10 essential facts about nappy rash

How to spot, treat and prevent this common but uncomfortable condition

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1) It’s caused mostly by poo, not wee

“Although a baby who’s been sitting in a wet nappy for too long is likely to get nappy rash, this is not the main reason it starts,” says Stephen Kownacki, chair of the Primary Care Dermatology Society. “It happens mainly because a baby’s poo contains digesting enzymes, which can start breaking her skin down if she’s left sitting in a dirty nappy too long. But nappy rash can also be aggravated by ammonia, which is made when your baby’s wee is broken down by bacteria from her poo, and in turn irritates her skin.”

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Don’t forget, your baby’s skin is nearly half the thickness of yours, so it’s more delicate and prone to getting sore.

2) It doesn’t just appear on the bottom

“Nappy rash can be present anywhere on the body where the nappy content can leak to,” says Stephen. “Don’t fit your baby’s nappy too tightly because it’ll keep the wee and poo close to the skin. But don’t fasten it too loosely, either, as this can cause the nappy to leak, which could lead to the nappy rash affecting the top of her legs, her lower back and the folds and creases of her skin.”

 3) Regular nappy changing won’t get rid of it

Although it helps to change your baby’s nappy often, because you’re limiting skin contact with wee and poo, it won’t stop a rash completely.

 4) Wipes can make it worse

“It’s not a good idea to use baby wipes when she has nappy rash as some contain additives like antiseptics, which will aggravate the rash further,” says Stephen. Use water instead.

 5) Teething isn’t a cause

“Contrary to popular opinion, teething doesn’t necessarily bring on nappy rash,” says Stephen. “But if your baby’s on antibiotics for any reason and gets diarrhoea as a side effect, nappy rash is more likely as there’ll be an increase in enzymes that break the skin down.”

 6) Bottlefed babies suffer more than breastfed

“A breastfed baby passes less waste than a bottlefed baby, as breast milk is more efficient in providing your baby with exactly what she needs. This reduces the risk of nappy rash as there are fewer enzymes to irritate her skin,” says Stephen.

 7) All nappy creams are not the same

There are two types. One’s a barrier cream, and works better if it’s used before the nappy rash appears. The other’s a treatment cream, to be used once the rash is present.

8) Too much nappy cream can make it worse

“Don’t put it on too thickly,” says Stephen. “It can create a film on the nappy lining, which reduces its absorption efficiency. Instead, put on a thin layer of cream so the wee can be absorbed properly into the nappy, while the cream’s still protecting your baby’s skin.”

9) It may not be nappy rash

Although nappy rash is very common, there are other ailments that might appear on your baby’s bottom, so it’s important to work out exactly what your little one’s got.

10) See your GP

You can buy all nappy creams over the counter, but if your baby’s a persistent sufferer and the costs are mounting up, talk to your GP about getting help on prescription.

Try this

  • Wash your tot’s bottom with just warm water, as soap can irritate the rash, and avoid talc.
  • At night put extra padding in a reusable nappy to give it more absorbency.
  • Use a nappy cream and if the problem gets worse and/or your baby develops a temperature, talk to your GP as she may have an infection.
  • Pat rather than rub her bottom dry.
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Could it be…

  • Eczema? Usually appears in folds and creases and if untreated 
can result in the skin flaking. It may also spread beyond the nappy region and will need separate treatment.
  • Thrush? Bright red and normally in folds of the skin, thrush may also have white scaling and look glazed or shiny. If you suspect this, see your GP for anti-fungal treatment.

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