Nappy Rash - the common causes and treatment advice

Nappy rash. Most parents have been there, you go to change your little one’s nappy and BAM, you’re presented with a bright red, sore looking bottom and nappy area. This is one of the most common complaints I see in the pharmacy with children during the nappy stage. It can be quite uncomfortable and can make even the happiest of babies irritable and unsettled. It’s also quite upsetting for the parents as there is often a feeling of guilt associated with nappy rash in that they somehow ‘let it happen’. I’m here to reassure you that it’s OK, it’s quite common and easily treated but like most conditions, prevention is better than cure.

What does it look like?

In mild cases nappy rash causes the nappy area to appear red and sore and is sometimes spotty in appearance.

In more advanced cases, some areas may appear red, shiny and swollen with the rash patches having a very defined border. Some areas of skin may also be broken. If this is the case please see your pharmacist or doctor.

What causes it?

Nappy rash is caused by irritation to the delicate skin in the nappy area. The most common cause is infrequent nappy changes. Prolonged exposure to urine & faeces (yes wee and poo) and friction from a damp nappy can irritate and damage the skin.

Other possible causes of irritation to the nappy area are heavily scented disposable nappy wipes and soap/detergent residue on cloth nappies.

Teething, while not actually a direct cause of nappy rash, I do find the two seem to go hand in hand. The excess saliva that is produced while teething is swallowed and can result in loose and slightly more acidic faeces, which if left to sit against the nappy area can cause irritation and result in nappy rash.

How do I prevent it?

Like most conditions prevention is better than cure.

• Frequent nappy changes are the best way to avoid nappy rash. I know no one wants to wake a sleeping baby however it’s important to change your child’s nappy regularly as it reduces the amount of time that the urine and faeces is in contact with the skin. If you’re travelling long distances in the car or on a flight, it’s still important to change your child’s nappy regularly. Change your child’s nappy as soon as they wake from a nap if they are wet or dirty and never put your child down for the evening with a wet nappy.
• Invest in good quality nappies that draw moisture away from baby’s skin. If you can afford it good quality nappies are worth the investment as they might buy you an extra half hour if you’re out and about as they actually absorb the moisture and wick it away from the skin.
• If using cloth nappies ensure that they are thoroughly rinsed to remove any soap or detergent residue that can cause irritation.
• At each nappy change make sure the area is wiped clean with fragrance free wipes making sure you clean in between the skin folds and ensure the area is dry before applying a new nappy.
• Apply a thick layer of barrier cream or balm at each nappy change. Those with Zinc Oxide (like our Baby Bottom Balm) are best as they help to provide a physical barrier to stop the urine and faeces from coming in contact with the skin. Zinc Oxide is also soothing to red and inflamed skin. If using cloth nappies we recommend using a biodegradable nappy liner to prevent the build up of nappy balms and cream in the cloth fibres.
• Nappy free time! Say what?? Yes you guessed it, let those little bottoms get some air. This is best done in an area where any accidents can be easily cleaned up and not on your favourite rug!

How do I treat it?

Most of the time mild nappy rash is treated easily and if the prevention measures listed above are adhered to it will clear within a few days.

• Apply a Zinc based soothing nappy nappy rash cream or balm (like our Baby Bottom Balm) to act as a barrier cream to prevent further irritation and to help calm and soothe the area.
• Sometimes using disposable wipes on the irritated area can cause discomfort so using soft cotton wool balls soaked in lukewarm water to clean the area can help. Ensure the area is completely dry before applying a new nappy.
• Using talcum powder or any antiseptic preparation on nappy rash is NOT recommended.

When should I seek further advice?

When the skin is irritated or damaged its normal barrier function is impaired and it’s possible to get fungal or bacterial infections and these require treatment with medicated creams under the advice of the pharmacist or doctor. Please seek further advice:

• If nappy rash persists, continues to spread or does not improve within a few days.
• If any areas of the skin are broken, there is pus or crusting present.
• If any areas are red, swollen and shiny with defined borders.

So hopefully this helps you understand the common causes of nappy rash and the preventative measures you can take to keep you little one’s nappy area rash free. Please feel free to leave any comments or questions below.

Erin is a mother and community pharmacist based in Brisbane, Australia.