Nappy Rash

Babies. Such a little word. Such little beings.

Someone wise once said to me that when you have children, you’ll never know a life without worry ever again, not even when they’re all grown up with children of their own. And now I know that’s true. There’s always something – they’re teething, they’re not eating, they never stop eating, they’re not sleeping, they’re sleeping too much, they’re unwell. And that’s before they hit puberty and bring a whole new barrel of issues with them!

I thought I’d start with a post on a condition that is really common in babies – nappy rash. This is one of those issues that suddenly becomes very important when you have a baby or you’re caring for one who is affected by it. Luckily, it’s relatively easy to treat.

On a side note, this is as good a time as any to send out a massive thank you to everyone who helps care for and raise children, especially grandparents. I know we would be in serious trouble without The Munchkin’s four wonderful and doting grandparents! Not just for their help looking after The Munchkin (allowing us to work and even the occasional date night out), but also for all their advice and support since she was born.

Back to nappy rash. Nappy rash is caused by irritation to the skin, usually as a result of contact with baby’s urine and faeces, and especially when it’s prolonger contact. Chemicals such as soaps, detergents and nappy creams can also lead to or exacerbate the rash. If your baby has sensitive skin or a skin condition such as eczema or psoriasis, they are more likely to get nappy rash. Some babies are prone to nappy rash when teething or unwell.

Basic nappy rash shows up as red, swollen and sore-looking skin in the nappy area. Usually the folds of the skin (and who doesn’t love a baby with rolls on their legs?) remain unaffected as the moisture doesn’t get in. It can be painful for baby and they may be very unsettled as a result, especially in the bath or overnight (as if there wasn’t already enough things to blame for sleep problems!).

If the rash is shiny with a sharply defined edge and little white spots surrounding it, it is likely it is infected with a fungus called candida (thrush). This may also spread to the creases, bottom, thighs and tummy and may be accompanied by a thrush in the mouth (oral thrush). In this case, speak to your pharmacist about an appropriate antifungal treatment for any affected areas, both in the nappy area and in the mouth.

If the rash is weeping or has yellow crusts and is accompanied by a fever, it’s probably infected with bacteria and you’ll need to consult your doctor for antibiotics.

Some babies get nappy rash no matter how well they are cared for, and some babies never seem to be affected by it. If your baby does get nappy rash, it is a relatively simple condition to treat and will generally clear up within 2-3 days of treatment. It makes sense that since moisture causes nappy rash, we need to keep the area as clean and dry as possible in order to treat and avoid it.

Important points to remember:

• Check baby’s nappy often and change it immediately if baby has done a wee or poo
• Gently clean the area with water or a specialised mild baby cleanser (chat to your pharmacist). I keep a spray bottle (the types hairdressers use which can be bought for about $1) filled with water on the change table. We also found using cooled chamomile tea was really soothing and gentle when The Munchkin was younger and had a bad flare-up.
• Pat skin dry, rather than rubbing it which can further irritate the skin. Try and avoid disposable wipes at these times as they can irritate the area further.
• You can use a baby powder (ones specifically for the nappy area, not talcum powder) to help keep the area dry.
• Apply a barrier cream all over the area, concentrating on the red spots. Your pharmacist can help you choose an appropriate one.
• Try and give baby some nappy-free time during the day. I used to pop The Munchkin on a towel on her change mat on the floor. Expect the occasional wee or poo accident. This got more challenging when she started rolling and then crawling, but her skin cleared up by then so didn’t need as much nappy-free time.
• Use non-soap bath lotions and oils in the bath to help soothe baby’s skin. Your pharmacist can help with selection. This is also important for babies with eczema or psoriasis. 

What about cloth nappies? Well, I’m proud to say that we’ve used cloth nappies on The Munchkin since birth (although she now has eco-disposables at night) and the evidence says that due to the very clever materials which absorb moisture whilst still allowing the skin to breathe, they have a lower incidence of nappy rash than disposables. Some babies are actually sensitive to the chemicals in disposables. If your baby does get nappy rash with cloth nappies:

• Wash at least every two days.
• Make sure they are thoroughly rinsed and dry before using.
• Allow them to dry in fresh air and sunlight as often as possible. The UV in the sunlight helps kill any bacteria.
• Avoid waterproof covers as these can make the area hot and sweaty.
• If using barrier creams with cloth nappies, use a liner (washable or flushable) as the creams can accumulate in the nappy and reduce the absorbency.

   

Consult your doctor if:

• The rash spreads outside the nappy area.
• The rash has not improved after five days of treatment.
• The skin is broken and the rash is severe.
• Signs of a bacterial infection are present (e.g. weeping, pus, yellow crusts, blisters).
• Baby has a fever, is very unsettled or is not feeding as well as usual.

If you’re in the area, please pop in and have a chat with the pharmacists at Terry White Chemists Berwick about all your health, and especially baby needs. The four owners are all pharmacists (and have 7.5 kids between them, ranging in age from their mid-twenties to one due in September!) and two of the other pharmacists are also mums. All our pharmacists would be pleased to help you choose the right products to help clear up and prevent nappy rash. And don’t forget to ask for a free Self Care Card to take home. They contain helpful information and tips and are available on a range of health topics, including nappy rash.

References and further reading

• Nappy Rash Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Nappy Rash Fact Sheet, Better Health Channel, published 2011 (accessed online 26 July 2011)
• Nappy Rash article, Professor Frank Oberklaid and Dr Leah Kaminsky, Raising Children Network (accessed online 26 July 2011)
• Rash Decisions - Why Does Using Cloth Nappies Help Prevent Nappy Rash?, My Green Nappy (accessed online 26 July 2011)