Disclaimer – This article is only to be used for informational purposes only, and does not replace the need to consult a health care professional to discuss the most suitable treatment for your child.
Pharmamum’s Ultimate Guide: Nappy Rash
Nappy rash unfortunately cannot be avoided, unless your baby does not wear nappies. No matter how vigilant you are as a parent with changing nappies, nappy rash is inevitable. I think as a parent, it’s important to be educated in nappy rash and have a good understanding of what causes it, what makes it worse and how it can be prevented as much as possible. With that knowledge, you will be in the best position in understanding how best to treat it and how to hit the problem ‘on its head’ when it first presents before it gets worse and at a point which causes the baby/toddler to be very uncomfortable or in a lot of pain.
So what is nappy rash?
Nappy rash occurs when the skin on your baby’s bottom becomes irritated as it is exposed to wet or dirty nappies for too long. The constant moisture and rubbing against the babies skin is what causes the skin to become red and sore. What does nappy rash look like? The babies bottom looks quite red, swollen and spotty. There can be a fungal component to nappy rash which is quite common and I often get asked ‘how can i tell if there is a fungal component?’ The best way to tell is if you are applying a simple barrier cream to the area and there is no improvement and/or the rash is shiny, bright and red with an obvious outline edge with red spots spreading out.
With my children, my eldest daughter got nappy rash really quite severe, whereas my youngest daughter did not. It does depend on their skin type and if they have sensitive skin. It is known to affect babies more who are prone to eczema/dermatitis.
What is the best treatment?
1.With nappy rash, prevention is the key. However, once treatment is started it usually takes 2-3 days to settle. I cannot stress enough the importance of a barrier cream. There are a lot of brands of barrier creams available ie Sudocream, Desitin, Nappy Goo etc. For the first four to six months of your babies life, changing the nappy before every feed is a great routine to get into (as it helps wake the baby up, so they are not so sleepy to feed). Using a pea size amount of a barrier cream in the nappy region, especially over night when your baby may not be changed for six or so hours (depending on how long they sleep for overnight) would be recommended. Urine and faeces are not so irritating to the skin at this early age in their lives. However, once your baby starts solids and goes through teething I would increase the pea size of barrier cream to at least the size of a 20 cent piece as you will notice a big difference once they start solids. When your baby starts solids and starts teething, the urine or faeces can really be quite irritating to the skin, if their nappy is not changed frequently. For disposable nappies they do say change them at least every four hours. I unfortunately learned the importance of a barrier cream the hard way with my eldest daughter. I would put a small amount of barrier cream on her after each nappy change because in the back of my mind I thought ‘oh what’s this really doing?’ but when the nappy rash got really red raw, and I could hardly touch her to change her nappy, I re-thought about using the barrier cream properly. I started to use the barrier cream at every nappy change and put a great big dollop of sudocrem on her nappy region, almost like you are ‘icing a cake’ and that is how thick it really needs to be. I could see it in my daughters face the relief the barrier cream gave her. The barrier cream contains zinc which is not only a barrier to the harsh irritating chemicals but also healing to the skin.
2.It is important to air the bottom, so having some nappy free time. If this sounds like your worst nightmare, allowing your baby to roam the house without a nappy on, you can place a nappy quite low down on your baby’s hips so that the air can pass through without the nappy having contact with the skin.
3.When cleaning the nappy region, it is best to use warm plain water and cotton wipes but if necessary use a sensitive alcohol free wipe to get the remains out of the nappy region. I personally found Curash sensitive, alcohol free wipes were really great at removing remnants of a dirty nappy.
4.It is best to avoid talcum powder because it is an irritant to babies lungs.
5.Another great tip I found to work well is to lower the bath temperature (only when your child has a bout of nappy rash) and it is causing her a great deal of discomfort. Just by lowering the bath temperature by a couple of degrees, will allow your child to actually sit down as otherwise the water can really sting your baby’s bottom and feel almost like a burn.
6.If there is a fungal component and you need to use both an anti-fungal whilst still using a barrier cream, it can be a little confusing to know when to put which cream on first and do I mix them etc. The anti-fungal cream needs to be applied two to three times a day. The best way I found worked for me was using the anti-fungal cream first and letting it absorb for half an hour to an hour. Then apply a thick layer of barrier cream so you are still protecting the skin from their excretions. Do this during the day at least two or three times. At night before you put them down to sleep I would just apply a very thick layer of barrier cream as your baby will be sleeping 10-12 hours (hopefully) and this will give there nappy region a good chance to repair and heal as well as protect from excretions overnight. The next day repeat the process until the rash has settled.
7. Once the nappy rash has disappeared, I would keep applying a large dollop of barrier cream at every nappy change to always protect the skin and prevent nappy rash. Then you will get to the point that you can judge for yourself with what is happening in your child’s life, ie if your child is teething and you notice their stools and urine irritating their nappy region more than normal, and the skin starts to appear slightly more pinkish and irritated, just apply that little bit more barrier cream along with changing the nappy more frequently and the irritation should calm down and settle nicely.
8. Nappy rash is made worse when teething. When you see that first tooth appear be sure to put extra barrier cream and more frequent nappy changes, and this will reduce risk of nappy rash appearing.
9. Some nappies are more absorbing than others, you find you go through nappies so quickly and the cost adds up. So one thing I did is buy a cheaper brand of nappies and use them during the day but at night time I would make sure I put the best quality, most absorbing nappy on, and I personally found huggies nappies to be the most absorbent out of all the brands that I tried.
10. Other remedies to use and add extra healing, is an oatmeal bath oil/wash ie adding Dermaveen oatmeal bath wash to the bath. Another option is cutting an old stocking (about 20cm long) and putting a cupful of oats in the toe area, tie a knot at the top, and leave it in the bath whilst your baby is bathing, as oatmeal has anti-inflammatory properties.
11. If the nappy rash is really quite severe and causing a lot of pain, Hydrocortisone cream which is a mild steroid is available over the counter,(ie Sigmacort or DermAid) and can be applied two to three times a day which will reduce the inflammation. You may need a health professional to help you assess whether there is a fungal component to the nappy rash, as just using a cortisone cream on a nappy rash, will make the rash worse, so using an anti-fungal cream and a cortisone cream together is the best way to go. You can get from the pharmacy a combined product called Hydrozole which is a combination of an anti-fungal called Clotrimazole and a mild cortisone called Hydrocortisone.
12. If your baby is unwell or has a fever or there is any pus, weeping, broken skin, blisters or yellow crusts, a doctor should be consulted. Also if the nappy rash is just not going away after a week please seek further medical attention.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.