Nappy rash is an extremely common irritation of the skin in babies and toddlers that develops where a diaper sits. It can vary from a mild redness to intense discomfort, but with the right care you can usually prevent it and treat it effectively.
What are the symptoms of nappy rash?
You may notice signs such as1:
- Bright red or raw-looking patches around the genital area and anus (in darker skin tones this may appear brown, purple or grey)
- Swollen or raised skin
- Blisters or small ulcers
- A rash spreading onto the tummy and buttocks
Affected children often cry or become fussy, especially when urine touches the irritated area.
What causes nappy rash?
The primary culprit is leaving a wet or soiled diaper on for too long, since urine and stool contain ammonia that damages the skin and increases friction2. Additional contributors include3,4:
- Pre-existing skin conditions (e.g. eczema, psoriasis or impetigo)
- Thrush (an overgrowth of Candida albicans)
- Plastic pants that trap moisture and block airflow
- Less breathable cloth diapers
- Alcohol or harsh chemicals in disposable wipes
- Residual soaps, detergents or fragrances on the baby’s skin or cloth nappies
- Acidic foods (like oranges, strawberries or tomatoes) making urine more irritating
Breastfed babies tend to have less irritating stool, so they are less prone to nappy rash6.
How can nappy rash be treated?
Thankfully, there are several home care measures you can take to soothe your baby’s rash6:
- Change nappies frequently
- Rinse your baby’s bottom with plain water instead of using wipes
- Avoid scented or alcohol-based wipes
- Skip talcum powders and antiseptics
- Choose disposable nappies that offer good absorbency and ventilation
- After each change, apply a protective barrier cream
- Don’t use plastic pants over cloth nappies
- Wash cloth nappies thoroughly and tumble-dry them until soft
- Keep your baby’s skin as dry as possible
- Give your baby regular periods without a nappy
In more stubborn cases, a mild corticosteroid ointment (for example, hydrocortisone 1%) may be recommended. If thrush is present, an antifungal cream could be needed. Always check with your doctor, child health nurse or pharmacist before using corticosteroid or antifungal treatments.
What complications can occur?
When addressed early, most nappy rashes clear up within a few days. However, an untreated rash can lead to thrush, which shows as well-defined bright red patches in the nappy area, sometimes with tiny pustules around the edges that can hurt your baby. If you suspect thrush, seek medical advice promptly.
When should you see a doctor?
If the rash persists beyond one week or you’re worried about your baby’s skin, consult your doctor. You should also seek help if7,8:
- The barrier cream isn’t helping
- The rash is spreading or becoming worse
- Your baby seems particularly uncomfortable
- You notice changes in feeding or sleeping patterns
- Your baby appears unwell or develops a fever
- There are blisters, open sores, or broken skin
- For boys, if the tip of the penis is red, swollen or crusted
- You think your baby might have thrush
How to prevent nappy rash
The best strategy is prevention, which remains important until diapers are no longer needed. Keep your baby’s skin clean and dry by changing nappies often. You can also:
- Apply a protective barrier cream routinely
- Avoid putting plastic pants over cloth nappies
- Provide regular nappy-free time