Baby's Skin: What to Expect & How to Care for It

Your little baby's delicious young skin can be at once her most gorgeous feature and her most troublesome one. After all, it's rare to find a baby who hasn't had at least one bout of diaper rash (if not many!), an encounter with heat rash or eczema, or some other skin-related worry before her first birthday. You might have other concerns too: infant acne, a birthmark, or a rash that appears over and over again.

Fortunately, most of these things are easily treatable, especially when your child is still young. After all, her skin -- like the rest of her -- is a work in progress!

Skin issues "absolutely run in the family," says Robert Brodell, MD, a dermatologist in Warren, Ohio. Whether your baby has trouble-free skin or suffers from rashes, he has his parents to thank! If problems do crop up, baby's pediatrician can handle most of them. In a few cases, you may be referred to a pediatric dermatologist -- for instance, if your child has chronic eczema or hives (both often caused by allergies) or chronic diaper rash, a skin specialist can help.

Babies don't need the kind of fussy skincare regime we may use. Rinsing baby with warm water and, at most, a mild baby soap -- not an adult cleanser -- is all that's needed. Baby moisturizers (we like ones from Johnson's and Baby Magic) are nice if baby's skin seems dry, but are otherwise not necessary. Same thing with baby powder: Cornstarch-based powders are useful for drying oily or wet areas, but not every baby needs them.

Never use a product with such adult-only ingredients as salicylic acid or retinol, because some of what goes on baby's skin is absorbed into his bloodstream. To be safe, stick with products sold in the baby aisle, unless directed by a physician.

"Diaper rash is universal," says Dr. Brodell, who treats many children in his dermatology practice. It's caused when urine or feces rub against bare skin. Diaper rash creams -- Desitin, Balmex, A&D, Aveeno, Baby Aquaphor, Triple Paste, and creams from Huggies and Gerber, to name a few -- can cure most rashes. For prevention, use one of these creams at every diaper change to form a barrier between baby's skin and her diaper contents.

Beyond that, change diapers promptly if there's a bowel movement, and about every three to four hours even if there's not (with the exception of nighttime -- no need to wake a sleeping baby -- or yourself). If a rash appears, a bath and time playing naked, without a diaper, can help clear it up.

Some babies suffer a second-stage diaper rash, infected by yeast. If a rash reddens and worsens within a day, or if spots break out around it, see a pediatrician for the okay to use a yeast-killing antifungal cream such as Lotrimin (sold over the counter), or a prescription nystatin ointment like Mycostatin. Some doctors also recommend anti-itch cream, like hydrocortisone.

Most rashes are variations of eczema or dermatitis, terms for skin reactions to nearly any irritant. If a rash breaks out, don't panic -- it may likely disappear with the same prescription we give for diaper rash and heat rash: a bath, followed by time naked or in loose clothing.

If a rash doesn't go away in a day or gets worse, take baby to the pediatrician for evaluation. In the meantime, here are the two most common causes of eczema:

• Wetness -- for instance, from drool. Baby can get a rash if drool, milk, or even mashed baby food dribbles down his neck or chest. Solutions include using bibs and burp cloths to mop up spills, and putting a barrier cream such as petroleum jelly on baby's face or neck (just like you do for his bottom).
• Irritation from detergent, fabric, or anything touching baby's skin. Even rubbing against your clothes may give baby a rash. Solutions include using baby-friendly laundry detergent, not using fabric softener or perfume, keeping baby from scratchy fabrics such as wool, and keeping baby from areas covered in pet hair.

Babies take tumbles and get cuts, bruises, and sometimes even stitches. But, "in general, kids heal quickly," says Dr. Brodell. Their young, thin skin is constantly shedding old layers and forming new ones, so even a bad scar may fade. Talk to your doctor about how you can help deep scars disappear.

For instance, says Dr. Brodell, previous generations believed in drying out wounds, but we now know that using a cream to keep wounds moist but clean helps them heal infinitely better.

1. Stork bites (aka salmon patches) An astounding one-third of light-skinned babies get these marks (though they can appear on babies of any skin tone), often on the nose, forehead, eyelids, or neck. The good news is that most patches fade by 18 months, if not more quickly. The exception is marks on the neck, which occasionally persist into adulthood.

2. Strawberry marks A strawberry hemangioma can be a startling birthmark, since it's generally bright red and may even bleed. It's caused by dilated blood vessels in the top of the skin. But there's no treatment necessary for a strawberry mark to fade, if not in the first few years, then usually by age 5.

3. Mongolian spots Most prevalent in babies of Asian and African ancestry, these bluish patches are usually on baby's lower back or buttocks. They, too, usually fade by about age 5.

What's good for baby's skin woes is subjective -- every baby is different. However, these have worked for parents in the American Baby Group:

• For itchy skin: Aveeno Soothing Baby Bath Treatment ($5; drugstores). Sprinkle this powdered oatmeal into baby's bathwater, or wet some of it in your hand and smooth it right onto baby's itchy spot while he's in the tub. You can see the relief on his face.
• All-purpose: Aquaphor ($5-$17; drugstores). This has cured eczema, dry skin, and even a mystery rash from one baby's umbilical cord. It prevents diaper rash, and the big tubs cost less per ounce than diaper rash ointment tubes. (Baby Aquaphor is the same as Aquaphor, just sold in the baby aisle.)
• For cradle cap: Gentle Naturals Cradle Cap Treatment ($7-$9; drugstores). If an infant has scaly, shedding skin on his head, this calendula-based oil removes it fast and gently.
• For chapping under the nose: Bath & Body Works Aromatherapy Remedies Cold and Sinus Therapy Lip & Face Balm ($6; Bath & Body Works stores). This balm, though not made specifically for children, soothes the chapping caused by a runny nose.
• For general rashes: Weleda Calendula Cream ($8-$10; usa.weleda.com). This all-natural, great-smelling barrier cream is a favorite for preventing rashes on baby's face caused by teething or drooling.
• For tough diaper rash: Triple Paste ($8; amazon.com, specialty stores). It's hard to find and fairly pricey per ounce, but we suggest keeping a tube on hand -- it's the best cream for clearing up a bad diaper rash, before a yeast infection sets in.

Originally published in American Baby magazine, March 2005.