by Sr Teresa Hayward (RM, RN, Lactation consultant, Infant & Paediatric Nutritionist, Baby Sleep Consultant)
While the term “nappy rash” is often used for any skin complaint that happens in the baby’s nappy area, there is a difference between a nappy rash (contact dermatitis) and thrush
Nappy rash (contact dermatitis)
The main cause of nappy rash is skin irritation caused by urine. This kind of rash is related to ammonia burn which is the acid found in urine.
It is rare for a breastfed baby to get a nappy rash, as breastmilk has antibiotic properties and this causes neutral stools.
Today’s nappies are designed to be super absorbent, but they need to be changed regularly, so with every feed.
Babies that get diarrhea, and those not digesting their sugars well and have a lactose intolerance and reflux are at higher risk of nappy rash. These baby’s poos are more acidic.
Teething babies are also at higher risk of nappy rash due to loose poos containing excessive amounts of saliva
Treatment:
With the treatment of any nappy rash, stop wet wipes straight away and go to cotton wool and water or a soft cloth. Clean the nappy area properly. Apply a zinc-based cream after each nappy change until it clears, once it is cleared, stop barrier cream and allow skin to breathe. Do not use a barrier cream with every nappy change if no rash and do not use Vaseline as a barrier cream as it is oil based and keeps wetness close to the skin.
If it gets worse or doesn’t clear, contact your well baby clinic.
Thrush
A rash that is red, spotty, angry-looking and mainly on the private areas or around the anus is thrush. It often follows oral thrush, and means that the gut is infected as well. This is called systemic thrush.
It is caused by a yeast infection where the mucous membranes have become infected by the fungus Candida Albicans
It will always start with a little red ring around the anus and the spots will follow. Little boys will get it above the penis and in the groin whereas little girls will get it on the private areas and in groin. It won’t be on the buttocks
Treatment:
As with nappy rash, stop wet wipes straight away and use cotton wool and water. Treat with an anti-fungal cream such as on recommendation from Well baby clinic or doctor. Treatment for systemic thrush is also important. Place baby on a Probiotic. Decrease babies and moms’ sugar and yeast intake. The well baby clinic sister should help you to determine the cause of thrush. If moms are breastfeeding, it is important to contact her Lactation consultant to ensure she is treated correctly
When to go to the doctor
If you have been to the well baby clinic and there is still no improvement, then it is time to go to the doctor. Be very careful of pharmacy mixed creams that may contain a mixture of zinc-oxide, cortizone and antifungal creams. They may work, but may actually be doing more damage as cortizone thins the skin and should only be prescribed by a doctor and not over the counter.
Nappy rash and antibiotics
Antibiotics often trigger diarrhea which can cause both contact dermatitis and/or thrush. This results in a terrible rash and a very unhappy baby. The diarrhea causes the contact dermatitis and the antibiotics cause the thrush. This happens because most antibiotics kill the healthy bugs in baby’s gut, leaving an ideal area for the fungus to grow, resulting in thrush. A probiotic will help prevent this
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