Revisiting infant nappy dermatitis: Causes and preventive care
Cleansing and care of the nappy area is a subject of concern to parents, health professionals and infant care product manufacturers alike. Nappy rash, or nappy dermatitis, is an inflammatory skin reaction of variable severity affecting the abdomen, buttocks, perianal and perineal areas. It is a common condition in infancy affecting more than half of all children, to some degree, before the age of 2 years. While seldom serious, it can be distressing for infants and their parents. The aetiology is multifactorial, involving factors that together impair skin barrier functionality. Known factors include over-hydration of the stratum corneum, raised pH and over-vigorous cleaning, which predisposes the skin to tissue loss and inflammation. Despite the ubiquity of this condition, there is a lack of unequivocal empirical data about best care practices; this situation leaves health professionals and parents in a quandary. Current best evidence and professional consensus supports: gentle cleaning using only specifically designed products, if any; frequent nappy changes; nappy-free periods; using modern superabsorbent nappy liners; and protecting the skin using a barrier product. Although it is not definitive, this information can be used by midwives to inform their conversations with parents about nappy area cleaning.
Infant skin cleansing is a controversial topic and one about which proponents of different regimes have strong opinions (Hugill, 2014). Nappy rash and nappy dermatitis are broad terms used to describe inflammatory changes in the skin of the nappy area (lower abdomen, buttocks, perianal and perineal areas) (Buckley et al, 2016). This article describes factors implicated in causing nappy dermatitis and explores nappy area care practices that could help to prevent the condition. Having an understanding of this topic is important for midwives as they are often asked by parents about what is best in this aspect of infant care, and they need to be able to provide evidence-based advice.
Statistics reveal that nappy dermatitis is a common disorder affecting both sexes equally, with an incidence peaking at around the age of 9–12 months (Blume-Peytavi et al, 2014). While most children might expect to have experienced an episode before they stop wearing nappies, precise figures show considerable variability (Garcia Bartels et al, 2012; Panahi et al, 2012; Yonezawa et al, 2014). This situation reflects different data collection timeframes, study populations and definitions (Buckley et al, 2016), but also possibly differences in infant hygiene practices. Exclusive breastfeeding may confer some protective advantage. The incidence of nappy rash and dermatitis is often reported as lower in exclusively breastfed infants—an observation that may reflect the lower incidence of infective diarrhoeas and the more acidic nature of the stool compared to formula-fed infants (Stamatas and Tierney, 2014).
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