Diaper Rash and Baby Eczema: Causes, Care and When to Call

Diaper rash: the common kind

• Red, sometimes shiny skin on the parts that touch the diaper most (bottom, thighs, genitals), usually sparing the deep skin folds. Caused by wetness, stool, rubbing and sometimes new wipes, foods or diarrhea.
• Change often: check and change soon after wet or dirty diapers, including once at night if the rash is bad.
• Clean gently: warm water and a soft cloth, or fragrance-free, alcohol-free wipes. Pat, don't rub, and let the skin dry fully.
• Barrier cream: a thick layer of zinc oxide paste or petroleum jelly at every change. You don't need to scrub it all off each time; wipe away the soiled layer and add more.
• Air time: a few minutes to an hour diaper-free on a towel each day.
• Go up a diaper size or loosen it a little. Skip baby powder and talc, which can be inhaled.
• Most irritant rashes clear in 2-3 days with this care.

When it might be yeast or infection

• Yeast (candida): bright, beefy red skin that goes into the creases, with small red spots or bumps at the edges. It often follows antibiotics or a rash that has lasted more than 2-3 days. It needs an antifungal cream, so call the pediatrician.
• Bacterial: yellow crusts, pus bumps, blisters or open sores need a look within a day, sooner with fever. A bright red rash around the anus can be strep and also needs a check.

Baby eczema (atopic dermatitis)

• Dry, rough, itchy patches, often starting at 2-6 months on the cheeks, forehead, scalp and the outside of the arms and legs. In older babies and toddlers it moves to the elbow and knee creases, wrists and ankles. The diaper area is usually spared.
• It comes and goes, is not contagious, and many children outgrow it or improve a lot by school age.
• Eczema, especially severe eczema, raises the chance of food allergy, so early allergen introduction matters; see the introducing common allergens guide. Food is rarely the cause of a flare, though, so don't cut foods without the doctor's advice.

Daily eczema care

• Moisturize at least once or twice a day, and after every bath: a thick, fragrance-free cream or ointment works better than a thin lotion. Use plenty.
• Short, lukewarm baths, about 5-10 minutes, with a small amount of gentle, fragrance-free cleanser only where needed. Pat dry and moisturize within a few minutes.
• Soft fabrics: cotton next to the skin; fragrance-free detergent; avoid wool.
• Common triggers: heat and sweating, drool and food on the face, dry winter air, fragrances, rough fabrics, and colds. Keep nails short and use mittens at night if scratching is bad.
• For flares, the pediatrician may suggest a mild steroid cream or ointment for short periods. Use it exactly as directed; used this way it is safe and helps the skin heal.

Cradle cap

Greasy yellow scales on the scalp, sometimes the eyebrows or behind the ears. Harmless and not itchy. See the newborn skin guide: loosen with a little oil, wash, and brush gently.

When to check in

Mention it to the pediatrician if: - Diaper rash isn't better after 2-3 days of care, keeps coming back, or looks like yeast. - Eczema isn't controlled with daily moisturizing, keeps your baby up scratching, or covers large areas. - Eczema looks infected: oozing, yellow crusts, or pus bumps.

Get same-day care for a temperature of 100.4°F (38°C) or higher in a baby under 3 months (with or without a rash), blisters, pus or spreading redness with fever, a baby who seems sick, or clusters of small, punched-out blisters in eczema patches (possible herpes virus infection); purple-red spots that don't fade when you press a glass on them mean 911 or the ER.