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Article Summary

Any baby who wears nappies (and what baby doesn't?) is prone to nappy rash. And while it may seem fairly innocuous, nappy rash may cause your baby significant discomfort, making effort, prevention and effective treatment very important.

Telltale Signs

When It's Not Nappy Rash

What Causes Nappy Rash?

Prevention and Treatment

Telltale Signs

You can easily recognise this common malady: your baby's bottom is red and inflamed, with swollen bumps around the nappy area. If the rash also has reddish pink bumps surrounding a red patch in the nappy area or around your baby's mouth, it may have already advanced to a yeast rash, which needs to be treated with topical antifungal medication.

Since your baby cannot tell you in words exactly what's wrong, he may express his discomfort through crying and irritability, especially at nappy-changing times, and possibly by a loss of appetite.

When It's Not Nappy Rash

What you think is nappy rash on your child's bottom may very well be another mild childhood skin condition. For this reason, it's important to recognise the difference between nappy rashes and other common ailments so you can treat each one effectively. Impetigo, seborrhoeic dermatitis, and prickly heat are the conditions most commonly mistaken for nappy rash.

Impetigo

Impetigo is a contagious bacterial skin infection that shows up in the nappy area and on the face and hands, with pimples and scabby, honey-coloured sores that blister and itch. Because this condition is contagious, all family members should wash their hands often with antibacterial soap to keep it from spreading. If you see this type of sore, call your doctor who will probably prescribe an antibiotic cream or oral antibiotic.

Seborrhoeic Dermatitis

Seborrhoeic dermatitis is a common skin condition that affects infants in their first year. You'll find raised, rough red patches covered with thick white or yellow scales on your baby's groin, genitals and lower abdomen; when similar patches appear on the scalp, the condition is known as cradle cap. Try applying an over-the-counter medicine such as cortisone or hydrocortisone ointment to the affected areas and keep your baby clean and dry. If the condition doesn't clear up soon, see your doctor, who may prescribe a stronger cortisone cream.

Prickly Heat

Heat and humidity can lead to prickly heat, caused when perspiration builds up on the skin and is unable to evaporate. Less common after about three months of age, this condition looks like an acne breakout, with very small pink bumps, and can show up in the skin folds in the nappy area, especially where the plastic lining of a nappy or nappy cover touches the skin. Moisture and humidity are the main causes of prickly heat; make sure your child is not overdressed and that his skin remains dry. If prickly heat seems severe, it's time to contact your GP.

What Causes Nappy Rash?

Most cases of nappy rash are a result of skin irritation from moisture in the nappy area. Changes in skin pH, damage from proteins found in the stool, and secondary infection with bacteria or yeast are the main culprits. Here are some other common causes:

Not cleaning the nappy area properly. Since nappy rash is caused by pH changes that occur when stools and urine combine, you'll want to gently and thoroughly clean any waste from your baby's tender skin. Use a gentle alcohol-free baby wipe or a soft baby washcloth and warm water. Sensitive skin does best with plain water, while other bottoms may need a mild soap. Avoid scrubbing with coarse washcloths as this will only make the rash worse and your baby more uncomfortable. While most modern baby wipes do not contain alcohol, be sure to read the label and avoid using those which do, since alcohol may sting and further irritate the rash.

Not changing nappies often enough. Studies have shown that infants who are changed at least eight times a day have nappy rash less often. Frequent nappy changes are important for two reasons: 1) prolonged wetness makes the skin fragile and prone to rashes; and 2) the more time urine and stools spend together, the longer the enzymes in the stool have to harm the baby's skin. Super-absorbent nappies can help by pulling urine away from the baby's skin and away from the baby's stools.

Yeast infections. Once your baby's skin has been wet for too long, it becomes susceptible to yeast rashes, the most persistent type of nappy rash. A course of antibiotics may cause diarrhoea, which can set off a yeast rash. You'll recognise this type of rash by the raised reddish pink bumps or white pus bumps surrounding a red patch in the nappy area. Your baby may also have white patches in his mouth, and your breasts may become sore if you're breastfeeding. Call your doctor as soon as possible for antifungal treatment if this condition persists.

Prevention and Treatment

Here's how you can prevent nappy rash from starting:

• Make sure you change your baby's nappies as soon as possible after they become wet or soiled.
• Clean your baby's genital area thoroughly after each bowel movement and allow the area to dry, being careful not to rub the skin too much or too harshly.
• Coat your baby's bottom with a thin layer of protective ointment or petroleum jelly.
• When putting on a fresh nappy, don't secure it too tightly, rather allow some air to circulate.
• Try using extra-absorbent nappies or those treated with petrolatum in the topsheet that touches your baby's skin.
• Keep a close watch on the nappy area if your child is taking antibiotics, or otherwise has diarrhoea, and change his nappies frequently.

Here are some tried and tested methods for treating nappy rash once it exists:

• Change your baby's nappies frequently to reduce moisture on the skin.
• Let the skin breathe by letting your baby spend a little time each day without a nappy (though you might want to have a nappy or cloth handy in case of an accident!)
• After a bowel movement, clean your baby's bottom thoroughly and pat it dry before putting a nappy on.
• Spread a thick layer of ointment containing zinc oxide or petroleum jelly, or one recommended by your baby's doctor, to prevent urine from reaching the irritated skin.
• If all else fails, try a different brand of nappies or a different detergent if your baby wears terry nappies.
• Consider using a disposable nappy with petrolatum in the topsheet.
• Call your GP if the rash doesn't clear up after a few days, or if blisters or pus-filled bumps appear.

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