Up to a third of babies get nappy rash at some point during their nappy wearing life. It’s not a nice feeling to open your little one’s nappy and see that tell tale red and sore bottom. But it’s very common and in most cases, very easy to treat at home. Here is everything you need to know about nappy rash.
I am not a trained medical practitioner, I am [just] a mum. Information on this site is never intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your health visitor, doctor or other qualified health provider with any questions or concerns you may have.
Getting to the bottom of it
If you’re a mum, the chances are you’ve encountered nappy rash before. I’ve heard that one in three babies and toddlers get nappy rash at some point, but personally I think this figure is far too low. Surely ALL babies get nappy rash at some point while they’re still wearing nappies?
(Answers on a postcard).
Both of my girls have had nappy rash. When Zoe had it, I took her to the doctors a couple of times. She was doing lots of poos (8 in one day was her record) and obviously this was impacting her poor little tushy. More on this later.
Sophia had nappy rash when she was a newborn. (Sob!) I didn’t take her to the doctors, but following the treatment steps outlined below, it cleared up at home. (Hurrah!)
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What is nappy rash?
Nappy rash is a common skin irritation that occurs in babies and toddlers who wear nappies. There are a few different causes (which we’ll look at later), but treatment is effective and can be carried out at home.
Recognising nappy rash
If the skin underneath the nappy looks red and sore, your baby probably has nappy rash. Sorry!
According to our wonderful NHS, nappy rash:
“…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.”
It can be mild or extensive, but it usually clears up quickly and easily enough.
How serious is it?
Most cases of nappy rash can be treated at home, and there are steps that can be taken to prevent it’s re-occurrence; or occurrence in the first place. It usually responds well to treatment and symptoms should improve within about 3 days.
If symptoms do not show any signs of improving after 3 days of treatment, or you have any other concerns, you should always consult a doctor or pharmacist.
If your baby or toddler gets nappy rash, one of the first questions you’re probably asking is, what caused the rash in the first place. In order to know how to treat and prevent nappy rash, understanding how it started is essential. Then you can treat it more directly.
Here are the main 6 culprits usually to blame when your little one develops nappy rash:
1) Skin’s exposure to wee or poo for too long
Babies have delicate skin.
Chemicals, fragrances, dyes in clothing, detergents and baby products can all cause the skin to react. Nothing could be more true than when it comes to a baby’s bottom.
Have you ever heard the expression, ‘soft as a babies bottom’? It’s true. Their little tushies are super soft, and just like the rest of them, needs looking after carefully.
One of the most common causes of nappy rash is wearing a wet or dirty nappy for too long. This means that the baby’s sweet, soft, squidgy little bottom, remains in contact with the dampness, friction and ammonia substances in the wee and poo for too long, causing irritation.
Also, generally nappies do not allow air to circulate very well around the bottom, and therefore keep the area damp.
You can see why it would be a problem not to change your baby’s nappy frequently enough.
On the other hand, the frequency of nappy changes may not be an issue. Perhaps the nappy area is just not being cleaned thoroughly enough. If there are remnants of the dirty nappy left on the baby’s bottom, again this could be causing the bottom to become sore, which can easily develop into nappy rash.
2) The nappy itself
Nappies are not all created equal.
There are huge differences in the quality, comfort, effectiveness and even the price of nappies. And I should know. When it comes to disposable nappies, I think I’ve tried most brands, and I definitely have my favourites. Keep reading to discover my top 3 choices when it comes to nappies.
A poor quality nappy, which doesn’t absorb the contents very well, means that the bottom will be staying in contact with the wee and poo a lot more. Which will irritate the skin and cause soreness if not resolved quickly.
Equally, if the nappy doesn’t fit well, it could cause chaffing which in turn could contribute to a sore bottom.
3) Baby wipes
If your baby suddenly suffers with nappy rash, and there is no accompanying diarrhea or changes to the nappy, think about the baby wipes you are using.
Generally speaking, babies have sensitive skin. But if your baby has super sensitive skin, baby wipes can cause an allergic reaction resulting in nappy rash. This is especially true if the wet wipes you use contain alcohol or fragrances.
When it comes to baby wipes, the purer, the better in my experience.
If your child has a bout of nappy rash, I’d definitely recommend looking at their diet as an initial course of action. If they’re not on solids yet, and you’re breastfeeding, this also extends to looking at your diet.
There are certain foods to watch out for that can cause nappy rash, including:
- Acidic foods i.e. citruses, tomatoes, strawberries
- Prunes and plums
- Proteins in certain foods i.e wheat, dairy, soy
The acidity in certain foods creates an acidic environment in your baby’s digestive system. This results in more acidic wee and poos, which can irritate at best, or burn at worse, your child’s skin. Ouch.
High fibre foods are a great natural remedy for constipation in adults. Any foods which are high in fibre, such as prunes, plums, apricots and grapes help to loosen the stools, thereby easing constipation. This is also true in babies. But too much of a good thing, can have adverse affects on your little munchkin. Any foods which are high in fibre can cause an increase in poos, which in turn can trigger nappy rash.
Having a Cows Milk Allergy is one of the most common childhood food allergies, affecting up to 7.5% of babies, most of whom will grow out of this by the age of 5. It occurs when your baby’s immune system reacts to proteins in cow’s milk, and one of the many symptoms of this include diarrhea. See the NHS guidance on Cow’s Milk Allergy, or CMA, here.
5) Recent course of antibiotics
If your baby is prescribed antibiotics by the doctor it means she must be suffering with a bacterial infection. The job of the antibiotics is to destroy the bacteria in your baby’s body. But did you know, not all bacteria is bad?
When the antibiotics get to work, the result is that they destroy both the good and the bad bacteria that live in your baby’s body. One of these good bacteria is the one that keeps the growth of yeast under control. If this gets depleted, it increases the chance that your baby may get nappy rash due to a yeast infection, called candida.
Sounds lovely doesn’t it.
On top of this, antibiotics sometime cause diarrhea. As the main culprit behind nappy rash is the bottom’s prolonged contact with wee and poo, a bout of diarrhea can often cause an onset of nappy rash to flare up.
Officially, teething is not a cause of nappy rash.
But if you speak to other members of the ‘mum club’ you may find their experiences do not agree with this.
Whilst teething may not be a direct cause of nappy rash, some of the symptoms that accompany the onset of teething, can contribute to nappy rash. For example, dribbling. Alongside the flushed cheeks, the swollen gums and the constant ear rubbing, babies often dribble a lot while they’re teething.
This increase in saliva can cause looser and more changeable poos. And as mentioned above, diarrhea can often result in nappy rash.
Don’t worry – there’s a light at the end of the tunnel.
As already mentioned, nappy rash is generally very easy to treat at home and usually clears up within a few days!!
Following these 8 simple suggestions below, should help nappy rash clear up when it occurs:
1) Change nappy more frequently
It probably seems like a bit of an obvious point to make. But that’s okay.
The number one cause of nappy rash is the bottom coming into contact with wee and poo for extended periods of time. The quickest and most effective way to stop the nappy rash getting worse, is to change the nappy more frequently.
I told you it was obvious.
The nappy area needs to be kept as clean and dry as possible in order to recover. Frequent changing of the nappy, limits the bottom’s exposure to wee and poo which will help it recover faster.
Not only does your baby’s nappy need changing more frequently, but you also need to ensure each time that the bottom is cleaned gently but thoroughly each time. You should wipe from front to back, and ensure there are no traces of wee or poo left behind. Check the creases to make sure none has been missed, and then make sure the bottom is properly dry before putting a clean nappy back on.
Top Tip: It is recommended that you don’t use talcum powder as it contains ingredients that could irritate your baby’s skin.
At the very least, you should be changing your baby’s nappy as soon as they have done a poo. But when your baby is suffering with nappy rash it would be better to change the nappy much more frequently than waiting for a poo to occur.
It’s also a good idea to give your baby a bath once a day, but avoid using bubble bath or soap. Dry the baby with gentle patting rather than rubbing, and don’t use lotions, other than a nappy rash cream, and/or barrier protection cream.
2) “Nappy Off” time
The best and most effective way to help a bottom recover from a bout of nappy rash is to keep it as clean and dry as possible. In our house, we do this by introducing regular “nappy off” time for the effected sufferer. How does this work in practise?
Obviously, you can’t explain to a baby that they need to lie still and not wee (or poop) while the nappy is off. I mean you could try, but I’m not sure how effective your instruction giving would be. If your baby is anything like mine, lying still for any length of time, and for any reason is basically a physical impossibility. The world is just too exciting and needs immediate exploration.
So how do you achieve nappy off time when you have an active baby, without all the mess?
Here are a few things you could try:
- Put the baby on a changing mat, or towels to try to limit making a mess of the floor.
- Do nappy off time in a room with a wipe-able floor, i.e. not carpet, making it much easier to mop up any messes that do occur.
- Ensure any vests, tops, or other clothing is tucked or folded out of the way. This reduces the risk of you needing to change the entire outfit later. Or, even better, do it naked. No, not you, mummy, your baby!
Distraction, distraction, distraction
So you’ve managed to do some damage limitation, to minimise the messes that will inevitable occur during nappy off time. But how do you get your baby to stay (reasonably) still?
I’ve heard that stapling your child to the floor is frowned upon!?
We love a bit of distraction in our house. If the toddler is just about to launch herself into the mother of all tantrums, distraction. When we’re on a long car journey and the kids are getting bored, distraction. It doesn’t have a 100% success rate, but implemented early enough, it works about 85-90% of the time.
I like those odds.
The same works with nappy off time. If you can find something that distracts your child’s attention from the fact they’re lying on the floor naked from the waist down, you’re onto a winner.
We shamelessly use screen time to distract our little ones for nappy off time. It’s proven to be the most effective way of keeping them still and happy for short periods of time. Watching any kind of media is so rare for them, that as soon as some is put in front of them, they drop everything, transfixed.
You can see why this works well in the context of nappy off time.
How long should you do nappy off time for?
How long is a piece of string?
I would say, as long as possible. For as long as your baby is happy to lie still and let their sore bottom get some exposure to the elements and air dry, the better. I usually aim for about 15 or 20 minutes, but if they’re really happy, and time allows, I might leave them for up to half an hour.
When I say ‘leave them’, I hasten to add that I’m still in the room with them, I’m not actually ‘leaving them’ alone at any point.
3) Consider a change in diet
When Zoe was a baby, she went through a phase where she would be doing anywhere between 5 and 8 poos a day! Not only were they very frequent, they were also the smelliest nappies I’ve ever experienced. (Gag!)
I know right! So gross!
You can only imagine the effect this was having on her poor little bottom. Even though I knew nappy rash was something that can be treated quite easily at home, I was concerned that it was simply getting worse, and that the constant poos were to blame.
So I took her to the doctors.
I wasn’t hoping for medication, I just wanted some advice. I was a new mum and things did not feel right to me.
Unfortunately, on this occasion, I didn’t receive any words of wisdom, or helpful advice. I was simply assured that babies can go through phases of pooing more, and that it would fix itself.
This wasn’t really the kind of advice I was hoping for.
Finding the cause
As soon as we introduced food to her, Zoe had been a foodie! She still is, aged 3 and a half.
After my rather disappointing visit to the doctor, I decided to think about what she was eating and if this could be causing the excessive poos.
One of her favourite foods was fruit. It didn’t matter what fruit it was, if she was offered it, she would devour it. It turns out, that she was eating way to much, and this was upsetting her stomach, which in turn was causing the nappy rash.
We went completely cold turkey on the fruit front, and within 24 hours, we saw a massive reduction in the number of poos. Within about 3 days of cutting out fruit entirely from her diet, her poos had returned to normal, and her nappy rash had almost completely gone.
After this we gently started to introduce fruit back into her diet, but on a much smaller scale. And things stayed settled in the nappy department.
Since then, if either of my girls ever has nappy rash, the first question I ask myself is, ‘how much fruit has she been eating?’ Such a simple thing, but just by tweaking their diet slightly, massive improvements have followed.
While we’re on the subject of diet, let’s talk allergies. As mentioned above, one cause of nappy rash could be food allergies.
Even though cows milk allergy is one of the most common forms of food allergy in babies, it still affects less than 8% of little ones. If you suspect your baby or toddler may have an food allergy, speak to your doctor or health visitor.
It’s always recommended that you make any drastic changes to your child’s diet, such as cutting out a major food group like dairy, under the consultation of a dietitian, who can ensure that your child is still getting all the nutrients and vitamins they need.
For more information about what you can do if you suspect your child has a cows milk allergy, check out this helpful article produced by our beloved NHS.
4) Try an alternative nappy
As I mentioned earlier, in my experience I have found that not all nappies are created equal.
In other words, some of the brands out there are fantastic, and some are a little disappointing. Good nappies can be expensive! But that doesn’t mean the cheaper alternatives are rubbish.
When Zoe started having nappy rash last year, there was no change to her lifestyle or diet at that time. The only thing that had changed was that I’d been trying to save money by buying a cheaper nappy. Unfortunately, it wasn’t made very well and not only did it rub the skin at the top of her leg making it sore, but every time I re-tried these nappies, she would get the beginning of nappy rash. So eventually, I stopped buying those.
Our favourite three:
1)Pampers Premium Protection. These nappies are not cheap! But now that Zoe is potty trained, and only needs to wear a nappy overnight, we don’t mind spending a bit more on a good quality nappy as we’re not getting through them very fast. They are super absorbent, very comfortable and have air channels for breathable dryness. We love them
2) Huggies. When we were in Disney World, Florida last year, we made a huge error one day and left BOTH girls’ changing bags in the hotel. We didn’t realise this until we arrives at Magic Kingdom for the day. Disaster! Fortunately, being the massively family friendly place Disney is, we were able to buy some nappies there. Albeit, over priced, Disney themed ones. Biggest surprise of all, these nappies were awesome! I’ve never bought these nappies here, on account of the price, but they were a real holiday treat.
3) Mamia. These awesome nappies from Aldi have been a winner for us ever since we accidentally stumbled upon them about 6 months ago. I have tried the home brand nappies from Tesco, Sainsburys, Lidl and Aldi, and these Mamia ones were our absolute favourite. I now use these ones exclusively for Sophia, and have had no problems at all. Fantastic!
If you think it might be the nappy contributing to the rash, try a few alternatives. Or maybe try a bigger size. If the nappy is too small and rubs, this can make the bottom sore and lead to nappy rash as well.
5) Respond to antibiotics
As mentioned above, antibiotics work by killing off both the good and bad bacteria in your body. One of these good bacteria keeps the growth of yeast at bay, and when it gets depleted the chances of your baby getting nappy rash due to a yeast infection increases.
According to Healthline, taking probiotics can help to reduce the risk of developing antibiotic-associated diarrhea by more than 50%. Probiotics could also be taken after a course of antibiotics in order to restore some of the healthy bacteria in the intestines that may have been destroyed by the medication.
Again, according to Healthline, fermented foods help restore the gut microbiota after damage caused by antibiotics. But what is it and is it safe for infants to consume?
Fermentation is simply a process that’s used to produce some of our favourite foods. Household favourites such as yoghurt and cheese are made this way. Kefir, which is a yoghurt like drink that my mother-in-law swears by, is a fantastic source of calcium and is rich in probiotic bacteria, which again helps the body repair itself after a course of antibiotics.
As for it’s safety, not only is it safe for infants over the age of 6 months, but it’s also recommended.
6) Try different baby wipes
When our girls were newborns, we didn’t use wet wipes at all. We had a little pot, which we filled with fresh clean water for every nappy change, and cotton wool balls. Was this a little faffy? It was actually. Wet wipes would have been soooo much more convenient, but we made the effort as we believed it was the best thing for their tiny, brand new bottoms.
(Even on holiday in Florida, with an 8 week old, we started off using wet wipes for ease, but after less than a day, Sophia’s bottom was starting to look a little sore. So we switched back to water and cotton wool balls. And her bottom thanked us for the inconvenience).
Let’s face it, wet wipes are a lot more convenient!
Once we graduated from water and cotton wool, we tried a few different brands of wet wipes and eventually settled on these Huggies Pure Ones.
We like these ones for a few reasons. They’re wet enough to clean properly, without being so wet that the bottom needs lots of drying after use. The individual wipes are easy to get out of the pack, so unlike with others we tried, you don’t get a handful at a time, or have to embark on a round of tug-of-war with the packet. Most importantly, they are 99% water based, and contain no fragrances, so our daughter’s sweet little bottoms have been well taken care of. In addition, they’re reasonably priced. They’re not the cheapest, or the most expensive. When it comes to price, they’re middle of the road.
If you find that your baby has nappy rash, and as far as you can see it’s not due to diet changes, or the nappy not being absorbent enough, consider the wet wipes you are using. Where possible, use fragrance-free and alcohol-free wet wipes. The Huggies ones mentioned above, do contain alcohol, but our girls have been ok with these. If they have another nappy rash flare up in the future, I would consider switching to an alcohol free version.
Or simply revert back to water and cotton wool balls.
7) Use a nappy rash cream
If you follow these simple steps, the nappy rash should clear up within about 3 days. If it hasn’t, or you have other concerns about your child’s well being, you should consult with your health visitor or pharmacist. They will be able to recommend a nappy rash cream you can use to help treat your baby.
Nappy rash cream is different to barrier protection cream.
Nappy rash cream is reactive. It’s something you use when your little one is suffering from nappy rash to help clear it up. Barrier protection cream, on the other hand, is proactive. It’s something you use after every nappy change as a preventative measure to stop your baby developing nappy rash in the first place.
You can use a nappy rash cream and a barrier protection cream at the same time, but you should apply the nappy rash cream first, and then wait a few minutes for the cream to be absorbed before applying the barrier protection cream.
8) See a doctor
As with anything related to your dear little ones, if you have concerns, go and see your doctor. Do you think the nappy rash is caused by an allergy, speak to your doctor. Does the nappy rash keeps coming back, speak to your doctor. If you think it could be a yeast infection, speak to your doctor. Or if for any other reason, you have concerns, speak to your doctor.
The best way to deal with nappy rash, is to prevent it happening in the first place. Following the guidance above will help you clear up nappy rash when it strikes, and will also help prevent it occurring in the first place.
As already mentioned, the best defence against nappy rash is a clean and dry bottom.
Here is a summary of things you could do, which if done daily will be a great preventative of nappy rash affecting our little ones:
- Change nappy frequently, and immediately after a poo
- Clean bottom gently but thoroughly, ensuring there is no residual poo left over.
- Wipe from front to back
- Use appropriate wet wipes (fragrance and alcohol free where possible)
- Bath regularly, but avoid using bubble bath or soap, unless it’s specifically designed and tested for babies sensitive skin
- Each time you change a nappy or give your baby a bath, make sure the bottom is dry afterwards
- Pat dry rather than rub
- Allow to air dry as much as possible
- Apply a barrier cream each time the nappy is changed*
- Encourage regular nappy off time
- Seek medical help if you think your little one may have a food allergy
*In my post, 25 Essential items to make life easier for every new mum, I recommend this amazing Burts Bees Diaper Cream that I have used on Sophia’s bottom since she was a newborn. Sophia was given antibiotics when she was less than a day old, due to concerns that she may have picked up an infection prior to being born. (Another reason they decided to deliver her by C section).
Looking back, this is probably what caused her nappy rash at such a young age. This cream not only helped the nappy rash clear up, but helped prevent its return.
Most of the time, when you open your baby’s nappy and see bright red, sore looking skin underneath, it’s not a reason to freak out and panic dial 999.
It’s not a nice thing to discover. But it doesn’t usually send alarm bells ringing.
It looks painful, and if you’re anything like me, you immediately start to feel small pangs of guilt, wondering if you’ve been giving my baby too much fruit or neglecting to change her nappy frequently enough.
But then once the initial guilt passes, it’s very easy to treat from home and is usually cleared up very soon afterwards.
(It’s worth pointing out that nappy rash is very common and can happen no matter how carefully you look after your little one’s bottom.)
When to seek medical attention
Sometimes, after a few days, if the nappy rash hasn’t gone, you may start wondering if it’s time see a doctor. If you’re asking yourself this, maybe you should just go. At the very least it will put your mind at ease that there isn’t anything more serious going on. And if there is something that needs medical intervention, you’ll be glad you trusted your instincts and sought help.
Other things to look out for that might indicate you should visit a doctor, include:
- The rash spreading
- The infected skin erupting into blisters, pimples or sores
- You notice symptoms of a yeast infection, such as a swollen red rash with white scales and lesions
- If your baby develops a fever or seems sluggish
- If the rash occurs within the first few weeks after birth (oops – didn’t I do this!)
If your baby has a stubborn nappy rash that doesn’t clear up after careful treatment at home, it’s possible that it may actually be a yeast infection.
Everyone has yeast in their body. It can be found in a few places, including the skin. Factors like antibiotics, stress, or irritation can throw off the microbial environment in the body, which in turn allows yeast to grow in excess. That’s when a yeast infection occurs.
Nappy rashes that are caused by a yeast infection called Candida are very common. Candida grows best in warm, moist places, so under a nappy is a perfect environment for it to thrive.
Amongst the causes of a yeast infection are:
- Not treating nappy rash for a few days
- Baby taking antibiotics (or mum taking antibiotics if you’re breastfeeding)
- Having had thrush in the mouth
- Nappy being too tight and rubbing the skin
Just like with regular nappy rash, a yeast infection can be treated at home. But you should speak to your doctor who will be able to confirm if it’s a yeast infection and recommend a good cream to use to help clear it up. It’s not dangerous, but it does need to be treated.
Trust your gut. If you feel like something isn’t right, the chances are, you’re correct.
Getting to the bottom of nappy rash
So there you have it, everything you need to know about nappy rash: how to spot it, treat it and prevent it; and when to seek medical intervention.
Do you have any little tricks up your sleeve that you use if your little one suffers from nappy rash?
I’ve found that people tend to have a lot of questions about nappy rash. Hopefully, if your baby has not had it before, this post will help you in the event that it strikes in the future.
At the very least, I hope you feel reassured that even if you look after your baby’s bottom very carefully, nappy rash can still occur, it’s not something you should feel guilty about.
Until next time,