Diaper rash is normally caused by irritations or allergies. When it is caused by irritations, it is usually because the diaper has been on too long or the urine/stool is especially acidic. Sometimes oranges, raisins, peanuts, candy, or other foods cause irritations because they are not digested well and large pieces survive in the stool. Or a harmless diaper that has been on all night, too tightly lodged in pants, or sat on for too long can cause diaper rash.
In other cases, the baby is actually allergic to a food or liquid ingested. They may have seemed fine upon eating/drinking, but as it moves through the bowels, it causes a problem. Sometimes there is severe cramping while trying to go. Sometimes there is diarrhea. Sometimes there is blood in the stool. (There shouldn’t be a lot, but there can be patches or a general red tinge all over). Sometimes the stool just smells really “off” (like a horse or strangely pungent). But a key sign of allergy is a diaper rash that bleeds when you wipe it. There may be little dots or blemishes on the skin which are extremely sensitive and tender so that the child screams when you wipe them or arches their bum up and away from you. Or they might clench their little buttocks together hard so you can’t wipe in there… all are signs that whatever they ate caused a bad enough reaction that you should take that food/drink out of their diet.
In our children, milk and orange juice were common culprits. If my second-born toddler had any citrus product, he would get this type of thing for several days on end. It was a hard cycle to get out of because he would have continual loose stools which required lots of wiping, but the wiping caused bleeding and open stings. In my fourth child, she had this reaction to milk products until she was about fifteen months old. I have heard of peanuts, wheat, and berries causing this type of reaction too—all highly potential allergens.
This doesn’t mean you can’t try these food again, it just means the little system is currently unable to handle them. Many babies have allergic reactions to peanut butter in the first year, for example, but eventually outgrow it in the second year. The same thing for milk/yogurt. Wait a couple months and try again later (with a SMALL amount, waiting for at least one diaper response. Take a weaning approach, and be patient.
Allergic reactions can also occur if the child is having a particular food too often. A child who is not truly allergic to peanut butter or bananas, for example, can develop an allergic reaction with loose stools and tender red rashes if they are eating those foods every day. As soon as you back off the dosage, they go back to normal. Varying the kind of peanut butter (almond, cashew), or other offending product, can help prevent allergic reactions.
In these types of cases, take advantage of what I call “pre-emptive diaper rash.” Before it breaks out in bumps or bloody blemishes, the skin sometimes just gets all red like a sunburn. The child exhibits sensitivity to being wiped, but if you can eliminate the offending food/liquid then (or you only served it in small amounts), and lather on some balm, you avoid the full-fledged diaper rash problem that sometimes takes days to heal. Most zinc-oxide ointments do fine at this stage.
But if the rash is full on, you’ll need a real ointment to keep the area protected in the diaper. Aquaphor is the best because it is really thick so it prevents irritation from the next urine/bowel. Try to keep liberal amounts of Aquaphor on the rash itself and after a few successful diapers with no stool in them, you should see some progress.
Use Pampers wipes for Sensitive Skin. They are dye-free, perfume free, and the softest kind available. Huggies or generic wipes will be too rough on a delicate rash.
Be aware that super-cleanness is also necessary for the area to heal. Getting every little spot pristine is difficult if the baby is experiencing lots of loose stools and pain during wiping. You’re tempted to back off and leave their little parts alone. But the area must stay entirely clean or parts of their stools will continue to irritate the skin and sting any open places.
Also be aware that open air is one of the best things for them because “hanging loose” keeps fibers from brushing up against and irritating the skin further. Obviously you can’t just let your baby go diaper-free for very long unless you have grass instead of carpet! But it does speed the healing, so try it for awhile on a towel, in the bathroom, or on the lawn if you live in a warm climate. Or you can try a disposable diaper loosely pinned instead. I used to let my older toddler go around with no diaper but sweatpants on for an hour since I knew he could avoid peeing for short amounts of time.
The last ingredient to healing is dryness. Change the diaper often and try to keep the area as dry as possible. Avoid strenuous wiping, or skip the wiping whenever possible. Use a “dabbing” motion when wiping instead of the usual “swiping” gesture, and pat the bum dry with a tissue or toilet paper. Bathe normally to keep the area really clean or soothe, but don’t bathe to heal the rash specifically–it doesn’t work. Baking soda can help the sting if you suspect it, but after baths, make sure you get all the little skin folds dry so irritated areas don’t chafe or breed bacteria.