Nappy Rash (Diaper Rash): How to Treat It Fast and When It Needs a Doctor

Almost every baby gets nappy rash at some point. It is not a sign that you’re doing anything wrong. Skin that spends hours in a warm, damp nappy gets irritated. With a few simple changes, most nappy rash (called diaper rash in North America) clears within about three days.

Imagine changing your baby at 3am and seeing angry red patches across their bottom. They cry every time the wipe touches their skin. You feel guilty and wonder if you’ve been changing them often enough. Take a breath. A gentle routine, some nappy-free time and a thin layer of barrier cream will usually settle it, and there are clear signs that tell you when it’s something more.

What nappy rash looks like

• Red or pink patches on the bottom, genitals or upper thighs on lighter skin
• On brown or black skin the rash may look darker, purple or grey, and can be harder to see
• Skin that looks sore, feels hot or is raised in spots
• A baby who is more unsettled than usual, especially during changes

Common causes

• Wee and poo sitting against the skin for too long
• Rubbing from a tight nappy or clothing
• Diarrhoea, teething or starting solid foods
• Perfumed wipes, soaps, bubble bath or laundry products
• Antibiotics, which make thrush (a yeast infection) more likely

A simple routine that works

1. Change nappies often, as soon as they are wet or dirty.
2. Clean gently with plain water and cotton wool, or fragrance-free, alcohol-free wipes.
3. Pat dry, don’t rub.
4. Give nappy-free time each day on a towel so the skin can breathe.
5. Apply a thin layer of barrier cream, such as zinc oxide or petroleum jelly, at each change. A pharmacist can recommend one.
6. Fit the nappy loosely enough to let air flow.

Avoid talcum powder (it can be breathed in), bubble bath, perfumed products and strong steroid creams unless a doctor has prescribed them.

But what if the cream isn’t working?

If the rash is still there after about three days of good care, it may be thrush. Signs include a bright red rash that goes into the skin folds, with small red spots spreading out from the edges. Thrush needs an antifungal cream, so ask a pharmacist, nurse or doctor. Sometimes a mild steroid or antibiotic is needed instead.

See a doctor or nurse soon if:

• The rash hasn’t improved after a few days of treatment, or keeps coming back
• There are blisters, open sores, pus or yellow crusts
• The rash spreads beyond the nappy area
• Your baby has a fever, or seems unwell, floppy or is not feeding

Get urgent help for any baby under 3 months with a temperature of 38°C (100.4°F) or higher, or a rash that doesn’t fade when you press a glass against it.

Sources: NHS (Nappy rash), American Academy of Pediatrics (HealthyChildren.org), Mayo Clinic. This guide is for general information and does not replace advice from your own nurse, doctor, health visitor or pharmacist.