Nappy Rash
Nappy rash, sometimes called napkin dermatitis occurs most often in infants 6-12 months of age. Most babies will have nappy rash at some time during infancy. A baby’s skin is much softer and thinner than an adult’s. Contact of urine or bowel motions with the skin and infrequent nappy changes can irritate, causing nappy rash. Advice from a pharmacist can help in both treating and preventing nappy rash from occurring.
A baby’s skin may be irritated by:
* Bowel motions - especially loose motions which may be caused by certain foods, medicines, infections or when teething.
* Urine - especially when the nappy is left on too long or when covered by plastic pants (plastic pants make nappy rash more likely by keeping the baby’s skin warm, wet and airless).
* Soiled nappies - constant wetting and re-wetting of the skin when left in contact with soiled nappies left on too long.
* Irritant substances - in nappy change creams e.g. lanolin, or in cloth nappies which haven’t been fully rinsed of detergents and antiseptics. Bleach, water softener, fabric softener or nappy rinse used when washing nappies can be irritant too.
* Excessive sweating - this is often a problem when plastic pants are used.
Important
See a doctor if the:
* Rash spreads outside the nappy area
* Rash is no better after five days of treatment (see over)
* Skin is broken and the rash is severe
* Rash shows signs of an infection
* Baby also has a fever, is irritable, is not eating well or generally seems ill.
Signs and symptoms
Simple nappy rash is a burn-like rash where the nappy touches the bottom. It is red, slightly rough, and scaly.
* Fungal infection is common, usually with thrush (candida). This causes a brighter red, shiny rash with sharply outlined patches, often with smaller spots out of the main area. Unlike a simple nappy rash, the creases of the skin may also be red.
* If the rash does not clear and the skin becomes broken, the area can become infected with bacteria - weeping or yellow crusting may be present (see a doctor if this happens).
Treatment
Simple nappy rash
* Clean the baby’s bottom at each nappy change with aqueous cream mixed with water. Avoid soap, talcum powder and nappy wipes as these may further irritate the skin.
* If possible, leave the nappy off as often as possible so the area is exposed to the air. Take care if the baby is outdoors as its skin is sensitive and burns easily
* While the baby has nappy rash, a good quality disposable nappy is best as it keeps the area drier. Choose the most absorbent type.
* Check the baby’s nappy every hour to ensure the irritated skin is not in contact with urine or bowel motions for long. Using a disposable nappy overnight will keep the skin drier for longer, which means you probably will not need to change the nappy until morning.
* Some soap substitutes or non-soap bath solutions also help to settle skin irritation in the nappy area (ask a pharmacist).
* Use oilated oatmeal or a handful of oats (put into the foot of an old stocking) in the baby’s bath. Squeeze the oatmilk onto the rash to calm it.
* Apply a healing protective cream (e.g. zinc and castor oil) after washing the baby’s bottom at each nappy change. This provides a water-resistant layer on the skin and prevents moisture loss. It also helps soothe the baby’s skin.
More severe nappy rash
* Hydrocortisone cream or ointment may be used for a short time to treat severe rash (ask a pharmacist).
* Hydrocortisone products will not stop nappy rash coming back. Find out what causes the rash and follow the Prevention section below.
* If the rash is infected with bacteria or a fungus, you will need a different cream or ointment. Ask a pharmacist or doctor.
Prevention
* Change wet or dirty nappies straight away.
* Gently wash the baby’s bottom at each nappy change with warm water using a soft face cloth. Use aqueous cream or a non-drying, non-soap cleanser when necessary.
* Pat dry and leave uncovered until completely dry
* Apply a protective soothing cream /ointment (ask a pharmacist).
* Rinse wet or dirty nappies well before placing in nappy soaking solution (always wear rubber gloves) or wash immediately with pure soap.
* Rinse nappies at least twice after washing to remove soap and chemicals. If possible, tumble dry as it makes the nappies softer.
* Nappy rash can occur with cloth or disposable nappies. Use a one way nappy liner next to the baby’s skin with cloth nappies. Use a cloth outer nappy instead of plastic pants.
* Keep nappies loosely fastened, especially at night to allow air to flow around the baby’s bottom.
* Nappies should be left off wherever possible to get as much air as possible.
Recommended reading:
Eisenberg, Murkoff, & Hathaway What to Expect, the First Years Angus & Robertson, 2000.
Contact
A doctor - listed under medical practitioners in the yellow pages of the phone book
A local Baby, Child or Infant Health Centre - listed in the white pages of the phone book.
A Self Care pharmacist. To find: (02) 6283 4777.
In case of poisoning, phone the Poisons Information Centre on 13 11 26 from anywhere in Australia.
Pharmacists are medicines experts. Ask a pharmacist for advice when choosing a medicine.
