Baby Skin Basics
Your infant is prone to all sorts of rashes, from acne to eczema. Read on for a guide to the most common baby skin conditions during the first year and how to treat them.
Looks like: A red, inflamed, itchy rash that may be scaly, crusty, or oozy. Eczema usually shows up around the three-month mark as dryness on the cheeks, and over the course of several months it may move to other parts of the body, like the folds of the neck, arms, and legs. "Once your baby starts crawling, the friction of her skin against the carpet can set it off on her kneecaps and elbows," says Nanette Silverberg, M.D., director of pediatric and adolescent dermatology at St. Luke's-Roosevelt Hospital, in New York City.
What's going on: Eczema is an inherited form of skin sensitivity that causes extremely dry skin. "Recent studies show that as many as 30 to 40 percent of babies with eczema have a genetic mutation in the skin proteins that normally work to keep moisture locked in and allergens locked out," says Parents advisor Lawrence Eichenfield, M.D., chief of pediatric and adolescent dermatology at Rady Children's Hospital, in San Diego. Although having eczema puts your child at a higher risk of developing food and/or respiratory allergies and asthma, it's pretty rare for a baby's eczema to be caused by a particular allergen.
How to help: Keep your baby's nails trimmed to prevent her from scratching at the rash. Make bathtime short (but don't avoid it), use lukewarm water and gentle cleansers, and apply a fragrance-free cream or ointment afterwards. Messy feedings and drool can further irritate sensitive skin, so dab on a bit of petroleum jelly before her meals and at bedtime.
If the itching is keeping your baby from sleeping, your pediatrician might suggest clearing up a bad rash with an antihistamine and a low-strength, OTC topical steroid, such as a cream containing .5 to 1 percent hydrocortisone. For severe cases that don't respond to treatment, the doctor might recommend allergy testing to rule out triggers and suggest giving your baby diluted bleach baths, which can kill bacteria that may further irritate the skin. "Luckily, eczema tends to improve as children grow, in part because older kids have thicker skin and become less sensitive," says Dr. Silverberg.
Looks like: Little zits on the cheeks and nose. Neonatal acne usually surfaces in the first few weeks and can last up to three or four months.
What's going on: Your baby is experiencing a mini puberty caused by your lingering hormones still circulating through his body. When acne shows up after the first few months, it's called infantile acne, and you're likely to see pus-filled pimples along with whiteheads and blackheads. "Sometimes this can be a sign of a hormone imbalance, but your baby may just have sebaceous glands that are particularly sensitive," says Dr. Eichenfield.
How to help: Neonatal acne should clear up on its own -- gently clean your baby's face at bathtime and avoid using any thick moisturizers. If the pimples persist or look particularly angry, see your pediatrician. For infantile acne, the doctor may suggest topical medications like the ones teenagers use -- antibiotics, peroxides, or retinoids -- and may also refer you to an endocrinologist to make sure your baby's hormone levels are normal.
Looks like: Flat red patches in the diaper area. If you see little red bumps at the edges of the rash, or if it starts to extend to the folds of the skin, it's probably a yeast infection.
What's going on: The sensitive skin on your baby's bottom can become irritated from being in close contact with urine and stool in diapers. "In cultures where babies don't wear diapers, they don't get diaper rash," says Dr. Eichenfield. "However, this problem is much less common than it used to be, now that we have modern super-absorbent diapers to keep moisture off of a baby's skin." Diaper rash tends to crop up when you add new foods to your baby's diet, which changes the makeup of his stool. Also, diarrhea is especially irritating, and when your baby's got it, it can be hard to keep up with diaper changes; this exacerbates the rash.
How to help: Change your baby's diaper frequently, pat her bottom dry, and let her spend some time diaper-free, when you can. Always use a thick diaper cream or an ointment like zinc oxide or petroleum jelly. They create a barrier, protecting skin from irritants and allowing the area to heal more quickly. Wipes can aggravate raw skin, so when your baby has a rash use cotton squares and mineral oil (a better choice than water because it requires less force and creates less friction), says Elaine Siegfried, M.D., professor of pediatrics and dermatology at Saint Louis University School of Medicine. She also suggests using diapers that are free of fragrance, dyes, and latex for at least a week after the rash clears up. If the rash worsens or doesn't respond in a week, see your pediatrician. Your child may have developed a secondary yeast or bacterial infection, which needs to be treated.
Looks like: Waxy pink or orange scales on the scalp. They can be mild or can grow so thick it looks like your baby's wearing a cap. Cradle cap generally shows up in the first month or two but can pop up anytime within your baby's first two years.
What's going on: This is a form of seborrheic dermatitis, which is also responsible for dandruff in adolescents and adults. "The most common cause is a yeast that grows on everybody's skin but prefers to live in greasy areas like the scalp," says Dr. Siegfried. Babies are prone to cradle cap because Mom's hormones that are still circulating through their body send oil-producing glands into overdrive.
How to help: For mild cases, just use a gentle shampoo to wash your baby's hair. You can also try massaging mineral or olive oil into the scalp and then washing it out. It's okay to next use a soft-bristled brush or your fingertips to brush out flakes, but be gentle. "The more trauma you inflict to skin, the more likely the scales are to reappear," cautions Dr. Siegfried. For a severe case of cradle cap, your pediatrician may recommend that you use a medicated anti-dandruff shampoo.
Cradle cap may look kind of funny, but it's not dangerous. "Transient things like little red spots, bumps, and scaly areas probably happen on other organs too -- who knows? But we don't have fancy names for them because we can't see them," says Dr. Siegfried. "If your child is growing and seems comfortable and happy, you don't have to worry so much."
What's going on: A white, cheesy coating that shields your newborn in utero from the drying effects of amniotic fluid.
How to help: At birth, a nurse will wipe off the vernix. The skin underneath may peel a little; this is normal and will last for about two weeks after birth.
Blue Fingers and Toes
What's going on: A newborn's immature nervous system makes her sensitive to cool or even normal temperatures.
How to help: The condition usually lasts for a few days after birth; the color should disappear when you move your baby to a warmer room or wrap an extra blanket around her. If it persists, appears elsewhere on the body, or is accompanied by breathing troubles, she may not be getting enough oxygen. Call your pediatrician at once.
What's going on: Yellow skin in newborns. It occurs when a baby's immature liver can't process bilirubin (which is produced when red blood cells break down).
How to help: Mild cases go away on their own. However, if your infant's jaundice hasn't disappeared within ten days, he may need special light treatment to eliminate the bilirubin. Doctors often detect jaundice in the hospital, but it can crop up after you've returned home, so keep an eye out for the telltale yellowish hue.
What's going on: Tiny red bumps that erupt when underdeveloped sweat glands become blocked. Prickly heat occurs mostly in warm weather and during the first three months of life.
How to help: Keep your baby as cool and dry as possible. Don't apply powder to the affected area; it will only trap sweat and make the condition worse.