Nappy rashes occur for most babies at some point, and is very common in children under the age of two. While teething can cause diarrhoea which in turn can cause nappy rash, what about nappy rashes happening at other times?
There are different reasons that can be triggering nappy rashes (or nappy dermatitis as it can be medically known!) in your baby- the common reasons are explored below.
Mild nappy rash is generally painless but more moderate or severe nappy rash can be quite uncomfortable and cause irritability in babies.
Contact Nappy Rashes
When baby's bottom is in contact over a period of time with the urine (wee) and/or faeces (poo) in the nappy, the skin can be triggered and result in a nappy rash. This is the most common cause for nappy rashes.
Prevention is cure here: the following actions all work towards keeping the area between the nappy and the bottom dry:
Keeping an eye on changing nappies soon after stools are passed and avoiding a urine build up in the nappy is the surest way to avoid this type of nappy rash commonly occurring.
Frequent nappy changing can clear up the nappy rash in a matter of days. For a baby under 12 months aim to change the nappy around five to seven times a day.
While material nappies are best for the environment, good quality disposable nappies can remove the moisture from the nappy and (unless sodden) and minimise contact between the skin and the irritating urine, and is the nappy of choice when there is a nappy rash occurring.
If using cloth nappies- check and change more frequently. Try and change as soon as becomes wet or soiled. Use of an absorbent cloth nappy insert can help wick away the urine and moisture to reduce contact with your baby's bottom. When washing the cloth nappies, rinse thoroughly so bleach or detergent is removed to avoid further skin irritation.
At each nappy change, wipe your baby's bottom gently with cotton wool, paper towel or a clean chug like cloth, dampened with Luke warm water. Avoid wipes when there is a nappy rash as they can further irritate the skin.
A thick barrier cream can also be applies at each nappy change and bath time to help protect the skin: for example Sudo cream or Betpanthan. The thickness provides an actual barrier- and if thick enough, should be hard to wipe off. Aim to have thick enough so you cannot see the skin through the cream.
A daily bath also helps to keep the area clean.
Nappy free time does wonders to help heal irritated skin.
Avoid use of antiseptics or talcum powder on the nappy rash.
Washing hand before and after nappy care can help reduce risk of infection, especially important if there is broken skin as often happens with nappy rash.
Nappy Friction and nappy rash
The friction of the nappy (cloth or disposable) can work hand in hand with contact with faeces and urine to cause nappy rash.
Look to creams that protect the skin and nappy choices that seem to be better tolerated. Plus, see nappy care recommendations above.
Diarrhoea and nappy rash
Diarrhoea often results in more acidic stools (faeces) which can be very irritating for the skin.
Treating the cause of the diarrhoea is important to get to the root of the issue. Also see nappy care recommendations above.
Reactions to products: nappy wipes and/or soaps used
Some babies do have skin that is sensitive to some commercial products, especially if scented.
Choosing low scented, more plain baby wipes can be very helpful in this space, although sometimes it is useful (with skin irritation) to replace nappy wipes with a Rediwipe towel wet with water or water with bath oil.
Consider looking at products you may be using to clean clothes/towels etc with and replacing with a more sensitive skin version- such as Omo Sensitive, and any other such promoted products.
In addition see nappy care recommendations above.
Infections and nappy rash
Infections such as yeast infections (such as Candida or thrush) or bacterial infections can cause nappy rashes.
Check with your GP if your baby is having ongoing nappy rashes to eliminate any medical reason such as bacterial or yeast infections.
While washing hands before and after nappy care is always important, more so if there is an infection causing the loose stools. See nappy care recommendations above.
Food Intolerances and nappy rash
If food seems to exacerbate nappy rashes in babies, then they are likely to be dues to food intolerances rather than food allergies.
These nappy rashes tend to be delayed, which means they don't occur straight away but maybe a couple of hours or the next day after trigger foods are eaten.
The food intolerance culprit is often salicylate, a naturally occurring chemical found in foods of plant origin in low, moderate, high or very high levels.
If your baby is salicylate sensitive, there maybe other clues that suggests this may be the case:
a family history suggesting natural food chemical intolerance (for example a family member that reacts to any of the following foods: tomatoes, capsicum, chocolate, pork, food additives such as msg) or a known salicylate or amine or glutamate of food additive intolerance in either the mother or fathers' family
some other issues occurring for your baby that is also triggered by food, so you may also have issues such as reflux, rashes (especially spotty rashes on the face) and irritability that seem to be exacerbated by food
Foods may seem to affect symptoms sometimes but not others (food intolerance is more about thresholds)
a reaction to baby panadol
Ongoing nappy rashes- like most issues can be due to a number of different issues. Work through the most likely first, and most easily addressed for example reducing contact time with urine and faeces.
If the nappy rash has not cleared up within 1 week or is severe- see your GP. Nappy rash breaks down skin which can predispose to a yeast infection, so getting on top of nappy rash is a good idea. Any medical concerns including allergies are best checked out with your GP.
Working through potential salicylate intolerance is best done with an experienced food intolerance dietitian with experience working with babies, to promote nutritional adequacy for mum and bubs!
References
Melbourne T. Kids Health Information : Nappy rash. Rch.org.au. https://www.rch.org.au/kidsinfo/fact_sheets/Nappy_rash/. Published 2022. Accessed May 16, 2022.