Dr. Jeremy Fishelberg
Whoever first made the claim that something was “smooth as a baby’s bottom” likely never had two weeks battling a relentless, inflamed, excoriated diaper rash.  This must be the same person that triumphantly said they were “sleeping like a baby”.  Babies are terrible sleepers!  But i digress.
Diaper rash can be a tenacious, persistent, distressing condition that is difficult to resolve despite how common and seemingly simple it is.  Don’t be deceived.  The skin is a complex and fickle organ and must be approached with thoughtful care.
The real challenge with diaper rash is the cyclical nature of the offending irritants to the skin.  Regardless of how thorough you are with cleaning and protecting the skin, the next wave of urine and stool is always hours away.  This makes caring for the skin in the diaper are a uniquely difficult challenge.
Two of the mainstays of good diaper skin care are frequent diaper changes and as much free air time as possible.  Changing the diaper frequently is the best way to keep the urine and stool from sitting on the skin and breaking down the skin’s natural defenses.  Giving the skin air time to breathe and recover after being cleaned is essential, yet carries obvious risk.  An old sheet, some old towels or a tile floor are some simple strategies to prevent the inevitable accident while enjoying the fruits of free air time.
So, when it’s time to change a diaper, follow these steps on your way to a fresh bottom:
1) Gently pat and the dab the area clean with hypoallergenic, fragrance free baby wipes.  Do not rub the skin.  Friction will irritate the sensitive skin even further.  Be gentle, even if it means using a few extra wipes.
2) Take a clean, dry burp cloth and gently pat the entire area until dry.  This is a critical and underappreciated step.  Gently patting the skin dry is essential; otherwise you will be locking in damp, swampy moisture to already damp, moist, broken down skin.
3) A scant amount of baby powder can do wonders.  I know what you may be thinking.   On the record, you are correct; we do not recommend routine use of baby powder.  The risk of aspiration exists with aggressive use of baby powder.  however, if you are very careful to use a very light hand to tap a little bit of baby powder, being sure to keep the powder away from the child’s mouth and nose, you can go a long way toward keeping the diaper area clean and dry.  So, to be clear, we do not want your baby to breathe in baby powder.  The risk of aspiration has led pediatricians to no longer recommend the use of baby powder.   If you are very careful, you may delicately sprinkle a scant amount of baby powder to help keep the skin dry.  Ninja move, just be very light and delicate to avoid breathing it in.
4) A thick, generous layer of Zinc based or Petroleum based diaper cream or ointment is next.
5) OTC Lotrimin should be considered anytime there is a red, beefy, marbled appearance particularly in the folds and creases and crevices.   Lotrimin would be the treatment for a fungal, yeast infection and would be best applied before the Zinc or Petroleum barrier diaper cream.
6) Sometimes the skin can get very red and raw.  Open wounds in the diaper area can be very painful and distressing for your baby.  In this case, saturating a cotton ball with Maalox and dabbing it generously on the red and raw open lesions can be very soothing and very comforting.  Maalox has a cooling effect on the raw skin.  This is an advanced move that can be a life saver to a tender bottom.  i would recommend doing this after step 2) above and then letting the skin air dry a bit before proceeding to step 3).
The last point worth making is that it can take time. Be patient and persistent.  Once you feel that the skin looks perfect and is back to normal, do an extra day or two of the above routine to help prevent an unwanted regression.
I hope this helps!  Feel free to come in and have us take a look if you need some help.  Hopefully this gives you a good battle plan the next time that baby’s bum starts to act up.
Whoever said “brevity is the soul of wit”?

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