Common Concerns in the Early Weeks - Part Five

So much happens so fast as your baby adjusts to life outside the womb and you adjust to life with this little person. Knowing what to expect and understanding why babies do what they do will help you ease more comfortably into parenting.

Diaper Rash: Prevention And Treatment

Take a close look at your newborn's blemish-free bottom. Its complexion may never be so clear for the next year. When you begin diapering, a rash is soon to come. Diapers and skin just don't go together without friction. To protect the surroundings from baby's excrement, diapers were invented -- and baby's skin rebels at losing its freedom to enjoy fresh air and sunshine.

Where does diaper rash come from? Start with ultra sensitive skin, add the chemicals of urine and stools, occlude the area with a big "bandage,": and rub it all together. Presto! You have diaper rash. Keep this mixture together long enough, and bacteria and fungi begin to grow into the weakened skin, and you have more diaper rash.

Excessive moisture on sensitive skin is the main culprit in diaper rash. Too much moisture removes the skin's natural oils, and wet skin is more easily damaged by friction. Once the skin has been irritated by excessive moisture, it is no longer a good natural barrier. Infants have a lot of fat folds around the groin. These moist folds of skin rubbing together is the reason a rash is most often seen in the creases of the groin. Just as the skin gets used to the wetness, solid foods present a different chemical irritants, and the rash changes -- the bottom's reflection of something changing at the other end.

Dealing with Diaper Rash

Don't take diaper rash too personally. "But I change him as soon as he wets," mothers often say, apologizing for their baby's persistent rash. Babies of even the most attentive diaper changers get rashes. But here are ways to lessen it.

Change frequently.
Studies have shown that infants who are changed at least eight times a day have fewer cases of diaper rash.

Try different types of diapers.
While each brand claims victory over diaper rash, experiment with both cloth and different brands of disposable diapers to see which one causes the least diaper rash.

Rinse irritants from diapers.
If washing your own diapers, to remove soap residues and alkaline irritants add one-half cup of vinegar to the rinse cycle. You can also request this treatment from your diaper service.

Rinse or wipe well.
During each change rinse baby's bottom, especially if the diaper is soaked or you smell ammonia. Experiment with what gets along well with your baby's bottom. Sensitive skin does best with plain water; some bottoms need a mild soap. Some sensitive bottoms rebel at the chemicals in disposable baby wipes, especially those that contain alcohol; some bottoms accept them without a rash. Try different wipes until you find the one that works.

Pat gently.
Blot dry with a soft towel or a clean cotton diaper. Avoid excessive towel rubbing or scrubbing with a strong soap on irritated skin. If even towel blotting reddens the skin, try using a hair dryer (lowest setting, twelve inches away) to blow-dry your babies bottom.

Air-condition baby's bottom.
Allow the diaper area to breath by applying disposable diapers loosely. Avoid tight-fitting diapers and occlusive elastic pants that retain moisture; reserve these pants for occasions when a leaky diaper would be socially unacceptable.

Keep bottoms up.
While baby is sleeping, expose his bare bottom to the air and occasionally to a ten-minute ray of sunlight near a closed window. Place naked baby on a folded cloth diaper with a rubberized pad underneath to protect bedding and blankets. In warm weather and after the newborn period let baby nap outside with his bare bottom exposed to fresh air.

Remove friction.
To reduce friction, try a larger-size diaper. Fold the plastic liner of disposable diapers outward so that only the soft area of the diaper touches baby's kin. A "border" rash around baby's belt line reveals friction as the culprit. Besides this diaper-to-skin friction, the fat folds around baby's groin rub together during cycling of the legs or during toddler walking. Apply a lubricant such as Original A & D Ointment or a zinc-oxide cream to reduce chafing along the groin creases.

Barrier Creams

For most rash less bottoms, creams and ointments are not needed, as they may prevent the skin from breathing naturally. But if your baby's bottom is prone to rashes -- "As soon as I get the rash cleared up, it starts again" -- barrier creams may be a good ounce of prevent. At the first sign of a reddened, irritated bottom, generously apply a barrier cream containing zinc oxide. Barrier compounds protect the underlying skin from irritants and friction rubs. Cornstarch, one of the oldest protective compounds, can be used in groin creases to prevent friction rubs, but in experience cornstarch cakes and is more of a nuisance than a help.

Dietary Changes

When conditions change at one end, expect changes at the other. Changing the diet -- including formula changes and beginning solids -- teething, or taking medicines all result in a change in the chemistry of stools and urine, producing a rash. (Incidentally studies have shown that breastfeeding babies have less severe diaper rashes.) As soon as these "mouth end" conditions change, apply barrier creams before the rash begins, especially if your baby is prone to diaper rash.

If baby is taking antibiotics, give a daily teaspoon or break open a capsule of acidophilus or Lactobacillus bifidus powder to lessen the antibiotic-produced diarrhea and resulting rash. If the rash doesn't improve quickly, try an antifungal cream. (See following.)

How to Be a Diaper Rash Detective

"Diaper rash" is really an umbrella term for a number of skin rashes in the diaper area. Here are tips for identifying and treating some specific types of diaper rash.

Allergy ring.
A red ring around baby's anus reflects a dietary irritant as the culprit, similar to a rash around baby's mouth when beginning a new food. Excess citrus fruit and juices and wheat are the main irritants. Discontinue the food to see if the red ring goes away. You may even need to drop the food from your diet if you are breastfeeding.

Contact dermatitis.
A red, flat, scald-type rash, contact dermatitis appears over the area of rubbing by the diapers, usually around the belt line and upper highs. A telltale sign of this type of rash is the sparing of the creases when the skin is not in intimate contact with diapers. Causes of the rash include a chemical irritant in the diaper itself or in the detergent, or chemical irritants that form after urine and stools remain in the diaper for a period of time. Chafing of synthetic material on sensitive skin is another possible cause, as are the chemical changes in the stools during diarrheic illness or antibiotic treatment.

To treat, soak baby's bottom in warm water for five minutes; after soaking, if you detect a whiff of ammonia on baby's diaper area, soak longer. Leave your baby diaper less as much as is practical. Experiment with different diapers and apply an over-the-counter 1 percent hydrocortisone cream twice daily for a few days in addition to your usual cream.

Your Own Diaper Rash RX

Try this "prescription" to treat your baby's diaper rash:

* zinc cream with each diaper change
* antifungal cream (Lotrimin)
* 1 percent hydrocortisone cream (do not use for more than three days without consulting your doctor)

Apply each twice daily at different times. (All three are available in over-the-counter preparations.)

Intertrigo
In appearance, intertrigo is just the opposite of contact dermatitis. It occurs where the skin folds rub together, as in the groin. This s caused by the "tropical climate" heat and moisture retention in the creases, resulting in irritation of the skin. When urine touches the irritated areas of the intertrigo, it may burn the skin, causing baby to cry. To treat, apply Original A & D Ointment to the irritated skin with each diaper change.

Seborrheic dermatitis.
The margins of Seborrheic dermatitis are sharply demarcated, and the condition looks like a big red patch over the groin, genitalia, and lower abdomen. This is one of the most sore-looking diaper rashes -- more raised, rough, thick, and greasy than any of the others. Besides the preceding preventive measures, this type of rash is usually treated with an OTC 1/2 percent or 1 percent cortisone cream or, if severe, a prescription cream. A word of caution: Do not use cortisone cream on the diaper area longer than prescribed by your doctor, as overuse may damage the skin.

Yeast rash (Candida).
If your baby's diaper rash persists despite all of the preventive measures and over-the-counter creams already mentioned, suspect yeast, and try an over-the-counter or prescription antifungal cream. A yeast rash is a reddish-pink, raised, patchy rash with sharp borders, primarily over the genitalia but with satellite spots sprinkled around the main area of rash and often appearing as tiny pustules. Yeast infection may occur on top of any of the preceding diaper rashes if they last more than a few days. Sometimes for persistent yeast rashes it is necessary to give an antifungal medication orally, as in treating thrush.

Impetigo.
Caused by a bacteria (usually streptococci or staphylococci), impetigo appears as coin-sized blisters that ooze a honey-colored crust. These are spotted around the diaper area, primarily around the buttocks. This type of diaper rash needs a prescription antibiotic cream and sometimes oral antibiotics.

Diaper rash is a fact of civilized, bottom-covering baby life. Like all the nuisance stages of infancy, it too will pass.

RX For Healthy Baby Skin

Healthy baby skin depends not only on what the skin touches and is exposed to (called the outside job), but also on what feeds the skin -- the inside job! Besides being kind to baby's sensitive skin by not using irritating clothing and not exposing baby to the damaging rays of the sun, feed baby's skin the right nutrients and you will continue to see and feel that adorable baby skin for a long time.

Hydrate baby's skin.
Like fertile soil, babies need lots of fluids to keep skin from drying out. Formula-fed babies should drink one bottle of water every day. Breastfed babies do not need extra water.

Oil baby's skin.
Next, healthy skin needs to rich in healthy oils. The best oils for healthy skin are omega-3 fatty acids. Besides breast milk the best food source of omega 3's is cold-water fish, such as deep ocean salmon. Flax oil and, to a lesser extent, canola oil, are also rich sources of skin-healthy omega-3 oils. In a pediatric practice, there have been dramatic results in patients with dry, scaly skin when prescribed with extra omega 3's for the breastfeeding mother's diet or one teaspoon of flax oil added daily to a bottle of formula for infants. For toddlers one tablespoon of flax oil added daily to a fruit-and-yogurt smoothie is prescribed.

There will be more articles on infants, breast or bottle feeding and other related topics to follow. So please keep an eye out for more of my articles.