Dealing with diaper rash

One of the (many!) benefits of using cloth diapers is the reduced likelihood of diaper rash, due to the fact that cloth diapers are more breathable than disposable diapers. A lot of parents who use disposable diapers apply diaper rash cream at every diaper change as a pre-emptive strike against diaper rash, however, diaper rash cream should only be used to *treat* diaper rash, not to prevent it.

Disposable diaper companies have done a great job of making parents believe that the 'stay-dry protection' of their diapers will help prevent diaper rash, however, diaper rash is rarely attributed to wetness, very few children will react to a wet cloth diaper. It is in the interest of disposable diaper companies to keep your child from feeling wet because it ensures you will be buying their products for as long as possible -- when your child feels wet in a cloth diaper, she can potty train up to a year earlier, with your help, of course. So, what causes diaper rash? There can be many reasons your child develops a rashy bum:

• sitting too long in a soiled diaper; ideally, you should change your baby every 2-3 hours (or when she poops), regardless of whether she is in cloth diaper or a disposable diaper. Once a cloth diaper gets saturated, it will leak, as a result, you are forced to change your baby more frequently in cloth diapers. The SAP (that's super-absorbing polymer to you!) in disposable diapers, on the other hand, can absorb up to 200-300 hundred (hundred!) times its weight in liquid, meaning you can go longer between diaper changes (you can, but you shouldn't!).
• food sensitivity/allergy; when you start feeding your baby solids around six months of age, you are supposed to introduce one food at a time, for two-three days in a row, so you can determine if your baby has a sensitivity or an allergy to it. Some foods may result in a diaper rash. I remember journalling my first daughter's inputs (and outputs!) when she started solids. Then she ate dog poo when she was 18 months old, and I loosened up considerably (the dog poo did not give her diaper rash, if you care).
• diarrhea; yes, the 'D' word, never pleasant to deal with, no matter what type of diaper you use. Diaper rash can be caused by contact -- loose, frequent stools can irritate your baby's delicate skin.
• teething; when your baby is teething, excessive drooling can cause diarrhea (see above).
• overheating; if your baby spikes a fever, or if you are dressing your baby too warmly overnight, you may notice a sudden onset of diaper rash. This type of rash is often accompanied by fluid-filled blisters.
• sensitivity to wetness; it's rare, but it happens. If you're using cloth diapers that hold wetness against your baby's skin, a fleece liner will wick moisture away from your baby's bum.
• chemical irritation; your baby may react to the chemicals in disposable diapers or disposable wipes. If you are using cloth diapers, your baby may be sensitive to certain detergents.
• fabric sensitivity; some babies may be sensitive to certain fabrics used to make cloth diapers, for example, the synthetic lining of a pocket diaper, or a certain type of binding on a diaper cover.

How do you know if your baby has a diaper rash? Diaper rash is ofen accompanied by some or all of the following symptoms:

• redness of the skin
• pimples, blisters, or broken skin
• tenderness -- baby will cry when you try to clean the area
• hotness -- the affected area feels warm to the touch

We have four kids, and until recently, we never really had to deal with diaper rash, save for the same rash all of our kids developed at around two weeks of age. I point this out to all new parents, not to scare them, but to warn them, newborn babies poop a lot. A LOT! If your baby is farting every 10 minutes, and each fart is accompanied by what I like to call a 'hershey squirt', your baby's bum is going to get rashy. This newborn rash was easy to clear up with frequent diaper changes and nekkid bum time.

My youngest daughter is 17 months old, and I was recently introduced to the misery of dealing with diaper rash (two separate bouts, a couple weeks apart). She woke up one morning with red, burning skin on her bum cheeks, each cheek had at least 20 fluid-filled blisters on it. To say she was in discomfort was an understatement -- she had woken through the night screaming, and I should have realized from the tone of her scream that something was amiss, however, hindsight is 20/20, when I took her diaper off in the morning, I felt awful!

Figuring out what causes diaper rash is basically a process of elimination, since there are so many possible causes. First, I blamed our (bleepity-bleeping) frontloading washing machine, and I stripped all of Grace's diapers. No dice, stripping the diapers didn't help the situation. We considered her diet, the fact she was cutting molars, etc. It took a while, but we finally figured out the culprit -- a new pair of footed fleece pyjamas paired with a pocket diaper overnight. We have used fleece pants overnight before, but her feet were never covered, and we have used pocket diapers overnight many times without issue.

Grace was overheating through the night, when I unzipped the pyjamas in the morning, I was overwhelmed with the smell of ammonia (that's why I assumed it was a detergent residue issue). Heat encourages the growth of bacteria, and fleece is not as breathable as cotton, so the pee in her diaper was turning into ammonia faster than it would if she was in a more breathable pyjama/diaper combination. The footed fleece pyjama/pocket diaper combination was essentially the 'perfect storm' for Gracie's poor bum!

If you are dealing with diaper rash, once you've figured out (and eliminated) the cause of the rash, there are things you can do to speed up your little one's recovery:

• avoid store-bought wipes, use facecloths with warm water to clean the diaper area thoroughly.
• change your baby's diaper more frequently -- the more, the better!
• use a diaper cream with calendula -- calendula is great for healing skin. If you're using cloth diapers, apply the cream sparingly to the affected area, and use a liner.
• give your baby diaper-free time where possible. Lay baby on an old blanket or a waterproof mat (put a facecloth on baby boy's bits!), or restrict mobile children to rooms with easy-to-clean flooring.

Getting rid of Grace's diaper rash proved to be as challenging as figuring out the cause -- at the recommendation of our daycare provider, we used diaper rash cream in combination with disposable diapers (the horror! the horror!). When our newborns got rashy, we always left them diaperless, however, having Grace in part-time daycare, that wasn't an option. After a few days of disposables coupled with rash cream, we saw no improvement. At that point, we switched to good ol' cotton prefolds coupled with a wool cover (and lots of diaper-free time at home), and we saw immediate results, the blisters started to scab over and peel off.

If your baby's bum does not improve within 2-3 days, you may want to check with your care provider for suggestions -- diaper rash should be easy to clear up once you've identified the cause, if you're dealing with a yeast infection, you will need to take a different approach to solving the problem.