Diapers/Diaper Rash

What is diapering?

An essential part of every baby's care is diapering. Until a child is toilet-trained, usually by 3 years of age, diapers are used to collect urine and bowel movements. It is estimated that a baby uses six to ten diapers each day - this translates to about 2,000 to 3,000 diapers each year. With so many diaper changes, parents want to know how to make this task quicker and easier.

Generally, there are two choices - cloth or disposable, and each type has advantages and disadvantages. There is no clear answer as to which is best. Parents need to decide what works best for their individual 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.

How to diaper your baby:

New parents often 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 some tips to help you diaper your baby comfortably and correctly:

• Use a changing table or pad placed waist high. This prevents bending and back strain.
  
• Have all diapers, wipes, and other items right above or below the table. Never leave a baby unattended, even for a brief moment.
  
• Have a washable or disposable mat on the changing table to lay the baby down on.
  
• Place your baby on the table with his/her head to the right or left. Most parents find one direction easier than the other.
  
• 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 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 to gently cleanse the baby's diaper area. Be sure to work from front to back.
  
• Lift the baby's legs and 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 two fingers between the diaper and the baby's abdomen.
  
• 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 decrease the odor and helps the environment.)

While this sounds very technical, it does not 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 boy baby'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.
  
• 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 there is bowel movement on the baby's back or legs.
  
• Try talking or singing during diaper changes as a distraction. Older babies can hold a special toy reserved for diaper time.
  
• Diaper sizes and shapes vary among manufacturers. Your baby may fit a certain brand for many months, then suddenly start leaking. Try a different brand if the one you are using is not working.

Yeast diaper rash:

Some diaper rashes are caused by a yeast called Candida Albicans, which often causes problems when a baby already has a diaper rash, is on antibiotics, or has thrush. This rash appears bright red and raw, covers large areas, and is surrounded by red spots. Call your baby's physician for a special cream to treat this rash, and follow the guidelines above. With proper treatment these rashes usually improve in two to three days.

Call your baby's physician if:

• any big blisters or sores (more than one inch across) develop
• the rash has not improved in three 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 starts acting very sick or has an unexplained fever

Caring for diaper rash:

Most babies will get a diaper rash at some time. Their bottoms are in frequent 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 the following:

• change diapers frequently
  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. Check at least once during the night.
  
• gentle cleaning
  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. Do not 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. Do not use any soap unless there is very sticky stool, then a very mild soap is okay; 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 or paper towel. A hairdryer set on cool can also be used. Leave the skin open to the air as much as possible. Fasten diapers loosely and do not use airtight rubber pants. If you use disposable diapers, it can help to punch holes in them to let air in.
  
• skin protection
  Petroleum jelly (Vaseline®) provides a good protective coating, even on sore, reddened skin, and is easily cleaned. A number of other ointments are available commercially; see what works for your baby and what your baby's physician 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. Cornstarch reduces friction and may prevent future rashes.

Preventing diaper rash:

Changing the diaper immediately and good cleaning are the best things you can do. Diaper rashes occur equally with cloth diapers and disposables diapers. Some children will get a rash from certain brands of disposable diapers, or from sensitivity to some soaps used in cloth diapers. If you use cloth diapers, bleach them by adding Clorox®, Borax®, or Purex® to the wash. Be sure to rinse the diaper thoroughly.

Urine:

Babies wet their diapers with urine several times a day. The number of wet diapers is a helpful sign of how much fluid the baby is taking in. Although it is sometimes hard to tell when a disposable diaper is wet, generally, a baby should have at least seven 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 indicate a problem. Dark yellow or even pinkish color urine may mean the baby is not getting enough fluid.

Call your baby's physician if you have concerns about how often or how much your baby is wetting diapers.

Bowel movements:

The first bowel movement of a newborn is called meconium. This is a sticky, greenish-black substance that forms in the intestines during fetal development. The baby may have several meconium bowel movements before this substance is completely gone from the baby's system. The next bowel movements are seedy-looking and are greenish-yellow. Breastfed babies usually have frequent bowel movements, 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 beige in color.

Occasionally, babies become constipated. This rarely happens in breastfed babies. Firm or formed 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.

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

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

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