Revisiting infant nappy dermatitis: Causes and preventive care

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).