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Diaper Rash—Child Care and Schools

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What is diaper rash?

Red and irritated skin in the diaper area. There are many causes. The most common are fungal, irritant contact, and seborrheic dermatitis.

  • Fungal diaper rash is caused by a yeast called Candida albicans. It can happen naturally, or commonly during or after a course of antibiotics.

  • Irritant contact dermatitis is caused by skin rubbing against a wet, soiled diaper.

  • Seborrheic dermatitis does not have a clear cause but may also be due to a fungus called Malassezia.

What are the signs or symptoms?

  • Redness in the diaper area.

  • Fungal

    • Rash is worse in the skinfolds (creases) within the diaper area.

    • Redness often bordered by red pimples ("satellite lesions").

    • Rash may have a shiny appearance.

    • Sores or cracking or oozing skin present in severe cases.

  • Irritant contact

    • The rash spares the creases and emphasizes areas in contact with the diaper (inner thighs, genital areas, and buttocks)

    • Absence of satellite lesions

  • Seborrheic

    • Red, greasy scales in diaper area. May also be located on scalp, face, ears, and neck.

What are the incubation and contagious periods?

  • Incubation period for fungal diaper rash: Unknown.

  • Contagious period: The yeast that infects the diaper area is widespread in the environment, normally lives on the skin, and is found in the mouth and stool. Candida diaper rash may occur with or following antibiotic use. Repetitive or severe Candida diaper rash could signal immune problems.

How is it spread?

  • Yeast

    • C albicans is present in the intestinal tract and mucous membranes of healthy people.

    • A warm environment (eg, diaper area) fosters growth and spread.

  • None of these causes of diaper rash are spread from one child to another.

How do you control it?

  • Use good hand-hygiene technique at all the times listed in Chapter 2.

  • Candidal (yeast) diaper rash: Treat with an antifungal cream so the quantity of yeast in any area is reduced to levels the body can control.

  • Contact/irritant diaper dermatitis: Keep the skin dry and reduce irritation through friction from rubbing of a diaper or other clothing. Avoid soaps or wipes that contain fragrance. Frequent diaper changes, air exposure, or avoiding rubbing of material against the involved skin may help.

  • Seborrhea: Treatment with antifungal cream or shampoo may help.

What are the roles of the teacher/caregiver and the family?

  • Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of ill children. That person, in turn, alerts the parents/guardians so they can seek treatment for the child.

  • Administer prescribed medication as instructed by the child's health professional.

Exclude from group setting?

No.

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.