Troubleshooting – Cloth Diapers for Beginners

To even better understand diaper rashes, I recently interviewed Dr. Lyndsey Garbi, the Chief Pediatrician of Blueberry Pediatrics. Dr. Garbi is a board-certified Pediatrician and Neonatologist who graduated from Emory University and attended the Sackler School of Medicine. She loves working in medicine and using technology to connect the parenting world with the doctor world. You can skip to the end of the article here to learn more about her and Blueberry Pediatrics. With my six years of experience speaking to moms and researching topics around cloth diaper rashes, combined with her expert help, I've put together this guide to help you prevent, start initial treatment for, and know when to see a pediatrician for your baby's diaper rash. Important note: This article is for information purposes only. It exists to help you with rash prevention and give you a better understanding of diaper rashes so that when you discuss your baby's rash with your pediatrician you're more informed.All rashes that don't clear up quickly, or that are recurring often, should be checked by a pediatrician to ensure they are manageable and do not require medical attention and/or medication. Never, ever, take another mom’s advice or an online article's sayso over the expert opinion of a medical professional who has spoken to you about your baby's health. When in doubt, always check with a pediatrician! Can Cloth Diapers Cause Diaper Rash? The most common question I get from parents who are considering cloth diapers is if cloth diapers cause diaper rashes. This is a strange question, and what I think they mean to ask is if diaper rash is more common in cloth diapers than disposable diapers. The answer is no, cloth diapers do not cause more diaper rashes than disposable diapers. While Dr. Grabi doesn't have many patients that use cloth diapers, she agrees that cloth diapers do not cause more rashes than disposables. "Diaper rashes are less frequent with cloth diapers," She said. "Just less frequent, but it’s the same rash." "Diaper rashes are less frequent with cloth diapers." Dr. Lyndsey Garbi, Chief Pediatrician of Blueberry Pediatrics In my own experience, I've seen many more parents gravitate to cloth diapers to get rid of rashes caused by the chemicals and plastics in disposable diapers, so it's nice to have this frequency question confirmed by a professional. What Causes Diaper Rash Even though diaper rashes are less common in cloth diapers, they still happen and need to be cleared up. I see so many parents in the cloth diaper community jump to the conclusion that their baby's rash must be caused by a cloth diaper wash issue. This is a dangerous assumption because it may lead you to change a wash routine that's working for one that's not, and the result could be making the rash worse or causing a new type of rash. So, what causes diaper rash? The truth is that there are a ton of things that can cause a diaper rash, like moisture, food sensitivities, allergies to detergents, fungal growth, allergies to synthetic fabrics, and, yes, cloth diaper wash issues, among other things. According to Dr. Garbi, the most common cause of diaper rash is, "Sitting in urine or poop for a prolonged amount of time, or reactions to certain baby wipes or products." Typical Diaper Rash Prevention With so many possible causes, it's no wonder why diaper rash is common. "Almost NO baby gets away with not having diaper rash," Dr. Garbi said. With that in mind, there are some things we parents can do to prevent diaper rash. Dr. Garbi highlighted the importance of frequent diaper changes again here, and the use of a good diaper cream. Diaper Creams With Cloth Diapers "We say to use the ointments as if “icing a birthday cake” - good barrier and selection of the right ointment is key," She said. Coconut oil is a fan favorite of the cloth diaper community. While Dr. Garbi confirmed coconut oil is in fact a nice way to try and prevent a rash and helpful for minor rashes, she said that usually, zinc-based products work best. If you've been around this site for a while you may know I've been testing different creams for "cloth diaper safeness" as zinc and petroleum creams are a bit of a grey area when it comes to how they affect the absorbency of cloth diapers. You can follow and watch my cloth diaper cream experiments here, but to summarize the current findings, zinc and petroleum creams are fine to use on natural fiber diapers (cotton, hemp, bamboo). However, if you're using synthetic pocket diapers consider using a fleece liner as the absorbency testing on those fabrics is still being done. Anecdotally, zinc does stain and begin to repel with repeated use on synthetic fabrics like pocket diapers, and petroleum can cause repelling; so better safe than sorry and use a liner with your pocket diapers. Reading Product Labels of All Baby Products In addition to frequent changing and a good barrier cream, Dr. Garbi said to consider the ingredients in your baby products as well. "Use natural products with as few chemicals in them as possible (make sure you check ingredients!). Not all products that are marketed for “kids” are good for them," She said. Minor Diaper Rash Treatment When Using Cloth Diapers Despite your best efforts at prevention, if a rash does happen (and it likely will), the good news is that most diaper rashes are minor and can be cleared up quickly. "It depends on how it's being treated, but a diaper rash will usually go away in a few days," Dr. Garbi said. These minor diaper rashes, which again are usually caused by urine or waste being in contact with the skin for too long, can often be cleared up with some good at-home remedies, including: A good diaper cream. A good zinc barrier cream will usually clear a minor diaper rash quickly. Once again, you can read all about cloth diaper cream use in cloth diapers and watch my absorbency experiments with them here, but what you need to know is that using a zinc or petroleum cream with your cloth diapers is fine as long as you're either using it with natural fiber inserts (cotton, hemp, bamboo) or using some DIY fleece liners. "Stay-dry" liners. Speaking of fleece liners, they can also help soothe minor rashes. Microfleece is great at pulling moisture away from the skin, giving baby a nice "stay-dry" feel. Liners can not be used in lieu of changing as soon as your baby is wet because the urine will still get on the liner, but it will give you enough time to catch that wet diaper and help alleviate some of the discomforts of a rash. Baths. Keeping your baby clean will help the area heal. "Air-time." Giving your baby a few minutes of diaper-free time in between changes can also help as it will allow the skin to air out a bit, so it's not always in the humid conditions of a diaper. When to Call a Pediatrician "If their first line go-to cream isn’t helping, if it looks worse, if it’s causing discomfort to the child, if the parent is not comfortable with handling it alone, or if it looks fungal - contact your pediatrician," Dr. Garbi said. "If their first line go-to cream isn’t helping, if it looks worse, if it’s causing discomfort to the child, if the parent is not comfortable with handling it alone, or if it looks fungal - contact your pediatrician."DR. LYNDSEY GARBI, CHIEF PEDIATRICIAN OF BLUEBERRY PEDIATRICS Yeast Diaper Rashes Candida albicans. Another type of diaper rash that parents may encounter is yeast diaper rash. Dr. Garbi explained that yeast diaper rashes are very common, though not as common as diaper rash without yeast as the cause. Yeast rashes require different treatments than other rashes, which I'll cover below, but first, let's talk about what a yeast rash looks like. What Does a Yeast Rash Look Like? A yeast diaper rash usually looks different than a typical moisture rash. "The skin is red with some red dots slightly outside the main red area -- we call them 'satellite lesions,'” Dr. Grabi said. Yeast Rash (Mild)Yeast Rash (Severe) How to Prevent a Yeast Diaper Rash Just like other types of diaper rash, the best prevention is keeping baby clean and dry. "Yeast rashes are caused by wet and damp areas, that’s where yeast like to grow in," Dr. Garbi explained. She added that the good practice of changing diapers quickly and treating any red areas as soon as you see them will help prevent yeast rashes. If you're just starting with cloth diapers and are having a tough time figuring out when to change baby without that blue line, here's an article with tips to help you "feel" when baby is wet. How Can a Yeast Rash be Cured? If, despite your best efforts, baby does end up with a yeast rash, anti-fungal medication will be needed. Some are over the counter, some need a prescription, Dr. Garbi said. Though I ALWAYS direct parents who suspect a yeast rash to seek the help of a pediatrician, Dr. Garbi told me that a yeast rash doesn't always need the confirmation and care of a pediatrician. "Using an antifungal without the guidance of a doctor is possible," She said. "But it helps to have someone know what it looked like at baseline, to guide on the use and length of medicine." Care of Your Cloth Diapers During/After a Yeast Rash Not sanitizing your cloth diapers properly following a yeast rash can leave yeast candida spores on the surface of the cloth diaper. According to the Government of Canada Pathogen Safety Data Sheets on Infectious Substances, "C. albicans can survive on inanimate surfaces for 24 hours to 120 days, and on palms for about 45 minutes. Albicans has been isolated from bed sheets, cots, and wash-basins of nurseries, and it has also been found to be able to survive and grow in distilled water at room temperature. The fungus can survive on drying in darkness for 5 hours, and 1 hour if also exposed to light." (Source). To ensure you're removing the yeast spores from your baby's cloth diapers I (and most others in the cloth diaper community) recommend washing them thoroughly using hypochlorite bleach, which is a potent biocide, and then drying them in the sun. Typically, the "just to be safe" recommendation is to continue to use bleach and sun-drying with your cloth diaper wash for two weeks after the infection has cleared. This will make sure any random spores left on the skin aren't allowed to multiply on a wet diaper that has been used right after washing (reinfecting baby). To bleach your diapers, follow the directions here. Other Causes of Diaper Rash As I mentioned at the top of this article, there are in fact some other causes of diaper rash, like food, product, or fabric sensitivities, and wash issues. Though these types of rashes are less common, it's important to be aware of them so that when you're looking for the cause of a rash, you'll know all the possibilities. Here's a quick list of the other causes of diaper rash I encounter regularly: 1. Food Sensitivities Your baby is trying all kinds of new foods and the like as they grow. Even if that food sits well with their tastebuds, it might do a number on their skin when it comes out. Anecdotally, this was the case with my daughter. After being unable to pinpoint the cause of her rashes, which flared up after each stool no matter how fast we changed her, I began a food journal that eventually led me to find the cause - yogurt. Starting a food journal and discussing any findings with your pediatrician is a painless way to monitor this for yourself, and maybe worth a shot, especially if it's only feces that is causing the rash. 2. Detergent Sensitivities Every detergent seems to have a proprietary chemical or two, so it's very possible that a new detergent can cause a reaction. Switching detergents may be necessary now and then, but be sure to make a mental note of what you're washing when you make a switch, so that if a rash develops you'll be able to tell if that's a possible cause or not. A note here that some skin reactions written off as detergent sensitivities, may actually be caused by using too much detergent. Make sure to carefully consider how much detergent you're using in your laundry, especially your cloth diaper laundry. More info on how to measure your detergent for cloth diapers is available here. 3. Product Sensitivities As Dr. Garbi pointed out earlier, not all products that are marketed for babies or kids are free from chemicals that can cause reactions. Make sure to watch carefully every time you change baby products like body wash, shampoo, diaper creams, etc., etc. And don't forget to read those labels! 4. Problems With Your Wash Routine - Diapers Not Getting Clean Yes, problems with your wash routine can lead to diaper rashes. This makes a whole lot of sense because if a diaper isn't cleaned properly, that means there is still waste or ammonia on the diaper, which means your baby's skin is basically sitting in that waste all the time. Creating a wash routine that carefully measures the amount of detergent you use according to your diaper laundry load size, your washing machine size, your water hardness, and your preferred detergent, is VITAL! Too little detergent, and there won't be enough to wash the waste away. Too much detergent, and you won't have enough water to rinse the detergent (and the waste it picks up) away. For step-by-step instruction on how to create the perfect wash routine, click here. 5. Problems With Your Wash Routine - PH Imbalance. In addition to problems with diapers that aren't clean, ph imbalances from diapers that have been bleached after ammonia buildup can also cause skin irritations. If you've bleached your diapers to "remove" ammonia smell from your diapers and now your baby has a rash, first consider doing a vinegar rinse to immediately lower the ph of your diapers, and then read this article about ammonia buildup to address the root cause of the problem without bleach. Need a Pediatrician's Help With Your Baby's Rash? Consult With Dr. Garbi and her Blueberry Pediatrics Team As I mentioned at the top of this article, Dr. Garbi is the Chief Pediatrician of Blueberry Pediatrics. She is a board-certified Pediatrician and Neonatologist. Dr. Garbi helped create Blueberry Pediatrics from the ground up to provide easy and affordable access to high-quality medical care to parents from the comfort of their homes. When I needed a pediatrician's help with this article, I went searching for one that is available for consultation, and quickly landed on Blueberry Pediatrics. And to be clear, they did not contact me or sponsor this post, I literally found them through Google and asked for an interview. I was immediately intrigued with them because I know some of our readers have a hard time getting their baby's rashes looked at, especially during COVID, and I think Blueberry Pediatrics may be able to help a lot of you through their app. Additionally, the Blueberry team created the promo code "BEGINNERS21 " (NOT an affiliate code, Dr. Garbi is just awesome) that will give anyone who uses it a free welcome kit ($100 off the welcome kit, which actually makes it really inexpensive to join). What is the Blueberry Pediatrics App? Blueberry Pediatrics’ app gives parents peace of mind with 24/7 virtual access to board-certified pediatricians, providing immediate health care for their kids at one low cost. Like having a “pediatrician in your pocket,” Blueberry’s affordable membership makes it easy for parents to get their children quality medical care without having to go into a doctor’s office - no matter the issue. From diagnosing illnesses, prescribing medication and providing advice for any concerns parents might have, Blueberry’s pediatricians offer parents comfort, peace of mind, and a higher level of protection for their children. How It Works: Become a Member: Once parents select their preferred membership type and create their children’s profile, a call will be scheduled with Blueberry’s Chief Pediatrician, Dr. Lyndsey Garbi, who will introduce the Blueberry pediatric team. Diagnosis & Treatment: Whether it’s a minor question about breastfeeding or sleep training, late-night illness, or, in rare cases, a serious enough situation to warrant an emergency room visit, Blueberry has you covered. A friendly, board-certified pediatrician will happily answer all and any questions, big and small, within 15 minutes, even in the middle of the night.Medical Kit for Immediate Diagnoses: Using the home medical kit parents can send images and vitals with their request, so their pediatrician has the same diagnostic information they would get in an in-person exam.