Nappy rash is one of those things that if not caught early, can become a really big problem. There are some simple steps to take to prevent nappy rash, or to sooth babies who have it and we asked midwife Nikki Khan to give us the low-down.

Research has shown that a baby’s skin is between 20-30% thinner than that of an adult’s skin (Paediatric Dermatology 27(2):125-31). A baby’s skin continues to mature for at least another year after birth and hence it is during this time that a baby is most prone to getting nappy rash (J Invest Dermatol. 2008; 1728-1736).

What is nappy rash?

About 1/3 of new babies suffer from some form of nappy rash, so you are not on your own! The rash usually develops when your baby is between 9 and 12 months old, but can occur earlier.

The main cause of nappy rash is the skin’s contact with wee and poo in a nappy. However good your nappies are there is always some moisture which can cause irritation. Your baby’s wee and urine combined create a substance called ammonia which irritates your baby’s skin and makes it sore and inflamed. Often it is the combination of poo and wee which irritates the skin the worst! So if your little one is poorly with a tummy upset and diarrhoea, her skin is going to get quite inflamed so will need to be watched closely.

In rare cases, your baby’s nappy rash may be caused by an underlying condition such as eczema or even an allergic reaction, but your GP can confirm this for you.

So the main reason for nappy rash is leaving your baby in a dirty nappy for too long but it could be that he/she may have overly sensitive skin too!

Different types of nappy rash

Many women think there is only one type of nappy rash, yet there are actually three main types of nappy rash:-

  1. Normal nappy rash is when the skin looks red and sore and can almost appear shiny. It occurs when the skin on the bottom has been in contact with a dirty nappy for a prolonged period or if the baby has a bout of diarrhoea. It is often the combination of wee and poo which causes the most irritation!
  2. A fungal nappy rash is a form of thrush, so treatment is often an anti-fungal cream which your Doctor will need to prescribe and this should be applied thinly to the area. This shows as tiny red spots and the genitals can appear swollen. This can occur if your baby is on antibiotics. It is important that if the nappy rash is fungal to avoid the usual barrier cream and ointment, as this can make fungal nappy rash worse. If you are unsure ask your GP or Health Visitor for advice;
  3. A bacterial nappy rash shows as infected spots or pimples and your baby is likley to have a fever. It can develop from a normal nappy rash where the skin has broken and the infection has developed through bacteria entering through the broken skin. This type of nappy rash may well need antibiotics, so you should see your GP if you think your little one has this and he will then monitor it to ensure it improves

How to avoid nappy rash

  • Always check your baby’s nappy before a feed and after a feed, don’t be fooled into putting your baby down to sleep for 4 hours with a wet or dirty nappy as this will make her sore in the end;
  • Always change your baby’s nappy even if it is just wee as this can irritate the delicate skin if some of the moisture leaks from the nappy as often happens!
  • Avoid using tight fitting plastic pants over nappies as the nappy itself can encourage fungal nappy rash which loves warm moist places to grow;
  • Give your baby nappy free time each day, obviously not for too long, in case your carpets get ruined with pee! A good time is when your baby is asleep & they can be laid on an absorbent towel ;
  • If using water to clean your baby’s nappy area, use a soft towel or cotton wool to dry & rubbing too hard!
  • Always clean the area thoroughly with warm water and dry the area well after each nappy change. Then apply a thin layer of barrier cream to help avoid nappy rash occurring – ‘clean, dry & apply’. The cream then acts as a protective layer between the wee & poo and your baby’s delicate skin. Sudocrem Care & Protect, for example offers a Triple Action Protection that not only creates a protective barrier, but also conditions the skin and guards against infection. Remember, a thick layer of barrier cream can actually block the pores stopping the skin from breathing!!
  • Avoid perfumed wipes as these can irritate the skin and if using wipes, make sure they are not alcohol based as this can irritate the skin too…
  • Finally, avoid using talcum powder when changing your baby’s nappy as this can cause further irritation and does not protect your baby’s skin against urine and faeces as a barrier cream would.

How to treat nappy rash and how long it will last

  • Once a normal nappy rash has been treated with a barrier cream, nappy free time and regular nappy changes it should start to improve after 3-4 days. There is a strong body of opinion and research that suggests regular use of a barrier cream such as Sudocrem Care & Protect reduces the chances of normal nappy rash (Paediatric News. Sept, 2010.);
  • Fungal nappy rash may take up to 5-7 days to improve after treatment with the antifungal cream. These creams need to be applied thinly to your baby’s nappy area 2-3 times a day. However, unlike the steroid cream which you stop using once your baby’s rash has gone, the anti-fungal creams have to be used for 7 to 10 days after the rash has disappeared. This will ensure that the rash has been fully treated!
  • Bacterial nappy rash can take longer to get better and may take 7-10 days of antibiotic treatment , but this will be monitored by your GP or Health Visitor;
  • Depending on the type of nappy rash your baby is suffering from, your GP may prescribe a steroid cream to help reduce the itching and redness. This would need to be applied thinly once a day over the sore area and can be stopped once the rash has disappeared. It is important to note that it must never be used for more than seven days in a row.
  • Finally always remember to wash your hands before and after changing your little one’s nappy so you do not introduce any new infection to their bottoms and also that you aren’t passing any infection on to other or yourself!

CONCLUSION

So prevention is obviously better than cure. Advising parents how to prevent nappy rash and how it can potentially develop if left untreated, enables parents to be empowered with the knowledge of identifying the different types of nappy rash, treating the rash appropriately and when to seek medical advice

By Nikki Khan, Sudocrem’s Expert Midwife