newborn skin concerns
Health

Top 5 newborn skin concerns

Many babies are prone to skin conditions in the first few months after birth. Here’s how to spot and treat the top 5 newborn skin concerns.

In the moments after birth, newborns are often red, bluish, or even grayish and bruised from their journey down the birth canal. They’re wrinkled, perhaps hairy (the fine covering is called lanugo), and even a little slimy (the vernix coating kept baby’s skin from coming in contact with the amniotic fluid).

Newborn skin is so thin you may be able to see veins underneath. Over the next week, the lanugo falls out and the vernix rubs off or is absorbed by the skin. Your newborn’s skin may peel, crack, or get flaky while it adjusts to the out-of-womb world. Using baby lotion on a child this young is safe as long as it’s fragrance-free, to prevent irritation. But products aren’t usually necessary to clear up these early skin problems – they’ll fade on their own. We examine the top five newborn skin conditions that your baby may have in the first few months.

1. Nappy Rash

Nappy rash is a common condition thought to affect up to a third of nappy-wearing babies at any given time. It causes your baby’s skin to become sore and irritated in the area around the nappy, and covered in pink or red spots or blotches.

Causes

Nappy rash is usually caused by your baby’s skin coming into contact with urine and faeces in their nappy. The rash usually develops when your baby is between nine and 12 months old. Most nappy rashes are mild and can be treated with a simple skin care routine. Your baby will usually feel no pain or discomfort. However, some nappy rashes are more severe and can be caused by an underlying condition or bacterial infection. A severe rash is painful and distressing for your baby. It usually requires treatment with medication

Symptoms

Mild nappy rash: If your child has mild nappy rash, a small part of their nappy area will be covered in a pink or red rash, usually made up of small spots or blotches. However, they should feel well and will only experience a stinging sensation when passing urine or faeces.

Severe nappy rash: If your baby’s nappy rash is severe, they may have more advanced and painful symptoms that make them distressed or uncomfortable.

Symptoms may include:

  • bright red spots
  • dry, cracked and broken skin
  • swellings, ulcers and blisters on the skin

The rash will cover a larger part of the nappy area and may spread down the legs or up to the abdomen (tummy). Your baby may cry more often than usual and be irritable.

Contact your GP immediately if your child develops severely inflamed (swollen and irritated) skin or a fever. This may be a sign of infection.

Top 5 newborn skin concerns

Treatment

Mild nappy rash: If your baby has a mild nappy rash, they will not normally need any medication or specialist treatment. Instead, there are steps you can take to safely treat the rash at home.

  • Leave your baby’s nappy off as long as possible. Not putting a nappy on your baby will help them to stay dry and avoid contact with faeces or urine. It is usually most convenient to leave your baby’s nappy off when they are asleep. You can lay them on an absorbent towel or somewhere where you can easily manage any soiling or wetting.
  • Avoid using soaps when cleaning your baby’s skin. Only use water to clean your baby’s nappy area in between changes. Use a soft material, such as cotton wool or a soft towel, when drying. Dab the affected area carefully and avoid rubbing their skin vigorously.
  • Avoid bathing your baby more than twice a day. Experts think this may dry out their skin and cause a more severe nappy rash.
  • Apply a barrier cream every time you change their nappy. Using a barrier cream or ointment after each nappy change will reduce the contact that your baby’s skin has with urine and faeces. zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams. Ask your pharmacist for advice about which cream is most suitable for your baby.
  • Change your baby’s nappy frequently. To lower the risk of your baby getting nappy rash, change your baby’s nappy as soon as they wet or soil it. If your baby has nappy rash, make sure you change their nappy more frequently than you normally would.
  • Consider changing the type of nappy you are using.

Severe nappy rash: If your baby has severe nappy rash, they usually need medication to treat the condition. Your GP will first check that you have been carrying out the skin care routines advised for a mild nappy rash. Once your GP is satisfied that the correct skin care routines are being followed, they usually prescribe some topical medicines to treat the rash. ‘Topical’ means that the medicine is applied directly to the affected area (in this case, the nappy area).

Topical corticosteroids

Corticosteroids help to reduce inflammation of the skin and relieve any itching and redness. Hydrocortisone cream is often prescribed. You have to apply it to your baby’s skin once a day. You can stop using hydrocortisone as soon as the rash has cleared, but do not use it for more than seven days in a row.

Topical anticandidals

An anticandidal medicine helps to treat any fungal infection that may be causing your baby’s rash. These are creams that usually have to be applied to your baby’s nappy area two to three times a day. However, unlike topical corticosteroids (which you stop using once your baby’s rash has cleared up), anticandidals have to be used for seven to 10 days after the rash has healed. This ensures that the infection is completely treated.

2. Eczema

Eczema in babies tends to develop around two to three months of age. It is largely hereditary and is often referred to as Atopic Dermatitis or Atopic Eczema. There is no cure, but there are ways to help improve the condition and reduce irritation.

Causes

Eczema is caused when the body makes too few ceramides. Ceramides are the fatty cells that help provide the protection barrier to the skin. If you don’t have enough of them, the skin will lose water and become very dry.

Heredity is a big factor in whether an infant gets eczema. If mum or dad have eczema, a baby is a lot more likely to develop it, too.

Defects in the skin barrier, allowing moisture out and germs in, could also be a factor.

Symptoms

Baby eczema shows up as patches of red skin. The skin is almost always itchy, dry, and rough. While it may appear just about anywhere on a baby’s body, eczema most often occurs on a baby’s cheeks and at the joints of their arms and legs.

Infant eczema can be easily confused with cradle cap, another red, scaly rash of infancy.

Top 5 newborn skin concerns

Treatment

During flare ups or acute inflammatory periods it is best to seek medical advice. Dermatologists and GPs will prescribe an individual treatment programme, which usually consists of a short term topical steroid and anti-inflammatory cream based on the GP’s and dermatologist’s assessment of the patient. If used correctly, the topical steroids prescribed by a doctor are very effective in treating eczema and controlling the distressing symptoms.

Some helpful points to bear in mind to manage the baby’s condition:

Bathing: Always use a soap free emollient product suitable for babies. Don’t bathe or wash a baby with water only: This has been shown to dry the skin further particularly in hard water areas.

With severe eczema, bathing is paramount in fighting infection.

There are specific products that have been designed to fight infected eczema. Try using a barrier cream to create a protective and moisture layer on the skin.

Moisturise: Keeping baby’s skin moisturised can help reduce discomfort. You may need to apply an emollient several times a day and certainly after bathing.

Use special clothing: There is a great range of specific garments that soothe the skin and protect from scratching. They are of huge benefit to both baby and parent. Avoid itchy fabrics such as wool – instead go for cotton garments.

Plus:

  • Keep nails short: No sharp edges.
  • Keep pets away: Pet hair can be a common irritant.
  • Go dust free: Keep the baby’s room as dust free as possible. Limit soft toys and furnishings.
  • Don’t use synthetic bedding.
  • Don’t use strong detergents: When washing clothing and bedding, use a non-bio washing product. Don’t use fabric conditioner.
  • Room temperature: Do not over heat baby or the room they are sleeping in.
  • Diet: There is a limited evidence that suggests sensitivity to foods can cause eczema to flare up. General advice when weaning is to introduce one food at a time so that you can notice any reactions. Never restrict a baby’s diet without seeking medical advice first.

“Eczema is a common yet complicated problem for many little people. As a baby’s skin is incredibly sensitive, there are many external factors that can irritate it, such as certain skin products, fabric detergents, even mum’s perfume!

However, if the eczema is longstanding and appears to have no connection to external triggers, then we need to look a little deeper. In natural medicine, we have the expression, ‘the condition of the skin comes from within’.

As our skin is a major organ for detoxification, it is worthwhile investigating what the body is reacting to, and what can we do to help it. In many cases, given the immaturity of a baby’s digestive system, they can have an inflammatory reaction to foods such as dairy and gluten.

A major allergy trigger in many Irish households is environmental mould, the spores of which are inhaled. Open windows every day for good ventilation, and properly address the source of the mould.

Suboptimal nutrition or poor absorption of nutrients can also lead to skin problems as the body is not getting the appropriate fuel to carry out its repair and detoxification functions. Given the often mysterious and deep-rooted causes of chronic eczema, it is worthwhile working with an experienced practitioner to help your child achieve optimal health.”

Fiona O’Farrell is a licensed acupuncturist and naturopath. She specialises in women’s health, pregnancy, fertility and children.

3. Birthmarks

A baby’s skin colouring can vary greatly, depending on the baby’s age, race or ethnic group, temperature, and whether or not the baby is crying.

Skin colour in babies often changes with both the environment and health. Some of these differences are just temporary, part of the physical adjustments a baby goes through.

Others, such as birthmarks, may be permanent.

Birthmarks are areas of discoloured and/or raised skin that are apparent at birth or within a few weeks of birth. Birthmarks are made up of malformed pigment cells or blood vessels.

Types of birthmarks

There are several different types of birthmark and some of them are very common. The two main types of birthmark are:

  • Vascular birthmarks (often red, pink or purple) caused by abnormal blood vessels in or under the skin.
  • Pigmented birthmarks (usually brown) caused by clusters of pigment cells.

Vascular birthmarks usually occur in the head and neck area, mainly on the face. However, both types of birthmark can appear anywhere, including inside the body. If surface blood vessels are affected, a vascular birthmark will appear red, purple or pink. If the affected vessels are deep, the birthmark will appear blue.

Pigmented birthmarks are tan or brown coloured skin marks.

Causes

It is not understood exactly why birthmarks occur, but they are not usually inherited. Vascular birthmarks are caused by abnormal blood vessels in or under the skin, while pigmented birthmarks are caused by clusters of pigment cells.

It is thought that port wine stains occur because the nerves that control the widening or narrowing of the capillaries (tiny blood vessels) do not function properly, or there are not enough of them. This means that blood is constantly supplied to the skin in that area, which makes it permanently red or purple in colour.

Port wine stains are sometimes related to other conditions, such as Sturge-Weber syndrome and Klippel-Trenaunay syndrome.

Treatment

Most birthmarks are harmless and do not need to be treated. Some types of birthmark will fade over time whereas other types, such as port wine stains, are permanent if they are not treated.

In some cases, a birthmark will need to be treated for medical reasons, for example if a haemangioma blocks the airways, affects vision or becomes ulcerated. Some people may seek treatment for cosmetic reasons.

4. Baby acne

Baby acne, sometimes referred to as milk rash or newborn acne, is common in infants, and is really nothing to worry about.

It can appear any time from birth up to a few weeks after the baby is born.

Symptoms

It can be seen on the cheeks, forehead and chin – and sometimes even the back of the neck or shoulders. It’s bumpy and can be the same colour as the baby’s skin, or a light pink colour. It’s usually not scaly or flaky.

You might notice that it seems worse occasionally, as a baby’s sensitive skin can be irritated by things such as saliva, vomit, certain types of fabric, crying episodes, and heat.

There is a similar skin condition that frequently occurs in newborns and is mistakenly called baby acne. In this case the baby has white bumps rather than red and these bumps are called milia. They are also called ‘milk bumps’ because they appear similar to a spray of milk on the child’s face. The bumps are typically on the nose, chin and cheeks but may occur on other parts of the body.

When the bumps appear inside the baby’s mouth they are a special type of milia called Epstein pearls. Milia are caused when small flakes of skin become trapped in pockets in the surface of the skin. They are not painful or irritating to the child.

Causes

Baby acne is thought to be caused by the hormones transferred between the mother and the baby in the final weeks of pregnancy, stimulating the oil glands in the baby’s body.

This is why it usually subsides after a few weeks, when the levels of the mother’s hormones in the baby’s body have fallen.

Top 5 newborn skin concerns

Treatment

There’s not much you can do to treat baby acne, apart from waiting for the hormones to leave the body. In fact, some treatments can even dry and inflame the skin, making things worse.

Baby acne generally doesn’t cause babies any discomfort, it won’t be itchy – so it’s best to leave it alone. If it seems that your baby does have a rash that is bothering him or her, on other areas of the body besides the face, or if it hasn’t cleared up after a few months, consult your baby’s doctor; it could be another skin condition.

If the rash starts and spreads quickly, appears with other symptoms such as fever, wheezing or is of a red or purple tinge, seek medical attention urgently. This could be an allergic reaction, or possibly a serious infection, such as meningitis.

5. Cradle Cap

Cradle cap looks like a very bad case of dandruff.

Symptoms

It can show up as a red area on your newborn’s scalp, covered with greasy, yellow, scaly patches. Over time the scales can start to become flaky so they rub off easily, often with bits of your baby’s hair attached. Sometimes cradle cap can cover the whole of your baby’s scalp but it can also appear on her face, and around her nappy area, armpits and nose. In these places it’s called seborrhoeic eczema (dermatitis) rather than cradle cap.

Cradle cap is very common in babies younger than eight months. It is likely to appear during your baby’s first three months, and it can linger for weeks or months. Older babies and toddlers can also get cradle cap. Although the condition can look unsightly, it’s not itchy and won’t cause your baby any discomfort.

Causes

It’s thought that cradle cap happens as a result of hormones left in your baby’s body from pregnancy. These stimulate secretions from the oil glands in the skin, making the skin cells on your baby’s head stick to the scalp.

These secretions reduce in the weeks and months after birth, which is why cradle cap tends to clear up on its own. Your baby may also have cradle cap if she has a family history of allergic conditions, such as eczema.

If you baby has cradle cap there’s a chance she could develop other seborrhoeic dermatitis conditions when she is older, such as dandruff.

Treatment

Your baby’s cradle cap should disappear on its own a few weeks or months after birth. It can sometimes take until your baby is two years old before it is completely gone. While your baby has cradle cap there are some ways you can gently remove the scales:

  • Regularly wash your baby’s hair with a baby shampoo then loosen the flakes using a soft brush.
  • Rub a mild baby oil or olive oil into your baby’s scalp, leave it for a while, even overnight if you want, then brush off the flakes. Then clean the remaining oil off by shampooing with mild baby shampoo.

Don’t pick It is tempting to pick at the scaly patches on your baby’s head, but try not to. Picking at it can leave sore patches that could become infected. If your baby’s cradle cap starts to look red and swollen, take her to the doctor. This could mean it is infected. Your doctor can prescribe an antifungal cream or a course of antibiotics.

More like this:

Diagnosing a rash
Soothing nappy rash
Baby bath basics

Ask Allison

Q My sister-in-law and I both work three-day weeks and we help each
other out with child minding on our working days, which up until recently has worked out really well. Between us, our kids are aged between five and nine years – the problem is that it’s now become quite apparent that we have very different parenting styles. I prefer my two daughters (seven and nine) to have a structured day. For example, in my house, we have allocated times for television and iPads, etc. My sister-in-law, however, lets the kids run loose after school – homework is ignored and my kids end up wired after eating sugary treats all afternoon. I am considering looking at after-school childcare for the kids, but I’m worried that this is going to cause a family argument. Is there a diplomatic way that I can ask my sister-in-law to introduce some discipline into her child-minding days? It certainly doesn’t do her two kids any harm when I am minding them in my own house!

A
In a word, no, there is no diplomatic way to do this as it may very likely seem like your saying that your parenting style is better than
hers. As L’Óreal says, ‘now here comes the science bit.’ Dr. Kaylene
Henderson, a child psychiatrist, wrote a very interesting blog about ‘the
science behind the Mummy Wars’. She explains that before she had
children of her own she hadn’t been aware of how parents have a
very specific sense of the right parenting style. She also found that parents could be very definite in defending their chosen parenting style. Dr. Henderson, who describes herself as a curious, scientific, open-minded person, was surprised at how defensive parents could be and, at times, of their judgemental attitude towards each other. She explained the neurology of the Mummy Wars; okay, I’ll need you to bear with me for a second. Warning; I’m about to use some neuro-techie language.

Why do we judge each other?
As we have all had different experiences, this means that we all have very different memories stored in our brains. Most of our memories are ‘explicit’ memories – these are ones that we can recall easily such as important dates that mean something to us; important birthdays, special events or stories of and about our lives.
There is another type of memory called ‘implicit’ memory that plays a
key role in our parenting. This type of memory is the stuff that you do on autopilot. Psychologists call these heuristics or rules of thumb –
such as tying your shoelace, or driving your car (once you have learnt
to do both first!). Otherwise we’d really waste a huge amount of time
pondering over tasks that we have readily available to us. This seems to be where the science bit of our parenting style kicks in. This implicit memory goes all the way back to when you were an infant being parented by your parents. This is when you started the process of storing up how they did it into your memories.
Unless you make a conscious choice and effort to parent differently, what you saw and unconsciously learnt will be your automatic go-to parenting style.

We learn habits
This can really kick into gear when we feel our parenting style is
being mirrored or highlighted by disapproval from another parent. I know the cold sweat you feel when your child decides to make their outstanding bad behaviour performance at, of course, the most public and worst time. The implicit autopilot of how your parents dealt with these outbursts will flow unconsciously from you if you haven’t worked super hard to be aware and consciously change the old habits.
What’s happening for the on-looking parent is that they see you doing something they are used to doing, but you are doing it all wrong. Simply, because that is not how they know how to do it.

Find a way that works
You both have different parenting styles – who is to say which type is correct? You just need to know what works best for your family and that’s the bottom line. The irksome feelings won’t go away. You can talk to your sister-in-law, but I’m adding a caveat that it would be hard not to hurt her feelings. What we’re possibly looking at is that you prefer a more structured form of parenting, whereas your sister-in-law has a more permissive style. I’m not sure the two styles can mix, the mixture is a bit like oil and water.
If a collaborative shared form of parenting style can be agreed upon, then that is great, but our learnt hardwiring may prove difficult to change despite the intent to do so.
Perhaps, your own instinct of changing childcare might work best for you. In terms of making childcare work; the fit is ultimately the most
important aspect as you want a cohesive congruent feeling of the other caregiver to just ‘getting it’, like in any good partnership. Best of luck
with this and I wish you both well.

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Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.