Nappy rash

Nappy rash refers to skin conditions that affect the skin area covered by nappies. It causes a sore, red rash which can be uncomfortable and should be treated.

Nappy rash is common in babies and toddlers. It can be mild or severe, depending on the cause and how it's managed. If your baby has nappy rash, don't blame yourself. Nappy rash can appear quite quickly and for no obvious reason.

Frequent nappy changes, careful cleaning of the skin and using a barrier cream almost always helps it heal.

The most common sign of nappy rash is red, irritated and moist skin in the area covered by your baby's nappy. It can affect a small area of skin or spread across their whole nappy area.

The area may also be puffy, shiny or scaly.

Nappy rash may be itchy, but in many cases, it may not bother your baby at all.

If left untreated, nappy rash can develop into blisters or open sores.

Nappy rash can develop when your baby's skin is:

• wet (with wee)
• dirty (with poo)
• irritated by rubbing from their nappy or clothing (friction)

Wee and poo

The most common cause of nappy rash is when your baby's nappy isn't changed often enough. Wee and poo contain ammonia and other chemicals which can irritate the skin. Moisture can also break down the top layer of your baby's skin and cause damage.

Some babies have sensitive skin that reacts quickly to any moisture or friction.

Thrush

Thrush can also cause nappy rash. Candida albicans, the type of yeast that causes thrush, likes warm, moist places such as the nappy area. Nappy rash caused by thrush may:

• be bright red
• be cracked and bleeding
• be crusted or blistered
• involve the body folds and other places
• have small red isolated dots

Babies can also develop oral thrush, which looks like white patches on their gums and tongue. This isn't related to nappy rash.

Thrush isn't painful, but it can be itchy and irritating. Often, thrush doesn't improve on its own and can get worse unless treated with an antifungal cream.

Other causes

Some foods, especially acidic fruits and vegetables, also cause nappy rash for some babies. These may include:

• oranges
• strawberries
• tomatoes

Conditions that may make your baby more likely to develop nappy rash include:

• skin conditions such as eczema and psoriasis
• infections such as impetigo and erythema
• allergies
• malnutrition

Be sure to also check that you are using wet wipes and soap that are made for babies. Some soaps and wipes can irritate your baby's skin.

If you are worried about your baby's nappy rash, you can show your maternal, child and family health nurse or doctor at your next visit. They can look for signs of infection, and advise you on how to care for your baby's nappy rash.

Visit your doctor if your baby's nappy rash does not improve after treating it at home. You can also visit if:

• you think the rash is getting worse
• your baby seems irritated by the rash
• you notice a change in your baby's feeding or settling behaviours
• your baby has developed a fever, body rash or seems unwell
• the nappy rash develops blisters, sores or the skin is breaking open

Your doctor can examine the rash, rule out other conditions and give you treatment advice.

Nappy rash is prevented and treated similarly. There are steps you can take to keep your baby clean, dry and irritation-free:

• Continue to use barrier cream.
• Use disposable nappies while you baby has nappy rash. These will help to keep their skin dryer than cloth nappies.
• Use plain, water-soaked cotton wool to clean your baby's skin, especially their skin folds.
• Change your baby's nappy often — at least 6 times each day and as soon as possible after they poo.
• Don't put their nappy on too tightly. Air flow around the rash will help it to get better.
• Don't use talcum powder or antiseptic wipes, as these could irritate your baby's skin.
• Use a gentle baby wash at bath time. Avoid using bubble baths or strong-smelling body washes and soaps.

It's also a good idea to give your baby some 'nappy free' time every day to move their legs freely and reduce friction against their nappy.

Complications of nappy rash include thrush or another infection. Medicated creams such as hydrocortisone may be prescribed for a red, inflamed rash. If your baby's nappy rash is infected, your doctor may prescribe an antifungal or antibiotic cream.

The best way to help prevent nappy rash is to keep your baby clean and dry. Change your baby's nappy frequently and follow the nappy changing tips above.

Ask your pharmacist to recommend a barrier cream to help prevent nappy rash.

To find a pharmacy or maternal, child and family health service near you, use the Service Finder tool.

Read the Sydney Children's Hospital factsheet on nappy rash.

Learn more about prevention and treatment of nappy rash at Telethon Kids Institute.