How to cope with sore bottoms when introducing new foods
It is widely acknowledged that babies are more susceptible to nappy rash when they start weaning.
Heather Morris, a Midwife and Resident Healthcare Professional at leading nappy cream brand Metanium, shares her insights into how to best prevent and treat mild nappy rash.
Weaning begins at six months and babies will start sucking smooth semi-solids from a spoon as part of the weaning process. This change in diet can be a trigger for nappy rash. [*Morris, 2012].
However nappy rash is not a rare occurrence. Most babies will get nappy rash at some point. Although it is common and mild cases are easily treatable, it can be a cause for concern. At any one time around one in three nappy-wearing infants will have nappy rash, with girls and boys equally affected**.
What is Nappy Rash
In general, the term ‘nappy rash’ describes an acute inflammatory reaction of the skin in the nappy area. A baby’s skin barrier function can be compromised by skin maceration (softening and breakdown of the skin due to prolonged exposure to moisture), friction (such as drying too vigorously) and prolonged skin contact with urine and faeces, which results in an increased skin pH.
What are the Features of Nappy Rash?
The most recognisable clinical feature of nappy rash is a well-defined area of erythema (skin redness) around the surface of the skin, which is in contact with the soiled nappy.
Your baby may appear agitated and uncomfortable as the rash may be itchy and painful. Uncomplicated nappy rash should settle with appropriate action and typically lasts about three days.
The management of mild nappy rash includes skin care advice for parents and carer givers together with the use of an appropriate barrier cream.
How can you prevent or ease mild nappy rash?
Self-management strategies may be advised, such as using a nappy with high absorbency; leaving nappies off for as long as possible; changing the nappy frequently and as soon as possible after it is wet or soiled; using water, or fragrance and alcohol-free baby wipes; drying gently after cleaning, by patting dry rather than rubbing and avoiding potential irritants such as soaps and bubble bath.
If there is mild redness, the use of a barrier preparation to protect the skin, can be applied thinly at each nappy change. CKS NICE recommends Zinc and Castor Oil ointment BP, Metanium® ointment, and white soft paraffin BP ointment. [CKS, NICE, 2018]
When to seek further help
Most cases of nappy rash are mild and easily treated without the need for referral. Self-management strategies together with an appropriate barrier ointment mean that nappy rash will usually resolve quickly.
If the initial treatment is unsuccessful, you will need to seek further medical advice, and if the rash appears inflamed and is causing discomfort, speak to your healthcare practitioner about prescribing topical hydrocortisone 1% cream, which can be applied once a day in addition to a barrier preparation, until the symptoms settle or for a maximum of seven days.
* Morris H, The bottom line on nappy rash, British Journal of Midwifery, 2012, Vol 20, No 9
** Merrill, L. (2015) Prevention, treatment and parent education for diaper dermatitis. Nursing for Women’s Health19(4), 324-336.