Bottoms up! Tips to prevent and treat diaper-area skin irritation in newborns
July 24, 2023
Many expecting parents stockpile diapers and wipes before their baby arrives – diaper cakes and mega-packs are common baby shower gifts, and you may receive a variety of brands. How do you know which ones will be gentle enough to spare your newborn from diaper rash, eczema, or skin irritation?
We encourage new parents to try different varieties to determine which one works best. Some diapers wick away moisture better than others, and some wipes contain harsher chemicals such as alcohol or fragrances that can dry or irritate the skin. Others contain emollients, which can form a film on the skin to relieve itching and scaliness.
Your baby might be allergic to the ingredients that are supposed to help – or they might have no problem switching from branded to generic and back again.
The good news is most babies’ skin isn’t as sensitive as you might think, so rather than focusing on which brand of diapers to buy we suggest following some best practices to keep your baby’s bottom as clean, dry, and comfortable as possible.
Diapering best practices
Newborn skin is usually coated in vernix, a cheesy substance that waterproofs a baby’s skin in utero and has been shown to support newborn skin health after delivery. We encourage parents to rub in the vernix like lotion. In fact, UTSW and many other U.S. hospitals have begun to delay a baby’s first bath to maximize the utility of the vernix, along with helping to regulate newborns’ body temperature.
After the vernix wears away, follow these best practices to keep their diaper area healthy and irritation-free long term.
- Use fragrance-free, dye-free soaps, wipes, and lotions. Sensitive skin products typically are devoid of alcohols and other chemicals that can irritate the skin. If these products work well, you can start to add one “fun” scented or moisture-locking product at a time if desired and see how your baby’s skin will respond.
- There’s no such thing as changing the baby too much. New parents are asked to track wet and dirty diapers, and sometimes they worry that frequent checking, wiping, and diapering in the first month will cause diaper rash. The longer stool and urine sit on the baby’s skin, the more likely they are to cause irritation. Wiping the waste away is a good thing, and you won’t harm the baby by doing it too often. Follow the baby’s cues, such as fussing, crying, or a noticeably wet or dirty diaper, and change them as soon as they wake up or if they are waking in the night to be fed.
- Use barrier creams generously. While diaper rash pastes, ointments, and creams – such as Aquaphor, Vaseline, or Boudreaux’s Butt Paste – won't heal irritated skin, they do provide a barrier so urine and stool can’t easily irritate it in the first place. We recommend applying a thick smear of cream with each diaper change. Don’t rub it in like lotion – it should sit on top of the skin like a barrier.
How to spot and treat irritated skin
Even with the best proactive measures, diaper-area skin irritation happens, especially after a bout of diarrhea. Try not to feel guilty when it does and focus on keeping your baby comfortable.
The first step is to avoid alcohol-based or scented diapers and wipes if the baby has red or broken skin – chemicals in these products can worsen skin irritation. Instead, use a water-based wipe or a warm, wet washcloth to clean the baby's bottom. Then, apply a generous portion of barrier cream and wait for the skin to heal.
Call the doctor right away if the baby suddenly develops a fever, has trouble eating, or is unusually fussy or lethargic – this may be a sign of a serious infection.
Most diaper-area skin irritation heals on its own, but moderate to severe symptoms may require a doctor visit. Here are some common conditions and symptoms, with tips to help your baby feel better:
- Diaper rash can vary from pink, dry patches to angry red, raw areas that break open and bleed. Even if the baby doesn’t seem bothered, start heaping on barrier cream to keep the irritation from progressing.
- Yeast infections are common in babies, especially in the hot summer months when the baby is sweating more than usual. Yeast fungi grow in moist skin folds, such as the genitals, knees, elbows, mouth, and neck. You might see white discharge; scaly skin; dark purple or red raised skin patches; or red, pus-filled spots that resemble pimples. Call the pediatrician to get an accurate diagnosis; they’ll likely prescribe a topical or oral anti-fungal medication to clear it up.
- Eczema and diaper dermatitis can be caused by excessive skin dryness, food or environmental allergens, irritating dyes or fragrances, or an overactive immune system. The baby’s skin will be itchy and raw, and they may develop a red rash or welts from scratching. Talk with a pediatrician about the best treatment, which may include changing soap, diaper, or lotion formulations; antihistamine or steroidal medication; or topical ointments to soothe itching.
- Irritation around the waist or thighs can indicate the baby is allergic to something in the diaper itself. Try switching to a sensitive formulation and ask the pediatrician whether they need a barrier ointment or covering over the irritated skin as it heals.
If your baby’s skin still looks irritated despite frequent diaper changes, switching brands of wipes or diapers, and applying barrier cream, talk with your pediatrician about next steps in treatment. They might refer you to a pediatric dermatologist or allergy specialist to help manage challenging or chronic skin irritation.
At the end of the day, most babies don’t need expensive or special diapering products to protect their skin. Some babies are simply more sensitive to certain fragrances, dyes, and chemicals found in common diaper and wipe brands. Try different combinations until you find one that works for your baby’s skin – and don’t hesitate to call us if you have questions.
To talk with a doctor about your baby’s skin care, call 214-645-8300 or request an appointment online.
