Diapers and Diaper Rash

Diapering your baby

A core 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 poop (stool). A baby uses about 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.

Choosing diapers

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

How to change a diaper

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. But it doesn't take long to get comfortable changing a diaper, and you'll get plenty of practice.

Here are the basic steps of diaper changing:

• Use a changing table or pad at the height of your waist. This prevents bending and back strain for you.

• Put all diapers, wipes, and other items within reach. Never leave a baby unattended on the changing table, even for a brief moment.

• Put a washable or disposable mat on the changing table. Lay the baby down on this.

• 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 poop 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. This may lead to a urinary tract infection.

• With the dirty diaper folded 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. Pull the front of the clean diaper 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 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. This is 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's a good idea to dump solid poop in the toilet before placing the diaper in the can. This helps reduce the odor and helps the environment.)

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's penis covered at all times. A 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 be needed if some of the poop 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 used only 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 what you are using isn’t working.

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's sometimes hard to tell when a disposable diaper is wet. 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 or light yellow. Changes in the odor and color may mean there is a problem. Dark yellow urine may mean the baby is not getting enough fluid.

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

Stool

The first poop (stool) of a newborn is called meconium. Meconium is sticky and dark brown to greenish-black in color. The baby may have several meconium and then mixed stool before this substance is completely gone from the baby's system.

Breastfed babies usually have frequent bowel movements at first. They may happen after every feeding, and even in between. These bowel movements are often loose, yellow, and seedy. Formula-fed babies have thicker bowel movements. They are more formed and yellow to light brown. Bowel movements with a greenish color are normal, too.

Sometimes a baby may become constipated. This is rare in a breastfed baby. Constipation in a baby is when stools are firm or formed and hard stools and occur only once a day or less. A baby may strain or fuss. But 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 organized 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 may mean the baby has diarrhea, especially if it is a sudden change. Contact your baby's healthcare provider if this occurs.

Talk with your baby's healthcare provider about your baby's bowel movements. Note how often they occur and what they look like.

Preventing and treating 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.

Despite this, most babies will get a diaper rash at some time. This is true whether they are in cloth or disposable diapers. Their bottoms are often in contact with moisture, bacteria, and ammonia. There is also 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 skin dry and clean. Check the diapers often. Check every hour if your baby has a rash. Change them as needed.

• Clean the 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. They can burn and increase irritation. You can sit the baby in a basin or tub of lukewarm water for several minutes with each diaper change. This helps clean the skin, and may also be comforting. You can also pour warm water from a pitcher or use a squirt bottle. Don’t use any soap unless there is poop that is hard to remove. Then use a very mild soap. 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 it very gently with a very soft cloth. Fasten diapers loosely. Don’t use airtight rubber pants. If you use disposable diapers, it can help to prick holes in them to let air in.

• Protect your baby’s skin. Petroleum jelly gives a good protective coating, even on sore, reddened skin and is easily cleaned off. Other kinds of ointments are available, too. See what works for your baby and what your baby's healthcare provider advises. Be very careful with all powders. Be sure the baby does not breathe them in. Don't use talcum powder. This is 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 advised.

• Treat a yeast infection as directed. Yeast overgrowth is common in the skin under the diaper. This is because of the moisture that can be trapped by the diaper. Your baby's healthcare provider will prescribe an antifungal cream. Apply the cream as directed. Change the diaper often. Keep the area open to air as much as possible. If the rash is not getting better with the cream, contact the healthcare provider.

When to call your baby's healthcare provider

Call your baby's provider if your baby has a rash that worries you, or if:

• Your baby has big blisters or sores more than 1 inch wide

• The rash is not better in 3 days

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

• The rash has pimples, blisters, boils, sores, or crusts

• The rash disturbs your baby’s sleep

• The rash spreads beyond the diaper area