Baby’s sore bottom: everything you need to know about nappy rash

Wunder Po beim Baby: Alles, was du zu Windeldermatitis wissen musst

A sore bottom, also called nappy dermatitis, is not uncommon in babies and toddlers. Did you know that about 2/3 of all newborns suffer from it? It is often a recurring problem that can have different causes. Therefore, treating the sore bottom can be a real challenge. We want to provide clarity on this topic and have compiled all the important information and tips for treating a sore bottom in this guide.


How do I recognise a sore bottom or nappy rash in a baby?

Sore bottom or nappy dermatitis is an inflammation of the baby’s skin. You can recognise it when the skin in the nappy area is reddened over a large area or a rash forms on the skin. Often the nappy rash starts small and harmless, but if it is treated too late or incorrectly, it can spread to the whole nappy area and, in rare cases, beyond. In addition to the redness, small blisters or pimples may also appear. In some cases, the stool smells sour. In very advanced cases of nappy dermatitis, there are also open sores and skin tears on the bottom, which can tend to bleed. Last but not least, this means often painful nappy changes for your little darling, as the unpleasant symptoms can be very stinging or itchy. Sleep problems, frequent crying and a general feeling of discomfort are also possible symptoms. Therefore, the problem should be treated as soon as possible to relieve your baby of the pain and not cause any lingering loss of trust between the two of you. After all, baby care is also always about intimate togetherness.

What is the difference between nappy dermatitis and nappy thrush?

Nappy thrush is not to be confused with nappy dermatitis. While nappy dermatitis is an inflammation of the baby’s skin, nappy thrush is a skin fungus. It is caused by Candida albicans, a contagious yeast fungus, and must be treated with antifungal creams. Nappy dermatitis, on the other hand, is not contagious. You can recognise a fungus in the nappy area by sharply defined, bright red rashes with small pustules or scales. At the edge of the rash, the skin often forms a whitish, scaly ring.

It is important to know that one does not exclude the other. Nappy rash and nappy thrush can therefore also occur together. If nappy dermatitis is not treated properly or does not heal, the risk of nappy thrush is greater, as bacteria and yeast fungi have easier access through the sore and cracked skin. In addition, these types of germs like to settle in the warm, moist climate of the nappy. Both conditions require different treatment approaches, which is why a correct diagnosis is extremely important. If in doubt, consult a professional you trust so that you don’t risk the condition getting worse. Your paediatrician can give you an accurate diagnosis by taking a skin swab.


The differences between diaper rash and diaper thrush at one glance:

Nappy dermatitis Diaper thrush
Inflammation of the skin caused by bacteria or germs Infection with yeast (Candida albicans)
Not contagious Contagious
Large nappy rash with redness, possibly skin tears and open areas that bleed In addition to the diaper rash, sharply demarcated, bright red rashes with pustules, often with a whitish, scaly wreath at the edge
Treatment with wound protection creams, ointments etc. Treatment with special antifungal ointments


Causes of sore buttocks in babies

There are many reasons why babies get sore. However, the most common reasons are:


  1. Too much skin contact with urine and faeces in the nappy.

This favours a moist nappy climate. The waterlogging causes the skin to swell, making it more permeable to bacteria and pathogens. The bacteria excreted with the stool can thus penetrate the skin more easily and lead to skin irritations and inflammations. Ammonia, which is released by the breakdown of urine, can also promote a sore bottom. Ammonia alters the pH of the skin, further weakening the skin barrier and reducing the natural defence mechanism. The longer the skin is exposed to these factors, the more it loses its ability to regulate itself and protect itself from the irritants. The result? The bottom becomes sore and causes itching, burning or pain, among other things.

By the way: The skin of newborns is 5 times thinner than that of adults and therefore all the more dependent on good protection.

  1. Synthetic ingredients in baby care products.

Tender skin needs tender care. Especially in the first year of life, the acid mantle of the baby’s skin is not yet so well developed, which makes the gentlest possible baby care extremely important in order not to unnecessarily stress the skin. Especially if your baby suffers from a sore bottom, natural baby care, free from allergens, harmful substances or perfume, is best suited to avoid further stressing the already irritated skin. Avoid frequent washing with soap, over-application of lotion and check your washing powder if necessary.

In rare cases, some children are allergic to the materials used in disposable nappies. If you are using disposable nappies, it is worth considering trying cloth nappies. The advantage of cloth nappies is that they are more breathable than disposable nappies, which helps to prevent waterlogging. This reduces the hot and humid nappy climate and the risk of a sore bottom. Try it out and see what works best for your baby (and your everyday life).


  1. Nappy or clothing that are too tight.

Nappies or clothes that are too tight can also irritate the skin because they create friction on the skin and chafe it. This makes it easier for bacteria to enter and can also lead to skin irritation. Furthermore, tight-fitting nappies reduce air circulation and promote a damp nappy climate.


  1. Dietary changes, food intolerances, allergies and certain foods

Especially at the beginning of complementary feeding, sore bottoms can occur more often because the digestive system still has to adjust to the new food. This includes very acidic foods such as citrus fruits, strawberries, pineapple, kiwi and tomatoes. They can contribute to urine being more acidic than usual and thus irritate the baby’s delicate skin during wetting. Hot spices can also contribute to a sore bottom. However, over time, the baby’s digestive tract will adjust, so it is not necessarily advisable to permanently avoid these foods. The quantity is crucial. In small portions, the foods mentioned do not usually lead to problems.

In addition, every baby is different. Some are more sensitive to certain foods than others. It is a matter of trial and error. If your baby has diarrhoea in addition to a sore bottom, for example, you can leave out certain foods for a while and see if the condition improves. It is important not to try too much at once, but always in bits and pieces, otherwise it will be difficult to understand where the effects come from. Ask your family if they know of any allergies.


  1. fungal or bacterial infections

A fungal or bacterial infection in the intestines can also cause a sore bottom, as this promotes diarrhoea and weakens the immune system. If this is a frequent problem, a stool sample taken by a doctor can provide clarification. Fungi usually appear after treatment with antibiotics.


  1. Teething

When your baby starts teething, the whole organism is more susceptible to infections because the nest protection starts to weaken. Nest protection is a temporary immune defence that the baby receives directly from the mother through the umbilical cord. The mother’s antibodies are transferred to the baby and help protect it from pathogens. This protection is strongest in the first two to three months of life and begins to weaken after six months. As a result, fever, diarrhoea and physical stress are more frequent. All these factors increase the risk of a sore bottom.


Treating of a sore baby bottom

Strict hygiene measures are part of the first aid for a sore bottom. Excessive skin contact with urine and bowel movements is the most common cause of skin irritation in the nappy area. Change the nappy as often as possible, preferably after every bowel movement. By doing this, you are already removing a large irritation factor from the delicate skin.

Thorough cleaning of the nappy area is also important. It should be as gentle and soft to the skin as possible. Mild wet wipes (without alcohol or perfume) or water and cotton pads are best. Natural oils also offer gentle cleansing, as they neither burn nor attack the skin. Almond oil has proven particularly effective in baby care because it is very mild and well tolerated by the baby’s skin. At the same time, it strengthens the skin barrier and soothes redness, rashes and itching. pH-neutral care products are also ideal because they do not upset the skin’s natural pH balance. Avoid rubbing the skin and use gentle patting to cleanse. Make sure to dry the nappy area carefully afterwards to avoid unnecessary moisture in the nappy.

The warm, moist climate in the nappy also promotes inflammation of the skin. Therefore, let your baby play without a nappy whenever possible. The more air and light there is, the faster the irritated nappy area will heal. This is because skin damage caused by moist skin is more severe than that caused by dry skin. Therefore, you should keep the nappy area as dry as possible and avoid any excess moisture. With these simple steps, you can create the optimal conditions for the sore bottom to heal quickly. In addition to hygiene and air, it is very important to rebuild the weakened skin barrier and promote healing. The use of a wound protection product is suitable for this. Nowadays, there is a wide range of options. It is easy to lose track of them all. What really helps?

Many swear by wound protection creams with panthenol or dexpanthenol, which support the regeneration of the skin and protect it from infectious agents. Zinc ointments are also popular. They have an anti-inflammatory and drying effect, which can contribute to rapid wound healing – especially in the case of weeping wounds. However, since zinc ointment dries out the skin, it is not suitable for long-term use. With creams and ointments, it is important that they are not applied too thickly so that the skin can continue to breathe. Furthermore, the constant use of creams can mean that the skin itself never gets a chance to regulate and protect itself. Therefore, natural ingredients and oils are a good alternative to promote healing without interfering with the skin’s self-regulating process.

Healing wool is also enjoying popularity. Healing wool is natural sheep’s wool that is full of lanolin and has an anti-inflammatory, nourishing and soothing effect on irritated skin.
And what about baby powder? Baby powder used to be the go-to on every baby’s bottom. But contrary to the old “custom”, it is only conditionally suitable for treating a sore bottom. Baby powder does bind moisture, but at the same time it forms lumps on the skin. These cause friction on the skin and further strain it. Furthermore, many baby powders contain perfumes, which can also have an irritating effect on sensitive skin.

There are also many home remedies that help with sore bottoms. For example, you can put cooled black tea on the skin as a poultice. Short sitz baths or medicinal baths with black tea or camomile can also support the healing process. The tannins in black tea have an antibacterial and disinfecting effect on the sore skin. A few drops of breast milk also help and can be applied to the irritated baby’s bottom.

Medication is not usually necessary to treat normal nappy dermatitis. If in doubt, consult a doctor or pharmacist. If the nappy dermatitis is already very advanced, special measures are necessary – also to rule out nappy thrush. All in all, it is important that you choose a method that is easy for you to implement in everyday life and that is as gentle and painless as possible for your baby. These were some of the reasons why we developed Milli’s magic wipes. Millis help to counteract sore bottoms in a natural way. The practical wound protection pads soothe skin irritations in the nappy area, protect the skin from becoming sore and are your ideal everyday companion thanks to the easy application. Find out more about Millis here.


How often should I change nappies if I have a sore bottom?

If you have a sore bottom, you should change your nappy more often than usual. A good guideline is to change the nappy at least 8 times a day, which corresponds to every 3 hours. In general, the nappy should be changed as soon as possible after a bowel movement. Be careful not to close it too tightly so that the air can circulate better (leave about a finger’s width between the belly and the nappy).


How quickly does nappy rash heal?

Usually, mild nappy rash heals quickly within a few days if it is treated properly. To help this, avoid possible risk factors as much as possible, keep the nappy area as dry as possible, use only mild products and use a wound protection product that promotes healing.


When should I see a doctor?

If the sore bottom does not go away after a few days, or even gets worse, see a doctor. If you have pus or blood on your bottom, dandruff, pustules or fever, you should see a doctor immediately.


How can I prevent diaper rash?

There are a few simple steps you can take to prevent nappy rash. First, it is important to change your nappy as often as possible and keep your skin dry. Try different types of nappies if necessary. Breathable nappies can help prevent unnecessary dampness, but occasionally changing nappies is also good for your baby’s skin. Cleanse the area with gentle products such as water or almond oil, and avoid using products containing alcohol or perfume to avoid further stressing the skin. Use a gentle wound protector of your choice to prevent a sore bottom. As nutrition also plays a big role here and can indirectly contribute to a sore bottom, it makes sense to check whether your child has certain intolerances. Especially at the beginning of complementary feeding and also when your baby starts teething, sore bottoms can occur more often. A little patience is needed.


Sore bottom, also known as nappy dermatitis, is a large area rash and redness in the nappy area. The symptoms are extremely uncomfortable for the baby and can lead to burning, itching and pain in the nappy area. Nappy dermatitis should not be confused with nappy thrush, which is caused by a yeast fungus and is contagious. Usually, a sore bottom heals quickly within a few days if treated properly and does not require any special medication. Because there are many possible causes, treatment can be challenging. However, sore bottoms and nappy rash can be treated and prevented with frequent nappy changes, gentle cleaning, a reliable wound protection product and, if necessary, a look at the diet. In some phases, sore bottoms can occur more often, e.g. when the baby is teething or starting complementary food. The best thing to do is to be patient and take action at the first signs, such as reddening of the skin. This will prevent a worse outbreak and you can enjoy your time together again sooner.

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