Nappy Rash causes and treatment options

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 like sensitive skin, eczema and very dry skin which might make nappy rash worse. When babies and toddlers suffer from teething, loose stools can also heighten nappy rash.

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 one week, 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 and in the folds of the skin

• 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 whether his nappy is wet or soiled. Change wet or soiled nappies straight away. Disposable nappies are better for nappy rash because they absorb more moisture.

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, with some sunshine on it. You can also try fastening her nappy loosely, to allow air to circulate freely.

Clean your baby’s skin Use lukewarm water and cotton wool or a light cotton cloth to gently wash your baby’s skin after each nappy change. Avoid using disposable wipes because they can irritate your baby’s skin, and some babies might be allergic to the preservatives in them. When you bath your baby, use a gentle, soap-free wash and avoid soaps or bubble baths. You can also put Rooibos tea bags into their bath to help with skin healing and soothing. After bathing, pat your baby’s skin dry and apply a simple moisturiser.

Use an appropriate protective cream after each nappy change Apply a simple barrier cream with every nappy change. Barrier creams include zinc and castor oil or Vaseline. You can get these creams from a supermarket or your pharmacy without a prescription. Put the cream on thickly to stop wee or poo touching your baby’s skin. If you’re putting it on thickly enough, you’ll still be able to see some of the cream at the next nappy change.

Talcum-based powders aren’t recommended for nappy rash. If a baby accidentally breathes in a puff of talcum powder, it can cause breathing difficulties. You can, however, try corn starch based baby powders.

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. If your baby has a bad case of nappy rash and you normally use cloth nappies, you could consider using disposable nappies until the rash has cleared up.

Medications For severe nappy rash or nappy rash that won’t go away with simple measures, your GP might recommend using corticosteroid and fungal creams or ointments like hydrocortisone 1%. You should use corticosteroids only after you’ve talked to your GP. Always follow the instructions on the packet when putting these creams on your baby.

Your GP might also prescribe particular creams or ointments if your baby has a secondary infection with bacteria or fungus (thrush).

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.

Thrush looks like bright red, shiny patches with clearly defined borders in the nappy area. Thrush can also affect the skin folds. Lots of red dots or pus-filled bumps (pustules) might appear beyond the outer edge of the rash. Treat thrush with an antifungal cream prescribed by your GP. 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 can help keep your child’s skin in good condition.

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A version of this article can be found at Raising Children.