What causes nappy rash and how to treat it

What is nappy rash?

Heather Morris, a Midwife and Healthcare Professional, says: “The term ‘nappy rash’ is used to describe a reaction of your baby’s skin to irritation.”

What causes nappy rash?

There are several causes of nappy rash which include:

• Prolonged exposure of the skin to poo and wee
• When your baby has recently taken a course of antibiotics
• Using harsh baby wipes, especially those containing alcohol
• A reaction to soap, bubble bath or laundry detergent
• Not cleaning the nappy area well enough, or frequently enough
• Something rubbing against your baby’s skin

“The usual function of your baby’s skin can be broken down when the skin is exposed to moisture for long periods (this is called skin maceration),” explains Heather. “Skin can also be harmed by friction, such as the nappy or your baby’s clothes rubbing on the skin. Another main cause is that the skin is in contact for long periods of time with faeces and urine, both of which are acidic.

“Try not to worry, as nappy rash is not rare and at any time, something like a third of all babies will have it. Your baby will probably have nappy rash at some time no matter how diligent you are about hygiene and nappy changing. It’s easy to treat, though if left untreated can become more serious. It affects girls and boys equally **.”

What does nappy rash look like?

It is fairly easy to spot the features of nappy rash, as your little one’s skin may:

• Look red, with some raised, red spots or pimples
• Have a red area of skin under the nappy
• It may be worse in the creases of the legs and around the bottom
• The skin may feel warm
• There may be blisters in more extreme cases

Heather says: “The easiest-to-spot nappy rash feature is a well-defined area of skin redness in the area that’s in contact with the soiled nappy, called ‘erythema’ on the surface of the skin.

“Your baby might be unhappy and uncomfortable, as nappy rash can be painful and itchy. Mild nappy rash should clear up in around three days with prompt action.”

Nappy rash and weaning

Weaning is a time when you might find that nappy rash becomes worse and people often ask, what foods can cause nappy rash?” As Heather explains: “Weaning starts at six months and your little one can start sucking purées from a spoon or chewing soft pieces of food as part of the process. Having only had milk or water up to now, this change in your baby’s diet can be a trigger for nappy rash.*”

Foods that may make nappy rash worse include acidic fruits like oranges and lemons and their juice, strawberries, tomatoes and pineapples. You may find your baby is sensitive to something else, so try cutting it out of your baby’s diet for a while to see if the rash clears up.

How to treat nappy rash

A good routine is often key to preventing and treating nappy rash. Follow our step-by-step guide to help keep nappy rash at bay.

• Make sure you change wet nappies frequently and dirty ones as soon as possible
• Thoroughly clean the whole of your baby’s nappy area with gentle baby wipes such as Huggies Extra Care Sensitive. Always wipe from front to back, to avoid urine infections
• Use a gentle barrier cream such as Metanium Nappy Rash Ointment after each nappy change to prevent nappy rash and to protect the skin from moisture. If nappy rash already exists, use a nappy change cream to treat it.
• It’s ok to give your baby a daily bath if they’re sore and itchy, but avoid soap, shampoo or body wash that contains harsh chemicals that might cause dry and irritated skin.
• When you have finished your baby’s bath, pat the skin dry gently but thoroughly, especially around the nappy area and in all the skin creases
• Don’t use baby powder, as this can be irritating
• Give your baby nappy-free time, so the air can get to the skin. Lay your little one on a towel to avoid accidents staining floors or furniture

How long does it take to cure nappy rash?

If you follow the above steps, nappy rash should clear up within about three to four days.

How to soothe severe nappy rash

Sometimes nappy rash becomes severe, and it may even lead to a skin infection. If you suspect this to be the case and if you can see a bright red rash that has red or white spots on it, you should speak to your GP, as your baby might need a prescribed cream.

When to seek further help

“Most cases of nappy rash are mild and easily treated without the need for referral,” says Heather. “Managing your baby’s skin routine and using a good appropriate barrier cream means it should resolve quickly. However, if you think your baby has an infection or the rash is severe, speak to your doctor about prescribing a mild, topical (applied to the skin) steroid cream, which can be applied daily in addition to a barrier cream until the symptoms clear, or for a maximum of seven days.

How to prevent nappy rash in the future

Once you are aware of what can cause nappy rash, and you know what things might trigger an outbreak, you can manage your baby’s nappy area. Heather suggests: “You might want to switch to using a high absorbency nappy, or you might leave your baby’s nappies off for as long as you can. You can also make sure you change your little one frequently. You should use a fragrance and alcohol-free baby wipe to clean your baby. Avoid things that might irritate your baby’s skin such as bubble bath and soaps.

“You can also use barrier creams to protect the skin, applied thinly at each nappy change. NICE *** recommends zinc and castor oil ointment or white soft paraffin BP ointment.”

References

* Morris H, The bottom line on nappy rash, British Journal of Midwifery, 2012, Vol 20, No 9

** Merrill, L. (2015) Prevention, treatment and parent education for diaper dermatitis. Nursing for Women’s Health19(4), 324-336.

Contributors

Sally J Hall Parenting editor, journalist & author