What is nappy rash?

Nappy rash is common in babies and toddlers. It can be very mild or quite severe, depending on the cause and how it's managed. If your baby has nappy rash, don’t blame yourself. The rash may not be because of something you’re doing or not doing. Nappy rash can appear quite quickly and for no obvious reason.

Nappy rash almost always improves with more frequent nappy changing, carefully cleaning skin and using a barrier cream.

What are the signs of nappy rash?

The first sign of nappy rash is red skin irritation in the area covered by the baby’s nappy. It can cover just some of their skin or spread across their whole nappy area. You may also notice:

• white pimples around your baby’s bottom and skin folds
• swollen skin in their nappy area
• that your baby is having trouble sleeping

If left untreated, nappy rash can develop into blisters and open sores.

What causes nappy rash?

Nappy rash can develop when your:

• baby’s skin is wet (with wee)
• baby’s skin is dirty (with poo)
• baby’s nappy or clothing rubs against their skin (friction)

Wee and poo

The most common cause of nappy rash is when your baby’s nappy isn’t changed often enough. Wee and poo contain ammonia, which irritates the skin. Some babies have sensitive skin that reacts quickly to any moisture or friction.

Thrush

Thrush can also cause nappy rash. Candida Albicans, the type of yeast that causes thrush, likes warm, moist places such as the nappy area. Nappy thrush looks like pimples, or is red and shiny, with clear edges.

Babies can also develop oral thrush which looks like white plaques on their gums and tongue. This isn’t related to nappy rash.

Thrush isn’t painful, but it can be itchy and irritating. Often, thrush doesn’t improve and can get worse unless treated with a specific anti-fungal cream.

Other causes

Some foods, especially acidic fruits and vegetables, also cause nappy rash. These include:

• oranges
• strawberries
• tomatoes

Some babies have conditions that make them particularly sensitive to nappy rash or can make it worse. These include:

• skin conditions such as eczema and psoriasis
• infections such as impetigo and erythema
• allergies
• malnutrition

Be sure to also check that you are using wet wipes and soap that are made for babies. Some soaps and wipes can irritate your baby’s skin.

How can I prevent my baby getting nappy rash?

The best way to help prevent nappy rash is to keep your baby clean and dry. Change your baby’s nappy frequently.

Types of nappy

Disposable nappies absorb moisture better than cloth nappies.

If you’re using cloth nappies, make sure to clean them well with a good quality detergent (laundry soap), and rinse them well.

You should also avoid using plastic pants (pilchers) since these will prevent airflow.

Nappy changing

During a nappy change, use cotton wool dampened with lukewarm water to clean your baby. Also, pat your baby dry instead of using a wiping motion. This will be less irritating for them.

A thick, good quality barrier cream can be applied after changing your baby’s nappy. This will stop moisture from wee and poo sitting on their skin. It will also prevent friction.

Warm the cream between your fingers before smearing it onto their skin. This will help the cream to spread. You can ask your doctor, midwife or baby health nurse about what creams they recommend.

How should I treat my baby’s nappy rash?

Nappy rash is prevented and treated similarly. There are steps you can take to keep your baby clean, dry and irritation-free:

• Use plain water-soaked cotton wool to clean your baby’s skin, especially their skin folds.
• Change your baby’s nappy frequently — at least 6 times each day and every time they poo.
• Continue to use barrier cream.
• Use disposable nappies while you baby has nappy rash. These will help to keep their skin dryer than cloth nappies.
• Don’t put their nappy on too tightly. Air flow around the rash will help it to get better.
• Every day, give your baby time to kick freely without their nappy on to reduce friction.
• Don’t use talcum powder or antiseptic wipes, as these could irritate your baby’s skin.
• Use a gentle baby wash at bath time. Avoid using bubble baths or strong-smelling body washes and soaps.

When should I see a doctor about my baby’s nappy rash?

Visit your doctor if your baby’s nappy rash does not improve after treating it at home. You can also visit if:

• you think the rash is getting worse
• your baby seems irritated by the rash
• you notice a change in your baby’s feeding or settling behaviours
• your baby has developed a fever, body rash or seems sick
• the nappy rash develops blisters, sores or the skin is breaking open

Your doctor can examine the rash, rule out other conditions, and give you treatment advice.

If your baby has thrush, they may direct you to use an anti-fungal cream. Steroid creams such as hydrocortisone may be prescribed for a red, inflamed rash. Or if the doctor thinks your baby has an infection, they may prescribe antibiotics.