Most babies develop a nappy rash at some stage. Usually it is mild and does not bother your baby. However, it can be more severe and sore in some cases. It can usually be cleared with the measures detailed below.
What causes nappy rash?
Nappy rash is a skin inflammation. Most cases are due to a reaction of the skin to urine and poo (faeces, stools, or motions). In addition, a germ called candida commonly thrives on the inflamed skin. (This is the germ that causes thrush.) Candida can cause a more inflamed rash which may include darker red spots spreading around the nappy area ('nappy thrush').
Nappy rash can occur or worsen when your baby is teething. It is unclear why teething can lead to nappy rash although it is thought that it is due to your baby producing more saliva.
What can I do to prevent or clear a nappy rash?
- Leave the nappy off as much as possible to let fresh air get to the skin. Obviously, you cannot leave the nappy off all the time. However, the more fresh air, the better. Try letting the baby lie without a nappy on a towel or disposable absorbent sheet for a period of time each day. (However, change the towel or sheet as soon as it becomes wet.)
- Change the nappy often. Ideally, change the nappy as soon as it is wet or soiled. The aim is to prevent skin being in contact with urine and poo for long periods. This is especially important if your baby is teething and has offensive, runny stools.
- Wipes are as effective as water. Studies have shown that using baby wipes has the same effect on your baby's skin as using cotton wool and water.
- After washing, make sure the baby's bottom is properly dry before putting on a new nappy. Dry by patting, not by rubbing, with a towel.
- Do not use powder such as talcum powder which may irritate the skin.
- Barrier creams or ointments that you can buy from pharmacies may help to protect the skin from moisture. Ideally, rub on a thin layer of barrier cream or ointment just before putting on each nappy. Do not apply too much, as this may reduce the 'breathability' of the nappy.
- Don't use tight-fitting plastic pants over nappies. They keep in moisture and may make things worse.
What treatments may be used?
The above measures are likely to clear a mild rash. If the rash becomes worse, a doctor or health visitor may advise one or both of the following in addition to the above measures:
- A mild steroid cream or ointment such as hydrocortisone. Steroids reduce inflammation. Apply sparingly as often as prescribed (before using a barrier cream or ointment) for a few days until the rash has cleared. A steroid cream or ointment should not usually be used for more than seven days.
- An antifungal cream (which kills candida). This is typically applied 2-3 times a day. Unlike a steroid cream, continue to use an antifungal cream for 7-10 days after the rash has cleared, to make sure all the candidal germs have gone.
- A combination cream containing an antifungal agent and a mild steroid is often given.
Sometimes the inflamed skin of a nappy rash becomes infected with other types of germs (bacteria). This may be suspected if the rash becomes worse, despite using the above treatments. In these cases an antibiotic medicine may be needed. Also, as mentioned, occasionally a nappy rash is due to an unusual or more serious skin condition. Therefore, if a nappy rash does not improve with the usual treatment described above, then see your doctor.
Further help & information
Dr Tim Kenny
Dr Louise Newson
Dr Hannah Gronow