Dr. Linda, my newborn has had a diaper rash for 5 days now and nothing is helping. What am I doing wrong? Could it be a yeast infection?

You are not doing anything wrong! It may be that your baby has a yeast infection called Candida dermatitis. Candida is a yeast which lives on some babies’ skin especially if their moms had a yeast infection during delivery or if they received antibiotics.

Lets start by talking about diaper rashes.

Irritant diaper rash, which is little red bumps, happens from the friction between the moist surface of your baby’s skin and the diaper which is why the rash doesn’t appear in areas where there is no friction such as the thigh folds.    

It starts out as a dry red rash and gets redder, wetter and more irritated as the rash gets worse.

Who gets diaper rash?

Babies who don’t get their diapers changed frequently enough, babies with diarrhea and babies exposed to antibiotics. Bottle fed babies also tend to get more diaper rashes. Since irritant diaper rashes make it easier for babies to get a yeast infection of the skin you want to do everything you can to prevent them.

How to prevent diaper rash:

Breastfeeding is a great way to prevent diaper rashes, but, however you feed your baby, keeping your baby’s diaper area as clean and dry as possible is the foundation of preventing diaper rashes of any sort. The moister your baby’s skin stays the more likely she is to develop a diaper rash.

Yeast Infection

A yeast infection rash (Candida dermatitis) is the result of irritated skin getting invaded by Candida, a yeast living on the skin of some normal newborns especially if their mothers had a vaginal yeast infection or were treated with antibiotics.

Yeast infection rash is an irritated, red rash which can look dry or moist.

Babies with both irritant diaper rash and with a yeast infection tend to be fussy and may cry when they have a bowel movement, pass urine and when you change their diapers so it can be challenging to tell the difference when the yeast infection is mild.

Here’s what you need to know about diaper yeast infection:

The yeast infection rash will get worse even with good care. You’re keeping the diaper area dry and clean, you’re giving your baby diaper free times and you’re not using chemicals on your baby’s skin and the rash is still getting worse.

The rash and redness of the yeast infection will spread into the skin folds where an irritant rash won’t.

The diaper area affected by the yeast infection may have white cheesy material on it especially in the thigh folds.

A yeast infection rash will last longer than three days even when you do everything you can to make it better.

When to see the doctor

If your newborn has any of the above,  if the rash spreads outside the diaper area, or it oozes or bleeds you need to see your doctor as soon as possible. If your newborn baby has a temperature of above 100.4 F( 38C), develops blisters or pimples, or is acting sick please see your doctor immediately.

Make sure your doctor looks inside your baby’s mouth and at your nipples if you’re breastfeeding. Yeast infection can also affect your baby’s mouth in the form of thrush which looks like thick white patches on the inner surfaces of your baby’s cheeks that you can’t remove easily. The yeast infection can also be on your nipples if you’re breastfeeding making them red and irritated and possibly painful. If your baby has thrush or you have a yeast infection of your nipples it’s important that these get treated at the same time or else the yeast infection in the diaper area will not go away or will keep coming back.

How to treat a diaper yeast infection

Keep the area as clean and dry as possible. Gently wipe the area clean with each diaper change. Use water with soft paper towels or soft washcloths washed in dye-free, fragrance-free detergent. If you want to use commercial diaper wipes choose fragrance and alcohol-free wipes, the fewer chemicals you use on your baby’s skin the better. Avoid wipes that contain alcohol or chemicals like methylisothiazolinone because they can increase skin irritation.

If you need to use soap, use fragrance-free and dye- free soaps. Be aware that even natural substances like essential oils can cause irritation to newborn babies’ skin.

Next, let the area air dry or pat it dry. Rubbing the rash will irritate it more. If you can, give your baby diaper free times during the day. You can put a nice barrier underneath her ( in case of accidents) and use the time to bond with her. Make eye contact, talk to her or sing to her.

Diaper yeast infections are usually treated with antifungal ointments, Nystatin or Gentian violet. Your doctor will prescribe one of these or, if it’s available over-the-counter, tell you the best one to use. Follow your doctor’s directions and you should notice an improvement in the yeast infection within a day to a day and a half.

Talk to your doctor about using probiotics to help prevent further yeast infection in your baby.

There are many home remedies that are used for diaper rashes but there are no studies on their use or safety in newborns.

Once the yeast infection is gone, if you want to use diaper creams to prevent irritant diaper rashes, choose pastes or ointments rather than creams or lotions. Pastes and ointments are thicker so they offer more protection and they contain fewer chemicals than  creams and lotions. Good barrier substances are Zinc oxide, Vaseline, Desitin, triple paste, A&D or Balmex.

As always I would love to hear from you. What is your favorite home remedy for diaper rashes?

Have a Happy, healthy day,