What’s Nappy Rash And How Do I Deal With It?

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Nappy rash. As a dad, you’ve probably come across nappy rash. Surely you have right? I know some parents say their kids never get nappy rash – especially parents who use cloth nappies, there seems to be a bit of a mythology about cloth nappies and nappy rash.

But you’ve seen it, haven’t you? You’re a normal guy.

It usually looks like just a red bottom and genitals. I remember it as “sore bum” from when I was a kid (not embarrassing at all)!

Of course, it can present as much worse than a red, sore looking bum - it can get as far as blisters and open sores and all sorts of nasty.

Anyway, I’m glad you admitted to it. You’re not a bad parent because of it. Well, I hope not anyway. But it’s tough, I know, to say you have “done a booboo” with baby. So well done. Now, we can get to business – what causes it, and how do we prevent it?

Nappy rash is used as a bit of a catch-all term for pretty much anything that looks sore “down there”. There are other causes of redness and soreness in baby’s nether regions, and these include:

  • Sweat rash/heat rash
  • Reaction to detergent/another agent
  • Crispy nappies (especially the longer pile nappies and booster, such as Little Lamb, when they are line dried)

We’ll touch on some of these too, and they are relevant to the topic. But when I’m thinking of nappy rash, I mean a rash or soreness caused by prolonged exposure to a dirty nappy.

What causes nappy rash?

As I mentioned above, a prolonged exposure to a dirty nappy can cause nappy rash. It can come on pretty suddenly, even between changes, but it will also get worse over time, so catch it in the early stages and you’re golden.

What happens is that the bacteria in poo causes the urine to break down to ammonia which is caustic and causes nasty soreness, especially with repeated prolonged exposure and insufficient treatment.

Obviously, this isn’t janitorial strength ammonia cleaner – nothing gets my sink looking shinier, by the way – but it’s still gotta be pretty unpleasant. So, the question is, how do we deal with it?

I know, as a guy your first inclination is probably to pretend it’s nothing and just hope that it goes away on its own. I would usually do that, but in this case, it’s someone else’s comfort we’re talking about, not my own, so I figure I should do something at least.

The obvious answer to how to prevent nappy rash is to change frequently, and especially after a poo. The problem is usually from the bacteria in the poo, rather than urine – so you can get away with changing wee nappies less frequently, but if your bum-wiping game isn’t on point you’re probably leaving bacteria on baby’s skin which ultimately leaves you in the same situation. That is to say, red bum and sore baby.

So, that’s step one – wipe thoroughly and wipe well. I don’t use baby wipes for the most part, only occasionally when I’m behind on my laundry or when I’m out. Baby wipes, by the way, can make a sore bum even sorer, so be careful with them when nappy rash has already set in.

What I use is a little flannel, specifically Cheeky Wipes (which you can get on Amazon), which I moisten with a little water. Sometimes we use a tiny bit of baby soap or a cleaning solution of some kind (link to bum wipe post). You can also use an essential oil like tea tree oil which is antibacterial and antifungal, but which can also be an irritant. Honestly, if nappy rash is a problem already I’d just step up the cleaning (using water only) and changing – but if you’re not at that stage yet, a drop of tea tree oil in some of your cleaning solution can be beneficial.

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Step two is to change frequently – it depends on how bad the rash is, but you could be talking every hour. Or, alternatively, leave the nappy off for a couple of hours a day, maybe morning and afternoon or after a bath or something, to give it time to air dry. This in itself with help to soothe a rash.

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Step three is to use a cream. Most common creams for nappy rash are basically barrier creams– Sudocrem and Metanium, for instance, or vaseline, or zinc oxide cream. Some of these might also have medicinal properties but the main thing they seem to do is prevent moisture, and thus bacteria and the ammonia, from reaching the skin.0

One problem with barrier creams is that they can be quite gloopy and if you’re using cloth nappies they might affect the absorbency of the nappies. If you find yourself needing to use barrier creams, you could use paper liners to keep it away from the nappies if you think it will help.

Other options exist, such as Weleda’s Calendula cream. The chamomile is supposed to be soothing to baby’s bottom and the cream base also acts as a barrier to prevent the nasties getting to the skin. It also smells a bit less medicinal than other creams and seems to do the job in our experience.

Bepanthen is another option which hydrates the skin, making it more supple and flexible which would probably prevent further cracking and chafing.

Creams, on the whole, as a sort of “band-aid” approach to nappy rash. If you’re not getting to the root of the problem, then you’re just going to be spinning your wheels. Get to it, dad!

Do cloth nappies cause diaper rash more than disposable nappies? Or vice versa?

This is something you've probably heard, one way around or the other. The answer, really, is no.

As I said above, nappy rash is caused by a baby sitting in a pooey nappy for too long. This can happen whether in a cloth diaper or a disposable diaper. The one advantage a disposable diaper may have is that the SAP holds moisture (urine) away from baby's skin more effectively, and since urine is the source of the ammonia then it may not hurt baby so readily.

Regardless, the key is to change frequently - often enough that baby doesn't sit in excrement for any length of time.

What about the chemicals?

The chemicals in disposable nappies may cause a reaction in some babies. In particular, fragrances may cause an issue. This could result in a red rash-like reaction.

The SAP is unlikely to cause any problem unless the nappy splits open and it is directly in contact with the skin - SAP is fairly inert but it is very good at drying things out (that's the point!). So if it comes into contact with baby's bum or bits it will dry them out and possibly make them sore.

Dioxins, bleach, blah blah blah - not a problem. The next time someone tries to scare you with dioxins in a disposable nappy, remember that cotton and other natural fibres are also sources - yes, that's right, your beloved cloth nappies have chemicals in (cue Beethoven's 5th symphony in C Minor).

The final word on this is that you need to change the nappy more frequently if your baby is experiencing a rash. Creams help but do not solve the basic problem, which is that sitting in poo makes you sore.

As I mentioned before, there are other causes of soreness and redness which may need to be ruled out – especially if you're sure your changing has been spot on.

Other approaches to try may be to keep a log of foods, especially novel foods, and see if any of these correlate with a sore bum. Also, if you’ve changed the bumvironment in any significant way – such as changed brand of nappy, changed detergent, different washing cycle, maybe it’s summer and you’re line drying your cloth nappies rather than tumble drying.

Finally, bear in mind that it could be thrush – thrush is a fungal (yeast) infection, and it likes to hide in moist areas. You’ll almost certainly need to see a doc for an anti-fungal cream and maybe a systemic medicine too.

Thrush is bright red, and baby won’t just be sore when you change him – it’ll be uncomfortable all the time. Another possibility is a bacterial infection, so keep your eye out (you DO have thermal imaging eyes, I presume?) for a fever too.

I hope this somewhat rambling article was of some help.

Definitely a different kind of thrush...