Nappy rash is a topic frequently touched on by parents thinking of using cloth nappies and is the concern of every parent. How do I avoid it? How do I deal with it?  Do cloth nappies cause more nappy rash?

It's important to know how nappy rash happens, recognise what nappy rash looks like and when to seek appropriate help.

 

What is nappy rash?

Nappy rash is inflammation (dermatitis) that occurs around the nappy area (buttocks, thighs and genitals) due to irritation of the skin and usually affects most babies at some stage. In fact, research suggests 1 in 4 babies are affected by nappy rash at any one point.

 

Symptoms

This can vary depending on the severity and the baby's skin tone but is generally redness on the skin but may look brown, purple or even grey on darker skin tones. In cases of severe nappy rash, the skin might be swollen, peeling and even have breaks in it leading to bleeding. In some babies, the rash may cause them to feel very uncomfortable or irritable, particularly during nappy changes or when there is compression against the nappy area i.e. in seated positions and car seats.

Nappy rash can affect babies of any age but is most common around 9-12 months of age. Newborn babies and infants are more prone to nappy rash and girls are affected just as much as boys.

 

Potential causes

1. Age 👶: Newborns and infants' skin is thinner and therefore more easily prone to irritation. As baby grows, their skin matures and is able to resist irritation more easily.

2. Irritation from poo/urine 💩💧: prolonged exposure to urine or poo can irritate a baby's sensitive skin. So if your baby is pooping more than usual (eg. due to diarrhea, allergies or antibiotics), they could be prone to nappy rash. Prolonged time between nappy changes can also lead to rash.

3. Diet 🍅: as your baby grows and starts to eat solid foods, they will poo more frequently than when they were breast or formula fed. Acidic foods such as those high in citric acid (tomatoes, oranges etc) can lead to nappy rash.

4. Rubbing: poor-fitting or tight nappies (either cloth or disposable) and clothes that rub against the skin can lead to nappy rash.

5. Infection 🦠: fungal infection (thrush) is the commonest cause of nappy rash, followed by bacterial infection. The areas covered by a nappy, baby’s bottom, thighs and genitals, are particularly vulnerable to rash because it's warm and moist, making it a perfect breeding ground for thrush and bacteria. A nappy rash due to infection will often penetrate the skin folds, creases and be associated with red dots around the skin folds/creases.

6. New Products 🧴: a new washing detergent, shampoo, or an ingredient in a lotion or oil can all irritate baby’s skin leading to rash.

7. Skin Sensitivity: babies with eczema and other skin conditions are more prone to nappy rash than others.

8. Wipes: particularly those that are fragranced or contain alcohol.

9. Antibiotics 💊: antibiotics affect the good bacteria in your baby’s gut and microbiome as well as the bad bacteria. The good bacteria help to prevent things like thrush occurring and therefore nappy rash. Antibiotics often also cause diarrhea leading to increased risk of rash. If you are breastfeeding and taking antibiotics, this can also have a similar effect.

 

Prevention

The best way to prevent nappy rash is to keep the nappy area clean and dry, especially soiled nappies as poo is more irritant to the skin than urine.

Be aware of the symptoms and as soon as signs of nappy rash appears, it is best to start dealing with it as soon as possible.

 

Solutions

 If your baby is going through a phase of having nappy rash:

• Clean their bottom gently with warm water at each nappy change, then gently pat dry the bottom area. Never rub or scrub baby's bottom.

 

• Try to leave baby out of nappies for regular short periods to let their skin breathe and let the rash dry. Place your baby with a naked bottom on a couple of prefolds laid out on the floor.

 

• Barrier creams or nappy rash creams are good for both treatment and prevention. It improves the skin integrity and acts as a barrier between baby's skin and urine/poo. These should not be rubbed in to the skin but sit on it, only a thin layer is needed.

 

• Use a nappy liner such as the Real Nappies Nappy Liners. These provide a dry layer between baby's skin and the nappy insert. But also while applying barrier cream, they help the cream to stay on baby's bottom and not be absorbed by the nappy insert.

 

• Change baby more often at times of nappy rash to help the healing process.

 

• Do not use talcum powder as it can exacerbate the inflammation.

 

When to visit a doctor 🩺

Most nappy rash gets better with these simple steps.

See your doctor if the rash does not improve within a few days or is severe. Persistent nappy rash that does not respond to nappy creams might need a medicated cream.

 

Do cloth nappies cause nappy rash?

When it comes to preventing nappy rash, there is no single nappy that is better than another.

There is no conclusive evidence in medical literature to suggest cloth nappies cause more nappy rash than disposables. In fact, in a recent review of available medical literature, authors were not able to conclude that disposable nappies cause less rash. It was apparent that better absorbing nappies were more likely to cause less rash.

Some feedback from the cloth nappy community that have used both single-use and reusable nappies:

 

   

 

If you find that your baby has repeated nappy rash in cloth nappies it's always best to not just treat the symptoms, but to see what might be causing it.

The most common causes for babies developing nappy rash when wearing cloth nappies are:

• not changing frequently enough,
• not having enough absorbency in the nappy so they get soaked too quickly,
• or issues in the washing routine including incorrect detergent dosage, wash load size, wash cycle length.

 

 

 

References:

https://starship.org.nz/guidelines/nappy-dermatitis/ [accessed 10.03.2024]

Baer EL, Davies MW, Easterbrook KJ. Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database Systematic Review. 2006; (3) https://doi.org/10.1002/14651858.CD004262.pub2

https://www.thenappylady.co.uk/news/nappy-rash-advice.html

Benitez Ojeda AB, Mendez MD. Diaper Dermatitis. [Updated 2021 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559067/

https://www.rch.org.au/kidsinfo/fact_sheets/nappy_rash/ [accessed 10.03.2024]