GETTING TO THE BOTTOM OF NAPPY RASH

Background. Nappy rash accounts for 20% of dermatology consultations i n childhood, but its causes are poorly understood. Aim. To determine t he incidence of nappy rash during the first four weeks of life in a ge ographically defined United Kingdom (UK) population, and to study the factors associated with developing the rash. Method The data are deriv ed from self-completed questionnaires of parents in the Avon Longitudi nal Study of Pregnancy and Childhood (ALSPAC). The response rate to a questionnaire about the child administered four weeks after delivery a mong parents of singleton infants was 87% (12103/13902). Results. The incidence of nappy rash was 25%. Fourteen highly significant possible causal factors emerged, of which 10 were retained in a logistic regres sion model: dirtying of nappy, contact with doctor about other problem s, history of rashes in joints or skin creases, type of nappy worn, be ing fed cereal, taken to mother's bed when waking at night, his tory o f cradle cap, general state of health, previous stomach upset, and bei ng only breast-fed. However, the relative risks were generally small. Conclusions. The likelihood of nappy rash increases with intercurrent illness and early introduction of cereals. Disposable nappies give lit tle protection, and this finding helps to endorse a recently introduce d hospital scheme arising from environmental concerns that encourages parents to use cotton nappies instead of disposables. For many babies, however, the causes of nappy rash remain unknown.