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Cloth nappies can be used during and after vaccinations, without the need of any specific laundering or treatment. The oral rotavirus vaccine is live and a small amount may be excreted in poo but thorough hand washing is the only precaution needed to prevent accidental cross contamination. People with immune conditions should be extra diligent with hand washing, consult your medical professional for more advice.
Eczema and skin conditions
Reactions to washing detergents are very rare , even in those with sensitive skin and eczema. Studies of people with allergic contact dermatitis show no reaction to laundry products in nearly 100% of cases. 
If your baby wears clothes washed in normal detergent without issue, their nappies can be washed in the same detergent. Ensure you get a diagnosis for skin conditions and comprehensive allergy testing by a medical practitioner or specialist.
Bleach treatments can be used to treat skin conditions like eczema.
Acidic Urine and Alkaline Degradation
The pH of a healthy humans urine ranges from of 6.5 to 8.0, i.e. it is neither acidic nor alkaline. Acidic urine is completely possible due to medical conditions, as is alkaline urine, but is rare.
The degradation of nappy inserts has often been attributed to ‘acidic urine’ which is an incorrect conclusion. It is far more likely to be from other causes, specifically the development of ammonia in the fabrics, physical damage or the age of the fabrics.
Urine is nitrogen rich as it contains urea CO(NH2)2. The urea cycle produces urea from ammonia NH3 in the body, catalysed by enzymes. Once urine leaves the body, even without the enzyme urease as a catalyst (which is found in a variety of things including bacteria), it will rearrange to form ammonia and carbon dioxide, it will just take longer. The pH of the environment becomes alkaline because ammonia is alkaline.
With repeat exposure ammonia is highly irritating to skin, it will cause redness in the nappy area, which is not normal, and corrosive to fabrics.
CO(NH2)2 urea + H2O water + urease = 2NH3 ammonia + CO2 carbon dioxide ((+H3)
Nappy rash can be caused by a combiation of the following;
- prolonged exposure to mousture
- enzymes from poo
- reactions to disposable wipes (for example an allergic reaction to the preservative Methylisothiazolinone)
- detergent (in the majority of cases all areas of skin in contact with clothing will have a rash)
See your GP for diagnosis. If the rash is a fungal infection the nappies will need to be sanitised.
Stains, smells, a smelly dry pail, and ammonia in night nappies indicate that the nappies are not being cleaned thoroughly. Ask for troubleshooting help if you experience any of these issues.
Treating nappy rash
- Wash nappies with a good detergent and warm/ hot water.
- Use a zinc based nappy rash cream at each nappy change
- Change nappies regularly
- See your GP again if the rash persists
Often fungal nappy rashes are secondary infections, after an initial rash. If your child has been diagnosed with a fungal nappy rash infection, all cloth nappies, wipes and other fabrics (e.g. towels) that can recontaminate the area must be sanitised. Fungal infections are often caused by the Candida species.
Either use disposables for the duration of the rash or sanitise everything each cycle.
Ensure that the treatment cream is an over the counter product specifically for fungal infections. Either dispose of any opened creams that might recontaminate, or wipe the cream off the contaminated area.
Oral thrush infections can be passed back and forth from breastfeeding mums to baby. If this occurs sanitise bras, nursing pads, towels and pjs if needed. There is no need to sanitise nappies if only oral thrush is present in children.
See the Sanitise page for more information.
Hand, foot and mouth disease
Hand, foot and mouth disease is a viral illness. There is no need to strip or sanitise nappies, and cloth nappies can be used during the illness. Ensure changes are frequent and use a zinc based rash cream to prevent irritation to blisters or sores and alleviate discomfort.
If sores worsen seek medical advice from a GP, as secondary bacterial/fungal infections can occur.
- Donald V Belsito, Anthony F Fransway, Joseph F Fowler Jr, Elizabeth F Sherertz, Howard I Maibach, James G Mark Jr, C G Toby Mathias, Robert L Rietschel, Frances J Storrs, James R Nethercott, Allergic contact dermatitis to detergents: a multicenter study to assess prevalence (May 25, 2021) <https://pubmed.ncbi.nlm.nih.gov/11807430/>.
- D.A. Basketter; J.S.C. English; S.H. Wakelin; I.R. White, Enzymes, Detergents and Skin: Facts and Fantasies (May 25, 2021) <http://www.medscape.com/viewarticle/575890>.
- National Eczema Association, Eczema and Bathing (May 25, 2021) <https://nationaleczema.org/eczema/treatment/bathing/>.
- Dr Lynne Gordon, Dermatologist, Adelaide, South Australia; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 31 January 2016, Methylisothiazolinone allergy (May 25, 2021) <https://dermnetnz.org/topics/methylisothiazolinone-allergy/>.
- Government of South Australia, Hand, foot and mouth disease - including symptoms, treatment and prevention (May 25, 2021) <https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/hand+foot+and+mouth+disease/hand+foot+and+mouth+disease+-+including+symptoms+treatment+and+prevention>.