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A nappy rash is a generic term thrown around by doctors and parents, much like colic as a diagnosis and it’s not.

Sitting in a nappy for months on end obviously means there will be delays in changing from time to time; a loose acidic poo or a course or 2 of antibiotics for a bad ear or chest. All of this can affect the delicate areas of the perineum (the delicate bits) of both boys and girls. Cleaning, wiping and applying creams become second nature for parents with kids under 2 years and comes at both a financial cost as well as on the more sensitive guts of gagging dads.

When it comes to caring for the area, especially early on, there are few tips.

Reserve wet wipes for travel and at home. Use cotton rounds dipped into cool Rooibos tea with no milk nor sugar to clean.

In girls, wipe inside the vaginal opening, on the sides and clear out poo and mucous. No girl wants to have poo in there. It will not damage the delicate tissues and will help to prevent a common problem of infantile labial fusion.

Nappies are expensive and also costly to the environment. Studies have shown a combination of non-disposables and disposables at night is the greenest option if water use, detergents etc. are taken into account. Also, be aware that there are bamboo nappies that are > 90% biodegradable on the market (eg. Bambo).

Choose a barrier cream that is in your price range and use it early on to protect the whole perineum.

So why do rashes occur?

Infections in the nappy area are relatively common and are either fungal (Candida Albicans / Thrush) or Bacterial (Staphylococcus aureus).  To help decide which, answer the following questions:

  • Has the mother, if breastfeeding, or baby been on antibiotics?
    Thrush is more likely.
  • Are there any signs of oral thrush?
    These are usually white plaques that look like milk but cannot be removed?
  • Are there blisters and any yellow crusting?

It is important as thrush responds well to topical antifungals such as Medaspor, Daktarin and Staphylococcus to antibacterials such as Fucidin, Nuban.

Probiotics and return to Rooibos wiping help too.

So what if it is not an infection?

The 2 other common causes of “nappy rash” are irritants or contact dermatitis and eczema.

If the rash is occurring on the most prominent areas, outer labia, bum or testicles, it is likely a contact irritation and more frequent changing, especially when at creche, of nappies as well as a thicker barrier cream such as Sudocrem or Antipeol, and potentially a change of nappy brand will often assist.

Eczema tends to occur in the creases of the leg or in areas where the nappy elastic is in contact with the skin and is frequently accompanied by a similar dry red, scaly rash in the flexures behind knees and elbow creases. This might respond to a nappy brand change but is often intrinsic and will need deeper moisturisation with intermittent use of an anti-inflammatory cream (steroid).

The final advice is for boy babies alone is if there is still a foreskin in place, remember it is very adherent to the glans for the first few months of life and does not require any mobilization. From 1 year, gentle retraction is important to start the freeing of the glans and varies hugely from boy to boy; some are loose and peel easily while others are tight and have a pinprick hole. Moisturize the foreskin and tip and don’t be alarmed by yellow secretions trapped under the foreskin (smegma); it is not an infection but normal penile glans secretions that will see the light of day as a thick white cheese once the glans is free.