Nappy rash is a fairly common condition that most parents will experience at some time or other with their baby or young child during the time that nappies are worn. This is generally mild and typically appears as a well-defined area of redness and scattered spots on the buttocks and perineum.

The most common times when nappy rash occurs are;

  • Teething
  • When baby has diarrhoea
  • Baby has a cold
  • Baby starting to sleep through the night
  • Weaning
  • Antibiotic use (either with a breastfeeding mum or the infant receiving antibiotics)
  • Swapping breast milk to formula

There are some factors which are noted to increase the risk of nappy rashes;

  • Prematurity – preterm babies are more at risk due to the reduced barrier function of their skin
  • Diarrhoea and conditions associated with increased stool volume and pH (e.g. formula feeding)
  • Use of broad-spectrum antibiotics, which not only ‘kill’ the ‘bad’ bacteria, but also disturb the healthy balance of the ‘good’ bacteria or flora of the gut. This predisposes to the baby developing candida sp. (‘thrush’)
  • Infrequent nappy changing and cleansing
  • Poor absorbency and breathability of nappies
  • Exposure to chemical irritants – in the nappies, soaps, detergents or wipes
  • Friction from nappies or vigorous cleansing

Prevention

 Aim to prevent nappy rash happening in the first place where possible.

Apply a thin layer of a suitable barrier preparation at every nappy change. These preparations form a protective lipid layer which acts as a barrier to irritants.A thin layer is advised, as a thick layer retains moisture causing skin damage and the breaking down of the skin

  1. Products suitable for use at every nappy change are available as ointments, lotions and sprays. A spray is convenient when out and about, when handwashing facilities are limited
  1. Choose a nappy with good absorbency that also fits well (not too big nor too tight) and avoid plastic pants
  2. Change nappy frequently and as soon as possible after baby opens their bowels
  3. Bath baby daily from age two weeks
  4. Dry baby’s skin gently
  5. Lie baby on a towel and changing mat and allow baby some nappy free time, ensuring that your baby does not get cold (warm room, suitable clothing on top half)
  6. Avoid soap, bubble bath, talcum powder, lanolin, arachis oil (peanut oil) and other products that may have fragrance or other ingredients that may cause sensitivity or an allergic reaction

Treatment of nappy rash

  •  Mild nappy rash should settle with appropriate management, as above, within about 3 days.
  • Ointments (applied as a thin layer) are generally more effective for treating nappy rash than creams and sprays/lotions, as they provide a better moisture barrier
  • For a baby who has a mild nappy rash and is otherwise well NICE suggest one of the following options;
  1. Metanium Nappy Rash Ointment (the yellow treatment one. The purple Metanium is the Barrier Ointment Protection)

2. Zinc and Castor Oil Ointment BP (note: this contains arachis oil so should not be used if there is a known sensitivity to peanuts or soya)

3. White Soft Paraffin BP Ointment

For a nappy rash that is inflamed and causing discomfort

 The baby should be seen by the GP, who may prescribe hydrocortisone 1% cream once a day (for babies over one month of age), until the inflammation subsides or for a maximum of 7 days. Parents should apply the hydrocortisone first and wait a few minutes before applying their chosen nappy rash ointment.

If the rash persists and Candida (thrush) is suspected, an imidazole cream (used to treat fungal infections) is needed, and the parents should be advised not to use nappy rash ointment until the infection has cleared.

If a bacterial infection is suspected or confirmed by a swab, the baby will need a 7-day course of oral flucloxacillin antibiotics prescribing by a doctor.

Referral to a paediatric dermatologist is necessary if there is uncertainty about the diagnosis, the rash persists despite optimal treatment, or there are recurrent, severe unexplained episodes.