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Nappy Rash

Nappy rash: causes, prevention and treatment *
Most babies will probably have nappy rash at some time in their nappy years. Even though most people who are parents today were nappied in cloth nappies there is a superstition that they cause nappy rash. Research has shown that "the type of nappy used is not a significant factor in the incidence of nappy rash" (Getting to the Bottom of Nappy Rash, R. Philip, A. Hughs & J. Golding. British Journal of General Practice, August 1997; pp.493-497). The major causes of nappy rash were found to be infrequent nappy changing and ill heath of the child.

As with other types of skin irritation, there are many different causes of nappy rash. In 70-80% of cases diarrhea has been found to be the cause: liquid poo spreads over a wide area of the skin and is very irritating. Infrequent nappy changes also make it difficult for the skin to protect itself from the causes of irritation, including diarrhea and the other causes mentioned here. The mixture of urine and faeces produces ammonia (high pH) and this increases faecal enzyme activity which makes the skin more susceptible to damage. Also, whilst urine alone does not usually irritate the skin, if the skin becomes very wet it is more susceptible to irritants. A wet nappy can also rub against the skin and cause soreness (though the redness will be in areas where chafing is likely, not in the skin folds). Other possible causes include reactions to allergens and irritants on baby wipes or nappies such as perfumes, residues of detergents and bleach, allergies to certain foods, (some foods can give faeces a higher pH and cause rash, usually around the anus), teething and the common cold. Severe nappy rash is often caused by thrush (Candida). With thrush the rash tends to be bright red and tender, with distinct edges with small red spots or pustules close to the large patches.

The following procedures will help to prevent (and cure) nappy rash.

1. Changing nappies frequently will reduce the effects of irritants to the skin. Cloth nappies do need to be changed regularly, every three to four hours during the day, or when soiled. Disposable nappies also need to be changed regularly, but because they feel dry until soaked and are so expensive it is often tempting to leave them on longer than recommended.

2. Make sure you clean baby's skin regularly and thoroughly. It is recommended that you gently wipe baby's bottom with a clean, warm, wet cloth at every nappy change for newborns, and several times a day for older babies. Even if they are only wet there will still be urine on the skin which could make baby sore. Clean gently, particularly in the leg creases and under the genitals in boys. Clean from front to back in girls to reduce the chances of vaginal infection, but there is no need to clean inside the vagina as this is self-cleaning. If you use a soap use a very mild one and rinse it off completely. Use a soft cloth wipe (fold each time to use a clean bit for each time you wipe) or cotton wool. Allow the skin to dry before putting on a fresh nappy.

3. Giving your baby an airing between nappy changes and as much 'air-time' (time without his nappy) as possible is a very powerful treatment. It always amazes me how quickly babies' skin heals.

4. If you are going to be at home for a few hours why not just put on a shaped nappy without a wrap and change it as soon as it feels wet. This way your baby's skin can breathe without being covered in plastic and you will notice as soon as she is wet so can change her immediately. It is worth keeping a handful of cheap/second hand nappies for this as they don't need to be very absorbent.

5. You should check regularly that your baby has not soiled their nappy (once an hour as a rough guide). Some nappies can hold the smell of a dirty nappy in so well that you may sometimes not notice for a while and your baby's skin may react to the faeces against his skin.

6. Using a good stay-dry nappy system or nappy liner will help to keep baby's skin dry. Pocket nappies or fleece liners designed to keep wetness away from baby's skin should help to prevent nappy rash, but if they are left on too long or are not stuffed with enough absorbent material baby's bottom will become wet. They also help to prevent the mixing of urine and faeces so reduce the production of irritating ammonia.

7. Always use breathable wraps on your baby as they will help to reduce the heat build up inside the nappy. Heat may increase the growth of microbes and hence contribute to nappy rash. Fleece wraps are very breathable, allowing air to circulate an cool the nappy area - they make a great choice for night time.

8. Caring for your nappies properly is important. A build up of detergent residue on your nappies can cause nappy rash. For more information on caring for you nappies see the relevant pages on caring for your nappies (shaped, natrual fibres; pocket nappies and synthetic fibres). Some people recommend rinsing nappies with white vinegar to help remove residue or soften nappies. I would suggest you try this with caution initially in case it causes further irritation (vinegar is acidic, low pH) or use it in a pre-wash rinse so that it is thoroughly rinsed from the nappy.

Nappy rash: what to do if a rash develops
If your baby does have nappy rash try to identify the cause. Has your baby been accidentally left in a wet or dirty nappy too long? Is she teething or unwell? Has he eaten something different that might have caused a reaction (e.g. we found both our babies had nappy rash following foods with a lot of tomato in them in their first 18 months or so. We have subsequently found that tomatoes are quite a common irritant in the early weaning months and a lot of ready made baby foods have a large proportion of tomato). Orange juice may also be irritating.

Most mild nappy rash will clear up quickly if you give your baby plenty of time without her nappy and follow the procedures above. When she does wear nappies keep using your cloth nappies but make sure that they are changed extra-frequently for a while so her skin is kept dry. While her bottom is sore be extra gentle when cleansing her. Using soft, scent- and chemical-free washable wipes or cotton wool with warm water or a mild baby lotion to gently cleanse and calm. For more severe nappy rash you could use the above procedures, but could also use some nappy cream to protect and speed the healing process such as Better Botty Balm, Natural Balm or Sudocrem. But beware! Nappy creams will ruin the stay-dry inner layer of your nappies (the fleece or suedette layer). If you are using pocket nappies and wish to use a nappy cream either use one of our thick biodegradable nappy liners to prevent the cream getting onto the nappy or temporarily switch to another nappy system to preserve the condition of your stay-dry nappies. (It is inexpensive to keep a wrap to use with your inserts and a liner for this purpose and other emergencies).

If your baby gets repeated or severe nappy rash, or it lasts for several days despite your treatment consult your midwife or doctor.

*Information about nappy rash was taken from Motherease (www.motherease.com)