Nappy Rash

What is nappy rash?

Most babies will get nappy rash at some time. It can be a rash with red spots or just soreness of the skin that is covered by the baby's nappy. If your baby develops nappy rash the skin can become inflamed and uncomfortable.

If the nappy rash is severe, blisters and small lumps may appear on the skin. The blisters may burst causing areas of moist, broken skin, which can easily become infected. The most frequent infection is thrush, which is caused by a yeast called Candida albicans. Thrush may appear first in the baby's mouth and look as if patches of milk are stuck to the inside of the mouth. Thrush in the nappy area causes the skin to become very red and raw. Blisters and pimples may form on other parts of the body.

If your baby has had nappy rash for more than a few days the skin may become infected.

What causes nappy rash?

The main cause of skin irritation is prolonged contact with a wet or dirty nappy. Some babies have especially sensitive skin which easily becomes red and inflamed if the nappy rubs against it. If the rash is difficult to clear or keeps recurring it may be a sign that the nappy needs to be changed more often.

In some cases the rash is caused by skin conditions, such as eczema or psoriasis, which can be made worse by wearing nappies.

How can nappy rash be prevented?

It is important to check regularly to see if your baby's nappy needs changing. This should be done every hour or so in new-born babies and every two hours in older infants. Generally you should change your baby's nappy after feeding and when you put them down to sleep.

If your baby is dirty use the nappy to clean off the worst of it. Then clean the whole area thoroughly using cotton wool and warm water or baby wipes. When you have cleaned the area, leave your baby to kick in a warm place to allow the skin to dry before putting on a clean nappy.

At present there is not enough evidence to show which kind of nappies is better or worse at preventing nappy rash, disposable nappies or reusable/washable nappies. Experts recommend that nappies with the greatest absorbency should be considered but acknowledge that there are other factors involved in parent choice, such as cost, convenience and environmental impact.

What is the best treatment for nappy rash?

Barrier creams are often very effective in the early stages of nappy rash and help to protect the sore skin from contact with a wet or dirty nappy. Ask your health visitor or pharmacist to advise you about which barrier cream to use.

If the rash gets very sore or won't go away, or if the skin is broken and infected, ask your health visitor or doctor for advice. Your baby may need a cream or medicine from your doctor, which can usually clear any infection. An antifungal cream may be prescribed. Antifungal creams used to treat nappy rash may contain clotrimazole or miconazole . Some antifungal creams can be obtained from a pharmacy without a prescription.

If the nappy area is inflamed as well as infected the doctor may prescribe a cream containing an antifungal and a steroid (eg, Canesten-HC® or Timodine®).

In more severe cases, leaving your baby to kick on a dry open nappy in a warm place as much as possible allows the air to get to the skin and will make the rash heal more quickly. In older infants, it is also helpful to leave the nappies off as much as possible.

Self-help measures

  • Change your baby's nappy often to keep the skin in the nappy area dry and clean
  • When you change your baby's nappy use cotton wool and warm water or fragrance- and alcohol-free baby wipes
  • Leave the nappy off for as long as possible
  • Make sure your baby is clean and dry before settling him/her down to sleep
  • Use a barrier cream and nappy liners if your baby has nappy rash
  • If the rash lasts for more than three days ask your health visitor or doctor to check your baby
  • Tell your doctor if your baby has a skin problem on any other area of their body

Fact sheet provided by MIMS

Date last reviewed: July 2016

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