Key points to remember

• change nappies as soon as possible after they become wet or soiled
• use a warm wet cloth for washing your baby’s bottom at each nappy change
• apply a barrier cream thickly at each nappy change
• give your baby as much 'nappy free' time as possible each day
• speak with your well child nurse, pharmacist or doctor if the rash continues or changes in appearance

What is it?

Nappy rash is a rash in the nappy area.  The skin looks red and raw, and can be spotty in appearance, particularly at the edge of the rash.

• it can be sore or itchy when the area is wiped
• your baby may be unsettled or irritable because of it

What causes it?

Wetness and irritants are the most common cause of nappy rash.  A rash caused by wetness and rubbing from wet or soiled nappies can be further irritated by infection or chemicals.

Wetness and rubbing
Constant wetness and rubbing can cause damage to the skin. The longer a nappy is wet or soiled the higher the risk of damage being done.

Irritation

• wee (urine) and poo (faeces) contain irritating substances which may lead to a rash if they are in contact with the skin for too long.  Runny loose poo can make nappy rash worse
• some baby wipes and soap can cause dry skin or make the rash worse
• detergents and soaking solutions used for cloth nappies can irritate baby’s skin - wash and rinse nappies twice

Infection
Yeast infection (candida or thrush) thrives in warm moist areas and so is often present when there is a severe nappy rash.  It can be treated effectively with the right cream.

How can nappy rash be prevented?

• prevention is best
• keeping the skin clean and dry by changing baby’s wet or soiled nappy as soon as possible (five to seven times a day for babies under 12 months of age) helps prevent nappy rash
• use a warm wet cloth for washing your baby’s bottom – some baby wipes and soap can cause dry skin or make the rash worse
• a barrier cream (such as zinc cream) applied thickly at each nappy change will prevent moisture and irritants from reaching the skin
• give your baby as much 'nappy free' time as possible each day
• a good quality disposable nappy will allow moisture to be absorbed quickly
• wash then rinse cloth nappies twice to remove soap residue, and avoid strong washing powders
• if using baby wipes choose brands with minimal or no fragrance and for sensitive skin
• avoid using plastic pants
• avoid talcum powder

When should I seek help?

Carry out all the care outlined in How can nappy rash be prevented? above.

See your nurse, pharmacist or doctor if the rash lasts for more than a few days.  It may mean that there is a skin infection present such as a thrush infection.

Your doctor will usually prescribe a cream to treat the infection.  Prescribed or medicated creams should be applied as directed at nappy changes and the barrier cream applied over the top.  Steroid creams should not be used under the nappy for more than seven days at a time.

You should see your doctor if a nappy rash is difficult to treat or doesn’t get better quickly. This may mean that there is an underlying skin condition such as seborrhoeic dermatitis or psoriasis.  These types of conditions need to be diagnosed and treated by your doctor.

References

1. The Royal New Zealand Plunket Society website: http://www.plunket.org.nz/your-child/newborn-to-6-weeks/health-and-daily-care/nappies-and-nappy-rash/ [accessed 25-2-13]
2. The Royal Children's Hospital Melbourne website ‘Kid Health Info’: http://www.rch.org.au/kidsinfo/fact_sheets/Nappy_rash/ [accessed 25-2-13]
3. The Children’s Hospital at Westmead website ‘Kids Health’: http://kidshealth.schn.health.nsw.gov.au/fact-sheets/nappy-rash [accessed 25-2-13]