Kids Health Info

Nappy rash

  • The most common cause of nappy rash (sometimes called diaper dermatitis) in children is irritation. Constant moisture from urine (wee) and faeces (poo) and friction from materials (e.g. cloth and disposable nappies) cause damage to the skin.

    In some cases, the skin can be further irritated by bacteria, yeasts (e.g. candida or thrush), detergents or nappy wipes.

    Most of the time nappy rash can be easily treated and cleared within a couple of days.

    Signs and symptoms of nappy rash

    • The skin in the nappy area generally looks red and raw, and can be spotty in appearance.
    • It can be sore or itchy when the area is wiped.
    • Your baby may be unsettled or irritable.

    Care at home

    Using good-quality disposable nappies is the best way to treat nappy rash. Disposable nappies allow the moisture to be absorbed quickly, which helps keep the skin dry. While cloth nappies are good for the environment, they do not absorb moisture as well as disposable nappies.

    • Prevention is important – aim to keep the skin clean and dry. Changing nappies frequently will minimise the amount of time that urine and faeces are in contact with the skin. As a guide, if your child is under 12 months old, change their nappy about five to seven times a day.
    • At each nappy change, wipe your baby's bottom gently with cotton wool, paper towel or clean Chux-type cloths, dampened with lukewarm water. Baby wipes can be very irritating and should not be used.
    • A thick barrier cream should be applied thickly at each nappy change. This will prevent the moisture and irritants from reaching the skin. Zinc paste is best. If the cream you use wipes off too easily, try another brand because the idea is to create a good barrier. These creams are available from your pharmacy, or may be prescribed by your doctor.
    • Try to let your child have as much time without the nappy on as possible.
    • Do not use talcum powder or antiseptics on nappy rash.

    When to see a doctor

    See your doctor if the rash does not improve within one week or is severe. Persistent nappy rash that does not respond to nappy creams might need a medicated cream, such as an antifungal (e.g. Canesten, Daktarin, Nystatin to treat candida infections) or hydrocortisone (e.g. Sigmacort 1% to treat the redness). These creams should only be used on the advice of your doctor or pharmacist.

    Some conditions, such as eczema or a skin infection, can be found on any area of the body, including the nappy area. They may not respond to the treatment used for nappy rash. Your GP, paediatrician or dermatologist will be able to diagnose your child’s rash and recommend the appropriate treatment.

    Key points to remember

    • Nappy rash can make your child's skin red and sore, and cause your child to be irritable and unsettled.
    • Prevention is important. Keep your child's skin clean and dry by changing nappies frequently, and use a barrier cream.
    • A good-quality disposable nappy is best if your child has nappy rash, and do not use baby wipes. Allowing nappy-free time can be very helpful.
    • See a GP if the rash does not improve within one week, or if the rash is severe or spotty and more sore than usual.

    For more information

    Common questions our doctors are asked

    How much barrier cream should I use?

    Apply a thick layer so that you cannot see the skin through the cream. You should reapply with every nappy change and bath.

    My baby’s candida just doesn’t seem to be getting better. What can I do?

    Candida can take longer to clear up than regular nappy rash, and it can often come back. Make sure you keep using the treatment that your doctor has prescribed until the infection has completely cleared up. Don’t stop the treatment if the nappy rash seems to be improving but it is still there. See your doctor again if the treatment isn’t working.

    We prefer to use cloth nappies. What is the best way to deal with nappy rash without using disposable nappies?

    We recommend the use of good-quality disposable nappies when babies have a nappy rash because they are more absorbent than cloth nappies. It is important to keep moisture away from your child’s skin when they have nappy rash. If you don’t want to use disposable nappies, use an absorbent cloth nappy insert, and try to change your baby’s nappy as soon as it becomes wet or soiled. When washing cloth nappies, make sure they are rinsed thoroughly so that detergent or bleach residue doesn’t irritate your baby’s skin.


    Developed by The Royal Children's Hospital Dermatology and Pharmacy departments, and Clinical Practice Guidelines Group. We acknowledge the input of RCH consumers and carers.

    Reviewed March 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.