Nappy Rash – What do I need to know?

Nappy rash – what do I need to know?Nappy rash is a common skin condition or type of dermatitis in babies and toddlers.  Any child young enough to wear nappies can develop nappy rash.  Once children are toilet trained at around two years of age, nappy rash generally isn’t a problem. Until then it’s not uncommon.

Most cases of nappy rash are mild and respond very well to simple management like more frequent nappy changing and applying a good quality barrier cream. Sometimes nappy rash needs specific treatments to target the cause for the rash e.g. Candida (thrush) or bacteria.

Try not to worry if your baby has nappy rash. Most babies will, at some time, get nappy rash no matter how well they are nurtured. Generally, it’s not caused by an infection or poor hygiene, but simply due to the sensitivity of a baby’s skin.

Read on to learn what’s important to understand about nappy rash.

What are the symptoms of nappy rash?

  • Generally the skin covered by the nappy appears red, inflamed and sore.
  • The rash may just be concentrated around the baby’s bottom, or all over the area covered by their nappy.
  • The rash may spread and extend up onto the baby’s tummy and across their bottom.
  • In baby girls, the rash can cover their labia and in baby boys, sometimes their penis and scrotum is affected by the rash.
  • May be spotty, looking like little pimples or ‘satellite lesions’. This generally means a thrush infection is present.
  • Can look shiny and red.
  • Blisters and broken skin can be present when nappy rash is severe, or caused by a bacterial or other skin infection.


What causes nappy rash?

  • A baby’s skin is sensitive to all sorts of irritants and some babies are particularly susceptible. When the skin covered by a nappy is in contact with moisture the skin reacts by becoming red and irritated. The ammonia and enzymes in wee and poo can be irritating to their skin and the acidic contact causes their skin to react. Sometimes nappy rash appears very quickly, even between nappy changes.
  • Rubbing caused by friction of the moist nappy aggravates the skin even more. This means the usual protective barrier function of the skin is compromised, causing their skin to react.
  • Some foods in a baby’s diet cause nappy rash, especially acidic type foods like tomato and citrus fruits.
  • Nappy rash can become worse when a baby is teething.


Other common causes for nappy rash

Often, a bacterial or yeast infection is the cause. This means there’s little improvement in the appearance of the nappy rash and despite frequent changes and barrier cream, the rash becomes worse and will not improve until it’s treated with special creams or ointments.



A thrush infection is caused by Candida albicans, a yeast organism which can also colonise in the gut and mouth.

A thrush infection can also happen when a baby already has nappy rash because their skin is vulnerable.  Small red dots or pimples appear around the baby’s bottom and in their creases. Thrush can cause itchiness and the baby to become unsettled.

Sometimes babies with nappy thrush also have thrush in their mouth (oral thrush). Anti-fungal treatments are needed for both their mouth and their nappy rash if this is present.

What if it’s not thrush?

Other skin conditions such as eczema, psoriasis or impetigo (school sores) can also make nappy rash worse. These conditions need specific treatments to treat the cause and the rash.

Topical steroid cream is sometimes needed if the skin is inflamed and sore, and baby eczema cream to treat any eczema.

How can I prevent and treat my baby getting nappy rash?

The key is to change your baby’s nappy frequently.  Removing a wet or soiled nappy so it’s not in contact with their skin is the single most useful thing you can do.

  • Clean your baby’s skin thoroughly after removing their soiled nappy. Use warm water or gentle nappy wipes to remove all traces of wee and poo from their skin.
  • Allow their skin to dry well.
  • Smear a good quality barrier cream onto their skin which will help to create a protective barrier between their skin and their wee and poo. If the cream is thick, try warming it between your fingers before you apply it.
  • Even if your baby doesn’t have a nappy rash, or it’s cleared up, use a barrier cream to ensure their skin barrier is maintained.
  • Use good quality, disposable nappies which will help to draw any moisture away from your baby’s skin.
  • Give your baby some time each day to kick freely without a nappy on. During floor time, lay them on a towel and give their skin a chance to ‘breathe’.


When should I take my baby with nappy rash to see a doctor?

See a doctor or healthcare professional if:

  • Your baby seems distressed or there are any changes in their feeding or sleeping patterns.
  • If your baby has a temperature or any other symptoms which you feel could be signs they are unwell.
  • If their nappy rash has blisters, pimples or crusts.
  • If the rash is spreading and getting worse, not better.


Top 5 tips to help treat your baby’s nappy rash

  1. Be especially careful when and how you change your baby’s nappy. Your baby will be more comfortable and their skin will heal more quickly with frequent nappy changing. Aim for at least 6 nappy changes over 24 hours, and more if your baby needs it.
  2. Air your baby’s skin as much as possible and leave their nappy off whenever it’s practical to do so.
  3. Only use warm water and cotton wool balls, a soft cloth or hypo-allergenic wipes to clean their skin.
  4. Avoid using strongly perfumed soap or washes in your baby’s bath. Aim for a pH which is closely matched to your baby’s skin pH – around 7 which is neutral, or below 5.
  5. Use a good quality nappy rash cream, preferably a barrier cream with zinc oxide. A thick cream is often more protective against the skin and will give the skin a chance to heal.



If your baby’s nappy rash isn’t getting better or, it’s getting worse, see your healthcare professional.

Written by Jane Barry, Midwife and Child Health Nurse.