Going Beyond Skin-Deep to Deal with Diaper Rash

By: Dr. Tanya Altmann MD

Diaper rash is a common condition in babies and newborns that appears as red, irritated skin in baby’s diaper area. While it often bothers baby, it can even be more bothersome to parents. Was it their fault for not changing baby frequently enough? Up until recently, diaper rash was only thought to be caused by prolonged exposure to moisture, poop, and urine. Just recently, a new link was uncovered between diaper rash and the rising pH levels of baby’s poop. If you’re unfamiliar with pH and why it matters, a higher pH means more alkaline and a lower pH means more acidic. Contrary to popular belief, it’s beneficial to have a more acidic environment in a baby’s stool. The more acidic environment means that stool enzymes (known to be harsh and irritating to baby’s sensitive skin) won’t be activated to cause irritation and skin breakdown. 

Here’s my approach to combating diaper rash, including tips to treat irritated skin and restore a healthy pH environment in baby’s diaper. 

1. Check baby’s bottom often
   
   Newborn babies poop and pee often. I’ve seen breastfed infants who poop up to 12 times per day (yes, 12!), while the average should be somewhere between two and five per day. The frequency of baby’s bowel movements can be hard to predict during those first few weeks, so be extra vigilant and check baby’s diaper often especially after a feed. I also like to remind my patients' parents that the stool coming out of their tiny human is not the same pungent smell that would come from a baby eating solids, so be sure to check that diaper often. 
2. Restore the good bacteria that naturally lower stool pH
   
   Since we now know that the pH levels of baby’s stool contribute to diaper rash, it's important to restore the good bacteria that naturally lower stool pH and make the environment more acidic. B. infantis is good gut bacteria that produces acidic byproducts that maintain a lower stool pH. Historically, B. infantis dominated the infant gut, but over the last 100 years, it’s been disappearing, as an unintentional consequence of modern medical practices such as antibiotics. Without B. infantis, babies tend to have more loose watery stool with a higher pH, creating conditions where diaper rash is more likely to occur. I recommend Evivo baby probiotic, the only baby probiotic that is clinically proven to restore B. infantis, reduce the number of loose watery stools, and correct baby’s fecal pH back to a healthy level.
3. Gently wash baby’s bottom in warm water
   
   If your baby has diaper rash, I recommend laying off the wipes for a day and gently washing the diaper area with warm water and a soft cloth. Next, gently pat baby’s bottom and slather on your favorite diaper ointment before putting on a fresh diaper. You might even consider letting your little one go commando while you’re at home to give them a diaper break.
4. Apply an ointment to protect the skin itself
   
   If you live in a humid region or you notice diaper rash, apply an ointment with zinc oxide. Ointment will help protect your little one’s sensitive skin and create a barrier between baby’s bottom and excess moisture, urine, and stool. This will also help allow the skin to heal. If the rash isn’t improving after a few days of your favorite diaper ointment, or if it worsens, see your pediatrician as some rashes need specific medication or treatment.

One thing all parents should remember is that most babies will get diaper rash at some point, but if you spot it early and take preventative measures, it should clear up quickly and not bother anyone. If your baby gets frequent rashes, a diaper rash persists, is causing discomfort, or if you have any concerns about your baby’s health, talk to your pediatrician. 

Dr. Tanya Altmann is a leading pediatrician and best-selling author.  Her expertise lies in baby nutrition and gut health, but she also speaks to everyday parenting issues. Altmann is the author of What to Feed Your Baby and Baby and Toddler Basics, as well as editor-in-chief of the American Academy of Pediatrics' parenting books, The Wonder Years and Caring for Your Baby and Young Child: Birth to Age 5. Dr. Tanya has made numerous media appearances and contributions over the years, but she would say her most important role is being mom to her amazing three boys.