Baby care

Nappy rash is any skin reaction appearing in a baby's nappy (diaper) area. The rash usually makes the buttocks very red and sore; the baby may cry every time when filling or wetting their nappy. Nappy rash can also involve the genital area but tends not to affect the skin creases.

Nappy rash is caused by contact between urine and skin. A rash is almost inevitable if there is prolonged wetness of the baby's skin. Allergy is not thought to be important, simple irritation by urine and stools is the main factor.

Babies with eczema tend to have more alarming-looking nappy rashes with a shiny appearance, while those with a family history of psoriasis can have scaly rashes resembling psoriasis.

In any nappy rash there can be added infection by bacteria or by a yeast called candida (which causes thrush - see below). These infections need specific treatment.

Many nappy rashes can be prevented by frequent changes of nappy, and ensuring adequate cleaning and drying of the skin prior to application of the nappy. It is a good idea to take a spare nappy on shopping trips and other outings.

Once present, nappy rash usually responds to letting the air get to the area as much as possible. When changing, it is important to clean the nappy area gently (warm water and cotton wool are ideal), dry it thoroughly and then leave the baby's bottom bare for as long as possible before putting on a fresh nappy. Even three sessions a day, each of 15 minutes, of "nappy-free" play-time can be effective in rapidly reducing redness and discomfort.

Just before putting on a clean nappy (but not earlier), apply an even layer of barrier cream. Your local pharmacist can advise you about an appropriate cream to use.

This is a matter of personal preference. Terry nappies are often used with plastic pants and could cause rashes because the baby would have moisture direct on their skin for longer periods. The elasticated legs of plastic pants can also chafe the skin.

However, if nappies fit well and are changed often, it does not matter whether they are disposable or not. Present day disposable nappies contain a gel that absorbs urine and takes the moisture away from the baby's skin.

Consult the doctor or health visitor for further advice if:

• The baby seems unwell or very uncomfortable.
• The baby has diarrhoea or is off their feed.
• A nappy rash fails to improve with the simple measures given above.
• There are distinct spots within the rash or spreading out from its edges.

These symptoms require a proper diagnosis from your physician so that appropriate treatment can be started.

Oral thrush (also called monilia) is a mouth infection caused by the yeast candida albicans. It tends to cause discomfort when feeding, and may produce visible white patches on the gums and the inside of the cheeks. The patches resemble milky curds but unlike milk cannot be wiped or rubbed off.

A baby can catch thrush from a mother who has it, either from her vagina during labour or from her nipples when breastfeeding. It can also indicate poor hygiene techniques in sterilising bottles, dummies, etc.

A child on antibiotics may also be predisposed to thrush. To some extent all humans carry this yeast, but only in small quantities because the normal balance of bacteria in the body is enough to prevent Candida from multiplying rapidly and causing symptoms.

Adults too can develop oral thrush, but babies are especially prone to it because their mouths are delicate and they spend so much time sucking. Babies with oral thrush may have thrush elsewhere as well, particularly in the nappy area. This is because the warm moist conditions under the nappy encourage the growth of candida.

If the mother is taking certain antibiotics and breast feeding, or if the baby is taking antibiotics orally, then these can trigger an attack of thrush. This is because they kill off some of the body's beneficial bacteria along with the harmful ones. In someone with an immune deficiency, whether an adult or a child, thrush can invade other parts of the body, but this is rare.

Upon suspecting their baby has oral thrush, parents may wish to speak to their health visitor who will be able to advise if a visit to the physician is required. The physician will be able to make a definite diagnosis. The usual treatment is a prescription for anti-fungal drops or a gel, used several times a day.

It is also important to control thrush in the mother if she has it, and to sterilize teats, bottles, teething rings and dummies properly. Any object a baby put in his mouth could carry the yeast, but rubber items which are beginning to perish or crack are especially prone to harbouring candida and should be replaced.

There are a number of alternative remedies for thrush in adults. However for babies most practitioners agree that conventional medicines are the quickest and most effective way to relieve symptoms. Consult your physician before using complementary therapies on a baby.

Apart from the initial diagnosis, a baby with thrush will need to see the doctor again if he is too uncomfortable to feed properly. This is unusual, but can lead to dehydration. Again, parents may wish to make use of the services of the health visitor in monitoring their child's progress.

In a baby, wind is air swallowed when feeding or crying. Though experts sometimes disagree on how important wind is, it is widely believed to cause discomfort and/or burping.

Younger babies are more prone to wind than older ones, and some babies are more "windy" than others. A baby who cries a lot is likely to swallow air and that in turn may cause more crying. It is sometimes thought that wind may be more common in bottle-fed babies, but this is unproven. However there is little doubt that a bottle held at too low an angle allows more air into the teat and thus causes more wind.

A teat which is too small, and which therefore makes a baby suck harder, is also likely to cause air swallowing, so it is worth checking the flow from the teat before a feed (for instance at the same time as checking the temperature of the formula). The milk should drip from the teat, when the bottle is upturned, like a leaking tap. Teats can block up with use: despite an adequate hole, old or perishing teats may not let milk out fast enough because the walls of the teat stick together and obstruct the flow.

Sucking from engorged breasts making feeding harder may also cause babies to gulp air. It is the experience of many mothers that dummies do not cause wind, but some babies do have problems with their feeding techniques which may predispose to wind, e.g. cleft plate.

It is worth trying to change techniques to see if it will help the problem. Some bottle-feeding mothers find it helpful to change the type of bottle (to one with a polythene lining bag) or the type of teat (to an "anti-colic" variety).

Wind can also be helped by the technique of winding, either just after a feed or once during it as well. It is not a good idea to pause during feeds to often, because the baby may just get hungrier and angrier and therefore gulp down more air.

The best known way of winding a baby is by holding him over your shoulder and rubbing or gently patting the back of his chest until he burps (use a towel or clean terry nappy to protect your own clothes). However this is only suitable for babies over six weeks or so because younger babies cannot control their heads well enough.

A smaller baby is best winded by holding him upright on your lap, with one of your hands under his chin to support his head while the other hand rub his back gently. Alternatively, some babies are happily winded lying on their stomachs having their backs rubbed (a good method for twins and higher multiples as it requires fewer hands for each baby).

Many mothers advocate gripe water but this should not be used in babies under a month old. Most gripe waters contain bicarbonate and could be harmful in excess so the stated dose must never be exceeded. There are anti-colic medications on the market and your local pharmacist or health visitor will be able to advise you.

Although some people advocate there is no scientific evidence to support the use of fennel and other herbal baby teas for wind. Warm water alone may help in moving the wind along.

Check with the physician or health visitor if simple measures do not work, or if the baby continues to be distressed.

Constipation is difficult to define in the very young because babies' bowel habits vary. However stools which seem hard, are small, pellets or difficult to pass usually classify as constipation.

Any baby who is short of fluid can become constipated. On the whole, bottle-fed babies are more likely to get constipated and may require extra fluid such as cool boiled water between feeds. Having said that, breast-fed babies often pass stools less often than mothers expect.

For reasons which are unclear, some breast-fed babies pass motions seemingly non-stop while others may only do so every other day; both can be completely normal.

Serious causes of constipation are unusual but include thyroid deficiency and various conditions that result in intestinal obstruction (bowel blockage) such as Hirschprung's disease.

A baby who has never opened his bowels from birth may have a condition called imperforate anus in which the anal canal is effectively a dead end. Hospital staff and midwives usually ask the mother/parent to observe and inform them when the baby passes their first stool to rule out imperforate anus. It is a rare condition, but does require surgery to correct it.

An underfed as well as an overfed baby can become constipated. If a baby is constipated, it is worth offering bottles of plain boiled (and cooled) water. This is especially useful in hot weather or if the baby is running a fever.

Bottle-fed babies who do not respond to extra water can benefit from a change of formula; talk to your health visitor about this. As an alternative, some health visitors suggest offering a teaspoon of freshly squeezed orange juice, diluted with two teaspoons of water.

See the doctor if the baby:

• vomits
• seems to be in pain
• continues to have constipation despite the suggestions above
• has a hard distended stomach with constipation

All babies cry, but they differ as to how much they do of it. Some seem more placid and contented while others are very vocal. When crying, newborn babies do not shed tears, but older babies can cry with or without tears. Both are normal.

Babies probably do not cry just to "exercise their lungs", as some suggest. They can cry for a variety of causes, such as

• hunger (a cry parents soon recognise)
• thirst (it is unusual, but can occur in hot weather)
• discomfort or pain (including colic - see below)
• boredom or loneliness
• tiredness
• illness
• a dirty or wet nappy (probably)
• fear

You should suspect a baby is ill if they are drowsy, feverish, off their feeds, unusually irritable, if they have diarrhoea or an odd shrill cry, or is snuffly or chesty. If any of these applies, or your instinct tells you your baby is unwell, always consult your physician.

When a baby is crying, picking them up may be enough to pacify them, or they may need feeding and/or changing too - these procedures should be tried first. Check too that their clothes aren't too tight, especially around toes and wrists, as sometimes a loose thread, ribbon or tight cuff can cause pain.

Some very young babies just need comfort or wrapping more snuggly (as long as they can't overheat) while others need more attention, especially if over two months. Many babies are soothed by being sung to, by soft music, by a tape of "womb" noises, or even by the sound of a nearby vacuum cleaner or tumble dryer.

Taking a baby out in their pram or in the car often works, but some may cry on returning home. In practice, dummies are very useful for many crying babies, as long as the parents are scrupulous about hygiene and do not use a dummy constantly.

Picking up and rocking a baby and talking to them is often the most effective pacifier, but obviously one can't do this 24 hours a day.

A baby who cries a lot puts enormous pressure on the parent and the whole household. A mother may feel inadequate if she believes people who tell her the baby's crying is somehow her fault (which is unlikely to be true).

Getting away from a crying baby is sometimes essential for a parent's sanity. Even leaving the room can work wonders if it puts a mother out of earshot for 15 minutes (but first she has to make sure that the baby can't come to any harm).

With a demanding baby, a parent just has to accept that less will get done. Things will improve, but for the time being it is best to be realistic about chores and aim to do the minimum necessary for safety and hygiene. Many household tasks can be postponed. When a crying baby does stop, a harassed parent is better off lying down for a rest rather than catching up on housework.

Some babies cry mainly at night instead of sleeping and letting their parents do the same. There are a number of ways one can help a baby sleep at night - from having a peaceful sleeping place to instituting a calm and predictable night-time routine.

Some of the resources at the end of this information sheet are also useful for sleeplessness.

Some advocate techniques such as baby massage and cranial osteopathy for babies who cry a lot. There is no very convincing evidence for cranial osteopathy, but massage may help both parent and baby relax.

Consider seeing the doctor if you think your baby might be ill (see symptoms above).

In the case of a constantly crying baby, seek help from your doctor or health visitor before you reach the end of your tether. This is for your and your baby's well-being: a difficult infant can make the most devoted parent lose control.

Your physician and health visitor can provide valuable emotional and practical assistance. There are further sources of help and support listed at the end of this factsheet.

In babies, colic is abdominal pain which occurs on and off, causing bouts of intense crying especially in the evenings. The baby may pull his legs up as if in pain. Colic (also known as evening colic and three-month colic) often starts at the age of two weeks and stops at three or four months of age, sometimes as suddenly as it began.

Nobody really knows what causes colic and there is considerable debate about various theories. Perhaps the most plausible is that the baby's bowel is somehow immature, which explains the effects of certain foods and the fact that babies outgrow colic.

Some breast-fed babies may become colicky when their mother eats certain foods such as oranges or strong tasting foods such as garlic. A few are intolerant of milk, so changing a bottle-fed baby to a dairy-free formula may help (but check with the physician or health visitor first).

Firstly if breastfeeding one can avoid foods which are known to cause a baby's colic.

During a bout of crying, cuddling the baby may be enough to stop the crying. Drinks of warm (cooled boiled) water can help. Winding the baby, or holding him in a different position can relieve the pain of colic.

A baby may improve by lying on his stomach (babies should not be put to sleep on their fronts) but they can be held draped over a parent's forearm, with the head supported, and walked around, and you can rub the baby's back gently at the same time.

Various medicines like gripe water and specially formulated anti-colic medicines can ease colic but you should check with your doctor if your baby needs these more than occasionally.

Teething is the process of a tooth emerging through the gum. The first tooth is usually a lower incisor and comes through at five to six months of age, but it can appear at almost any time in the first year.

Experts sometimes say that teething produces nothing but teeth. It is not true that it causes high fever, convulsions, coughs or many of the other symptoms that have over the years been put down to teething. However most mothers and physician's would agree that teething can cause

• pain
• dribbling
• frantic chewing
• red cheeks
• crying
• perhaps diarrhoea
• nappy rash
• strong smelling urine
• exacerbation of eczema

Something to chew, be it a teething ring or a rusk, often satisfies a teething baby. A teether which is kept in the fridge can be especially soothing.

Simply rubbing the sore gum may bring relief, as can various teething gels which contain local anaesthetic. Babies who are particularly fractious from teething benefit from paracetamol syrup for pain relief. Your health visitor or local pharmacist will be able to advise you.