The PuClas3 project. 2016. (accessed 8 October 2019)

Incontinence associated dermatitis: moving prevention forward. Proceedings of the Global IAD Expert Panel. 2015. (accessed 26 September 2019)

Blume-Peytavi U, Hauser M, Stamatas GN, Pathirana D, Garcia Bartels N. Skin care practices for newborns and infants: review of the clinical evidence for best practices. Pediatric Dermatology. 2012; 29:(1)1-14

Brandon D, hiu CM, Heimall L, Lund CH, Kuller J, McEwan T, New T. Neonatal skin care, 4th edn. Washington: Association of Woman's Health Obstetric and Neonatal nurses; 2018

Buckley BS, Mantaring JB, Dofitas RB, Lapitan MC, Monteagudo A. A new scale for assessing the severity of uncomplicated diaper dermatitis in infants: development and validation. Pediatric Dermatol. 2016; 33:(6)632-639

Eichenfield LF, Frieden IJ, Zaenglein A, Mathes E. Neonatal and infant dermatology e-book.: Elsevier Health Sciences; 2014

Flanagan M. Wound healing and skin integrity: principles and practice.London: John Wiley and Sons; 2013

Furber C, Bedwell C, Campbell M, Cork M, Jones C, Rowland L, Lavender T. The challenges and realties of diaper area cleansing for parents. Journal of Obstetrics Gynecology Neonatal Nursing. 2012; 41:(6)13-25

Guest J, Greener M, Vowden K, Vowden P. Clinical and economic evidence supporting a transparent barrier film dressing in incontinence associated dermatitis and peri-wound protection. Journal of Wound Care. 2011; 20:(2)76-84

Gupta AK, Skinner AR. Management of diaper dermatitis. International Journal of Dermatology. 2004; 43:(11)830-840

Hale R. Newborn skincare and the modern nappy. British Journal of Midwifery. 2013; 15:(12)45-47

Hughes K. Neonatal skin care: advocating good practice in skin protection. British Journal of Midwifery. 2011; 19:(12)773-775

Hugill K. Revisiting infant nappy dermatitis: causes and preventive care. British Journal of Midwifery. 2017; 25:(3)150-154

Jones K. Advice to promote healthy neonatal skin and treat common skin disorders. British Journal of Nursing. 2013; 21:(4)244-247

Kenner C, Lott JW. Comprehensive neonatal nursing, 5th edn. New York: Springer Publishing Company; 2014

Lavender T, Bedwell C, O'Brien E, Cork MJ, Turner M, Hart A. Infant skin-cleansing product versus water: a pilot randomized, assessor-blinded controlled trial. BMC Pediatrics. 2011; 11:35-44

Lawton S. Understanding skin care and skin barrier functions in infants. Nursing Children and Young people. 2013; 25:(7)28-33

Evidence based selection of skin care options for infants and children. 2012. (accessed 22 September 2019)

Lumbers M. Caring for and cleansing a baby's skin. British Journal of Nursing. 2018; 27:(3)18-20

Lumbers M. How to manage incontinence-associated dermatitis in older adults. British Journal of Community Nursing. 2019; 24:(7)332-337

Ness MJ, Davis DM, Carey WA. Neonatal skin care: a concise review. International Journal of Dermatology. 2013; 52:14-22

NHS. Nappy rash: your pregnancy and baby guide. 2019. (accessed 10 September 2019)

National Institute for Health and Care Excellence. Postnatal care up to 8 weeks after birth. 2015. (accessed 10 September 2019)

Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. Journal of Investigative Dermatology. 2008; 128:(7)1728-1736

Penzer R. Prescribing emollients for dry skin conditions. Nurse Prescribing. 2013; 11:(6)276-283

Shin HT. Diagnosis and management of diaper dermatitis. Pediatric Clinics of North America. 2014; 61:(2)367-382

Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatric Dermatol. 2014; 31:(1)1-7

Voegeli D. Moisture-associated skin damage. Nursing and Residential Care. 2010; 12:(12)578-583

Voegeli D. Incontinence-associated dermatitis: new insights into an old problem. British Journal of Nursing. 2016; 5:(5)256-262

Watkins J. Common skin complaints in neonates. British Journal of Midwifery. 2016; 24:(1)12-16

Weatherspoon D. Baby's skin. International Journal of Childbirth Education. 2018; 33:(2)13-17

White JML, McFadden JP. Exposure to haptens/contact allergens in baby cosmetic products. Contact Dermatitis. 2008; 59:(3)176-177

Understanding the vulnerability of a baby's skin to help treat and prevent nappy rash

02 December 2019
Volume 27 · Issue 12


With an estimated one third of all nappy wearing babies and toddlers experiencing nappy rash at any one time, it is critical that health professionals both understand the causative factors of nappy rash while also having full insight into prevention and management of this common complaint. Nappy rash can range in severity from mild to severe and can cause great discomfort and distress. Understanding the process and timescale of how a newborn's skin changes and develops helps support health professionals in understanding why certain skin cleansing regimes are supported, ensuring best practice is implemented.

The first breath taken within seconds of birth is a vital role allowing the lungs to fill with air (Kenner and Lott, 2014)—signifying the moment the baby is now living in a gaseous (air) environment rather than a fluid (amniotic fluid) environment. This change in environment can greatly impact the skin, the bodies largest organ; moving from a wet to dry environment. A crucial role of the skin is to act as a barrier; problems occur if this barrier becomes impaired. Watkins (2016) acknowledged how many common health complaints in newborns relate directly to the skin, these include: cradle cap, dry skin and rashes, including milia, heat rash and nappy rash.

Establishing good skincare regimes from birth has been seen to be beneficial in supporting healthy skin throughout life (Ness et al, 2013). Nikolovski et al (2008) identifies how the stratum corneum (the outer most layer of the skin) fully develops during the first 12 months of life; making this first year even more critical in ensuring appropriate evidence-based skincare regimes are implemented.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month