You've heard it said that you don't even need rash cream for cloth diapers because they're great for sensitive bottoms. This is absolutely true for most babies. However, once in awhile a child just has super sensitive skin and even with cloth diapers they get frequent rashes and breakouts. This was the case for my daughter.
It wasn't always the case, though. For about the first year of her life, we never saw a rash and never touched any rash cream. Then, when she started going to daycare once or twice a week and bringing home all sorts of viruses and bugs, and she picked up Hand, Foot, and Mouth Disease. If your child has had this bug, you know that it can come with a rash on the bottom as well as the obvious hands, feet, and mouth. Unfortunately, having this bug gave her skin that was suddenly super sensitive and susceptible to rashes. In fact, we went from having never used the rash creams given us when she was born, to having a couple huge, week-long rashes a month. Over the course of the next year, we definitely found different diapering solutions that helped her case and found that we needed to be very flexible with the different types of diapers we chose to use.
We also discovered a couple of the causes for rashes on sensitive skin.
One major cause of diaper rash for babies with tender skin is the type of detergent you use. If your child is having diaper rash and you're not sure why, try switching detergents and see what happens. We always used Ecos, which is an all natural detergent with natural ingredients that we found at Sam's Club in bulk for super cheap. It seemed to work fine and wasn't the cause of my daughter's many diaper rashes. But it might not work for your baby. I would buy a couple samples of different cloth diaper detergents to see which your baby reacts best to.
Another thing that can easily cause diaper rash is buildup on your diaper. This buildup can be from any number of things: rash creams not intended for use with cloth diapers, the wrong kind of detergent, not enough rinses, not enough water in the machine, fabric softeners, hard/soft water issues, or simply urine/ammonia buildup that occurs gradually over time. Build up can be remedied by stripping your diapers, and sunning them can help as well. Stripping usually involves adding extra, hot rinses with no detergent, or even handwashing your diapers in Dawn dish soap until there are no bubbles. In any case, you need to find a way to get rid of this build up.
Yeast in diapers
If your child gets a fungal infection that causes their rash the yeast can remain on those diapers and cause your baby to get reinfected, even if you've managed to clear up the rash. Some of the time that my daughter struggled with rashes, I suspected that yeast may have been the problem, thanks to the Hand, Foot, and Mouth Disease. You can soak and wash your diapers in something like Bac Out, which should kill that yeast, and you can also sun your diapers. In any case, it probably won't be a one and done deal. Until both your baby's bottom and the diapers are all cleared up, the yeast rashes will continue to appear because the diapers and your baby will reinfect each other until both are free and clear of yeast. I'd probably continue washing the diapers with Bac Out and sunning them for about a week after my daughter's rash appeared.
Sometimes, the fabric of your diaper may be the problem. Your child may not do well with synthetic fibers, in which case you may have to stick with things like cotton or hemp instead. So try a different kind of diaper for a while and see how your baby's bum reacts.
Another of my favorite rash-busting cloth diaper solutions was to put breatheable diapers on Bunny. It wasn't uncommon to find her wearing a fitted diaper without a cover. There were even occasions where we put her in flats or prefolds coverless--but I wouldn't recommend that unless your baby has already pooped for the day because the lack of fitted legs means that little turds can find their way all over your house if you're not careful. When we were out of the house, I covered those breatheable diapers with wool or fleece covers. Just giving her that little bit of breathability worked wonders. Besides, going coverless makes you totally and completely aware of exactly when your baby has soiled their diaper.
Do you use rash creams? If not, why not trying something like CJ's BUTTer Diaper Cream or Grovia's Magic Stick (our ointment of choice). If you already use rash creams, how about switching brands for awhile? Try something with different ingredients. Or, try something all natural like pure coconut oil or olive oil. You can also use a non-cloth diaper safe rash cream as long as you use a liner to protect your diapers. Or nix the rash creams altogether and see if maybe your baby's bum is just crying out to be free from any ointments.
A handful of times during my daughter's diaper days, I put her in a disposable diaper and doused her with a heavy layer of traditional Desitin or some other widely commercialized rash cream. This may work for your child, but I found that putting her in a disposable diaper only exacerbated the situation.
A lot of the time, my daughter's rash happened if she wasn't changed immediately. I figured this out rather quickly and always changed her diaper quite promptly, but just one incidence at daycare or in the church nursery where someone let her sit in her poop for more than a couple of minutes was enough to give her a rash that took a week to clear. For us, the simplest solution to prevent these rashes was to change her diapers frequently. If we could help it, she never sat in her diaper once it was soiled and as long as we kept up with that, her bum was happy.
Potty train ASAP
Finally, I decided to force potty training. I felt that I just needed to get Bunny out of diapers as soon as possible. It wasn't that we couldn't find solutions for her rashes, but if we missed just one soiled diaper, then she was cracked and raw for a week and it was just so painful for her. So we put her through a "potty training bootcamp" the day after she turned 2 and effectively eliminated all diaper usage in about a month and a half, which meant she never had a rash again!
I came to the conclusion that I don't think I could have survived Bunny's sensitive skin if we'd been using disposables. I couldn't imagine having all those harmful chemicals up against skin that was already so delicate. Despite the fact that once the rashes started it was definitely a challenge to find solutions to clear them up, I feel that cloth diapers definitely made the task a lot easier and gave us lots of different solutions to try. I still stand by the fact that cloth diapers, in and of themselves, are the best diaper rash remedy!