Our newborn's diaper rash keeps getting

Open sores in a newborn's nappy area that are getting worse despite frequent changes and barrier cream are the point to push for a second look — book the next appointment with your pediatrician (Monday the office opens at 8) and ask for a review of the sores themselves, not just a phone reassurance; that is a reasonable thing to ask twice, and I am not diagnosing anything here.

1. What you have tried vs. the levers actually left

• Frequent changes + thick cream: already the right first two moves, and the barrier layer works by sealing, so a thinner layer applied at every change often works better than a thick one that wipes off. That is a routine change, not a new medicine.
• Scented wipes: these are the one thing to retire now. Fragrance and preservatives are common irritants on broken skin. Water plus a soft cloth you already have is enough; rinse the area with plain water at the next change, pat dry with a soft cloth, let the skin sit bare for a minute or two, then the cream. A nappy that is only soiled does not need wiping at all.
• Open sores: the standard irritant nappy rash settles with the routine above. Sores that are spreading, weeping, or not starting to dry are the point where a clinician needs to look, because skin that has lost its surface is a different problem from a red bottom — and telling those apart by looking at a photo is not something either of us can do.
• Air time is free and helps: a few minutes with the nappy off on a towel, 3–4 times a day, while you are changing the baby anyway. Keep the nappy loose for a stretch rather than tight.
• What I cannot do: pick a different cream for you. Antifungal, steroid or antibiotic creams are the ones a clinician decides on and often a course, and buying them online or digging out an old tube changes what the next prescription should be. Nothing to put on the skin that is not already in your cupboard, and nothing your pediatrician did not suggest.

2. Avoid list

• No scented wipes, fragranced soaps, wipes "for sensitive skin", or anything new to test on broken skin.
• No leftover steroid, antifungal, or antibiotic cream from another child or an old box; nothing bought online for this.
• No powder, starch, or dry powder between the skin and the nappy, and none in the skin folds.
• Do not peel loose skin, pop blisters, or scrub the sores. Let cream and nappy do the work.
• Do not switch or dilute feeds, or start any new food or drop, while the skin is this broken — nothing about feeding will fix an irritant rash, and changing several things at once makes the picture harder to read.
• Do not stop nappy changes "to let it breathe". Air time is the break, the nappy change is the routine.

3. Red flags — stop home care and get clinical or urgent help

Go now, call your local emergency number, if any of these appear:

• The skin peels or sloughs in sheets, or blisters appear — this is not nappy rash and needs immediate assessment.
• Redness spreading beyond the nappy area onto the belly or thighs, hot, swollen, or much more painful than it looks.
• The baby is floppy, unusually sleepy, hard to wake, feeding poorly, or has fewer wet nappies than usual.
• Green or blood-flecked vomit, or a swollen, hard belly.

Same day, no waiting for the appointment:

• Any temperature of 38 °C or above, or a temperature that is low or drifting (a newborn does not always run hot when unwell).
• Sores that get bigger or more numerous within 24 hours, weeping, smelling, or crusting yellow.
• Waking at night with this, or the baby crying during changes.
• No sign of new sores drying by tomorrow evening — that is the "second look" trigger, and it is not a failure on your part.

Decision tree you can screenshot

1. Newborn, nappy area, open sores, getting worse → call the pediatrician office at 8 on Monday, ask for a same-day or next-day slot for the nappy area, and say in the first line: "open sores in the nappy area that are not healing despite frequent changes and barrier cream, and a cream you suggested is not settling it."
2. While waiting: water not wipes, pat dry, thin layer of the cream you already have, nappy loose, a few minutes air time at each change. Photograph the area once today and once tomorrow morning, same light.
3. Any red flag above → emergency number or same-day care, and do not wait for the appointment to be free.
4. Seen, and the clinician is happy with the home routine → keep the routine for 48 more hours and set the review point.

What success looks like in 24 hours — not a cure, just the three things that tell you the routine is working: no *new* open sores appearing, the existing edges looking drier rather than wetter, and the baby feeding and waking as they normally do. If all three are true you are on track and the appointment is confirmation, not an emergency. If new sores are still opening tomorrow, that is the clearest argument for the second look — and "it is not healing, here is the photo at 8am" is a completely reasonable thing to say to a pediatrician.

One question that changes the urgency: is the baby feeding and wetting normally today, and do you have any temperature reading at all?

Nothing here is a diagnosis and I am not changing anything your pediatrician prescribed. If you tell me which country or city you are in, I can point you to the official route for a second opinion outside the office.