Nappy Rash

Nappy rash is a term used for inflammation of the skin that occurs in the nappy area. Almost all babies develop it at some stage when they are in nappies. It tends to be due to a combination of factors, but the most important one is related to the wearing of nappies, as the name suggests.

What is it?

Nappy rash commonly happens when a baby’s skin is exposed to wet or dirty nappies for too long. Urine is sterile (there are no germs in urine). However, germs on the baby’s skin, and in the nappy, change chemicals in urine into other chemicals – such as ammonia, which is very irritating to skin. Leaving a wet nappy on a baby for long periods of time can make the rash worse.

Just having a nappy on for a long time is not the only cause of nappy rash. Some babies get nappy rash no matter how well they are cared for, while others do not get nappy rash, even when they are not changed very often. Some babies may have very sensitive skin and rashes on other parts of their bodies. Others may have infections, such as thrush, making the rash worse. Some babies only get nappy rashes when they have a cold or some other viral illness.

Mostly nappy rash can be treated successfully at home. See your doctor if your baby’s nappy rash looks severe, is hurting your baby or if it doesn’t clear up within a few days.

What causes it?

To get nappy rash a baby needs to have sensitive skin (often inherited) and a trigger agent, such as exposure to urine and faeces for too long, being unwell (including having diarrhoea), or having an infection on the skin such as thrush.

What are the symptoms?

Inflamed skin – the skin around the genital area and anus looks red and moist.
Blistering – the skin may blister, then peel, leaving raw patches (ulcers).
Spreading – the rash can spread onto the tummy and buttocks.
Ulcers – small ulcers can sometimes form on healthy skin near the area of the rash.

Are there any natural therapies?

• Aloe vera gel is very cooling to inflamed skin, and can be applied liberally.
• Thrush can normally be treated with anti-fungal (e.g. tea tree) ointment or cream.
• Recurrent thrush may indicate an imbalance of the baby's intestinal flora.

Most nappy rash responds in a few days to nappy rash ointments and soothing creams designed especially for babies' sensitive skins.

What else can I do?

• Change your baby more frequently.
• Use disposable nappies, which absorb the urine quickly, leaving the surface of the nappy (which is next to the skin) dry.
• Use only soaps made for babies and baby wipes that do not have alcohol in them. (Wipes made for babies do not have alcohol, but wipes made for adults often do have alcohol in them. Alcohol stings badly on damaged skin).
• Clean your baby’s bottom with plain water at nappy changes. If this does not clean the skin well enough, try sorbolene cream, which is a simple and soothing cream.
• Use a barrier cream, such as zinc and cod liver oil or zinc and castor oil, to keep wetness away from baby’s skin.
• Make sure you change cloth nappies often and do not put plastic pants over them whenever possible.
• Rinse thoroughly all washed nappies to remove traces of detergents and other chemicals. Then, if possible, dry them in a tumble drier which makes them much softer than drying them in the sun.
• Don’t put a nappy on your baby whenever practical.

Did you know?

Babies who have rashes on other parts of their bodies, such as cradle cap or eczema (on the face or under the chin), are more likely to get nappy rashes. Often others in the family will also have had rashes including nappy rash.