Dealing with Diaper Rash: Advice from Angela Freeman, Nurse Practitioner

Diaper rash is often one of the more elusive challenges for blind and visually impaired parents. Without sight, the parent most often relies on their tactile sense of touch to determine if their infant is indeed coping with this uncomfortable condition.

Peer Advisor and Blind Parenting Series Coordinator, Holly Bonner, interviewed Angela Freeman, MSN, RN, NP-C, regarding the medical facts and treatments available for combating diaper rash.

Meet Angela Freeman, MSN, RN, NP-C

Head shot of Angela Freeman

Ms. Freeman is a Family Nurse Practitioner board certified with American Academy of Nurse Practitioners. She received a Bachelors of Science with a concentration in biochemistry from Seton Hall University. She also holds her Bachelors of Science in Nursing, obtaining her BSN, from the prestigious Rutgers School of Nursing (formerly University of Medicine and Dentistry of New Jersey). After gaining experience in the Observation Unit of Community Medical Center in Toms River, NJ, she quickly moved into their Surgical Intensive Care Unit (SICU). Angela sought her Masters of Science in Nursing (MSN) from Stockton University while working full-time in the SICU. She became board certified in 2010 and began working in Geriatric Care at Monmouth Medical Center in Long Branch, NJ. Ms. Freeman currently practices as a Certified Palliative Care Nurse Practitioner (NP-C) for Hackensack Meridian Health, providing comprehensive symptom management for chronically ill patients. A wife and mother of two daughters, Angela has both professional and personal experience coping with the many challenges of motherhood.

Interview with Angela Freeman

What is diaper rash?

“Diaper rash is a form of skin irritation that develops in the diaper-covered region of an infant. It is also sometimes referred to as dermatitis, an inflammation of the skin.”

What's the most common age that diaper rash can occur?

“Diaper rash typically occurs in infants and children younger than 2 years old, with a majority of occurrences between 9 and 12 months. During this developmental period, babies are usually independently sitting in their diapers. They are also eating solid foods, which may change the acidity of the bowel movements.”

What are some of the "visual" and "non-visual" signs of diaper rash?

“Visually, red, patchy irritation is found on baby's skin in the genital area, the thighs, and/or the buttocks. The most common "non-visual" indicator is a change in your baby’s disposition. Your infant may seem more uncomfortable than usual during routine diaper changes. They may also cry or become increasingly fussy when the diaper area is washed or touched. This increased irritability is a good "non-visual" sign that there may be an issue with diaper rash. Another "non-visual" cue, some babies may develop flaking, dryness, peeling/scaling of the skin. It is also not uncommon for dry raised bumps, called papules, or fluid-filled raised bumps, called pustules, to occur. Blind and visually impaired parents should pay close attention to both behavioral and tactile indicators.”

How can you treat diaper rash?

“There are over the counter options in the form of ointments or creams that can help treat, relieve discomfort, and protect delicate skin. Those formulated with zinc oxide help aid in avoiding possible reoccurrence. Follow these steps for in home treatment:

  • At the first sign of slim irritation, apply a liberal coat of chosen diaper aid to the entire diaper area at every diaper change.
  • Keep skin clean and dry by changing wet diapers frequently and as soon as possible after it is soiled.
  • Wash the skin with tepid water using a washcloth after each diaper change. Gently pat the skin and avoid friction or rubbing. Avoid skin irritants such as soap or disposable wipes that contain fragrance or alcohol.
  • Allow skin to air dry without a diaper for short periods during the day
  • Some popular over-the-counter products include A+D, Balmex, Desitin, Triple Paste, and Lotrimin (for yeast infections).”

When should you take your baby or call the doctor?

“The following signs require you to seek help from a medical professional:

  • If the infant cries in pain when the diaper rash is touched
  • Fever
  • Signs of blistering or if rash begins to bleed
  • If the rash spreads to other parts of the body beyond the skin covered by the diaper
  • If the diaper rash does not improve in seven days despite treatment or reoccurs
  • If the diaper rash appears also to have a bacterial infection. Yellowish-colored crusting may, in fact, be impetigo and require antibiotic therapy
  • If you suspect the rash could be from an allergy
  • If the rash is accompanied by diarrhea continuing for more than 48 hours”

“Overall, if you have any doubt regarding the health and well-being of your child, call your doctor or take them to the nearest emergency room.”

When would you need prescription intervention for diaper rash?

“Diaper rash with a bacterial or yeast (fungal) infection will require a prescription. The area covered by a diaper is especially vulnerable because it's warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes can typically be found within the creases of the skin, and there may be red dots scattered around the creases. Treatments may include:

  • A mild hydrocortisone (steroid) cream
  • An antifungal cream, if your baby has a fungal infection
  • Topical or oral antibiotics if your baby has a bacterial infection.”

What preventative measures can parents take to avoid diaper rash with an infant?

“In my professional opinion, I would say the best methods of prevention are the following:

  • Diapers should be changed often.
  • If you use cloth diapers, avoid using plastic pants as this does not allow for air transmission.
  • Zinc oxide is very effective. Apply a diaper rash cream, lotion, paste or ointment to act as a barrier between your baby's skin and a dirty diaper with each change.
  • As a general rule, stick with products designed for babies. Avoid items containing baking soda, boric acid, camphor, phenol, benzocaine, diphenhydramine, or salicylates. These ingredients can be toxic for babies.”

What advice would you give blind and visually impaired moms about diaper rash?

“I would advise blind and visually impaired parents to first choose a pediatrician or medical practice that will work with you in the event your child is diagnosed with diaper rash. As stated, there are methods of intervention that will lessen but not totally eliminate, the chance your baby will develop diaper rash. If you can integrate these preventative measures with the support of medical professionals in your chosen pediatric practice, both you and your child will be better off. I would also encourage blind and visually impaired parents to be kind to themselves. Diaper rash can happen to any infant—including those with two sighted parents. Don’t waste time beating yourself up. Instead, learn from the experience and work to integrate the preventative methods into your daily routine.”

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