What can be done to keep babies' skin healthy?

Establishing a skincare routine that keeps babies' skin healthy remains a challenge for midwives and parents, since up to 50% of babies suffer from at least one episode of nappy rash at some time. Nappy rash is an irritant contact dermatitis caused by the interaction of several factors, particularly the prolonged contact of the skin with urine and faeces, which makes the skin more prone to disruption through friction with the nappy. Infection is not a primary cause of nappy rash, though secondary infection by Candida albicans can occur. Prevention of nappy rash is the ultimate goal, but if the condition does develop, treatment should aim to reverse the skin damage and prevent recurrence. We propose that routine baby skincare should comprise gentle cleansing whenever the nappy is soiled (using warm water or alcohol-free baby wipes), the use of good-quality super-absorbent nappies, and the application of a barrier preparation at every nappy change. Ideally, a barrier preparation should be clinically proven to be effective in babies and mimic the skin's natural function by forming a long-lasting barrier to maintain optimum moisture levels. It should not contain any unnecessary ingredients, including antiseptic, preservative or perfume (or other potential sensitisers), or any ingredients that are toxic or have undocumented safety. Treatment of nappy rash should comprise essentially the same actions as its prevention. Application of a barrier ointment at every nappy change can help to both prevent and treat this condition. Topical steroid therapy should be reserved for use where the condition has failed to respond to other approaches, and antifungal treatment should only be employed where Candida infection is established or suspected. Implementing these measures would form a simple skincare routine that could help keep babies' skin healthy.