Nappy Rash

Key points to remember about nappy rash

• the main cause of nappy rash is wearing a wet or dirty nappy for too long
• change your baby's nappies as soon as possible after they become wet or dirty
• use a warm wet cloth for washing your baby's bottom at each nappy change
• make sure the area is dry before putting on a new nappy 
• put on a barrier cream thickly at each nappy change
• give your baby as much nappy-free time as possible each day
• speak with your Well Child nurse, pharmacist or doctor if the rash continues or changes in appearance

What is nappy rash?

Nappy rash is a very common skin condition. The skin looks red and can be spotty, particularly at the edge of the rash. It happens when the skin on your child's bottom is damaged and irritated.

Usually nappy rash is mild and doesn't bother your baby but it can be sore when you wipe the area. Sometimes if the skin is raw, it can be very sore. Nappy rash may make your baby unsettled or irritable.

What causes nappy rash?

The main cause of nappy rash is wearing a wet or dirty nappy for too long.

Wetness and rubbing

Constant wetness and rubbing can cause damage to the skin. The longer a nappy is wet or dirty, the higher the risk there is of damage to the skin.

Irritation

• wee and poo are irritating and can lead to a rash if they are in contact with the skin for too long
• watery loose poo can make nappy rash worse
• some baby wipes and soap can cause dry skin or make the rash worse
• detergents and soaking solutions used for cloth nappies can irritate baby's skin

Infection

Yeast infection (candida or thrush) can grow in warm moist areas and may be there if your baby has a severe nappy rash. It can be treated with a cream.

Sometimes nappy rash can be caused by bacteria.

How can I help prevent nappy rash?

You can prevent nappy rash by doing some simple things around nappy changing and:

• using a barrier cream or ointment
• giving nappy-free time
• choosing quality disposable nappies or taking good care of cloth nappies

Nappy change

• change your baby's wet or dirty nappy as soon as possible (5 to 7 times a day for babies under 12 months of age)
• use a warm wet cloth for washing your baby's bottom - wash the area gently
• make sure your baby's bottom is properly dry before putting on a new nappy - dry by patting with a towel, not rubbing

Avoid the following as they can cause skin irritation:

• baby wipes - if you need to use baby wipes, choose brands for sensitive skin, with minimal or no fragrance
• soap, bubble bath and lotions
• plastic pants
• talcum powder

Barrier cream

Barrier creams or ointments may help to protect your baby's skin from moisture. They form a barrier between your baby's skin and the poo or wee. Put on a barrier cream thickly at each nappy change.

Examples of barrier cream:

• zinc and castor ointment
• white soft paraffin ointment
• Bepanthen
• Sudocream

Nappy-free time

Give your baby as much nappy-free time as possible each day.

Nappies

If you are using disposable nappies, choose a good quality disposable nappy that allows moisture to be absorbed quickly.

If you are using cloth nappies:

• rinse dirty nappies immediately in cold water before washing
• wash the nappies in a hot wash
• use gentle laundry powders
• rinse them twice to remove soap residue
• dry them in the sunshine whenever possible

When should I seek help for nappy rash?

Most nappy rash gets better with these simple steps.

See your nurse, pharmacist or doctor if the rash lasts for more than a few days. It may mean that there is a skin infection such as a thrush infection.

What other treatments may be used?

If your baby's nappy rash doesn't get better with simple measures, your healthcare provider may suggest a mild steroid cream or ointment, or an antifungal cream. Occasionally, antibiotics are needed to treat infected nappy rash.

A mild steroid cream or ointment such as hydrocortisone

Steroids reduce the redness and inflammation. Use only a very small amount. Follow the instructions. Put the cream on before using a barrier cream or ointment. Use it for a few days until the rash has cleared. You don't usually need a steroid cream or ointment for more than 7 days.

An antifungal cream that kills thrush (candida)

You usually put this on 2 to 3 times a day. Unlike a steroid cream, keep using an antifungal cream for 7 to 10 days after the rash has cleared, to make sure all the fungus has gone.

Use this without a barrier cream so that you clear up the infection first. Then use the barrier cream to help clear up the nappy rash.

Antibiotics kill bacteria

Occasionally broken skin from nappy rash can become infected with bacteria. You may need to take your child to the doctor who may precribe antibiotic medicine. Your child takes the antibiotics by mouth. You may also need to put on cream or ointment.

See your doctor if your baby's nappy rash doesn't get better.