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Expert answers your nappy rash questions

What is the bottom line when it comes to nappy rash? What causes nappy rash? What helps to get rid of it? And is it actually possible to prevent it? We put your questions to midwife Nikki Khan, who has lots of ideas to keep babies' butts happy

1. What are the main causes of nappy rash?

About 1/3 of newborns suffer from some form of nappy rash.

The main cause of nappy rash is the skin's contact with wee and poo in a nappy. How ever good your nappies are there is always some moisture, which can cause irritation. Your baby's wee and poo combined create a substance called ammonia, which irritates your baby's skin and makes it sore and inflamed.

Often it is the combination of poo and wee which irritates the skin the worst! So if your little one is poorly with a tummy upset and diarrhoea, their skin is going to get quite inflamed so will need to be watched closely.

In rare cases, your baby's nappy rash may be caused by an underlying condition such as eczema or even an allergic reaction, but your GP can confirm this for you.

So the main reason for nappy rash is leaving your baby in a dirty nappy for too long but it could be that he/she may have overly sensitive skin too.

2. Is there any prevention for it?

Yes.

• Always check your baby's nappy before a feed and after a feed, don't be fooled into putting your baby down to sleep for 4 hours with a wet or dirty nappy as this will make them sore in the end;

• Always change your baby's nappy even if it is just wee as this can irritate the delicate skin if some of the moisture leaks from the nappy as often happens.

• Avoid using tight fitting plastic pants over nappies as the nappy itself can encourage fungal nappy rash which loves warm moist places to grow;

• Give your baby nappy free time each day, obviously not for too long, in case your carpets get ruined with pee! A good time is when your baby is asleep & they can be laid on an absorbent towel;

• If using water to clean your baby's nappy area, use a soft towel or cotton wool to dry and avoid rubbing too hard.

• Always clean the area thoroughly with warm water and dry the area well after each nappy change. Then apply a thin layer of barrier cream to help avoid nappy rash occurring – 'clean, dry & apply'. The cream then acts as a protective layer between the wee & poo and your baby's delicate skin. Remember, a thick layer of barrier cream can actually block the pores stopping the skin from breathing.

• Avoid perfumed wipes as these can irritate the skin and if using wipes, make sure they are not alcohol based as this can irritate the skin too.

• Finally, avoid using talcum powder when changing your baby's nappy as this can cause further irritation and does not protect your baby's skin against urine and faeces as a barrier cream would.

3. Are particular nappies a trigger eg. disposable as opposed to re-useable?

There is no definite decision on whether disposable or cloth/re-useable nappies are better to help reduce the risk of nappy rash.

However, it does seem that disposable nappies are generally better at keeping the baby's bottom drier, thus reducing the moist environment that can trigger nappy rash. However if cloth nappies are used, as long as they are changed regularly the nappy rash risk should be similar as this will reduce the amount of time that baby's skin is in contact with urine and faeces.

4. What can you do if you notice early signs of it?

Start treating your baby. Once a normal nappy rash has been treated with a barrier cream, nappy free time and regular nappy changes it should start to improve after 3-4 days. There is a strong body of opinion and research that suggests regular use of a barrier cream reduces the chances of normal nappy rash (Paediatric News. Sept, 2010.).

Other forms of nappy rash, such as fungal nappy rash and bacterial nappy rash may take longer to improve. You should consult your GP if you think your baby has either of these, and medication can be prescribed. Your midwife or GP will then help monitor treatment.

Finally always remember to wash your hands before and after changing your little one's nappy so you do not introduce any new infection to their bottoms and also that you aren't passing any infection on to others or yourself.

5. What is the maximum time a baby should be in a nappy before it's changed?

It is a good idea to check your baby's nappy every 2-3 hours by testing with a clean finger inside the nappy. Some disposable nappies have a wetness indicator on them, which changes color when the nappy is wet. As long as the nappy is dry, the nappy can remain on, so by checking regularly, even overnight, which normally coincides with feeds, nappy rash can be avoided.

6. What advice would you give to a mum whose baby is very uncomfortable overnight in a nappy?

Firstly, it may be something as simple as the nappy being too tight or rubbing your little one's skin, so ensure your baby is in the right nappy for his/her weight. You may see signs of leakage or discomfort that also can mean the current nappies are too small. Also, if your baby wakes for a feed overnight, always change the nappy before and often after a feed as feeding can trigger a bowel motion.

So how ever peaceful your baby appears to be following a feed, never risk lying him or her down without checking and changing the nappy otherwise she/he may well wake up an hour later feeling uncomfortable. Some mums will give nappy free time overnight with the baby lying on an absorbent towel, if your baby is uncomfortable due to nappy rash. Always remember to change the absorbent towel though if it gets wet.

7. In your opinion, what is the oldest a baby/toddler should still be in a nappy?

Every baby is different and the type of nappy your baby needs changes as your baby grows and becomes more active. For instance a newborn needs between 8 to 12 nappy changes daily compared to older babies who need 6 to 8 changes a day.

Parents usually start to think about potty training and weaning from nappies between 18 months and 3 years old but there are plenty of children aged 3 - 4 years who still need a night nappy, and bed-wetting can sometimes persist up to the age of five years old.

Using trainer pants during the day such as 'pull up pants' can help and once toilet training during the day is sorted, night toilet training can sometimes take a bit longer. Therefore using pull-up disposable nappies at night are a useful option to use for toddlers until they are trained.

It is important that parent's watch for signs of their baby being ready to start toilet training as sometimes the older the child is the easier and quicker it can be! So don't feel pressurized to get your baby out of nappies too early...every child is different!

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