ABCs for Baby Skin

Learn how to identify and treat your newborn’s skin ailments
By Cara Lucas

Rookie parents, be warned. Your newborn baby’s skin is bound to erupt in some sort of rash during his or her first year—but don’t worry, because most of it is completely benign, says Johns Hopkins Children’s Center dermatologist (and mom) Kate Puttgen, MD.

Unfortunately, irritated skin is almost inevitable due to the fact that baby skin is so new and vulnerable. It is also relatively thin, has less pigment, and hasn’t mastered the science of regulating temperature like the big kids’ thicker, more mature skin. In just a year, though, this organ can become the protective barrier it is meant to be, serving many different roles ranging from sun protection to fighting off bacteria.

Knowing what to look for, what not to fret about, and tricks for alleviating any discomfort are key to getting through your child’s first year. Below are the most-experienced first-year skin problems for children:

Cradle Cap (Seborrheic Dermatitis)

What is it? Neonatal dandruff, also known as seborrheic dermatitis, is extremely common and is thought to be due to a combination of overabundance of skin oil and irritation from a yeast called malassezia. It tends to cause flaky white-to-yellow scales in oily areas such as the scalp or ear during the first three months of life.

How do I treat it? Most cases of cradle cap require nothing more than gentle washing and observation. This is usually sufficient for it to clear up on its own. Petroleum jelly, warmed almond oil, or olive oil can help relieve some of the crusting. Simply massage into the hair before their bath, pat dry, and gently comb hair with a soft brush to remove the loosened scales.

When should I call the pediatrician? If crusting persists or gets worse over time, your pediatrician may prescribe an antifungal cream or shampoo, says Puttgen.

Diaper Rash

What is it? The diaper area is an ideal environment for skin irritation to occur—exposure to stool and urine is almost a guaranteed formula for breakouts. Diaper rash is the most common skin problem among babies and is marked by red, inflamed patches or bumps on your baby’s buttocks and genital area. Harsh soaps, sweat, moisture, or diapers that are too tight can also cause a rash or worsen an existing rash.

How do I prevent and treat it? Change diapers as soon as the baby urinates or has a bowel movement, and don’t forget to wash your hands before and after you do so. Always dry your baby’s skin thoroughly, and apply petroleum jelly or a zinc oxide-based cream with each diaper change to protect his or her bottom. Never use talcum powder and try to avoid perfumed baby wipes or wipes that contain alcohol. Keep the diapers loose and let the baby air out in his or her birthday suit every now and then. An antifungal or mild corticosteroid cream used for short periods can speed up healing.

When should I call the pediatrician? According to Puttgen, if the rash doesn’t get better within a few days, if it spreads further, becomes oozy, or if your baby develops a fever (a sign of infection), it’s time to see a doctor. A fungal infection should be suspected in all babies taking antibiotics, which can disrupt the balance between good and bad bacteria and cause yeast overgrowth.

Erythema Toxicum

What is it? Erythema toxicum is a benign condition that affects the majority of newborns in the first days and weeks of life. Don’t worry parents: although it’s bothersome, it really is harmless. Hallmark signs of the condition are yellowish papules surrounded by red skin. It is usually located on the face, though it can be found on the trunk, upper arms, and thighs as well.

How do I treat it? Typically no treatment is needed. The rash will clear up on its own within a few weeks.

When should I call the pediatrician?

If your baby has signs of erythema toxicum, a routine exam can confirm the diagnosis and provide reassurance until it clears on its own—usually relatively quickly.

Eczema (Atopic Dermatitis)

What is it? Eczema is a long-term skin disorder involving dry, scaly, and itchy rashes. According to the National Institute of Health, it’s due to a hypersensitivity reaction (similar to an allergy) in the skin that leads to long-term swelling and redness. People with atopic dermatitis may lack certain proteins in the skin, which leads to greater sensitivity. It is most common in infants, starting as early as two to six months of age, but many people outgrow it by early adulthood.

How do I prevent and treat it? Keep your baby’s fingernails short to avoid scratching as much as possible—light gloves on your baby’s hands can also help with this. Keep the skin hydrated with organic lotions like pure shea butter, or even olive oil. Soaking your baby in an organic oatmeal bath for 15 minutes a day can help to alleviate some of the itching as well.

When should I call the pediatrician? If eczema does not respond to moisturizers, symptoms get worse, or if there are signs of infection such as fever or pain, it is best to call a doctor who may prescribe an antihistamine or topical cream.

Intertrigo

What is it? Usually appearing in the skin folds of chubbier babies, intertrigo is a red, weepy rash that occurs when the skin stays moist or rubs together. It can develop from drool or spit-up that seeps into and collects in your baby’s skin creases. Because the top layer of skin is gone, it can become easily infected.

How do I prevent and treat it? Treat skin gently and keep clean. Pat the skin dry, and apply a zinc oxide or cod liver oil cream to help maintain a dry area. If the intertrigo is under the baby’s chin, wearing a bib to catch drool can be helpful. When babies get strong enough to move their neck, intertrigo is more likely to go away.

When should I call the pediatrician? If the rash is not getting better or seems to be spreading, call a pediatrician. Thrush infection can develop on top of this rash and should be addressed by a professional.

The basic rules of neonatal skincare, Puttgen says, are “less is more” and “bland and simple.” Babies don’t need an elaborate skin care regimen, and they require barely any products. Keep bathing to a minimum to avoid stripping the skin of its natural protective oils—two or three times a week is sufficient. And, since baby skin is highly absorbent, it’s critical to use fragrance-free, hypo-allergenic products. Avoid perfumes and dyes, which can seriously irritate newborn skin.

A final tip for parents is to always keep your baby’s skin protected from the sun. Avoiding the sun altogether by using physical barriers (clothing, hats, and stroller covers) anytime you take your baby outside best achieves this goal. Avoid sunscreens if possible. If they must be used, choose a fragrance-free, hypoallergenic sunscreen that lists zinc oxide or titanium dioxide as active ingredients.