What is nappy rash?

Nappy rash is a red, irritating skin rash in the area which is covered by the nappy.

What causes nappy rash?

Nappy rash is caused by urine and faeces sitting close to the skin for extended periods of time.

Almost all children will have at least one episode of nappy rash in their lives. It is very common and does not mean that you have not been caring for your child.

Some parents report that their child's nappy rash is worse when they are teething, if they use disposable nappies or if they use cloth nappies, or if they use certain types of soaps or detergents when washing the nappies.

What is the treatment for nappy rash?

The nappy area should be kept clean and dry as much as possible. It is advisable to change nappies frequently. Some people find using cloth nappies better than disposables, for others it makes no difference. You will need to experiment to find out what suits your baby.

If using cloth nappies, ensure that all traces of detergent or soap are rinsed out of the nappies when washed. If soaked in a nappy soaking agent, the nappies should be well rinsed.

At each nappy change wash the buttocks and surrounding area with warm water using a soft cloth. Carefully pat dry and apply a barrier cream, such as lanolin or zinc and castor oil cream.

If there is any sign of a rash or a broken skin area, wash the buttocks then apply a dilute solution of baking soda (dissolve one teaspoon in a tumbler of water) and dab gently over the area. Leave the nappies off for as long as practical, and expose the buttock area to the air and sunlight.

Apply whatever cream or ointment has been prescribed or suggested by your doctor, nurse or pharmacist. There are a number of suitable applications available. It is important to use one that does not burn or aggravate the skin. For example, zinc and castor oil cream heals whereas petroleum jellies will cause discomfort to any reddened or broken area.

After applying the cream or ointment, place a piece of clean gauze or soft nappy liner over the affected area before putting the nappy on again.

Do not wash the affected area in soap too often. Weekly is enough. Do not use talcum powder or plastic pants.

Most nappy rashes get better without any other intervention. If, however, the rash does not look as though it is improving after four days, or is spreading to the area beyond the buttocks, it is important to see your doctor.

The rash may have become infected and an antibiotic cream may be necessary. If your baby has other skin problems, such as eczema, a cream containing hydrocortisone (which stops inflammation) may be prescribed.

Other important points

Remember, it is not unusual for babies to get a nappy rash and most parents/caregivers become familiar and expert at treating the condition. Talk to other mothers and get their tried and tested tips. They will also be valuable support for you.

If you use baby-sitters make sure they know your routine about nappy changing. Contact your doctor, practice nurse or Plunket nurse if the rash is getting worse after three or four days.

Be wary of disposable baby wipes if your child has a nappy rash, especially if it is raw and the skin is broken. They may contain a perfume and may sting if applied to broken skin.

Many commercially available nappy rash creams contain peanut or arachis oil, often undeclared on the label. If your child has allergies discuss what type of cream to use with a pharmacist.

Prevention is the best course of action

• rinse soiled nappies immediately in cold water before washing
• wash the nappies in a normal hot wash in the washing machine
• make sure they are rinsed well before drying
• put the nappies on the washing line whenever possible rather than in the dryer. Sunshine and fresh air are great germ killers!

For further information and support talk to your doctor or practice nurse.

Written by Anna Mickell RCpN. Reviewed by everybody, June 2005.