Changing Nappies

Before you change your baby's nappy, wash your hands and get everything you need in 1 place, including:

• a changing mat or towel
• cotton wool and a bowl of warm water, or fragrance and alcohol-free baby wipes
• a plastic bag or bucket for the dirty nappy and dirty cotton wool or wipes
• barrier cream to protect your baby's skin
• a clean nappy (and liner and cover if you're using cloth nappies)
• clean clothes.

The best place to change a nappy is on a changing mat or towel on the floor, particularly if you have more than one baby.

That way, if you need to see to another child for a moment, your baby can't fall. It's best done sitting down so you don't hurt your back.

If you're using a changing table, keep an eye on your baby at all times. You shouldn't rely on the straps to keep your baby secure. Never walk away or turn your back.

Older babies may try to wriggle away when you're changing them. You could give them a toy or use a mobile to distract them.

It's just as important to clean your baby fully whether they have wet themselves or done a poo.

If your baby's nappy is dirty, use the nappy to clean off most of the poo from their bottom.

Then use the cotton wool and plain warm water (or baby wipes) to remove the rest and get your baby really clean.

Clean the whole nappy area gently but thoroughly and make sure you clean inside the folds of skin.

Girls should be cleaned from front to back to avoid getting germs into their vagina.

Boys should be cleaned around the testicles (balls) and penis, but there's no need to pull back their foreskin.

If it's warm enough, let your baby lie on the changing mat without a nappy on for a while. Wearing a nappy all the time makes nappy rash more likely.

If you're using disposable nappies, take care not to get water or cream on the sticky tabs as they won't stick if you do.

If you're using cloth nappies, put in a nappy liner and then fasten the nappy. Adjust it to fit snugly round the waist and legs.

Chat to your baby while you're changing them. Pulling faces, smiling and laughing with your baby will help you bond and help their development.

Try not to show any disgust at what's in their nappy. You don't want your baby to learn that doing a poo is something unpleasant or negative.

Disposable nappies can be rolled up and resealed using the tabs. Put them in a plastic bag kept only for nappies, then tie it up and put it in an outside bin.

Washable cloth nappies don't have to be soaked before they're washed, but you may choose to soak them to help get the stains off. Check the washing instructions first.

Cloth nappies can be machine washed at 60C, or you could use a local nappy laundry service.

There's no evidence that using washing powders with enzymes (bio powders) or fabric conditioners will irritate your baby's skin.

Wash nappies that are dirty with poo separately from your other washing.

To avoid infection, wash your hands after changing a nappy before you do anything else.

If your baby's old enough, they can wash their hands with you as it's a good habit to get into.

Your baby's first poo is called meconium. This is sticky and greenish-black.

Some babies may do this kind of poo during or after birth, or some time in the first 48 hours.

After a few days the poo will change to a yellow or mustard colour. Breastfed babies' poo is runny and doesn't smell. Formula-fed babies' poo is firmer, darker brown and more smelly.

Some infant formulas can also make your baby's poo dark green. If you change from breast to formula feeding, you'll find your baby's poos become darker and more paste-like.

If you have a girl, you may see a white discharge on her nappy for a few days after birth.

It's caused by hormones that have crossed the placenta to your baby, but these will soon disappear from her system.

These hormones can occasionally cause slight bleeding like a mini period, but in both cases it's nothing to worry about.

Babies do an average of 4 poos a day in the first week of life. This goes down to an average of 2 a day by the time they're 1 year old.

Newborn babies who are breastfed may poo at each feed in the early weeks, then, after about 6 weeks, not have a poo for several days.

Formula-fed babies may poo up to 5 times a day when newborn, but after a few months this can go down to once a day.

It's also normal for babies to strain or even cry when doing a poo.

Your baby isn't constipated as long as their poos are soft, even if they haven't done one for a few days.

From day to day or week to week, your baby's poos will probably vary.

If you notice a definite change of any kind, such as the poos becoming very smelly, very watery or harder (particularly if there's blood in them), you should talk to your doctor or health visitor.

If your baby's poos look pale, this can be a sign of liver disease.

Speak to your health visitor or GP if you notice this.

Infant constipation isn’t common. However, your baby might have infant constipation if he or she has hard or pellet-like bowel movements or bowel movements that appear difficult to pass, causing your baby to arch his or her back or cry. Or infrequent or less frequent bowel movement. 

Breastfed babies are rarely constipated as breast milk is almost 100% completely digested and utilized by baby’s growing body. Breast milk leaves little “leftovers” to cause constipation. Many breastfed babies do have infrequent bowel movements however this does not mean that they are constipated.

Formula fed babies may have constipation more often than breastfed babies. Unlike breast milk, formula is not as easily digested nor is it as completely absorbed and used by a baby’s body.

Keep in mind that the normal amount of bowel movements an infant passes varies depending on his or her age and what he or she is eating. Infants also have weak abdominal muscles and often strain during bowel movements. Infant constipation is unlikely if your baby passes a soft bowel movement after a few minutes of straining. 

Infant constipation often begins when a baby starts eating solid foods. If your newborn seems constipated, contact your Health Visitor or GP for advice. 

What can help?

• A warm bath
• Bicycle legs: place your baby on her back and lightly hold her legs in a half-bent position. Gently begin to move your baby’s legs as if she is riding a bicycle.
• Tummy massage: Gently massage and rub baby’s tummy in a clockwise direction. Place your hands at baby’s navel and massage in a circular motion, moving your hand(s) out and away from the centre of baby’s belly.
   

Around 1 in 4 babies and toddlers in nappies have nappy rash at any one time. It doesn't usually develop in newborns, but all babies can get nappy rash.

Nappy rash can be caused by:

• your baby's skin being in contact with wee or poo for a long time
• the nappy rubbing against your baby's skin
• not cleaning the nappy area or changing the nappy often enough
• soap, detergent or bubble bath
• Alcohol-based baby wipes
• some types of medicines, such as antibiotics or laxatives (used to make a baby poo more often)

There may be red patches on your baby's bottom, or the whole area may be red. Their skin may look sore and feel hot to touch, and there may be spots, pimples or blisters.

Most babies with mild nappy rash don't feel sore, but if the rash is severe your baby may feel uncomfortable and be distressed.

Treating nappy rash

If your baby gets nappy rash, you can usually treat their skin yourself.

If the rash isn't upsetting your baby, at each nappy change apply a thin layer of a barrier cream to protect their skin. Ask your health visitor or pharmacist to recommend one.

Follow this advice to help look after your baby's skin.

• Change wet or dirty nappies as soon as possible.
• Clean the whole nappy area gently but thoroughly, wiping from front to back. Use water or fragrance-free and alcohol-free baby wipes. 
• Bath your baby daily – but avoid bathing them more than twice a day as that may dry out their skin.
• Dry your baby gently after washing them – avoid vigorous rubbing.
• Lie your baby on a towel and leave their nappy off for as long and as often as you can to let fresh air get to their skin.
• Do not use soap, bubble bath, or lotions.
• Do not use talcum powder as it contains ingredients that could irritate your baby's skin.
• Make sure your baby’s nappy fits properly. If it is too tight then it can irritate the skin and if it is too loose, then the nappy will not be able to soak up pee properly.

Nappy rash usually clears up after about 3 days if you follow this advice. You should keep following this advice as this will help prevent nappy rash from coming back.

If the rash is causing your baby discomfort, your health visitor or pharmacist can recommend a nappy rash cream to treat it.

You should apply the cream first and wait a few minutes before you apply the barrier cream.
 

If the rash doesn't go away or your baby develops a persistent bright red, moist rash with white or red pimples that spreads into the folds of their skin, they may have an infection.

Ask a pharmacist or health visitor for advice. The pharmacist may recommend a cream for you to use.

If the rash is severe, take your baby to the GP who may prescribe cream or medicine. Follow a GP's instructions on whether and when to apply barrier cream as well as the prescribed cream.

It's normal for babies to develop skin rashes, but it's important to know the difference between a minor irritation and a condition that requires attention.