Raising Children Network: the Australian parenting website
  • A-Z Health Reference
  • Suitable for 0-3Years

Nappy rash

 

Nappy rash is common and may occur despite the most careful attention to your baby. Almost all children wearing nappies get nappy rash at some stage.

When to see the doctor

Take your child to the doctor if:

  • the rash has not improved after three or four days, despite following the below measures
  • blisters, crusts or pimples appear
  • your child is distressed and not sleeping
  • your child has an unexplained fever
  • the rash is spreading
  • the end of your child’s penis is red and swollen, or has a scab on it.

In cultures where nappies are not worn, nappy rash is unheard of. Cloth nappies tend to cause fewer problems than disposables, which do not let air circulate as much. If possible plastic overpants should not be used for the same reason.

What causes it?

Various factors combine to cause nappy rash. The main cause is prolonged contact of a wet or dirty nappy with the baby’s skin. Ammonia may be released from the urine and this further irritates the skin. The use of plastic pants may make the rash worse because air cannot reach the skin and, as a result, moisture is retained. Associated conditions such as eczema or thrush may make the rash worse.

What are the symptoms?

The skin in the nappy region looks red and sore. Some areas of skin may be raised or swollen and there may even be ulcers present. Skin folds are usually not involved because they are protected from exposure to urine. The rash may cause discomfort or pain, which may make the baby irritable and cry more often.

How is it treated?

Simple measures will usually work and the rash will improve or disappear in a few days. A good course of action will include: 

  • changing nappies frequently: this keeps the area dry and gives the skin a chance to heal. You may have to check every hour or so to see if the nappy is wet or soiled. If it is, change it immediately.
  • letting the baby’s bottom ‘air’: expose your baby’s bottom to the air for as long as possible each day. Even during naps, you can leave the baby lying on an open nappy or a towel. Fasten nappies loosely, so that air can circulate freely.
  • cleansing the skin gently using lukewarm water and a mild soap: always rinse thoroughly and pat dry gently with a towel. Disposable wipes usually have alcohol in them which will sting the already raw areas. Cleansing with running water is preferable when possible.
  • using an appropriate protective cream after each nappy change: these can be purchased from the chemist without a prescription, but it is a good idea to check with your doctor or maternal and child health nurse. Do not use cortisone creams or ointments – these can all make the rash worse. If there is a secondary infection, your doctor may prescribe particular creams or ointments.
  • rinsing cloth nappies thoroughly after they are washed, to remove soaps. Bleach is most effective in killing bacteria, but make sure the nappies are rinsed. Ensure the nappies are quite dry before using them again.

Complications of nappy rash

Secondary infection can sometimes occur, especially thrush (fungus or yeast). These bugs are normally present on the skin, but are real opportunists and multiply when the chemical balance has been disrupted in their favour. Thrush appears as bright red and shiny areas in the napkin area; they have clearly defined borders and also affect the skin folds. Numerous red dots (satellite lesions) may be studded beyond the outer edge of the rash.

Treat with an antifungal cream which will be prescribed by your doctor. As opposed to a simple nappy rash, which clears up quickly, thrush can take longer to clear, and has a tendency to recur. Treatment can be prolonged, and sometimes very frustrating.

How can I prevent it?

If used consistently, the simple measures outlined above should help prevent nappy rash. Keep the nappy area clean and dry, and use protective sorbolene creams (often containing a zinc oxide base).