Nappy Rash Advice
16 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:
- Sweat rash - a classic sign is a red mark around the waistband, where sweat has gathered as baby sleeps.
- 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?).
- 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.
- Detergent build up - over time a residue of detergent can build up in the nappies, or in the binding of the wraps and can cause sensitivity. Try washing two or three times without any detergent and reduce the amount of detergent used in future washes. A capful of white vinegar can also be included in the wash now and again and will help to strip out any residues.
- Dietary effect - see comments below about keeping a food diary.
- 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 or in the microwave. 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.
- 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.
- Reaction to a sanitising agent used in the nappy bin, especially tea tree oil.
- 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.
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, or by microwaving the washed and wet nappy. 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.
As tea tree oil is antibacterial, you can mix in a tiny amount with the cream that you use (this may work best with one of the more semi liquid creams available). But use it sparingly - it is an essential oil, and very strong, so only add a drop. There is a small chance that some children may become sensitive to tea tree oil if it is used regularly or in too large a quantity, so be aware of this. Indeed, some children's rash may be caused by oversensitivity to tea tree oil in the first place.
Red clover is a traditional remedy for nappy rash and this is available in cream form.