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Nappy rash

What does nappy rash look like?

Nappy rash doesn't always look the same. But if your baby's nappy area looks irritated and red, chances are he has it. His skin may also be a little puffy and warm when you touch it.

Nappy rash may be very mild — a few prickly red spots in a small area — or quite extensive, with tender red bumps that spread to your baby's tummy and thighs. There's no need to panic, though: Dealing with nappy rash is part and parcel of baby care, especially in the first year or so of your baby's life.

How did my baby get nappy rash?

Nappy rash can be caused by anything from a new food to your baby's own urine. Here are the most likely culprits:

  • Wetness. Even the most absorbent nappy leaves some moisture on your baby's delicate skin. And when your baby's urine mixes with bacteria from his stool, it breaks down and forms ammonia, which can be very harsh. Although a baby left in a dirty diaper for too long is more likely to develop nappy rash, any baby with sensitive skin can get a rash, even if his parents are nappy changers.
  • Chafing or chemical sensitivity. Your baby's nappy rash may be the result of his nappy rubbing against his skin, especially if he's particularly sensitive to chemicals like the fragrances in a disposable nappy or the detergents used to wash a cloth nappy. It could also be that a lotion or powder you're using for nappy duty doesn't agree with your baby's delicate skin.
  • New foods. It's common for babies to get nappy rash when they start eating solid foods or are introduced to a new food. Any new food changes the composition of the stool, and it might increase your baby's bowel movements as well. If you're breastfeeding, your baby's skin could even be reacting to something you're eating.
  • Infection. The nappy area is warm and moist — just the way bacteria and yeast like it. So it's easy for a bacterial or yeast infection to flourish there and cause a rash, especially in the cracks and folds of your baby's skin.
  • In addition, babies on antibiotics (or whose breastfeeding mothers are on antibiotics) sometimes get yeast infections because antibiotics reduce the number of healthy bacteria that help keep yeast in check as well as the harmful bacteria they're meant to destroy. Antibiotics can also cause diarrhea, which can contribute to nappy rash.
  • Thrush is a type of oral yeast infection. Some babies with thrush develop a yeast infection in their nappy area too.

Should I take my baby to the doctor for a nappy rash?

It's probably not necessary. With some diligence, you should be able to say good riddance to your baby's rash in three or four days without a doctor's visit.

Do call the doctor if the rash looks as though it may be infected (has blisters, pus-filled pimples, oozing yellow patches, or open sores). She may prescribe a topical or oral antibiotic for your baby.

For a nappy rash caused by a yeast infection, your doctor may prescribe an antifungal medication to use in the nappy area. Also call the doctor if your baby develops a fever or his rash doesn't go away after several days of home treatment.

What's the best way to treat nappy rash?

Keep your baby clean and dry by changing his nappy frequently. That may mean getting him up at night for a nappy change.

Rinse his nappy area well at each nappy change. Some parents keep cotton balls and a squirt bottle or an insulated container of warm water at the changing table for easy, gentle cleanups. Pat your baby's skin dry — don't rub!

Using a barrier ointment — one that forms a protective layer on the skin — after every nappy change can help protect your baby's irritated skin from stool and urine. There are several good barrier ointments on the market, including petroleum ointment and white zinc oxide, which is thicker and good for protecting very sensitive skin.

Put your baby's nappy on loosely or use a nappy that's a little big on him to allow for better air circulation. If your baby wears cloth nappies, don't use plastic pants. If you buy disposables, try a different brand to see if that helps.

When the weather is warm and your baby can play outside or in a room with an easy-clean floor, leave his nappy(and ointment) off for as long as possible every day. Exposure to the air will speed healing.

Consider letting your baby sleep with a bare butt whenever he has a rash. A plastic sheet under the cloth sheet will help protect the mattress.

How can I prevent nappy rash?

Here are some good preventive measures:

  • The best defense against nappy rash is a dry bottom, so change your baby's nappy as soon as possible after it becomes wet or soiled.
  • Clean your baby's genital area thoroughly with each nappy change. Pat his skin dry — never rub it.
  • If your baby seems prone to nappy rash, coat his bottom with a thin layer of protective ointment after each nappy change. There are several good barrier ointments on the market, including petroleum ointment and white zinc oxide (which is thicker and good for protecting very sensitive skin). It's okay to use plain petroleum jelly as a barrier, but it rubs off easily.
  • Skip the talcum powder, as the dust is harmful to your baby's lungs if he breathes it in. If you want to use powder, choose the safer cornstarch-based type. Shake powder into your hand, away from your baby; never directly on or near him, and keep the container well out of his reach at all times. At every nappy change, carefully wash away any powder that accumulates in your baby's skin folds.
  • When your baby starts eating solid foods, introduce one new item at a time. Waiting a few days between each introduction will make it easier to determine whether sensitivity to the food causes a nappy rash. If it does, you can eliminate that food for the time being.
  • Don't secure the nappy so tightly that there's no room for air to circulate. Loose clothing will let your baby's bottom breathe. Avoid plastic pants and other airtight fabrics.
  • Don't wash cloth nappies with detergents that contain fragrances, and skip the fabric softener — both can irritate your baby's skin. Use hot water and double rinse your baby's nappies. You might also add half a cup of vinegar to the first rinse water to eliminate alkaline irritants.
  • Breastfeed your baby for as long as you can. Breastfeeding boosts your baby's resistance to infections in general and makes him less likely to need antibiotics, which can contribute to nappy rash.
  • If your baby goes to daycare, make sure that his caregivers understand the importance of taking these measures to prevent nappy rash.



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