Nappy rash

Nappy rash commonly happens when a baby’s skin is exposed to wet or dirty nappies for too long. Urine is sterile (there are no germs in urine). However, germs on the baby’s skin and in the nappy can change chemicals in urine into other chemicals. These include chemicals such as ammonia, which is very irritating to skin. Leaving a wet nappy on a baby for long periods of time can make the rash worse.

Some babies get nappy rash no matter how well they are cared for. Others do not get nappy rash, even when they are not changed very often. Some babies may have very sensitive skin and rashes on other parts of their bodies. Others may have infections, such as thrush, which make the rash worse. Some babies only get nappy rashes when they have a cold or some other viral illness.

Most cases of nappy rash can be treated successfully at home. See your doctor if your baby’s nappy rash looks severe, is hurting your baby or doesn’t clear up within a few days.

Signs
The signs of nappy rash include:

• Inflamed skin – the skin around the genital area and anus looks red and moist.
• Blistering – the skin may blister and then peel, leaving raw patches (ulcers).
• Spreading – the rash can spread onto the tummy and buttocks.
• Ulcers – small ulcers can sometimes form on healthy skin near the area of the rash.

All of this damage to the skin is very sore and the baby can be very unsettled, especially when they pass wee (urine) that comes into contact with the rash. Many babies with nappy rash do not sleep well, waking often due to pain.

Common causes
Common causes of nappy rash include:

• Sensitive skin
• A trigger factor or ‘agent’.

Sensitive skin
Babies who have rashes on other parts of their bodies, such as cradle cap or eczema (on the face or under the chin), are more likely to get nappy rash. – This tendency is often inherited – other members of the family may also have had rashes including nappy rash.

Trigger factors or ‘agents’
Some things can trigger nappy rash, including:

• Ammonia – chemicals in urine may be changed into ammonia, which ‘burns’ the skin.
• Thrush (candida) – thrush exists in faeces (poo) normally but the levels rise sometimes without obvious causes. This can occur when a baby needs antibiotics for another infection. Thrush can make a nappy rash much redder and more painful.
• Chemical exposure – chemicals in nappy-soaking solutions, laundry detergents and fabric softeners can irritate the skin of very sensitive babies. Some baby wipes may cause irritation if they contain alcohol. Some scented soaps or baby lotions can also irritate the skin of some babies.
• Plastic pants – these may keep the baby’s clothes clean and dry, but they prevent airflow. Because the clothes do not get wet, a baby may be left in a wet or dirty nappy for a long time and this keeps the baby’s skin wet.
• Friction or rubbing – rough nappies can rub and chafe at the baby’s sensitive skin.

Prevention and treatment
Suggestions to treat or prevent nappy rash include:

• Change your baby more frequently.
• Use disposable nappies, which absorb the urine quickly and leave the surface of the nappy (that is next to the skin) dry.
• Use only soaps made for babies and baby wipes that do not have alcohol in them. Wipes made for babies do not have alcohol but adult wipes often do. Alcohol stings badly on damaged skin.)
• Clean your baby’s bottom with plain water at nappy changes. If this does not clean the skin well enough, try sorbolene cream – a simple and soothing cream.
• Use a barrier cream, such as zinc and cod liver oil or zinc and castor oil, to keep wetness away from baby’s skin.
• Make sure you change cloth nappies often and, whenever possible, do not put plastic pants over them.
• Rinse thoroughly all washed nappies to remove traces of detergents and other chemicals. Then, if possible, dry them in a tumble drier – this makes them much softer than drying them in the sun.
• Don’t put a nappy on your baby whenever practical.
• Give pain relief if necessary. Rashes such as nappy rash are very painful, especially when urine gets onto them. If your baby is unsettled, try some paracetamol to ease the pain (check the bottle to see how much to give to your baby).

Seek medical advice
If your baby’s nappy rash doesn’t improve after a few days, see your doctor. The nappy rash may be infected (for example, by thrush) or your baby’s skin may be very sensitive. If your doctor suggests creams for thrush or steroid creams (such as hydrocortisone cream), follow the directions for use. Wash the skin well, put a thin layer of the cream on, then (after a couple of minutes) cover the skin and the cream with a barrier cream, such as zinc and cod liver oil. (Note: zinc creams leave stains on nappies and clothes. Many people use disposable nappies while treating nappy rash.)

Where to get help

• Your doctor
• Nurse-on-Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• Maternal and Child Health nurse
• The Maternal and Child Health Line (24 hours) Tel. 13 22 29
• The Royal Children’s Hospital Tel. (03) 9345 5522

Things to remember

• Nappy rash is commonly caused when a baby is left in a wet or dirty nappy for too long.
• Prevention and treatment options include more frequent nappy changes, using disposable nappies and covering the sore area with a barrier cream (such as zinc and cod liver oil or zinc and caster oil creams). Make sure that you use pure soaps made for babies and baby wipes that do not have alcohol in them.
• If the nappy rash does not get better in a couple of days, or if it spreads onto the tummy, get advice and treatment from your doctor.

You might also be interested in:

• Baby care - weaning.
  
• Colic.
  
• Cradle cap.
  
• Maternal and child health services.
  

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This page has been produced in consultation with and approved by:

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The Children's Hospital at Westmead

Last updated: December 2009

The information published here was accurate at the time of publication and is not intended to take the place of medical advice. Please seek advice from a qualified healthcare professional.

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