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Nappy rash - Management
Basis for recommendation
These recommendations are based on expert opinion from review articles [Atherton, 2004; Gupta and Skinner, 2004; Scheinfeld, 2005] limited trial evidence, and pragmatic advice to reduce the skin's exposure to irritants which cause nappy rash.
Choice of nappy
- Experts recommend using nappies with the greatest absorbency.
- A series of randomized controlled trials suggest that children wearing breathable, disposable nappies with a gel matrix experienced significantly less nappy rash than children wearing non-breathable, standard nappies [Davis et al, 1989; Philipp et al, 1997; Odio and Friedlander, 2000; Akin et al, 2001; Baldwin et al, 2001].
- However, a Cochrane systematic review concluded that although the studies do favour breathable, gel matrix nappies, the results should be reviewed with caution as all the studies were open to significant bias [Baer et al, 2006].
Leave nappies off
Frequent nappy changes
- A US cross-sectional survey of 1089 infants, showed the incidence and severity of nappy rash was significantly lower (p < 0.03) when parents reported more frequent nappy changes [Jordan et al, 1986].
Avoid soaps, bubble bath, or lotions
- Soaps, bubble bath, or lotions can remove fats (lipids) from the skin, making it more vulnerable to irritants and microorganisms.
Avoid bathing more than twice a day
- Expert opinion from review articles suggests that bathing a child more than twice a day may dry out their skin and lead to worsening nappy rash [Atherton, 2004].
Use fragrance-free and alcohol-free baby wipes
- Two clinical trials (n = 163) showed that fragrance-free and alcohol-free baby wipes are suitable for use on nappy rash, and are as good as using water alone. Baby wipes have the advantage of being convenient and soft (which minimizes frictional damage) [Ehretsmann et al, 2001].
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