Nappy rash

Nappy rash is a red, irritating skin rash in the area covered by the baby's nappy.

undefinedMost nappy rash can be improved with simple measures such as:

  • changing nappies more often
  • rinsing cloth nappies thoroughly
  • washing baby’s buttocks in warm water with mild soap or soap substitute then rinsing well and drying
  • applying a protective cream/ointment
  • using nappy liners
  • leaving the baby's nappy off for a time when practical.

See a doctor if: the rash does not improve after a few days, if it extends beyond the nappy area, or there are signs of infection such as swelling, blistering or pus.

Causes

Nappy rash is caused by urine and faeces sitting close to the skin for extended periods of time.

Almost all babies or toddlers will have nappy rash at some stage. It is very common and does not mean that you have not been caring for your child. Some parents report that their child's nappy rash is worse when they are teething, if they use disposable nappies or if they use cloth nappies, or if they use certain types of soaps or detergents when washing the nappies.

Treatment

  • The nappy area should be kept clean and dry as much as possible.
  • Try changing the nappy more often.
  • Some people find using cloth nappies better than disposables, however a formal review did not find any difference. (Baer, 2006)
  • You will need to experiment to find out what suits your baby.
  • If using cloth nappies, ensure that all traces of detergent or soap are rinsed out of the nappies when washed. If soaked in a nappy soaking agent, the nappies should be well rinsed.
  • At each nappy change wash the buttocks and surrounding area with warm water using a soft cloth. Use mild soap or soap substitute to wash the baby's buttocks when there is a dirty nappy, and rinse soap off thoroughly. Carefully pat dry and apply a barrier cream, such as lanolin or zinc and castor oil cream.
  • If there is any sign of a rash or a broken skin area, wash the buttocks then apply a dilute solution of baking soda (dissolve one teaspoon in a cup of water) and dab gently over the area. Leave the nappies off for as long as practical, and expose the buttock area to the air and gentle sunlight.
  • Apply whatever cream or ointment has been prescribed or suggested by your doctor, nurse or pharmacist. There are a number of suitable applications available. It is important to use one that does not burn or aggravate the skin. For example, zinc and castor oil cream heals whereas petroleum jellies (e.g. vasaline) will cause discomfort to any reddened or broken area.
  • After applying the cream or ointment, place a piece of clean gauze or soft nappy liner over the affected area before putting the nappy on again. Do not use talcum powder or plastic pants.

When to seek help 

  • Most nappy rashes get better with these simple measures. If it is NOT improving after four days, OR is spreading to the area beyond the buttocks, see your doctor or Plunket nurse.
  • The rash may have become infected and an antibiotic cream may be necessary.
  • If your baby has other skin problems, such as eczema, or the rash is not improving, a cream containing hydrocortisone (which stops inflammation) may be prescribed.
  • Be wary of disposable baby wipes if your child has bad nappy rash. They may contain a perfume and may sting if applied to broken skin.
  • If your child has allergies discuss what type of cream to use with a pharmacist as many commercially available nappy rash creams contain peanut or arachis oil (these can irritate the skin), often undeclared on the label.

Prevention

  • Rinse soiled nappies immediately in cold water before washing.
  • Wash the nappies in a normal hot wash in the washing machine.
  • Make sure they are rinsed well before drying.
  • Dry outside on the line whenever possible rather than in the dryer. Sunshine and fresh air are great germ killers.

Learn more

Napkin dermatitis DermNet NZ, 2014
Nappy rash Kidshealth and Paediatric Society of NZ, 2013

References

  1. Baer EL, Davies MW, Easterbrook K. Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database of Systematic Reviews  2006, Issue 3. Art. No.: CD004262. DOI: 10.1002/14651858.CD004262.pub2. Link to Cochrane Library

Credits: Health Navigator October 2014.