Bepanthen^®

I know you don't want to start using disposable nappies and I understand why, but there is clinical research to show that for children prone to nappy rash, ideally good-quality, super absorbent disposable nappies can help. Studies have shown that compared to washable cloth nappies, they cause less nappy rash and also less severe nappy rash. So, I would suggest you continue with your terry nappies and at the first sign of a sore bottom you change over to disposables until the soreness is gone and use a thin smear of Bepanthen at each change.

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Many mothers are concerned about nappy rash at teething times. But the simple fact is that teething, of itself, does not give rise to nappy rash. However, what is going on around teething may. Any medication which you give your child, including a teething gel which is swallowed, could change the content of the stool which would then promote nappy rash. In addition, a child's diet might change when he or she is teething because they might refuse some normal foods and you have to fall back on very soft, cool foods (such as yogurt) which the baby will take and therefore get more of than usual. I know it is hard and no mum likes to see her baby distressed from teething, but if your baby is prone to nappy rash at teething time, I suggest you refrain from giving any medication at all. It is wise to remember that any medication - even an over-the-counter teething preparation including herbal and homeopathic preparations given by mouth - will also appear in the urine and possibly cause irritation.

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As you don't say what you have been using on your daughter's bottom – I would have to recommend that you try Bepanthen, if you haven't tried it already. Most babies will get nappy rash with frequent loose stools because of the digestive enzyme present in faeces, so I know it is very difficult to keep your baby's bottom free of soiling. So, I would suggest that you use a thin smear of Bepanthen all over the nappy area and into the skin creases, plus around her anus with every nappy change whether it is soiled or not, as well as gentle and thorough cleansing.

My other thought would be for you to see an NHS allergist. Not a High Street allergist, but a medically qualified one who would be able to give you some really good tips on your daughter's milk and soya allergy. You should see your doctor for more advice.

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There are two kinds of nappy rash – that which is on the outer parts of the skin and that in the skin creases. Dermatitis on the outer part of the skin is mainly due to friction from nappies, occlusion by the nappy and the presence of faeces and urine. The kind of nappy rash that starts in skin creases is sometimes caused by an infection. And, with this type of infection, you should see your doctor to exclude this problem. But in general everyday use, and I would suggest Bepanthen as the nappy ointment of choice, you only need a thin smear. Indeed in the research on premature babies – that was all that was needed. With my own grandchildren, whom I changed just last night – I use a blob about the size of a pea and gently rub it all over the nappy areas including the skin creases. And with your little boy, the scrotum should be included and the area of skin around his anus.

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I'm sure you're doing nothing wrong, though I would suggest you pay careful attention to good hygiene and gentle cleansing. See Question 2 above for my more advice on this. There is no particular frequency you should change nappies – your baby decides when you should change the nappy according to how often she wees and how often she has a soiled nappy. The most important thing that any parent could do to prevent and treat nappy rash is to remove a soiled nappy as soon as she gets the slightest whiff, because it is the enzymes in stools that cause the problem.

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You're absolutely right that simple water is the best way to clean your baby's skin in the first few weeks – though gentle cleansing with high quality sensitive wipes is fine too. There is absolutely no reason why you can't use Bepanthen. I can't speak for any other nappy creams because they haven't been researched on babies' skin in first few weeks.

I would strongly suggest that you don't use zinc or titanium oxide containing preparations to prevent or treat nappy rash because they don't provide a very effective barrier and are generally unsuitable for daily use in a preventative capacity. They are also difficult to remove and this can result in frictional damage to the skin if you try to remove them too vigorously.

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Antibiotics can cause nappy rash because they kill off millions of good bacteria in the intestine which allows not such good bacteria and candida to overgrow. If your baby gets nappy rash after a course of antibiotics you should ask your doctor to look for candida in the stools and treat accordingly and ask about a probiotic too.

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There are several preparations that you might use on your baby's eczemative skin that would be safe but they wouldn't necessarily be effective in helping to prevent or treat nappy rash. It is difficult for you to find something that is both safe and effective given your son's eczema. And, I would have to recommend Bepanthen because it is the only nappy ointment I know which has been used for over 50 years safely and effectively. It has been shown to be safe and effective in protecting from the causes of nappy rash in premature babies who have the most delicate skin - therefore it would be effective for your son.

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Nappy rash is a form of contact dermatitis as a consequence of the barrier function of the skin being damaged through prolonged contact with faeces and urine and occurs in anything from 30-50% of babies in their first year. This is because a baby's skin is a work in progress and doesn't have the efficient barrier and healing properties of adults' skin.

Contrary to popular belief, it is not the ammonia that is released from urine that does the most harm, it is the digestive enzymes, specifically proteases that occur normally in faeces. That is why it is so important to remove a soiled nappy quickly.

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It is essential that the ingredients of a nappy preparation should be as simple as possible. Nappy preparations should be free of perfumes, fragrances, colours, preservatives, antiseptics, antibiotics and antifungals. They should also not be tacky and sticky – mainly because they are difficult to remove from your baby's skin and zealous cleansing may damage the skin. Bepanthen is transparent, easy to apply, easy to remove, doesn't stain and has a neutral smell – so you shouldn't have any more problems.

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Anything which changes the balance of bacteria in a baby's intestine could give rise to a sore bottom. An infection will do this, but so will any form of medication. Even medication that doesn't contain antibiotics – although I have to say that antibiotics are the worst culprits. So, it depends what the cause of the tummy upset is, but I don't find it surprising that a sore bottom may follow an upset tummy.

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I can't see why there would be anything wrong in putting white of egg on a baby's bottom – buy why do so when there are such excellent preparations as Bepanthen that is scientifically proven to moisturise and protect from the causes of nappy rash? And Bepanthen is even drawn attention to by Great Ormond Street hospital.

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I would not be in favour of using a zinc or titanium oxide containing barrier cream or Vaseline because the latter is too occlusive. The only barrier ointment that II can recommend is Bepanthen because it is so well researched.

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What makes Bepanthen different to me is that it conforms to all the safety criteria I would want to see in a nappy rash preparation. By the way, Bepanthen is not a CREAM, Bepanthen is an OINTMENT. If you are using a cream on your baby's bottom, you are putting preservatives on the bottom area because all creams require preservatives. Ointments do not and therefore Bepanthen is free of preservatives. The other important factor that counts for a great deal with me is that Bepanthen is so well researched and the research is robust and convincing. So convincing that its use is emphasised by the Department of Dermatology at Great Ormond Street.

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Yes – it should be – and well done for being so careful! You're a good mum.

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Because Bepanthen is unique. It conforms to all the criteria that have been laid down by Great Ormond Street – in that it is simple, pure and contains none of the list I mention previously (perfumes, fragrances, colours, preservatives, antiseptics, antibiotics and antifungals). But most importantly it contains an ingredient that is a form of Vitamin B5. We know that Vitamin B5 has two very important actions – it works deep in the cells of the skin to promote healing but also it encourages the skin to produce its own ‘fatty mantle' which acts like a natural barrier cream.

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Yes, there is if you are very observant. With a thrush infection there are frequently tiny little spots which are quite distinct either within, around the edges or on the clear skin away from the nappy rash. If you see any of these signs, consult your doctor.

The second thing you could look out for is to see if the nappy rash involves the skin creases. If there is redness together with oozing (which may be white-ish) in the skin creases then, this may indicate a thrush infection. And also – if thrush is present, the nappy rash won't get better with the use of Bepanthen on its own you'll need an anti-fungal preparation.

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I would have to say that I would nip nappy rash in the bud simply by upping the times I use Bepanthen each day.

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Not to my knowledge.

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Baby wipes, as long as they are high quality, alcohol free and gentle do not make nappy rash worse and no, you should not use soap and water to cleanse your baby's bottom. Never, ever use soap or detergent. If your baby has nappy rash, I would even suggest not putting anything in the bath water other than aqueous cream BP and use it as if it were a soap.

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I can say “yes” with some confidence. The most convincing scientific proof about the safety and efficacy of Bepanthen was studies done in premature babies to assess the protection against the causes of nappy rash. The study included 54 babies divided into two groups. One group received standard hospital care, the other one, the standard care plus a thin smear of Bepanthen ointment. The ointment was used at each nappy change, unless soiled. Results showed that there was three times more nappy rash where the babies didn't have Bepanthen applied.

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See my advice in this question

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One of the first stages in the development of nappy rash is ‘maceration' of the skin – meaning softening – and it's true that helps the skin to keep an efficient barrier of fatty substances of its own. However, Bepanthen is intended for use in the nappy area, and I can't recommend using it elsewhere.

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See my advice in this question

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Your son scratching could simply be due to the freedom he feels once the nappy is removed and his skin 'relaxes'. It would be a good idea to keep his nails short so he can't break the skin and introduce infection. And of course, you should insist that he washes his hands if he scratches his bottom area to help prevent him carrying germs elsewhere. One thing that I suggest you exclude because it is associated with an itchy bottom - although it is usually worse at night - is worms. Don't take fright! Worms are quite common - especially if your little boy mixes a lot with other children (for example at a playgroup or nursery) and uses common toilets. If you suspect this might the case, then go and see your doctor who will be able to recommend a suitable treatment.

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The younger the baby, the more delicate the skin - with the most fragile skin belonging to premature babies. And if your baby has a red, sore looking bottom I think you should be using a nappy ointment. The only ointment I know which has been used in premature babies and is proven to be safe and effective in protecting from the causes of nappy rash is Bepanthen. I would suggest you use a thin smear at every nappy change.

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Certain foods may not suit your baby, but I think it is unlikely that any particular food would cause nappy rash - as long as it is a food suitable for your baby's age. I have already expressed my view on titanium oxide based products. I am not sure that coconut oil or any other oil should be used in the nappy area. As a dermatologist, I would have to say that skin has no need of oils – it can't use them and they don't help to moisturise or protect the skin. What the skin needs most is water - and this is most efficiently delivered in the form of a water-in-oil emulsion and this is exactly how Bepanthen delivers water to the skin and keeps it well moisturised.

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I am worried about the word excoriated which sounds as if your baby's skin is broken and, given that you seem to be doing everything right and applying Bepanthen with every nappy change, I think it would be wise to look for an infection of some kind. Though rare, babies can get nappy rash from thrush and bacterial infection. This doesn't mean that you should use a nappy preparation with an antifungal or an antiseptic for every day use, but in your case I think your doctor should try to pin down either thrush or a bacterium and then use the appropriate preparation to treat the problem.

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No -why? Once a baby is weaned both of these fruits are wonderfully nutritious, strawberries for vitamin C and blueberries for antioxidants and should be included in all babies' diets from the age of about 9 or 10 months according to how mixed your baby's diet is. You could start by introducing very small amounts and if your baby likes them – carry on!

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When you say you have tried every product – I hope you are using Bepanthen at least 3-4 times a day. I would also suggest that you should speak to your doctor about your son having a probiotic or prebiotic supplement. This will provide your son's intestine with good healthy bacteria and help to keep his stools healthy too.

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I don't believe that any food per se causes nappy rash. An excess of any fibrous food like fruit and vegetables could cause slightly more frequent and softer stools.

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Frequent use of Bepanthen will not make your baby's skin more prone to nappy rash - it will do the opposite.

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No nappy cream – not even Bepanthen - will necessarily cure nappy rash with one application. The aim of Bepanthen is to restore the integrity of the skin through healing and to restore the skin's natural fatty barrier. Being immature, baby's skin is not good at either of these and so needs constant support through the infant and toddler years to help maintain its health. As Bepanthen has been shown to protect against the causes of nappy rash , my advice would be to use Bepanthen at every nappy change or at least after every soiled nappy. With my own grandchildren, I prefer to use it at each nappy change to protect them from the damaging effects of the next soiled nappy.

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I think it is important with nappy rash to pay attention to good hygiene and cleansing properly. 'Properly' doesn't mean rigorous, it means gentle and thorough because over-cleansing damages the skin and encourages nappy rash.

Here are a few tips for you;

• don't use any form of soap or detergent because they 'de-fat' the skin
• use water alone. The best fragrance and alcohol-free baby wipes are also fine and have the advantage of being very soft to minimise friction
• in addition, once a day you could use a moisturising cream and dissolve it in water as if it were soap. I would suggest aqueous cream BP and make sure to rinse thoroughly and gently pat dry.

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No, Bepanthen does not. You're thinking of steroid creams and they should only be put on a baby's bottom under medical supervision.

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