Nappy Rash: Prevention & Treatment

by | May 25, 2022

While it’s not a serious ailment, nappy rash can be incredibly uncomfortable for your little one. Pippa Naudé tells us  how to treat it quickly and effectively.

According to UK National Health Service statistics, up to a third of babies and toddlers in nappies develop a painful red rash in the nappy area at some time.

The most common form of nappy rash, called contact dermatitis, is caused by the urine or faeces in a nappy irritating a baby’s delicate skin, explains registered midwife Candice Phipps.

“The inflamed skin usually appears red or raised, and the area may also feel warm to the touch. The nappy rash may be mild and just in the nappy area, or severe and spread outside the nappy area,” she adds. Unsurprisingly, other symptoms include tears and unhappiness!

Treatment tips

Luckily, treating nappy rash is simple. The Mayo Clinic recommends the following – all of which are also good practices to help prevent nappy rash:

  • Change your baby’s wet or dirty nappy promptly, to prevent irritation.
  • Clean your baby’s bottom with water and a face cloth or cotton balls. Soap or wet wipes are not necessary, but if you want to use them, opt for products that are made for sensitive skin and fragrance-free. This is to avoid aggravating your baby’s skin further.
  • Let your baby air dry or gently towel dry. When completely dry, apply petroleum jelly or bum cream to create a protective barrier on the skin.
  • If possible, let your baby go nappy-less for a while to allow the skin to breathe. This can go a long way to helping the skin heal.
  • When putting on a nappy, make sure it’s not too tight, as this can chafe the skin and make the rash worse.
  • Wash your hands well after a nappy change, to prevent any spread of bacteria or yeast (just in case these are present).

Phipps adds that nappy rash rarely requires medical attention. However, if it doesn’t clear up after four to seven days, or worsens (such as developing blisters or pus), book an appointment with a healthcare professional.

Other causes of nappy rash

Aside from soiled nappies, there are other possible causes for nappy rash.

Eczema: While eczema, a dry red itchy rash, most commonly occurs on the cheeks, arm creases, ankles, knees and sometimes behind the ears and neck of babies, it can appear in the thigh creases.

“In this type of reaction, the affected area is not necessarily in contact with the allergen. It could be that your baby is reacting to the nappy, the bum cream, wet wipes or a detergent,” says Phipps. The best treatment is to identify the cause and remove it.

Heat rash: Phipps explains, “Heat rash is seen most commonly in the skin folds in the nappy area in hot weather, as perspiration can’t evaporate and irritates the skin. It looks like acne and appears as small pink bumps.”

To treat heat rash, you’ll want to help your baby stay cool. Going nappy-less can help, as well as not putting nappies on too tightly or overdressing your baby.

Thrush: The most severe type of nappy rash is caused by thrush (a fungus). Phipps describes it as “a red pin-prick (spotty) rash, outside of red, inflamed, shiny patches. It is caused by a yeast infection. The rash starts around the anus (as it comes from the gut), and the spots then follow and can spread from there.”

She adds that thrush needs to be treated with an antifungal cream prescribed by your doctor, and, because damp, warm nappies are the perfect environment for thrush, care should be taken to change nappies as soon as they get soiled. A rash from thrush usually takes longer to disappear compared to normal nappy rash, and it can often reappear.

Cloth or disposable, which is better?

Despite some moms believing otherwise, your baby can get nappy rash regardless of whether you use cloth nappies or disposables.

Catherine Dowie from the South African Cloth Nappy Users group (SACNU, explains that most cloth nappy rashes are either caused by sensitivity to wetness or thrush. She advises: “If the cause is wetness sensitivity, the solution is to use a stay-dry layer like suede or fleece as a liner against the skin. In the case of thrush, the yeast spores can live in the cloth nappies and a bleach strip wash is required to treat them properly. The nappies should not be used until the rash is completely clear.”

Stripping is a deep cleanse, which Dowie says can be done in the following ways:

  • In a washing machine, add half a cup of bleach to a litre of water and put the load on a rinse cycle. Don’t add anything else to the load.
  • In a half full bath, add half a cup of bleach and soak for 30 to 45 minutes.
  • In a bucket of 4 litres of water, add one tablespoon of bleach and soak for 30 to 45 minutes.

Follow a soak with a warm wash using detergent but no softener, to break down the bleach.

If your baby often gets a rash using a certain brand of disposable nappies, consider trying a different brand to see if that helps.

Home remedies

Many moms swear by these (sometimes surprising) home remedy treatments for their baby’s nappy rash:

  • Clean your baby’s bum with cooled rooibos tea instead of water
  • Use cornflour to help keep the area dry
  • Mix egg whites and apply on the affected skin
  • If you run out of bum cream, use nipple cream instead
  • Use breast milk on the affected skin
  • Use fish oil instead of bum cream.

Ditch the talc

In the past, talcum powder was often liberally dusted into babies’ nappies to help keep them dry. However, doctors now recommend against this, as there is a risk your baby could inhale the fine powder, and irritate their lungs. Use bum cream or petroleum jelly instead, or go natural and don’t apply anything to your baby’s bottom.