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Sore Bottoms Caused By Disposable Nappies?

teddy bear beside pile of disposable nappies

This post has been written by Fiona Boorman, Children’s Specialist Nurse at BBUK.

Recent reports in the press have suggested disposable nappies could be causing chemical burns to children’s bottoms. Product testing regulations in the UK are among the best in the world, so soreness due to a reaction to something in the nappy itself is unlikely.

There are many reasons for children getting nappy rashes. These include:

  • Strong urine (wee), which may irritate the skin, although nappies do absorb urine quickly to keep the skin dry. Increasing water and water based drinks, throughout the day, will make the wee less irritating.
  • Children not being changed quickly enough after they poo – it is not always possible to change straight away, but wee and poo together can cause nappy rashes. Sometimes the child’s diet may make poo more likely to cause skin redness.
  • Children may get dry skin, eczema or skin infections in their nappy area.
  • Some children are more sensitive to some wipes.
  • If the nappy is too small or fits poorly, it is more likely to cause rubbing and irritate the skin resulting in red areas.
  • If the nappy has leaked or is over filled, so moisture is next to the child’s skin.
  • A child in a nappy is more likely to have a rash than those wearing cotton pants, as the air is less able to reach the skin. Potty/toilet training as soon as possible is a good way of managing or avoiding nappy rash. Also, where possible, allowing a bit of ‘nappy-free’ time for babies, during the day.

Signs of poorly fitting nappies

Baby nappy on a white background

  • Red marks on the skin beneath the nappy may be due to rubbing or chafing, often inside their thigh.
  • Children may fiddle with their nappy if they are tight or uncomfortable, making the products more likely to burst or leak.
  • Toddlers may walk awkwardly (John Wayne style) or even refuse nappies!
  • Tapes may stick to the skin if there is not enough stretch,
  • The nappy leaks.

We generally take more care of fitting children’s shoes than we do their nappies

Nappies often fit better if, after taking them from the pack, they are folded in half lengthwise and tugged gently, to help the elasticated cuffs to stand up and act as a more effective leakage barrier.

It is best to avoid using talc or barrier creams on your child’s nappy area as these can block the special one-way pores in the nappy. The pores are designed to let wee through into the nappy quickly and keep it there so your child’s skin stays dry. If your child does need a cream on their nappy area, then use the minimum you can and rub it in well.

In older children – around 20 months onwards – maybe soreness in the nappy area is the cue to get the toilet training underway? There are toilet training suggestions on the nappy fitting table below.

Many children with disabilities can toilet train at a similar age to their typically developing peers. There is more information on toilet training children with disabilities available on our website at www.bbuk.org.uk/children-young-people/children-resources/ or contact our helpline on 0161 607 8219 or email bladderandboweluk@disabledliving.co.uk

Toilet Training Stages & Nappy Sizing

Age Nappy size Weight Toilet training suggestions Reasons
At birth – 2 months New born 2-5kg
2-4 months New born (1), Mini (2) 3-6kg
4-8 Midi (3) 4-9kg
7-12 months Maxi (4) 7-18kg, average 9.6kg • Buy a potty
• Read about constipation
• Find out what is ‘normal’ and speak to your Health Visitor or GP if child’s poo is hard, painful to pass, difficult to push out, or they are pooing less than 4 times a week
Constipation needs treating, so bowel and bladder work at their best.
10-15 months Maxi+ (4+) Maxi pants 9-20kg • Once baby can sit, get them used to potty at changing times.
• No pressure to do anything, but if they do – give lots of praise!
• Try to do most changing in the bathroom or toilet.
• Make sure your child is drinking enough.
• Potty becomes familiar
• Child starts to associate the toilet with wee and poo.
12-24 months Junior (5) Junior pants 22-25kg, average 14kg • Read stories and talk positively about wee and poo.
• Show poo going down the toilet (tip it off their nappies) and flush.
• Get them to help with wiping.
• Clean them whilst sitting on the toilet or potty rather than lying down.
• Around 18 months, buy pants.
• Lets them know it is a normal part of life
• Developing skills
18-30 months Junior Plus (5+) Junior Pants 13-27kg • Buy/find toilet seat reducer and a step so knees are higher than bottom when they are sitting on the toilet.
• Once your child can be dry for at least 60-90 minutes, try them in pants, guiding them to the toilet or potty every 60-90 minutes particularly after meals, snacks/drinks and a bath.
• Praise success – use “Never mind let’s try again” for accidents.
• Blowing ‘bubbles’, whistles and blowing toys whilst sitting on potty/toilet can help.
• Opens bottom, helps poo out.
• Relaxes child by giving stability.
• They are probably ready.
• If they are upset they will not relax to do a wee or poo and may hold it in instead.

See more…

Free downloadable leaflet by BBUK: ‘Talk about going to the toilet’

‘Myths on Chemical burns in the Diaper area’ Kara Shah MD, PhD Clinical Pediatrics 2017 Vol.56 135-155.

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