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Nappy Rash: What Parents Need To Know

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Nappy Rash: What Parents Need To Know



Nappy rash occurs when a baby’s sensitive skin rubs against the nappy that is constantly wet and soiled. It is like an adult wearing a wet suit around all day. Although it cannot always be prevented, prompt treatment for the specific cause of the condition will keep soreness to a minimum.

Most babies will suffer from nappy rash from time to time. By knowing how nappy rash occurs and what can aggravate this common condition, parents and carers can take measures to ensure that it never becomes a serious problem.

What causes Nappy Rash?


The most common cause of nappy rash is ammoniacal dermatitis. Ammoniacal dermatitis occurs when there is a chemical breakdown of urine by natural bacteria on the skin. The (alkaline) ammonia produced by this process has a burning effect on a baby's soft skin (Youngson and Jacoby, 2005). Feinbloom (2000) notes that babies fed on formula milk may be more prone to ammoniacal dermatitis, as their stools are more alkaline than those of breast-fed babies, and the bacteria in the faeces thrive in an alkaline medium. Ammoniacal dermatitis most commonly occurs if soiled nappies are not removed immediately, or if urine-soaked nappies are left on too long. It may also arise if the child's parents do not wash and sterilize cloth nappies thoroughly, so that bacteria are still present.

Another cause of nappy rash occurs when rough, hard nappies rub against the skin, which make it sore and less resilient to the harsh effects of ammonia. The condition can also be aggravated by plastic pants, which prevent moisture from evaporating, keeping wetness next to the baby's skin (Younson and Jacoby, 2005).

A third cause of nappy rash is from the fungus infection Candida albicans. A baby might contract this yeast infection in the mouth, either at birth from the mother if she has a vaginal yeast infection herself or when feeding from an unsterilized nipple. Feinbloom (2000) explains that the yeast fungus bacteria then leaves the mouth and travels down and out of the bottom into the faeces. Occasionally cradle cap causes nappy rash. Dandruff falls from the scalp and spreads the condition to other parts of the body, including the nappy area (Feinbloom, 2000).

What are the symptoms of Nappy Rash?


Ammoniacal dermatitis starts in the form of moist red patches around the baby's genitals. It can also be identified by the smell of ammonia that is given off. Left unchecked, the condition can spread over the whole nappy area and beyond. Within a matter of hours, the rash can develop an extremely red appearance. During the stages that follow, the baby's skin becomes thicker-looking and more wrinkled. It develops a paper texture and may peel. Eventually the skin becomes raw and ulcers may form (Youngson and Jacoby, 2005)

When a yeast infection causes the nappy rash, it starts around the bottom and may spread across the baby's buttocks. The yeast fungus can also be seen inside the mouth as white patches, similar in appearance to milk curd, on the tongue, palate, and inside the cheeks (Youngson and Jacoby, 2005).

How do you treat Nappy Rash?


Parents and carers should always clean a baby's bottom thoroughly using soap and water, or baby lotion if it seems sore. Different types of cream including Zinc, castor oil and silicone-based barrier cream can be applied before putting on a clean nappy. Nappies should be left off when possible—this will help moisture to evaporate and will aid healing. If the baby has to wear nappies during the day, parents should make sure they are changed as often as possible. Today's disposable nappies are more absorbent than washable ones but should not be left on for too long. Some are made to absorb wetness where absorption is most needed—thicker at the front for boys and at the back for girls (Youngson and Jacob, 2005).

It is important that parents wash, rinse, and sterilize all cloth nappies thoroughly. They should avoid harsh detergents and make sure that all traces of soap have been removed. A final rinse in an acidic solution will discourage the breakdown of urea.

If a rash persists, a more specific treatment may be required. Left untreated, the rash could become infected, and this in turn could lead to other infections in the genital area.

If a baby's rash is caused by the effect of ammonia on the skin, the doctor will prescribe a soothing ointment. Some creams may clear up the rash much more effectively than others. Once a cream has been found that works for a baby, it should be noted in case the rash returns. If a yeast infection is causing the rash, the treatment usually involves applying a fungicide. Alternatively, antibiotics may be given in droplet form (Feinbloom, 2000).



Youngson, R.M. and Jacoby, D.B. (2005) Encyclopedia of Family Health (Vol 4): Marshall Cavendish: New York.


Feinbloom, R.I. (2000) Pregnancy, Birth, and the Early Months: The Thinking Woman's Guide. 3rd Ed. Perseus Publishing: Cambridge, MA.

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