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Diapers/Diaper Rash

Diapering your baby

An essential part of every baby's care is diapering. A child is usually toilet-trained around 3 years old. Until then, diapers are used to collect urine and bowel movements. It is estimated that a baby uses 6 to 10 diapers each day. This adds up to about 2,000 to 3,000 diapers each year. With so many diaper changes, you may want to know how to make this task quicker and easier.

Generally, you can choose either cloth or disposable diapers. Each type has advantages and disadvantages. There is no clear answer as to which is best. You need to decide what works best for your baby and family. Many families choose to use some of both. Listed below are some of the pros and cons of each type of diaper.

Cloth diapers

Pros

Cons

  • Soft on baby's delicate skin

  • Delivery service available

  • Cheaper than disposable

  • Reusable

  • Allow a baby's skin to breathe, which may help heal diaper rash

  • Are available in a variety of absorbencies and textures

  • May leak, requiring a diaper cover or pants

  • Home washing is time consuming

  • Sanitizing cloth diapers uses water, detergent, energy

  • Difficult to use when traveling

Disposable diapers

Pros

Cons

  • Convenient, throw away

  • Wick moisture away from baby's skin with absorbent material, which may help prevent diaper rash

  • Easy to use when traveling

  • Waste in landfills of nonbiodegradable material and bowel movements

  • Many parents don't change the diaper until it is too soaked, increasing the risk for diaper rash

  • Higher cost

How to diaper your baby

As a new parent, it's normal to feel awkward trying to diaper a squirming baby. It can be frustrating not knowing how to hold the baby or where to place the diaper the first few times. However, it does not take long to get comfortable changing a diaper, and most parents get plenty of practice.

Here are the basic steps in diaper changing:

  • Use a changing table or pad placed at waist height. This prevents bending and back strain.

  • Have all diapers, wipes, and other items within reach. Never leave a baby unattended, even for a brief moment.

  • Use a washable or disposable mat on the changing table to lay the baby down on.

  • Open a clean diaper and set it aside.

  • Undo the tabs or pins of the dirty diaper. Hold the baby's legs in one hand and pull the front of the diaper down with the other hand.

  • If there is a bowel movement in the diaper, use the front of the diaper to wipe most of the mess toward the back of the diaper. Never wipe from back to front as this may lead to urinary tract infection.

  • With the dirty diaper pressed flat under the baby, use a wipe or damp washcloth to gently wash the baby's diaper area. Be sure to work from front to back.

  • Lift the baby's legs, slide the dirty diaper out, and set it away from the baby.

  • Place the back of the clean diaper under the baby and pull the front up between the baby's legs.

  • Secure the adhesive tabs or carefully pin the diaper corners snugly together. You should be able to place at least 2 fingers between the diaper and your baby's belly. If using safety pins, direct the pin away from the baby's belly, toward the sides. Always put one hand under the diaper when pinning so you don’t poke the baby with the pin by mistake. If you use cloth diapers with Velcro, you won’t need safety pins.

  • Place the dirty diaper in a container near the changing table to save steps. A lid that opens with a foot pedal is a plus. (It is a good idea to dump solid bowel movements in the toilet before placing the diaper in the can. This helps reduce the odor and helps the environment.)

This may sound very technical. But it doesn’t take long to change a diaper once you have done it several times. Some special tips to remember when changing a diaper include:

  • Keep a baby boy's penis covered at all times. A free stream of urine can go through the air over the changing table and onto the floor, or into your face or the baby's face.

  • With messy bowel movements, hold the baby's legs carefully to prevent feet from kicking into the diaper.

  • Some diaper changes may require clothing changes if the diaper has leaked. A bath may also be needed if some of the bowel movement gets on the baby's back or legs.

  • Try talking or singing during diaper changes as a distraction. Older babies can hold a special toy that is only used at diaper time.

  • Diaper sizes and shapes vary depending on the brand. Your baby may fit a certain brand for many months, then suddenly start leaking. Try a different brand if the one you are using isn’t working.

When to call your baby's healthcare provider

Call your health care provider for any rash that causes concern. Call your baby's provider if your baby has:

  • Any big blisters or sores (more than 1 inch across) develop

  • The rash has not improved in 3 days

  • The rash becomes solid, bright red, raw, or bleeds

  • Pimples, blisters, boils, sores, or crusts develop

  • The rash interferes with sleep

  • The rash spreads beyond the diaper area

  • Your child is fussy or irritable

  • Your child has a fever

Caring for diaper rash

Most babies will get a diaper rash at some time, whether they are in cloth or disposable diapers. Their bottoms are often in contact with moisture, bacteria, and ammonia, and there is rubbing from the diaper. Babies and toddlers are at risk as long as they are wearing diapers. Rashes are much easier to prevent than to cure. Many rashes can be treated by doing the following:

  • Change diapers often. The most important thing is to keep the area dry and clean. Check the diapers often, every hour if your baby has a rash, and change them as needed.

  • Clean baby’s skin gently. Frequent and vigorous washing with soap can strip the baby's tender skin of the natural protective barrier. Wash gently but thoroughly, including the skin folds. Don’t use diaper wipes if your child has a rash, as they can burn and increase the irritation. You can sit the baby in a basin or tub of lukewarm water for several minutes with each diaper change. This helps clean and may also be comforting. You can also pour warm water from a pitcher or use a squirt bottle. Don’t use any soap normally. But if there is stool that is hard to remove, then a very mild soap is OK. Wash gently and rinse well. Baby oil on a cotton ball can also be used.

  • Pat dry or leave diapers off for a while. Let the skin air dry, or pat very gently with a very soft cloth. Fasten diapers loosely and don’t use airtight rubber pants. If you use disposable diapers, it can help to punch holes in them to let air in.

  • Protect your baby’s skin. Petroleum jelly provides a good protective coating, even on sore, reddened skin, and is easily cleaned. A number of other ointments are available. See what works for your baby and what your baby's healthcare provider recommends. Be very careful with all powders. Be sure the baby does not breathe them in. Do not use talcum powder because of the risk of pneumonia. Powders may retain moisture and hold it close to the baby's skin. This makes the rash worse. Ask your child's healthcare provider before using diaper powder or home remedies such as cornstarch. In general these are not recommended.

Preventing diaper rash

To help prevent diaper rash, change diapers as soon as they are soiled. Make sure to remove urine and stool from your baby's skin with gentle cleaning.

Urine

Babies wet their diapers several times a day. The number of wet diapers is a helpful sign of how much fluid the baby is taking in. It is sometimes hard to tell when a disposable diaper is wet. But a baby should have at least 7 wet diapers each day. Fewer wet diapers can mean the baby may not be taking in enough fluid.

Normally, a baby's urine is clear and yellow-tinged. Changes in the odor and color may mean there is a problem. Dark yellow or even pinkish color urine may mean the baby is not getting enough fluid.

Call your baby's healthcare provider if you have concerns about the amount of color or odor of your baby's urine.

Bowel movements

The first bowel movements of a newborn are called meconium. Meconium is sticky and dark brown to greenish-black in color. The baby may have several meconium and transitional bowel movements before this substance is completely gone from the baby's system. Then bowel movements are loose and yellow.

Breastfed babies usually have frequent bowel movements at first, sometimes with every feeding, and even some in-between. These bowel movements are often loose, yellow, and seedy. Formula-fed babies have thicker bowel movements that are more formed and light brown.

Occasionally, babies become constipated. This rarely happens in breastfed babies, who can go many days between bowel movements after the first few weeks of life. Firm or formed, hard stools that occur only once a day or less than once a day, may mean a baby is constipated. A baby may strain or fuss with constipation. However, all young babies will strain and grunt when having a bowel movement. That’s because the muscles of the rectum and anus are not yet coordinated enough to fully relax as stool passes through. If you think your baby is constipated, contact your baby's healthcare provider.

Very runny or watery bowel movements, especially if there is distinct change, may mean the baby has diarrhea. You should contact your baby's healthcare provider if this occurs.

Talk with your baby's healthcare provider about your baby's bowel movements and their frequency and appearance.

Medical Reviewers:

  • Freeborn, Donna, PhD, CNM, FNP
  • Lee, Kimberly G., MD, MSc, IBCLC