Nappy Rash - causes and treatment

Updated: Jul 7, 2020

Nappy rash is extremely common in babies and toddlers who wear nappies (according to the NHS it affects up to a third of them at any one time) and most children will experience it at some point.

While not medically trained, I would like to share with you my top tips for preventing and treating nappy rash, gained from my years working as a nanny, in nurseries and now as a mum. Most nappy rash clears up with in a matter of days. However, if you have any concerns that your child’s nappy rash is not getting better, is getting worse or maybe infected, please seek medical advice from your Health Visitor, local pharmacy or GP.

Causes of nappy rash

The most common cause of a child getting nappy rash is their skin being in contact with the ammonia and digestive enzymes in their wee or poo for too long. However, ‘too long’ is a very individual term. Some children are simply more prone to nappy rash than others. This may be because their poo is more acidic, their skin in more sensitive or a combination of both.

One thing that is true for all children I have ever cared for is that poo causes nappy rash much quicker than wee and that diarrhoea will cause it even quicker. (There are more enzymes in poo than wee and they are more active in runny poo). Furthermore, wee is absorbed into the nappy and away from the skin (as long as it is not too full), while poo remains in contact with the skin.

Other causes of nappy rash include;

  • Antibiotics may cause nappy rash in some babies/toddlers

  • Nappy rubbing against your baby’s skin

  • Allergic reaction to baby wipes, detergent residue in cloth nappies, or soap

  • Teething seems to trigger nappy rash in some children - the theory being that, as they dribble more, their stools become looser and cause more nappy rash. The same is said about a cold.

How to spot nappy rash

Spotting nappy rash and treating it quickly means its impact for your child should be minimal. For most children, most of the time, the skin round their nappy area and their bum is a pink and calm looking. For children with nappy rash this is not the case. There may be red patches on your baby's bottom, or the whole area may be red. Their skin may look sore and feel hot to touch, and there may be spots, pimples or blisters. I tend to think of nappy rash in three stages:

Stage one: The nappy area looks a darker pink or very slightly red. There may be a light rash but there is no heat. Only a small area is affected, often between the bum cheeks or around the scrotum. This rash usually doesn’t bother your child and is quick to respond to treatment.

Stage two: The nappy area looks red, inflamed and angry and may feel warm to touch. The rash may be in patches, with ‘stage one’ also visible or it may cover a large area. Your child may show some mild signs of discomfort or may not. This takes a little more time to clear up.

Stage three: The nappy area looks red, inflamed and angry. It is hot and there are patches of weeping skin. Your child is likely to show signs of pain or discomfort as they are cleaned. This takes longer to clear up.

In my experience, nappy rash can come on slowly, or can seem to jump straight to stage three with no warning.

How to prevent nappy rash

The best way to deal with nappy rash is to try to prevent it in the first place.

  • Change nappies regularly and immediately after every poo

  • Clean the whole nappy area well, with either water or alcohol and fragrance free wet wipes. (wipe from front to back)

  • If your child is prone to nappy rash use a barrier cream at every change (Sudo Cream, Bepantham and Metanium are the ones most known in the UK)

  • Bath your child regularly, but no more than twice a day

  • Make sure reusable nappies are fully rinsed

  • Try to give your child’s nappy area some air time each day.

As a baby, my little one used to enjoy ‘air time’ on her change mat each evening before her bath. As a toddler it is more challenging, but we get a couple of minutes as she watches her evening bath being run (she stands on our bath mat to catch any wees!)

Treating nappy rash

Despite your best efforts it is very likely your child will get nappy rash at some point. I know my own child had a bad bout of it around 5 months when she had a tummy bug. We again had patches of it around 14 months when she went through a phase of stealth pooing!

The quicker you catch nappy rash the easier it is to treat. Once the skin starts to be affected it can very quickly progress through the stages.

For stage one nappy rash

I have found that a careful clean, a bit of barrier cream and vigilance with the next couple of nappies being changed promptly is often all that is needed.

For stage two and three nappy rash, follow these tips.

Clean the area fully - remember to wipe front to back

‘Air time’ - In my experience the only thing that really shifts nappy rash, particularly once it has reached stage three, is allowing it plenty of time in the air. The more ‘air time’ you can give the area, the quicker the rash will clear up. If you can, try and give even a short period of 'air time' at each nappy change. For large areas of stage three rash you may need to try and do some longer spells of 'air time'.

  • For a non-moving baby this is simple to do. Lay their change mat on the floor and place a towel on top of it (to catch any wee). Strip their lower half but leave their top half clothed to keep them warm. Then simply let them have a wriggle and kick about nappy free. (For a little boy, place a flannel or a muslin over their penis to catch any wee). Let them kick about for as long as they are happy. You should start to see the rash area begin to dry out and any weeping areas dry over.

  • For your mobile baby/toddler it can be harder. As above lay them on their change mat with their bottom half free. Try singing songs, reading books or even a short spell of TV to keep them still. If they are old enough, you can try and explain why you want them to lie still for a while. If they are walking, another option can be to let them run around outside nappy free, where a wee incident is less of an issue.

  • If your mobile baby/toddler won’t stay put for long enough and has a severe rash, you may want to try taking their nappy off at nap time. You can lay a puppy training mat under them to collect any wee.

‘Pat Rag’ - Before you put a nappy back on, whether you have had airtime or not, make sure the whole of the nappy area is fully dry. Keep to hand a muslin or a flannel to use as a ‘pat rag’ (wash regularly). Gently pat, don’t rub as this will cause more pain and irritation. Patting the area dry after each change can also be helpful for those children who are just prone to getting nappy rash.

Cream – apply a thin layer of barrier cream. It can be tempting to slather your child in cream in an attempt to sooth their irritated skin. However, all this does is cover the nappy in cream, meaning it is unable to do its job of absorbing anything the child produces, and instead the content of the nappy is held next to the child’s skin, irritating it further.

Remain vigilant – and keep changing nappies regularly

If the rash doesn't go away or your baby develops a persistent bright red, moist rash with white or red pimples that spreads into the folds of their skin, please seek advice from a pharmacist, Health Visitor or GP as your child may have an infection.

Further information on Nappy Rash can be found via the NHS web pages.

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