Nappy Rash Advice

24 CommentsMonday, 28 July 2014

Research done at Bristol University shows that children in real nappies are no more likely to have severe nappy rash than children in disposables. Personally, I think they are less likely to, simply because their parents are more aware of when to change nappies etc and how well to clean the whole nappy area.

The term "nappy rash" is often used incorrectly to indicate any kind of redness on baby's bottom. However, it is a very specific term, and relates to the chemical effect when stale urine interacts with the bacteria from faeces to create ammonia, which effectively burns baby's bottom. Bad nappy rash results in open sores. There are many other sorts of rashes which are not nappy rash, and are dealt with differently - it is a case of eliminating possible causes.

Other possible causes of redness might be:

  1. Sweat rash - a classic sign is a red mark around the waistband, where sweat has gathered as baby sleeps.
  2. Heat rash - similar to a sweat rash, but you may also find baby is prone to this in other parts of the body as well, not just in the nappy area (maybe hairline, neck, elbows or armpits?)
  3. Reaction to detergent - if you are using a brand that has not been a problem before, check to see if it has a new formulation or call their customer care line. Try switching brands for a few days to something known to be mild (eg Surecare or Filetti) and see if this makes a difference. If it is a reaction to the washing powder, you may well also find new rashing on the face, if your child sleeps with their face to the sheets.
  4. Detergent build up or not enough detergent - over time a residue of detergent can build up in the nappies, or in the binding of the wraps and can cause sensitivity. Equally if you haven't been using enough detergent the same thing can happen. Follow our strip washing guidelines to remedy both.
  5. Dietary effect - see comments below about keeping a food diary.
  6. Nappies are not clean enough - if you wash nappies at 40, this is an indication that you need to give them a "blast" at 60.  Maybe there is a yeast infection that has been picked up in the nappies - if this is so, you will need to sort out both the yeast infection and any clothes that have been contaminated before you can go back to washing at 40.
  7. Thrush - little red spots are the classic sign. See your doctor for how to clear this up, and make sure you wash nappies at 60 until it is sorted out.
  8. Reaction to a sanitising agent used in the nappy bin, especially tea tree oil.
  9. Newborn sensitivity - if you don't use fleece liners or have a tumble drier to soften the nappies, longer pile terry can be a bit scratchy on a newborn baby's skin.

However, here is an explanation of how "real" nappy rash arises, along with a few basic tips to deal with it:

Urine is sterile when it first comes out (unless your child has an infection). Whilst your child has a wet nappy only, there is no real risk of nappy rash developing. However, as soon as they have had a poo, the bacteria in the faeces reacts with stale urine on the skin to produce ammonia. It is this that irritates the skin and causes nappy rash to develop. Once baby has got any redness, you might wish to change nappies more frequently than you would normally do, until the irritation settles down.

It is in order to avoid stale urine on the skin that you are advised to change nappies frequently, so that when they do poo, there should be less for the bacteria to latch onto. Also, you should be careful to clean baby's whole nappy area thoroughly. A child can safely sleep all night in the same real nappy because they do not usually poo in their sleep - but it is important to change them first thing in the morning and cleanse particularly thoroughly at this change, before the stale urine has had a chance to react with any bacteria from faeces.

Sometimes you will find a child goes red as soon as they have a poo, regardless of how long their nappy has been on, and sometimes you will find that they have no redness at all. I believe this is where dietary factors come in, changing the composition of the faeces - if you find a pattern of rashing develops, try keeping a food diary to see if you can identify what might cause it. If you are breast feeding, this means a food diary for your own consumption. One product which is known to have quite an irritant effect for many people is fresh orange juice. Tomatoes and avocados are other common culprits.

Some children do seem to get a reactive rash when they first switch from disposables to cotton nappies. Their bottoms have been used to being kept artificially dry, and there may be an initial sensitivity to wee, as they readjust. Many children who use cotton nappies react very badly if they have to use disposables when on holiday etc - this is probably a reaction to unfamiliar chemicals against the skin, so is sort of the same thing: a change of environment. I suppose it is a bit like people from Kent moving to Scotland - they have to harden up to the weather! Anyway, it is important to give it a few days under what you might call a “watching brief”, and it will almost certainly resolve itself. I hasten to add that I'm talking about a bit of redness here, not lesions of any kind - you should always investigate the underlying cause of these.

Avoid chemical wipes, as these are an irritant for your baby, which will make it harder for you to clean them. Switch to something particularly soothing as a wash recipe or use plain water, or stick to natural herbal wipes.

You don't need to use nappy rash cream every change, because this does inhibit the skin's ability to breathe. Keep it for when baby's bottom looks a little red, and then apply a fine layer, well rubbed in. Ironically, if nappy rash really sets in, it is usually best to leave off the creams altogether, because of the way they stop the air getting to the skin underneath. If it is practical for your child to go without a nappy for a while, this may help a severe rash. Your child will certainly benefit.

Make sure you clean the whole nappy area thoroughly at nappy change time, not just the genital area - wipe down the waist and tops of the legs as well. If baby develops spots at leg or waist openings, you are not cleaning far enough. If you generally use fleece liners, switch to flushable ones while the rash is around - the fleece may be keeping the area a bit too warm to heal properly.

Of the chemical preparations: Sudocrem is the most popular nappy rash cream in the UK, and this seems to work very well, and also blends in quite easily. Anecdotal evidence suggests that Sudocrem is very good as a preventative but not so good once nappy rash has actually developed. Zinc oxide cream is also suitable for dealing with nappy rash, but seems to be more difficult to rub in. Baby Savlon is another product you could use. There are other products equally well suited. If baby's skin is still wet from cleaning, the cream will be more difficult to rub in. Metanium (available on prescription or over the counter) stains like mad, but is exceptionally effective. We would recommend using paper liners when applying creams to help to prevent the fabric of the nappy from becoming too 'gunked up' as there is always a risk it may affect the absorbency.

Vaseline is nice and easy to rub in, but does not allow the skin to breathe. However, it might be useful as a barrier when the rash is caused by caustic poo due to teething, as it gives you a bit of time to get the nappy off before the full force of the acidity hits the skin.  You have to be incredibly careful if you do use this as if it transfers onto your nappies it will make your nappies water resistant and will damage their absorbency. This is a step of last resort.

Do try our own camomile wash recipe as a non chemical alternative to any barrier cream. We also sell two fabulous 100% natural creams Weleda Calendula and Purepotions Lavender Nappy Salve, which are far more effective than chemical creams. Our advisors swear by these for nappy rash and sensitive skin.

If you get repeated rashing or rashing that appears as soon as the nappy is wet, the first thing you should think of is sterilising the nappies, either by washing them as hot as they can be washed.  If you wash nappies in with the family clothes, make sure there are no yeast infections from family pants that are being passed on and wash nappies on their own at 60 degrees for a while.

If the problem is solved by a switch to disposables, it is almost certainly a contact reaction of some sort, which may mean insufficiently clean nappies, reaction to detergent or nappy bin sanitiser.

Make sure your baby is wearing good quality, non sweaty PUL wraps, or is able to go without a wrap (or even without a nappy) for some time during the day. A PUL or even more breathable wrap (like essential at night, as this is when sweat rashes develop with some non breathable covers. Although this is not nappy rash, it does not help. Little red spots might mean thrush, for which a doctor's advice should be sought. They will probably prescribe something like Canesten to clear this up, but don't forget to sterilise the nappies so that your baby does not get reinfected.

Get as much information as you can from your books/health visitor etc. Don't be afraid to ask for help. Ignore anyone who tells you that nappy rash is what you get when you use real nappies. This is rubbish, and will not help you get to the bottom of the problem.

Red clover is a traditional remedy for nappy rash and this is available in cream form.

Mel McGonnell
Sunday, 16 October 2016  |  8:28

Hi Wendy,
I've read the comments on sterilising nappies. Can you tell me if it is advisable to microwave nappies with elastics such as bumgenius and bumbles, to sterilise them? Or is it possible to wash hotter than 60 as a one off instead (my machine does a 95 wash). The reason I ask is because my little girl is getting repeated rashing around her legs and I believe I am washing with the correct amount of our usual powder (having done a strip wash a few months ago). I wondered if there could be a build up of either detergent or urine in the leg elastics though. The rash disappears when we use disposables. Thanks for your advice.

Wednesday, 26 October 2016  |  10:39

Hi Mel, no we don't advise you microwave nappies with elastics or velcro as they could melt or be damaged by the hot temperature. The microwave trick we only ever used on wipes or flat nappies and never any bamboo fabrics.

The repeated rashing does sound like you have a build up of some sort. Make sure you're doing a rinse cycle first and then the longest 60deg wash with extra water function. It's a good idea to occassionally do a wash with a full dose of detergent and then another wash without any detergent to ensure not enough and too much are both covered. We generally find that people use too much detergent at least by the returns we get. If you can smell detergent on them you've used too much (get someone else to smell your laundry as you get used to the smell).

Kirstie Fenn
Monday, 5 December 2016  |  12:53

My son has a yeast infection, we have been given treatment but my concern is with our nappies. I currently soak over night in miofresh and wash at 40, will soaking and washing at 60 definitely clear the infection from the nappies or should I be doing something more to prevent reinfection? Many Thanks!

Thursday, 19 January 2017  |  15:53

60deg can clear it but not always. In some cases we've found only a 90deg wash was killing the thrush spores. 90deg is well above nappy wash guidelines so must be done with caution as it can cause damage to elastic and fabrics. Test one nappy first.

Sophie Wright
Wednesday, 4 April 2018  |  19:07

My 10 month old keeps getting awful nappy rash - bleeding and really sore and painful. I put her in disposables for a couple of days and use metanium and it seems to clear up. Back to cloth and its back again. I thought it was teething but put her in cloth for 1.5 hours today after 5 days of disposables and shes red and sore already, so it does seem to be impacted by cloth. Using a combo of baba+boo and tots bots nappies. What do I do first - try fleece liners, strip wash all the nappies, buy some cloth-friendly cream...?
Thanks for any ideas...

Saturday, 7 April 2018  |  21:41

Start with strip washing your nappies following our method, then add fleece liners and start using a nappy cream as that sounds like some strong wee irritating the skin. Make sure you're changing incredibly frequently while the strong wee is happening. Baby is at a key teething age.

Friday, 6 April 2018  |  17:14

Hi, Just wondered if you have any ideas for my little boy. He is 18 months old and has very itchy and red 'boy bits'. Had it swabbed and its not fungal. He's had antibiotics and anti bacterial creams. Also tried all sorts of barrier creams. The only thing that helps him is piriton, and when it is particularly bad, we have to use a medium potency steroid cream on it. I really don't want to use that, so any ideas at all would be great! He did have severe baby eczema, but that had mostly cleared up before this started. He's had it for 3 months now and we suspect a possible teething link. Thank you!

Saturday, 7 April 2018  |  21:43

Hopefully you're u sing washable wipes, if so use your camomile and honey tea bag recipe to help. Give a quick splosh int he bath morning and evening to give the skin a thorough clean. I always used to add some olive oil in the bath and rub that on the nappy area to help break down and remove water resistant nappy creams. Lots of nappy free time as much as you can.

Additional fluids encouraged (water not juice) to help dilute strong wee before bed.

Wednesday, 11 April 2018  |  12:32

Thanks for your help. I will certainly try the olive oil idea and look at washable wipes. We'd love to do nappy off time but the second the nappy is off he grabs at it with his nails and makes it bleed. :o( Poor boy.

Friday, 13 April 2018  |  11:48

Try and keep babies nails short so they can't do any more damage. The more air to their bottoms the quicker the skin will heal.

Jasmine Kersey
Sunday, 26 August 2018  |  9:59


I wondered whether coconut oil could be used with real nappies if using a disposable liner? We found coconut oil to be very effective in stopping any nappy rash whilst using disposable nappies. My 14 week old has a very sore bottom having just switched from disposables.

Am I correct in assuming that going back to disposables for a few days to be able to use coconut oil and to clear up any redness before returning to using the real nappies would be a waste of time as his skin just needs to get used to them.

I've prewashed using Fairy powder. Is it known to be harsh on babies' skin?


Thursday, 23 May 2019  |  15:48

Coconut oil is fine and safe to use with cloth nappies. Fairy non bio is also fine to use.

Thursday, 15 November 2018  |  9:39

Hi, my daughter has stared getting a spotty rash around her waist since being in reusables at night. She was fine when only in reusables during the day, and the rash is only at the waistline. We are using little lambs.
Any ideas on how to get rid of the rash? She does look like shes trying to grab at it.

Ali Cann
Thursday, 3 January 2019  |  19:59

Hi, I'm looking for some advice as my 6 month old boy has had red/raw areas, which occasionally then becomes dry. It's worse along his tummy and thighs so I think it must be from where the nappies are rubbing. His actual bottom is fine. We don't have a tumble drier so I'm worried that the nappies are too hard after air drying. Is there anything that would help with this? I use tots bots bamboozle stretch at night and bumgenius elemental all in one during the day. Thanks

Wednesday, 29 May 2019  |  20:32

Hi Ali, rubbing the nappies together can soften them. Have you also tried a strip wash?

Wednesday, 9 December 2020  |  12:22

I had been using Totbots all in ones in day time and bamboozles at night for about 3 months full time (intermittently before while i tried it out!) without any problems. Following a cold, teething and a bad run of night time poos my daughter had a very stubborn but not severe nappy rash. Having tried metanium, waleda, strip washes, canestan, and LOTS of nappy off time we have managed to clear it with a spell in disposables. Canestan made no difference and it never looked like thrush. However everytime i return to my reusables the rash returns within 24 hrs and continues to worsen if i persevere for a few days with them, ultimately resulting in me trying a repeat strip wash and period in disposables. I think ive tried 3 times now and am starting to give up. Do you have any experience of this and any suggestion?

Sunday, 10 January 2021  |  8:43

Hi Katy, it sounds like for some reason the strip wash isn't effective. Some reasons for this can include not using enough detergent or overfilling the machine. If you contact our advice team on we can help you find the correct solution.

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