Nappy rash is common and can happen no matter how careful you are about looking after your baby’s bottom. Almost all children who wear nappies get nappy rash at some stage.
Causes of nappy rash
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 wee can irritate your child’s skin.
Plastic pants often make nappy 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, psoriasis, thrush or impetigo, which might make nappy rash worse.
Symptoms of nappy rash
The skin on your child’s bottom will look red and sore. Sometimes nappy rash might go up onto your child’s tummy or spread up towards your baby’s back. Some areas of skin might be raised or swollen, and there might be breaks in the skin. These breaks are called ulcers.
The skin folds aren’t usually affected because wee doesn’t get into them.
The rash can cause discomfort and pain, which can make your baby irritable.
When to see a doctor about nappy rash
You should take your child to the GP if:
- the rash hasn’t improved after three days, even when you use the treatment steps below
- blisters, crusts or pimples appear
- your child is upset and isn’t 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.
Nappy rash treatment
Simple measures are often the best. Nappy rash will usually get better or go away within a few days of taking the following steps.
Change your baby’s nappies frequently
Frequent nappy changes keep the nappy area dry and give your child’s skin a chance to heal. Check your child every hour or so to see if his nappy is wet or soiled. Change wet or soiled nappies straight away.
Let your baby’s bottom ‘air’
Give your baby’s bottom some 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 she’s sleeping. You can also try fastening her 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 him dry with a towel. Use running water to clean your baby where possible.
If you’re using disposable wipes, make sure they don’t contain alcohol or other irritants, which will sting and irritate the raw areas on your baby’s skin. Also, some babies might be allergic to the preservatives in disposable wipes.
Use an appropriate protective cream after each nappy change
Apply a simple cheap barrier cream – for example, zinc and castor oil, Vaseline or Dermeze – 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 your baby’s nappy. Bleach is most effective for killing bacteria, but make 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 nappy rash or nappy rash that won’t go away with simple measures, your doctor might recommend using cortisone creams or ointments (hydrocortisone 1%). Creams containing steroid medication should be used only after you’ve talked to your doctor. Always follow the instructions on the packet when putting these creams on your baby.
Your doctor might also prescribe particular creams or ointments if your baby has a secondary infection with bacteria or thrush.
It isn’t clear whether cloth or disposable nappies are better at preventing nappy rash. The most important thing is to change a wet or dirty nappy straight away. Many parents prefer to use disposable nappies for a bad case of nappy rash, then go back to cloth nappies once baby’s skin has healed.
Complications of nappy rash
It takes weeks for your baby’s skin to repair itself, so her skin will be more vulnerable to things that irritate it.
Secondary infections such as thrush (fungus or yeast) can happens. Thrush looks like 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 or pustules (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 regular nappy rash and often comes back. Treatment can take a long time, which can be frustrating.
Nappy rash prevention
Always keep your child’s nappy area clean and dry. Change your child’s nappy frequently and give his bottom air as often as you can.
Protective barrier creams like Vaseline, Dermeze or zinc and castor oil can help keep your child’s skin in good condition.