Q&A: What should I do about diaper rash caused by my baby's daycare center?

There are two parts to your question that I want to be sure to answer—the first regarding diaper rashes in general, and the second pertaining specifically to diaper changing in childcare.

I always start out diaper rash conversations by clarifying that diaper rashes are so-called simply because they occur in the diaper area, not because diapers are necessarily to blame for every rash that occurs. In fact, modern-day disposable diapers are typically designed to minimize diaper rashes by keeping urine and moisture away from the skin. The other important point to make is that there are two main categories of diaper rashes: those caused by irritation and those caused by yeast (or other) skin infections. Infrequent diaper changes can contribute to an increased likelihood of diaper rashes—both because they allow skin irritants (in other words, pee and poop) to have more/longer contact with the skin and because a soaked and/or soiled diaper also provides the moist environment in which yeast love to grow/spread.

When it comes to diaper changing in childcare, I happen to have some extra expertise on the subject, as I am not only a pediatrician but the owner of a 200-student educational childcare center. While I can't tell based on the information you've provided in your question whether or not your son's diaper rashes are truly the result of infrequent diaper changes (which they may or may not be), I would recommend to all parents with children in childcare that they take the time to inquire about diaper changing policies and procedures (not to mention other important health and safety policies and procedures).

Established diaper changing recommendations in childcare should include checks for wetness and/or soiling every hour or so simply by feeling the diaper through a child's clothing. However, a more careful check that includes looking in the diaper should be done every couple of hours, with the diaper changed if there's any pee or poop. This schedule can admittedly be challenging in the childcare setting—especially when a single caregiver is responsible for tending to more than a couple of children. That's why it's particulary important to see/ask your childcare provider(s) if they have a set diapering routine/schedule, and even request that each diaper change be written down for you to see at the end of each day. While you're taking the time to discuss and assess your childcare provider's diaper changing schedule, don't forget to double check other important diaper changing aspects, including that:

• diaper changing area is safe,
  
• hands—both your childcare provider's and your child's—are washed after diaper changes.
• gloves are ideally being worn and a new/clean paper liner is being placed under each child for each diaper change
• diaper changing surface is appropriately cleaned between changes
• dirty diapers are removed and disposed of without contaminating any other surfaces

Parents who take the time to partner with childcare providers in reviewing diaper changing policies and procedures can really help to insure that everyone is on the same page, and that realistic and appropriate measures are being taken to minimize the chances of future diaper rashes.