impetigo isn't particularly common, but I wanted to mention it because it can happen in the diaper area, and I have actually encountered it as such.  Also, the instance I dealt with came about because of a severe diaper rash that left open sores, and those breaks in the skin allowed bacteria to get in. 

Impetigo is described as appearing "first as irregularly shaped discolored spots, then [turning] into weepy honye-colored lesions that crust and scab." (pg. 435)  It is a bacterial infection caused by either streptococcus or stapylococcus bacteria (pg. 332).  A mild case can be cleared up by over the counter antibiotic ointments, but impetigo is contagious and can also require prescription antibiotics (by mouth or ointment), so you should consider seeing your child's pediatrician if you suspect your child has impetigo.