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What is a diaper rash and is it serious?

Written by Joanna E. Betancourt MD FAAP

A diaper rash is any rash that develops inside the diaper area.

In mild cases, the skin might be red. In more severe cases, there may be painful open sores.

It is usually seen around the groin and inside the folds of the upper thighs and buttocks. Miles cases clear up within 3 to 4 days with treatment.

What causes diaper rash?

Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:

  • Too much moisture
  • Chafing or rubbing
  • When urine, stools, or both touch the skin for long period of time
  • Yeast infections
  • Bacterial infection
  • Allergic reaction to diaper material

When skin stays wet for too long, it starts to break down.

When wet skin is rubbed, it also damages more easily. Moisture from the soiled diaper can harm you baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop.

More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period.

Diaper rash occurs more often when:

  • Babies get older-mostly between 8 to 10 months of age.
  • Babies are not kept clean and dry.
  • Babies have frequent stools, especially when the stool stay in their diaper overnight.
  • Babies have diarrhea
  • Babies begin to eat solid foods
  • Babies are taking antibiotics or in nursing babies whose mothers are taking antibiotics.

When to call the pediatrician?

Sometimes a diaper rashes need medical attention. Talk with your pediatrician if:

  • The rash does not look like it’s going away or gets worse 2 to 3 days after treatment.
  • The rash includes blisters or pus-filled sores.
  • Your baby is taking antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.
  • Your baby has a fever along with a rash.
  • The rash is very painful. Your baby might have a skin condition called cellulitis.
  • What can I do if my baby gets diaper rash?

If your baby has a diaper rash (and to prevent future diaper rashes)

  1. It’s important to keep the area as clean and dry as possible. Change wet or soiled diaper right away. This helps cut down how much moisture is on the skin.
  2. Gently clean the diaper with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance.
  3. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing.
  4. Pat dry; do not rub. Allow the area to air-dry fully.
  5. Apply a thick layer of protective ointment or cream (such as on that contains zinc a oxide or petroleum jelly). These ointments are usually are usually thick and pasty and do not have to be completely removed at the next diaper change.
  6. Remember, heavy scrubbing or burring will only damage the skin more.
  7. Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled part does not rub against the skin as much.
  8. Use cream with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful.
  9. Check with your pediatrician if the rash a) has blisters or pus-filled sores; does not go away within 2 to 3 days; Gets worse.

Many parents ask me if a cloth diaper is better than disposable diapers. Research suggests that diaper rashes are less common with the use of disposable diapers.

However, what is more important than the type of diaper is how often it is changed. Whether you use cloth diapers, disposables, or both, always change diapers as needed to keep your baby clean, dry, and healthy.

Hopefully, this little bit of background on diaper rashes give you some good insight about this condition that many babies have.

Dr. Betancourt is a board certified pediatricians and a Fellow of the American Academy of Pediatrics. She has 3 kids and gets a little grumpy when she doesn’t get a chance to workout at the gym at least 3-times a week. 

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Such a simple, kind way to illustrate why we take the time to buckle-up

Post originally appeared on seattlemamadoc.com Written by Dr. Wendy Sue Swanson MD

When I first watched this video, the computer volume was off (I didn’t know it) and I thought this was a silent video. I loved the stillness of the quiet mixed with the emotion of the ad.

I cried (yes, I’m the kind of person who always does) one of those quiet cries, the kind where you’d never know I was crying unless you were looking straight into my eyes. Tears just dripped silently.

Instead of being impregnated with fear, this public service announcement is loaded with hope.

Isn’t it amazing how much people love you?

Dr. Swanson practicing pediatrician and the mother of two young boys.  She sees patients at The Everett Clinic in Mill Creek, Washington. She is also  on the medical staff at Seattle Children’s and am a Clinical Instructor in the Department of Pediatrics at the University of Washington. Dr. Swanson is passionate about improving the way media discusses pediatric health news and influences parents’ decisions when caring for their children.

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Starting Solids: The Old and the New and the Myths

Written by Kristen Stuppy MD

Many parents are excited yet apprehensive to start foods with their infants. So many questions, so many fears. So much food introduction guidance has changed in recent years, that what you did with your older kids might not be current. Change takes time, so not everyone agrees on the “new” rules. Talk to your own pediatrician to see their take on it all!

The older “rules” for starting foods were so confusing… different sources will vary on these rules.

  • don’t feed before 6 months is now ok to feed at 4 months if baby’s ready
  • don’t give nuts, eggs, and other “allergy” foods until ____ (2/3/5 years, varying by expert) is now it is okay to give allergy foods unless there is a family history of food allergy
  • don’t start more than one food every 3-5 days is now introducing multiple foods at one time is ok
  • start with rice, then add vegetables, then meat., wait until last for fruit is now begin with any foods, but try to make nutritious choices, such as meat which is high in iron and protein

Variations of this were plenty, depending on the provider’s preferences. No wonder there is so much confusion!!!!

New rules are much easier. I like easier.

  • Start new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
  • Don’t give honey until 1 year of age.
  • Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy. Any foods in any order. Multiple new foods on the same day are okay. Common sense will hopefully guide types of foods. Nothing too salted. Try nutritious foods, not junk.

These minimal rules can make parents weary.

What about food allergies if foods are given too early?

Research does not support the thought that starting foods earlier lead to allergies. In fact, there is research to support that starting foods earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases. If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. Talk with your pediatrician in that case.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. ~ Back to the no textures your baby will choke on… nuts are hard and round– two no-nos, peanut butter is thick and sticky– another choking risk.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food.

Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent (not cause) allergy. In the case of nuts, since there is also a choking risk, you can try a food cooked with nuts or nut oil.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods. Saving fruit for last simply doesn’t seem to make a difference.

Adding fruits alone is not very nutritious though, so fruits should be added along with other more nutritious foods. The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year?

Cow’s milk is not a meal in itself (like breast milk or formula). It is missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. Cow’s milk may lead to allergies or eczema, including formulas made with cow’s milk.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well rounded diet as long as they don’t show any allergy risks to milk. Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so. There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed. Pureed meats (preferably from your refrigerator… baby food meats are not very palatable!) are a great source of nutrition for baby! Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we know what they’re allergic to if we start several new things at once?

First, most kids are not allergic.

Second, if they are allergic to a food, it is often days/weeks/months before the allergy is recognized. Waiting 3 days between food introduction simply doesn’t allow recognition unless it is hives or anaphylaxis, and there are a small number of foods that account for most of these reactions.

If your child has one of these reactions we can test to see what the offender was. This is recommended with severe allergies since people with one allergy might have other allergies, and identification for avoidance is important.

Allergy symptoms can be broad and often are not specific: dry skin (eczema), runny nose, hives, swelling of lips, difficulty breathing, vomiting, diarrhea, or blood in the stool. If you think your child is allergic to a food, discuss with your doctor. Severe symptoms (anaphylaxis) demand immediate attention!

How do we know when to start foods? I wanted to start to help baby sleep through the night, but I heard starting too soon increased obesity and diabetes.

When babies are able to sit with minimal support and hold their head up and when thye show interest in food by reaching for it they might be ready. They can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

In formula fed babies it has been shown to increase the risk of obesity at 3 years (6x!) if foods are started before 4 months of age. That risk is not seen in exclusively breast fed infants or those who begin foods after 4 months of age.

It is still an old wive’s tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods. As they eat more food, they will need less breast milk or formula. In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home made foods?

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home made foods. I didn’t make baby foods when my kids were babies because I thought it would be too hard, but now I puree foods to put into recipes (my kids are like many who aren’t fans of veggies and I want to improve their nutrition). It really isn’t hard. You can take whatever you are cooking for your family and put it in a food processor or some blenders and with a little water to get it to a texture baby can eat: voila! Home made food. There are of course many baby food cook books and ideas of how to freeze meal-sized portions so you can make multiple meals at one sitting. There is help for parents who want to safely prepare baby food at home at the USDA website.

My baby only wants table foods. Is that okay? Don’t they need pureed foods first? He doesn’t have many teeth!

Pureed foods are what most babies start with due to the easy texture, but some babies quickly develop the ability to pick up small pieces of food with the pincher grasp (finger/thumb) and want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

Most babies will be able to eat table foods between 9 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

How much juice should my baby drink?

In general I think babies don’t need juice at all. They can practice drinking from a cup with water. Juice adds little nutritional value and a lot of sugar. Eating fruit and drinking water is preferable. If they do drink juice, it should be 100% fruit or vegetable juice, not a fruit flavored drink! No more than 4 ounces/day of fruit juice is recommended.

What about organic?

There is not enough evidence to recommend organic food, since the nutritional components of the foods are similar regardless of how they were farmed.

Organically grown foods do have lower pesticide residues than conventionally farmed produce, but it is debated if this is significant or not to overall health. Conventionally farmed produce have the pesticide levels monitored, and they fall within levels that are felt to be safe.

Organic farming rules also dictate no food additives or added hormones, which is also an area of study for health risks and benefits, but not enough data is available to give an educated opinion yet.

Organic farming is generally felt to be better for the environment, but the sustainability of that is questioned.

Many argue that the taste of organic foods is superior.

Organic farming might increase the risk of bacterial and fungal contamination or heavy metal content, so it is very important to wash fresh fruits and vegetables well prior to cutting or eating (as you should with all fresh foods).

For more information, see the USDA site.

A backyard garden can be inexpensive, organic, and a great way for your kids to learn about growing and preparing healthy foods!

 

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

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Expecting a Child? Need to Find a Pediatrician? What Questions Should You Ask?

Written by Natasha Burgert MD

“Who is going to be the doctor for your new baby?”

Your OB wants to know. Your friends have asked. Your mother is wondering.

Finding a pediatrician is on the “to-do” list of all expectant mothers and fathers. New families often begin the search for a potential baby doctor by asking for recommendations from their OB doctor, family, and friends.

Some families begin by looking at the American Academy of Pediatrics website.Regardless of how you find a pediatrician, truly determining if a doctor is going to be a good match for your family is often done by interviewing.

I have seen plenty of glowing mothers-to-be sitting in my office with the seemingly standard “interview sheet” from babycenter.com or WhatToExpect.com.

Parents come to my office with a “recommended question list” because they don’t really know what to ask. This is certainly understandable since, for most families, interviewing a doctor is new territory.

But although these lists of questions are a good start, I don’t think they get to the heart of the matter.

What most parents really want to know is if a pediatrician is likable. Is this person going to be someone I can ask questions? Do we have something in common? Are we going to get along?

Compatibility is what most parents are searching for.

Here are 5 questions I would ask a potential baby doctor during an interview.

1. “Tell me about your office.”

Office hours and locations, contact numbers, hospital affiliations, and basic biographical information is fairly standard on every medical practice website. Use the web to get the basics, but let the doctor tell you where he thinks his office really shines.

This open-ended approach gives the doctor an opportunity to say what he thinks is the most important, interesting, or significant about the place where he works.

If the doctor does not cover any specific question you have about the function of the office, then ask.

2. “Why did you choose to become a pediatrician?”

The million dollar question. This is an opportunity for you to learn about the person behind the white coat. Of all the medical specialties, why did she choose to take care of kids?

3. “What are your thoughts on antibiotics and vaccinations?”

For most doctors in pediatric healthcare, antibiotics and vaccinations are common medical interventions.

How a doctor chooses to use antibiotics, and for what illnesses, does vary. With the increasing concern of antibiotic resistance and super-infections, having a physician who can clearly define when antibiotic use is appropriate for your child is important.

Vaccinations are a fundamental building block for child health. A physician’s beliefs and attitudes towards vaccinations will effect the recommendations they may or may not provide.

Also, some physicians will not see patients if the recommended vaccination schedule is not followed. Allowing a doctor to openly express his opinion on immunizations can begin productive dialog about this very important topic.

4. “What do you love about your job?”

Does this doctor have a passion for the underserved? Does he love to see kids with chronic illnesses, like asthma or ADHD? Does she love to teach?

Asking a doctor to share the best part of his job may reveal a common interest. Or, allow you to determine if your family’s needs will be best supported.

5. “What do you like to do outside of work?”

Pediatricians often look alike on paper. We all go to medical school, complete a pediatric residency, and get certified by the American Board of Pediatrics.

Asking the doctor what she enjoys doing outside of work may be enough to make the person on paper become a new partner in the care of your family.

Good luck in your search!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com