Nappy rash

Causes

Many things can combine to cause nappy rash in your child. The main cause is wearing a wet or dirty nappy for too long. Prolonged dampness, friction and ammonia substances released from urine can irritate your child’s skin.

Plastic pants often make the rash worse because they stop air circulating normally and keep the nappy area damp. Soaps and detergents left on cloth nappies after washing can also contribute to nappy rash. Sometimes children also have other conditions such as eczema or thrush, which might make nappy rash worse.

Nappy rash doesn’t happen in cultures where babies don’t wear nappies.

Symptoms

The skin in your child’s nappy region will look red and sore. Sometimes the rash might go up onto your child’s tummy and bottom. Some areas of skin might be raised or swollen, and there might be some ulcers. The skin folds aren’t usually involved because urine doesn’t get onto them.

The rash can cause discomfort and pain, which can make your baby irritable.

When to see your doctor

You should take your child to the doctor if:

• the rash hasn’t improved after 3-4 days, even when you use the treatment steps suggested below
• blisters, crusts or pimples appear
• your child’s upset and not sleeping
• your child has an unexplained fever
• the rash is spreading
• the end of your son’s penis is red and swollen, or has a scab on it.

Treatment

Simple measures are often the best. The rash will usually improve or disappear within a few days of following these steps:

• Change your baby’s nappies frequently. This keeps the nappy area dry and gives your child’s skin a chance to heal. Check your child every hour or so to see if the nappy is wet or soiled. Change wet or soiled nappies straight away.
• Let your baby’s bottom ‘air’. Give your baby’s bottom air for as long as possible every day. You can leave baby lying on an open nappy or a towel (naked from the waist down) even while he’s sleeping. You can also try fastening his nappy loosely, to allow air to circulate freely.
• Clean your baby’s skin. Use lukewarm water and a mild soap to wash your baby’s skin. Rinse the skin thoroughly and gently pat her dry with a towel. If using disposable wipes, make sure they don’t contain alcohol, which will sting the raw areas. Use running water to clean your baby where possible.
• Use an appropriate protective cream after each nappy change. Apply a simple cheap barrier cream (for example, zinc and castor oil, vaseline jelly) thickly with every change. You can get these creams from a supermarket or your chemist without a prescription. Talcum-based powders aren’t recommended for nappy rash, because accidentally breathing in a puff of talcum powder can cause breathing difficulties in babies.
• Rinse cloth nappies thoroughly after they’re washed. This gets rid of soap residue in the nappy. Bleach is most effective for killing bacteria, but be sure to rinse the nappies well in fresh water after using bleach-based detergents. Ensure the nappies are quite dry before using them again. Avoid plastic overpants if you’re using cloth nappies.
• For severe or prolonged cases of nappy rash, your doctor might also recommend using cortisone creams or ointments (hydrocortisone 1%) if the rash stays red and hasn’t improved with simple measures. Creams containing steroid medication (for example, hydrocortisone) shouldn’t be used for more than 3-5 days in a row without medical supervision. Your doctor might prescribe particular creams or ointments if your baby has a secondary infection with bacteria or thrush.

Complications

Secondary infections such as thrush (fungus or yeast) can occur. Thrush appears as bright red, shiny areas in the nappy area. These red areas have clearly defined borders. Thrush can also affect the skin folds. Lots of red dots (satellite lesions) might appear beyond the outer edge of the rash.

Treat thrush with an antifungal cream prescribed by your doctor. Thrush can take longer to clear than a regular nappy rash and often comes back. Treatment can take a long time, which many parents find frustrating.

Prevention

The simple measures outlined above should help prevent nappy rash if you use them consistently.

Keep your child’s nappy area clean and dry. Protective sorbolene creams can help keep your child’s skin in good condition.

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