Dr Phil Kieran: I’m worried about my grandson’s angry nappy rash

I used a zinc-based cream with all my babies, and it didn’t do them any harm. What would you suggest?

Every parent has dealt with nappy rash at some stage.

Several factors cause the condition. Firstly, baby skin is more delicate, as it hasn’t had a lot of practice at being skin yet (technically, we call this an immature skin barrier function, but I like my description better). 

Secondly, poo has a different pH to skin and so can irritate it and break it down. Thirdly, nappies keep the skin moist and rub up against it, which can cause physical trauma.

Most parents will apply a barrier cream or ointment to the area first. This reduces friction and keeps faeces and urine off the skin, allowing it to maintain a healthy pH.

For most children, a barrier cream will quickly settle the irritation, and there is no evidence that ones containing zinc or petroleum jelly harm the skin.

Natural creams can also provide a barrier function. For a longer-lasting effect, I recommend thicker, more paste-like creams.

If your daughter wants to stick with ‘natural’ products, I would suggest changing the baby’s nappy more frequently than you think is necessary. 

It is normal to change a newborn’s nappy up to 10-12 times per day; for a four-month-old, it’s eight times a day. 

If she uses reusable nappies, they may need to be changed more frequently, as they may not be as absorbent.

I would also recommend nappy-free time, as allowing air to get at the skin will help it heal and become stronger. 

Leaving the nappy off may lead to more floor-cleaning (as it did in our house), but babies love this time, and it will help the nappy rash settle quickly.

When cleaning the skin during nappy changes, avoid using anything that further irritates it. 

I suggest using cooled boiled water and cotton wool and allowing the skin to dry thoroughly, before applying creams or putting the nappy back on.

Both you and your daughter are right in this discussion about barrier creams.

The zinc paste you used when your children were growing up did them no harm, but your daughter is entitled to make different choices for her children. Information changes over time.

Taking a different path to raising our children can be seen as criticism by our parents. 

I prefer to see it as our way of trying our best for the next generation. We can listen to our parents’ wisdom and innovate.

• If you have a question for Dr Phil Kieran, please send it to parenting@examiner.ie