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What causes nappy rash?
Q: What causes nappy rash, and what steps can we take to prevent it?
Cara Spokane
A: Cara, almost all babies get nappy rash at some time. In fact, more than half of babies between 4 and 15 months of age have at least some trace of a nappy rash every two months.

nappy rash is caused by a breakdown in the natural layers of protection of the skin on your baby’s bottom. The following things can break down the skin’s protection and cause a rash:

  • Urine and feces staying on the baby’s bottom for too long

  • Rubbing by the nappy, or too vigorous cleaning

  • Allergic reaction to chemicals in the nappy area, nappy wipes or soap

  • Infection with yeast or bacteria

  • The best way to prevent nappy rash is to try to minimize exposing your baby’s bottom to things that can irritate the skin:

  • Change your baby’s nappy frequently to keep him as dry as possible. Cloth nappys tend to be less absorbent than disposable nappys and should be changed more frequently. Newborns pee and poop more frequently and may need to be changed every one to two hours; older infants and toddlers may need to be changed every two to four hours. Be sure to change your baby’s nappy as soon as possible after a bowel movement.

  • Clean your baby’s bottom gently. Generally, you need to clean your baby’s bottom only when she has a bowel movement. You can use a nappy wipe or a soft cloth moistened with water. If you have a baby girl, be sure to wipe from front to back to help prevent urinary tract infections.

  • When you bathe your baby, use baby soap. Avoid adult soaps that have deodorants, perfumes, antiperspirants and other chemicals that can irritate your baby’s skin.

  • At the first sign of a nappy rash, try the following to help clear it up quickly:

  • Change your baby’s nappy more frequently. This helps protect your baby’s rash from further irritation by urine and stool. If possible, try leaving your baby without a nappy for periods of time to help dry her skin.

  • Don’t use scented nappy wipes. These may contain perfume, alcohol and other chemicals that can irritate your baby’s skin. Look for hypoallergenic nappy wipes and consider prerinsing them in warm water to remove the chemicals so you can clean your baby with just a moist cloth.
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  • If your baby’s bottom is tender, clean with water instead of nappy wipes. You can use a spray bottle with warm water or rinse her bottom in the sink or tub.

  • Dry your baby as gently as possible. You can use a towel or washcloth and pat her dry (don’t rub); or use a blow dryer on the low or cool setting to avoid burns.

  • Try using an over-the-counter protective ointment (with zinc oxide or petrolatum) on your baby’s nappy area. This can help protect the skin from irritation from urine and stool, and help it heal. You don’t need to rub off the ointment with each nappy change.

  • If your baby has a more severe nappy rash that has blisters, open sores, or doesn’t go away within three to four days, contact your baby’s doctor. Your baby may need an antifungal cream or powder for a yeast infection, or antibiotics for a bacterial infection of the nappy area.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician