Nappy Rash

What and Why?

In traditional communities, particularly in warm climates, a mother who carries her baby around with her constantly develops great intimacy with him, and senses instinctively when he is about to empty his bladder or bowel; she has time to remove his clothing and let him void somewhere appropriate. In these circumstances his skin is easily cleaned and remains well ventilated, cool and dry; unhealthy rashes are practically unthinkable.

Economic development inevitably complicates all this. Not only do many individual mothers develop a distance from their children, but their whole community distances itself from naked patches of earth. The child cannot tell his mother what he needs, and there are few places she can take him where it is hygienic or polite to let him drop his excreta. The napkin is society’s answer. It is in effect a portable latrine, which solves these two problems only by creating new ones to replace them.

In the first place, the skin covered by nappies is kept warmer and damper than is good for it, with hardly any ventilation. This makes it very susceptible to fungus infection. The most readily available is usually Candida albicans or thrush, which may already be thriving in his intestine and therefore present in the faeces held by the nappy against his skin. If he has been treated for infection with an antibiotic, the colony of thrush is likely to be larger and more assertive — especially if he has been artificially fed with dried cow’s milk preparations that cannot sustain his immunity so well.

Secondly, faeces and urine are allowed to mix with each other for several hours, after being voided separately. Urine is free of microbes when it is passed, but faeces always teem with them. Bifidus bacteria predominate until you finish exclusive breast feeding and are highly protective against infection. But artificial or mixed feeding encourages the growth in your baby’s colon of coliform bacteria, which overgrow and replace his colonies of bifidus bacteria. Coliforms are much more likely to cause trouble generally, and are in particular able to feed by breaking down the urea in his urine-soaked nappy, releasing appreciable amounts of ammonia. This gas stays dissolved in the dampness as a very caustic alkali, which burns his skin.

Most nappy rashes arise from one or other of these problems, or a combination of them. If you can detect a strong odour of rotten fish when you change your baby’s nappy, then ammonia is playing some part. The rash looks like a burn, with a uniform sore red surface which wrinkles easily. The edge is flat, indistinct rather than clear-cut, and no more livid than parts further in. Particularly bad patches may ulcerate and become infected with bacteria, which may then discharge offensive pussy material which stains the nappy.

Thrush, on the other hand, is blotchy and has abrupt margins that are slightly thickened and raised, where the fungus is most active. The blotches tend to start small as livid spots, and broaden overe the course of several days into patches with irregular outlines. Bacterial spots and sores often develop if the skin is sufficiently disturbed.

What can I do?

Advice to maintain and maximise health

1. Revel in intimacy with your infant, from pregnancy onwards. Bathe with him, have him naked in bed with you, and breast feed. Carry him with you everywhere you can in a sling or back-pack. This may not enable you to do without nappies, but undoes a fundamental error in developed culture which tarnishes parenthood, deprives your children of you, and diminishes the potential of your entire family life.

2. Breast feeding is strongly protective against infection of any kind, and nappy rashes in particular. You will notice unpleasant changes in your infant’s faeces within two weeks of changing to cow’s milk, unless by then he can cope with eating fibrous vegetable food as well.

3. Disposable nappies go against the grain of thrifty people, but they have now surpassed cotton fabric in efficiency, and no longer much exceed them in real cost. Composting the bio-degradable part, or burning it as fuel, will appease your conscience honestly if incompletely.

4. If a rotten fish smell rises from overnight nappies, obtain some Borax (Boracic Acid BP) from the chemist and dissolve a teaspoonful in a pint of warm water. Sprinkle this on a batch of nappies, and allow them to dry. Keep these for night-time, or any other long stage. The borax neutralizes ammonia as it is formed, and solves the problem. (If you have a redundant scent spray, dissolve as much borax as you can in much less hot water, and dilute it a little before use; a fine mist of this is sufficient, and takes less drying.)

5. Heal ammonia burns with Comfrey or Calendula Ointment. Zinc and Castor Oil Cream protects healthy skin from getting soggy. Antiseptics may irritate, and are more likely to be harmful if they are absorbed through your baby’s skin and stored in his fat.

6. In the first summer after he learns to walk, let your child run around at home with his feet and bottom naked, indoors and out. Let him wee and poo on your garden soil, and help you to bury poos shallow in its surface with a trowel. This is completely hygienic fertilizer, and a thoroughly wholesome lesson for everyone: it can no longer disgust you, and your child — who knows his poo is useful — never learns to believe that it is dirty. Potty training then follows on quite naturally and without effort, in an entirely positive and cooperative atmosphere. Bed-wetting is then unlikely to be a problem.

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