Nappy rash is very common in babies and toddlers who wear nappies. Prevention and treatment of nappy rash can be challenging, especially for babies who have very sensitive skin.
Nappy rash can appear quickly, almost between nappy changes. However, it can also clear up pretty quickly, especially with more frequent nappy changes and using a barrier cream, or nappy rash treatment.
What causes nappy rash?
There are a few main reasons for nappy rash, but the main one is when there is a loss to the skin barrier function. The most common cause is when the baby’s skin is exposed to the enzymes contained in their wee and poo, so their skin becomes wet and irritated.
Another name for nappy rash is irritant contact dermatitis. This is because irritants, wee and poo, cause the skin to become inflammed and red.
What does a nappy rash look like?
Nappy rashes tend to be on the skin covered by the nappy. Warm, moist environments are ideal for skin conditions to occur.
Other causes for nappy rash:
- A baby’s sensitive skin and potential to easily react to irritants.
- Friction between the nappy and the baby’s skin.
- Plastic coverings from waterproof pants.
- Toiletries including soaps, detergents, chemicals, fragrances, plant and food products (when the baby is eating solid foods).
- Some disposable baby wipes, especially those with a built-in fragrance.
- Skin conditions such as eczema, dermatitis or impetigo.
- Colonization with micro-organisms, commonly Candida albicans (thrush). NB Babies who have a skin infection caused by thrush are at increased risk of also having thrush in their mouth.
- A recent course of antibiotics. These may cause diarrhoea and a secondary thrush infection.
- Some babies develop a nappy rash when they are teething.
- Particular foods, especially those which are more ‘acidic’ such as tomatoes, strawberries and citrus fruits.
How can I prevent my baby getting nappy rash?
Change your baby’s nappies frequently. Newborn babies need to have around 12 nappy changes each day and older babies at least 6 changes/day.
- Avoid using plastic over pants on your baby.
- Consider changing the brand of nappies you’re using on your baby if you feel this may be contributing.
- Allow your baby to have as much nappy free time each day as possible.
- Clean their skin gently, but thoroughly, at each nappy change.
- Avoid using powder in your baby’s nappy area.
- Apply a good quality barrier cream or baby rash cream at each nappy change.
How will I know if my baby has nappy rash?
You may not know your baby has a nappy rash until you take off their nappy to change them. Some nappy rashes are irritating and cause the baby to become unsettled. Others don’t seem bothered when they have a nappy rash at all. Often, wee and poo causes irritation to the skin which is one reason for frequent nappy changing.
Nappy rash looks like:
- Red spots on the baby’s skin which has been in direct contact with their nappy.
- Red skin in their skin folds. Sometimes the skin within the folds is shiny.
- Scaling and swelling of the skin.
- Red spots and sometimes ulcers of the skin.
- Small pimples and/or pustules – these can mean a thrush infection.
What is the treatment for nappy rash?
Most treatments for nappy rash are based around more frequent nappy changing. No matter what the cause, the skin tends to improve if it is kept clean and dry.
Use warm water with a soft cloth to clean the skin at every nappy change. Water wipes can be helpful.
Pat the skin dry, or allow it to air dry. Be very gentle as nappy rash can be painful.
Allow as much nappy free time as possible. Lay your baby on a towel or rug and allow them to move about freely.
Give your baby a bath at least once each day. Use warm water and a fragrance free baby wash or cleanser. Check any wash is pH neutral, around 5.5 is ideal and formulated for babies.
Avoid using any soaps and bubble baths. Even shampoo diluted in bath water after rinsing can be irritating.
Apply a thin layer of barrier cream on your baby’s nappy rash at every nappy change. Warm it between your fingers before applying onto your baby’s clean skin. Doing this will help to avoid their skin ‘dragging’ as you’re putting the cream on.
When you change your baby’s nappy, clean off any wee or poo and then apply another layer of barrier cream over the top.
Make sure you wash and dry your hands well after changing your baby’s nappy. It’s easy for cross infection to happen.
What is the best cream to use for my baby’s nappy rash?
You have a lot of choices around what type of nappy rash cream you use for your baby. However, most rashes respond well to any of these:
- Zinc cream. If your baby’s rash is not improving to standard cream, zinc creams with a higher concentration can be effective.
- White, soft paraffin or petroleum jelly/cream.
What can I do if my baby’s nappy rash isn’t improving?
Take your baby to be seen by a doctor. Sometimes specific nappy rash treatment creams are needed for nappy rash which is not responding to simple treatments. Hydrocortisone ointment is one option. Other nappy rash treatments include creams which contain anti-thrush agents, or combinations of zinc/hydrocortisone/fungal agents.
Many parents take a photo of their baby’s rash as a way to gauge any changes, especially when using a new nappy rash treatment.
You can also speak with a pharmacist or Child Health Nurse about your baby’s nappy rash.
Written for Sudocrem by Jane Barry, Midwife and Child Health Nurse, September 2024.
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