Almost all babies get nappy rash at some point, no matter how well they’re cared for. Although it may cause your baby discomfort and pain, nappy rash is seldom serious. A type of dermatitis that affects the buttocks, genitals, and thighs of babies, the condition usually lasts only a few days but can develop into a persistent rash that indicates a secondary skin condition or infection.
Symptoms of nappy rash include inflamed, red, moist skin that may feel warm to the touch and can blister and peel. The rash can spread to the tummy and buttocks, and small ulcers sometimes form on healthy skin near the area of the rash.
Nappy rash can be caused by anything that irritates your baby’s skin, usually because of the hot, humid environment resulting from the constant wearing of nappies. Babies who have particularly sensitive skin and are prone to rashes on other parts of their bodies, like cradle cap or eczema on the face or under the chin, are more likely to get nappy rash. The tendency is often inherited – other family members may have had skin rashes, including nappy rash. Some babies only get nappy rash when they have a cold or some other viral illness.
The most common cause is prolonged contact with wet or dirty nappies. Urine is normally sterile, but germs on your baby’s skin and in the nappy can change chemicals in urine into other chemicals like ammonia, which is extremely irritating to the skin. Leaving a wet nappy on a baby for long periods of time can make the rash worse.
Irritation may also be the result of inadequate drying of the baby’s skin after a bath, or of friction and rubbing from tight-fitting nappies or plastic pants. Plastic waterproof pants also prevent airflow, meaning that the baby’s bottom stays wet longer. Your baby may be allergic to the chemicals in disposable nappy elastic, or to particular lotions or soaps, or even to the chemicals in the laundry detergent you’re using to wash cloth nappies.
Bacterial infections like staph and strep may complicate nappy rash, and antibiotics prescribed for other illnesses can disrupt the normal balance of “good bacteria” which keep fungal organisms like yeast under control. If the mother or caregiver has a vaginal fungal infection, that can be transmitted to the baby. Some studies indicate that breast-fed babies experience fewer nappy rashes than bottle-fed babies, because breast-fed babies tend to have smaller stools which are less irritating to the skin.
To treat nappy rash and help prevent it recurring, change your baby’s nappies frequently – about five to seven times a day for babies under a year old, and through the night too. Clean your baby’s bottom thoroughly at every nappy change with cotton wool or a facecloth and plain water, and make sure the area is properly dry. If you use baby wipes, choose alcohol-free brands. Protect the skin with a zinc oxide or petroleum jelly ointment, making sure that the product is thick enough to form an effective barrier. When your baby has nappy rash, don’t use baby powder or corn starch as it can build up in the skin folds and hold moisture, providing an ideal environment for bacterial growth. A warm bath for ten minutes, three times a day, with 20ml of baking soda added to the water, can help relieve a sore bottom.
Switch to disposable nappies if you suspect cloth nappies are aggravating the problem: good quality disposable nappies allow moisture to be absorbed more quickly. Fold the plastic of disposable nappies away from your baby’s body and don’t fasten them too tightly. If you’re using fabric nappies, try to minimise the use of plastic pants while your baby has a rash. Rinse cloth nappies twice after washing them, using 10ml of vinegar to a litre of water for the final rinse, and if possible dry them in a tumble drier to keep them soft. Don’t use bulky or multi-layered nappies, and let the baby go without a nappy completely whenever possible. Consider changing your brands of soaps and detergents. Give your baby extra water or cranberry juice to drink, to dilute the urine, and don’t add new foods to his or her diet until the rash has gone.
Usually, nappy rash will clear up after a few days of treatment. If the rash doesn’t improve within a week or two, see your doctor: he or she can prescribe an appropriate topical antifungal treatment.
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