Nappy Rash: Causes, Symptoms and Treatment

Most babies will get nappy rash at least once, even with super-absorbent nappy technology and frequent nappy changes. In most cases, mild nappy rash clears up in a few days with simple at-home treatment. Find out more about what causes nappy rash, what nappy rash looks like, and how to prevent and treat it.

What Is Nappy Rash?

Nappy rash is a common condition that typically forms when the sensitive skin on and around your newborn or older baby’s nappy area becomes irritated, for example if it remains in contact with urine or poo for too long.

Nappy rash can make your baby’s skin red, hot or sore in patches, and sometimes it can cause spots or blisters. With proper treatment, nappy rash usually clears up within three or four days, but if the rash doesn’t noticeably improve within a couple of days, or if it gets worse, see your midwife or doctor for advice.

An important way of protecting your little one against nappy rash is changing your baby’s nappy frequently.

What Does Nappy Rash Look Like?

Common signs of nappy rash can include:

• Red blotches or patches on your newborn or older infant’s bottom or the whole nappy area

• Pimples, spots or blisters

• Hot, sore-looking skin

• An irritable or fussy baby.

What Causes Nappy Rash?

Even with frequent nappy changes, nappy rash can still happen. In the next sections, we’ll explore some causes of nappy rash and situations in which it might occur.

Nappy Rash Caused by Irritants

Skin irritation is the most common cause of nappy rash, and often it is a result of

• Your baby’s skin being in contact with wee or poo for too long

• Chafing from a nappy that’s too tight and rubbing against your baby’s skin

• Not cleaning the nappy area or changing the nappy often enough

• A reaction to detergents, soaps, bubble baths or some alcohol-based baby wipes

• Certain types of medicines, such as antibiotics or laxatives

You may notice red patches on your baby’s bottom, or the whole area may be red. Most of the time, babies don’t feel sore if they experience mild nappy rash. However, if the rash is severe your little one may feel uncomfortable and be distressed.

Make sure to change your baby’s nappy regularly, keep the nappy area clean and apply nappy cream. It’s also a good idea to use highly absorbent nappies and make sure they fit correctly without being too tight to avoid chafing.

Fungal Nappy Rash in Babies

If the nappy rash doesn’t clear up within two or three days, your little one may have a fungal infection. In this case, your health visitor or doctor can advise you on the best treatment.

If your baby’s nappy rash is caused by a fungal infection you might see more severe nappy rash symptoms, such as:

• Pus-filled blisters in the folds of the skin or other areas

• Bright red, moist patches

• Distress.

Your doctor may prescribe an antifungal cream or medicine. This will usually clear up the infection within a week or so, but you may be advised to keep using it for longer to prevent reinfection.

Bacterial Nappy Rash in Babies

While rare, nappy rash may be caused by a bacteria called impetigo, a skin infection that’s very contagious but not usually serious. Impetigo typically starts with red sores or blisters, which may be harder to see in brown or black skin. The sores or blisters burst quickly leaving behind crusty, golden-brown patches.

If you believe your baby’s nappy rash may be due to a bacterial infection, contact your baby’s GP for diagnosis and treatment. Avoid using an over-the-counter antibiotic cream to treat the nappy rash unless advised to do so by your child’s GP.

Nappy Rash Caused by Allergens

You may find that your baby is sensitive or allergic to certain substances or ingredients, such as

• Dyes in soap or laundry detergent

• The elastic band in nappies

• Fragrances in soap, laundry detergent, fabric softeners, or nappy wipes

• Preservatives in creams

• Ingredients found in baby powder, lotions and oils

• Food – allergens can be passed on to your baby through breast milk or other solid foods your baby eats once they start on solids.

A rash may show up shortly after your little one is exposed to an allergen. If you notice a rash, consider switching to another type of nappy, wipe or cream for two weeks to see if that helps it clear up. If you suspect a food allergy, try removing that food from your baby’s diet. Visit your child’s GP for a detailed diagnosis, any necessary tests and treatment recommendations.

Other Skin Conditions You Might Mistake for Nappy Rash

A rash can sometimes be a symptom of something other than just irritated skin. It’s a good idea to familiarise yourself with the symptoms of other common skin conditions so you’ll be able to tell them apart from a simple nappy rash.

Some common baby skin conditions include:

• Cradle cap. Crusty or flaky patches of skin could be a sign of cradle cap. It’s most common on the scalp, but cradle cap can also appear in the nappy area so you might mistake it for nappy rash if that’s where you notice it first.

• Oral thrush. One possible cause of a fungal nappy rash is oral thrush. This yeast infection of the mouth is common in newborn babies, because their immune systems are still developing. The candida yeast that causes it can end up in your baby’s poo, spreading the infection to the nappy area. This is why, if your little one has a nappy rash caused by a fungal infection, it’s a good idea to check their mouth as well. The symptoms of oral thrush can include a white coating on the tongue or white spots in or around your baby’s mouth.

• Eczema. Itchy, sore or cracked skin could be eczema. Sometimes it can get inflamed, causing redness. Eczema is most common on the face, scalp, hands, insides of the elbows and backs of the knees, but it can also appear anywhere on the body. If you suspect your little one has eczema, see your doctor for advice on how best to treat it.

If you’re not sure precisely what might be causing nappy rash or any other rash on your newborn or older baby’s skin, ask your health visitor or doctor for advice. Get more tips on how to care for your little one’s delicate skin.

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Nappy Rash Treatment and Prevention

The steps for treating nappy rash and preventing it are very similar, so if you want to know how to get rid of nappy rash as well as help prevent it, try these remedies:

• When your baby has a wet or dirty nappy, change it as quickly as possible. This is probably the very best way to treat or prevent nappy rash. Keep in mind that newborn babies may need around 8 to 12 nappy changes a day

• Gently clean your baby’s bottom with each nappy change. Rinse the skin with warm water or use unscented, alcohol-free wipes

• Gently pat your baby’s skin dry with a clean towel or – even better – leave the nappy off for a little while before putting on a new one to let the skin air-dry

• Apply a very thin layer of barrier cream just before putting the nappy on

• If your baby seems distressed or uncomfortable, ask your health visitor, pharmacist or doctor to recommend a nappy rash cream or ointment

• Give your little one a bath daily until the nappy rash clears up. Once a day is enough though – bathing your baby more often than that could dry out their skin

• Make sure your baby’s nappy fits properly – for example the tapes should fasten symmetrically, the nappy should cover the buttocks and the nappy should fit snuggly under the belly button

• When you can, let your baby go without a nappy. For example, you could spread out a towel during playtime and keep your baby’s nappy off for a while

• If your baby has nappy rash don’t use soaps with fragrances, bubble baths, lotions or talcum powder as these can further irritate the skin.

Severe Nappy Rash and Treatment

In some cases, nappy rash may become bad, leading to additional discomfort for your little one. Severe nappy rash might present itself with symptoms like blisters, swelling, and broken or raw skin areas. As we mentioned in the above sections, severe nappy rash might be caused by a fungal infection.

How to treat severe nappy rash, is a common question from parents. If your baby is distressed and the rash doesn’t improve after a few days of implementing the usual nappy rash treatments, it’s best to seek advice from your baby’s doctor or health visitor. Remember, even bad and severe nappy rash can be managed and your baby can feel comfortable again with the right care, remedies and treatment.

When to See the Doctor

Check in with your health visitor or doctor if you think your newborn or older baby’s nappy rash may be caused by a fungal or bacterial infection – this could be the case if the rash lasts longer than a couple of days, especially if it seems severe.

Also let your doctor or health visitor know if your baby has a rash along with a fever or if your little one seems very uncomfortable or distressed.

Seek urgent medical attention if your little one has a rash anywhere on their body that doesn’t fade when you press a glass against it. This could be a sign of meningitis, which needs to be treated immediately.

Other symptoms of meningitis include if your baby seems confused, is breathing rapidly, shaking uncontrollably, seems over-sensitive to light and/or has unusually cold hands and feet.

The Bottom Line

Even when you’re careful to frequently change your little one’s nappies, there’s still a good chance that they will get a nappy rash at some point. You can do your best to prevent them by following the above tips, some of which aren’t just great for warding off nappy rash, but for your baby’s overall skin care.

The good news is that most mild cases clear up within a few days with simple treatment and your little one’s skin will soon return to being as smooth and soft as, well... a baby’s bottom!

If the rash doesn’t clear up with these measures, your baby’s GP will be able to recommend suitable treatment. For example, if your little one’s nappy rash is caused by fungus or bacteria, a special cream or medication may be required.