Nappy rash: care and when to see a GP

When your baby otherwise seems well, prompt nappy changes and gentle cleaning and drying are a reasonable first step for sore or irritated skin. Keep the routine simple and avoid rubbing or over-washing.

Not every rash in the nappy area has the same cause, and appearance alone cannot confirm what is causing it. The safest guide is how the rash changes and whether your baby is comfortable and otherwise well.

What nappy rash means and what appearance cannot tell you

Nappy rash describes sore or irritated skin in the nappy area, but it does not tell you the cause. Different conditions can affect this area, and more than one problem can occur at the same time.

That is why a photograph or a feature such as colour, spots or where the rash sits cannot confirm ordinary irritation, thrush, a bacterial infection, eczema, allergy or another condition. A health professional may need to assess both the skin and how your baby is overall.

This article gives general UK information rather than a diagnosis or individual medical advice.

Gentle care to try at home

If your baby otherwise seems well and none of the reasons to seek help in this guide apply, keep care simple and gentle:

• Change a wet or dirty nappy promptly, without waiting for a fixed schedule.
• Clean the area gently with water, or use fragrance-free and alcohol-free wipes.
• Pat the skin dry gently; avoid rubbing, scrubbing or repeated washing.
• Give your baby some nappy-free time when it is practical and safe.

Prompt nappy changes and gentle cleaning and drying can help protect irritated skin; there is no need to follow a fixed schedule.

Use a well-fitting, absorbent nappy rather than one that is overly tight. There is no set duration for nappy-free time, and these steps cannot guarantee that every rash will clear.

Barrier care and advice from a pharmacist

A barrier cream can help protect the skin. A pharmacist can advise on a suitable product and how to use it, especially if the rash is causing discomfort and your baby otherwise seems well.

Do not use a cream as a reason to delay advice when the rash does not go away, gets worse or spreads, or when your baby seems very uncomfortable or unwell. If another cause is suspected or gentle care is not enough, a pharmacist or GP may recommend different care or treatment after considering both your baby and the rash.

What to avoid on the affected area

• Soap, baby lotion and bubble bath.
• Talcum powder and antiseptics.
• Over-washing, rubbing or scrubbing.
• An overly tight nappy.
• Unsourced home remedies or homemade preparations.

Avoid adding medicines or mixing treatments on the basis of appearance alone. A pharmacist or GP should guide decisions about antifungal, antibiotic, steroid or other medicines after considering your baby and the rash.

When to ask a pharmacist, health visitor or GP

Ask a health visitor or GP for advice if the rash does not go away, gets worse or spreads, or your baby seems very uncomfortable. There is no single safe waiting period for every baby, so use these changes rather than a fixed number of days.

Ask a pharmacist

A pharmacist can advise on a suitable barrier product or medicine when the rash is causing discomfort and your baby otherwise seems well. Pharmacy advice does not replace a health visitor or GP review for a rash that persists, worsens or spreads, and it does not replace urgent advice when your baby seems unwell.

Contact a health visitor or GP

Arrange an assessment if:

•the rash does not go away, gets worse or spreads;

•your baby seems very uncomfortable;

•the skin is broken;

•the rash seems severe or unusual, or is not responding to appropriate gentle care;

•there is warmth or redness around broken skin.

Warmth, redness or broken skin do not by themselves prove that the rash is infected. These are reasons to ask for an assessment, not clues for diagnosing the cause at home.

Ask a health professional for advice when the rash does not go away, gets worse or spreads, or your baby is very uncomfortable.

If your baby was born prematurely, has a weakened immune system, has an existing skin condition or has another relevant medical vulnerability, ask their own health professional whether this general advice is suitable.

When urgent or emergency help is needed

Fever, feeding changes, fewer wet nappies or unusual behaviour do not diagnose the cause of a rash. They can mean your baby needs a broader assessment, even if the skin seems to be improving.

Call your GP surgery now or NHS 111

A high temperature is 38C or more. Call your GP surgery now or NHS 111 if:

•your baby is under 3 months and has a temperature of 38C or higher;

•your baby is aged 3 to 6 months and has a temperature of 39C or higher;

•the rash occurs with a high temperature;

•your baby is feeding much less than normal or is not feeding normally;

•nappies are unusually dry or there are fewer wet nappies;

•your baby is not their usual self, is unusually sleepy, is inconsolable or seems seriously unwell;

•you are worried about the rash and are unsure what to do.

For a child under 5, call NHS 111 rather than using 111 online. Do not wait for a cream or another home-care step to work if any of these signs apply.

Call 999 or go to A&E now

Nappy rash questions