diagnosing a rash
Health

Diagnosing a rash

Rashes and other skin conditions are very common in babies, particularly newborns as their skin adapts to a new environment. Find out how to identify and treat various skin rashes and ailments.

Your perfect, tiny baby is lying in your arms when all of a sudden you notice a spot, or a blemish, or a flake that you hadn’t noticed before. What to do? Firstly, don’t panic. Babies are prone to many rashes that are considered normal. But how do you go about diagnosing a rash? Here are some of the most common skin conditions to watch out for. This is just a guide, so always consult your GP for a proper diagnosis of your baby’s skin condition.

Nappy rash

Most babies will get nappy rash at some time in the first eighteen months. Nappy rash has a variety of causes, the most common being extended contact with urine (wee) or stools (poo). A baby with sensitive skin may be prone to nappy rash that stems from another cause. Often a child with very sensitive skin may react to a nappy rubbing or chafing the skin. Soaps, highly perfumed baby washes or baby wipes can cause irritation. Diarrhoea can also cause nappy rash.

Signs of nappy rash can vary from small red patches to larger patches of red, and often blistered skin. Your baby’s skin may feel hot to touch and look sore and raw. When it comes to nappy rash, prevention is better than cure.

How to treat

  • Always change wet or dirty nappies as soon as you can. Very young babies can need changing as often as 10 or 12 times daily, with older babies needing to be changed at least six to eight times.
  • Clean the whole nappy area thoroughly, wiping from front to back. Use plain water and cotton wool, or water baby wipes. Often perfumed baby wipes can cause a reaction or irritate sensitive skin.
  • Leave your baby’s nappy off for as long and as often as you can to let fresh air at the skin.
  • Once your baby’s bottom has been thoroughly cleaned, apply a barrier cream to the skin. This will protect your baby’s skin.
  • If your baby does get nappy rash, it can be treated with a nappy rash cream. Your Public Health Nurse or pharmacist can recommend the best one for your baby.

If the rash doesn’t go away or if your baby develops a persistent bright red rash with white or red spots, they may have a thrush infection. If you suspect your baby has thrush, visit your GP.

Milia

Milia are minuscule white cysts that can appear on the surface of your baby’s skin, usually on the face. They appear because the oil glands on your baby’s face are still developing. Milia are classified into two types: primary milia, which occur on normal, healthy skin; and secondary milia, which can appear where skin has been affected by another skin condition.

Milia can occasionally be found on the roof of the mouth in infants. These are known as Epstein pearls and are considered normal in infants.

How to treat

The life span of a milium can be up to three months, and as tempting as it may be to try to remove it, don’t! There is no treatment required for milia and they are completely harmless. These little white bumps on your baby’s skin will disappear in time and trying to remove them could cause scarring or infection.

Cradle cap (seborrhoeic dermatitis)

Cradle cap is the name given to the yellowish, greasy scaly patches that can often appear on the scalp of infants. It is a very common and harmless condition that generally doesn’t cause any discomfort to the baby. Cradle cap usually occurs on the scalp, but may also appear on the face, ears and neck, in skin folds at the back of the knees, and in the armpits in some infants. The scales will eventually start to dry out and lift from the scalp, flaking away. This can make the skin underneath appear red. Sometimes the hair can come away with the flakes.

Cradle cap usually appears in babies within the first two months of life and tends to clear up by itself after a few months, but can last much longer. The cause of cradle cap is not definite, although it may be linked to overactive sebaceous glands, which are the glands in the skin that produce an oily substance called sebum. Cradle cap is not contagious nor is it due to poor hygiene or allergies.

How to treat

Cradle cap requires no specific treatment and most cases of cradle cap will clear up on their own in time. However there are a variety of specialised cradle-cap shampoos available from pharmacies that may help clear up the condition. Massaging a natural oil such as almond or olive oil into your baby’s scalp at night can help to loosen and lift the crust, avoiding the fontanelle (the soft spot on your baby’s head). It’s important not to pick at the cradle cap scales as this may cause an infection.

Baby eczema

Eczema is a persistent itchy skin condition. Eczema usually starts within the first five years of life, most often in the first six months and often lasts into the teenage years. In some cases it may last into adulthood. Eczema can range from very mild to a more severe form, also known as atopic dermatitis. Often there is a family history of eczema or asthma.

In young babies, eczema appears mainly on the face, but can also affect other parts of the body. Once your baby starts to crawl you may find that their eczema worsens on their elbows and knees. From the age of two the areas affected tend to be the creases of the elbows and knees, the wrists, hands and ankles. In young babies, eczema is inclined to appear red and weepy. In older children it appears drier and a child’s skin may appear thickened with prominent lines. This is known as lichenification.

How to treat

Eczema tends to flare up when the skin is very dry, or is agitated by irritants or allergic triggers. Eczema tends to be worse when the air is dry and improves in more humid weather. Applying a barrier cream, such as Vaseline, on the chin and cheeks of a teething baby can help to protect the skin from irritation caused by drooling. Daily bathing is recommended for infants and children with eczema. A ten-minute bath in warm water is plenty. Bubble baths and soaps should be avoided as they can irritate the skin. A gentle, natural sponge should be used to wash your baby and their skin should be thoroughly rinsed in clean water. Washing your baby using rough facecloths or synthetic sponges will irritate the condition and may hurt them.

Immediately after bathing, a perfume-free moisturiser or emollient should be applied to your baby’s skin. Ideally, a baby with eczema should have a moisturiser or emollient applied twice daily, to protect the skin. Moisturisers with a high oil content are the best choice for use on eczema as they provide longer-lasting protection. If your child’s skin becomes infected, take them to see your GP or health care provider, as they may need an oral antibiotic or cream to clear the infection and improve the eczema.

Any rash that is accompanied by fever or general unwellness in your baby should be investigated immediately, as should any lump or bump that isn’t going away.

Babies aged under one year have extremely delicate skin. Their immune systems are also immature until the age of 10. If babies have a family history of eczema, asthma or hayfever they are likely to develop eczema. This likelihood is increased if they use perfumed products routinely on their skin. I strongly recommend using bath oils, moisturisers and nappy creams that can contain as little ingredients as possible.

When bathing, use a gentle bath oil and keep the temperature of the water as tepid as possible. Always follow up with a plain moisturiser. We tend to overheat our homes in Ireland. Always keep children’s rooms between 18°C and 20°C degrees. Also, don’t overwrap babies – they can’t control their body temperature very well, which leads to over heating. Sweat left on the skin can lead to rashes, which can usually be cleared up with a mild steroid. Any new rashes should always be checked out with a GP. Selene Daly, Dermatology Clinical Nurse Specialist. www.selenedalyskincare.com

Call your GP if…

If your baby has developed a rash and seems unwell, or if you’re worried, see your GP to find the cause and any necessary treatment. It’s especially important to be aware of the warning signs of meningitis.

More like this:

Common baby skin conditions
Your guide to baby’s sensitive skin
How to treat a cradle cap

ASK JESSICA

Q. I’m would like to start an exercise programme that will benefit my emotional health as much as my physical health, but I don’t know which type of class would be best. Should I consider choosing from yoga, pilates, tai chi, or could you recommend a class, please?

A It’s great that you have decided to get into exercise. The benefits to you are going to be great. You’ll sleep better, have more energy, better skin, reduced stressed, not to mention all the amazing physical benefits of your clothes fitting better, and looking healthy, trim and toned! My advice to you would be to try them all. Even if some don’t offer pay-as-you-go sessions, if you get in touch directly with the instructor, they will almost always let you try it out first to see if it’s for you. All of the above things that you mentioned are great for mental health, so it really will be a personal preference as to which you go for. On top of the classes you mention, all forms of exercise will give you great mental rewards so consider the not so obvious interval training sessions, bootcamp, and circuits too, as you will also feel on top of the world after a class like that.

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ASK LUCY

Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….