Newborn Skin: Common Issues

Common Skin Issues :
Due to their sensitivity, your baby's skin is more susceptible to various infections and skin issues. It can be a common issue and should not cause undue worry. However, if you realised that they are having frequent bouts of outbreaks or the skin problem do not seem to be receding, it is best to seek the advice of your doctor the soonest. Still, more often than not, it can be easily remedied or prevented. The key is to understand the type of skin issue that is happening to their skin.

Infantile Eczema

Eczema is an inflammation of the skin that causes itchiness and dry skin. In babies, it may start to show up only after two months old. Eczema comes and goes, often with differing severity, but it is treatable and some children eventually outgrow it, though some others may carry it to adulthood or develop other atopic illnesses like allergy and asthma.

• Symptoms

The first sign of eczema is often patches of red, leathery skin which may appear anywhere on the body. Although it is not localised and may spread to other parts of the body - especially around the folds of the skin, behind the knees, and the nappy area - it is more commonly found on baby's cheeks, neck folds and joints of the limbs. This can sometimes be mistaken for heat rash. Eczema results in extremely dry and sensitive skin so you may find baby being unusually irritable and often attempting to scratch at the affected areas.

• Causes

1. Allergens. Eczema causes baby's skin to be highly sensitive to minute dust particles like air pollutants, dust mites, pollens, moulds, and pet dander.Parents who suffer from eczema often pass it on to their child. Aside from hereditary cause, eczema, an atopy illness, may also be triggered by a variety of irritants that result in a reaction in the body's immune system. Some of these irritants include:
2. Weather. Climate and temperature changes and high humidity can trigger infant eczema because baby's skin perspires less effectively, thus it is also less efficient in regulating the body temperature.
3. Diet. Some food are known to cause skin reactions in babies, particularly citrus fruits (e.g. orange), dairy products (e.g. milk, egg, peanut, chocolate), and seafood (e.g. shrimp). Food colouring and preservatives can also cause eczema.
4. Clothing. Babies with eczema should avoid clothing made from wool and lycra as they tend to irritate the skin.
5. Toiletries and detergents. Everything from body lotion, bath foam, perfume, to the type of laundry detergent and hand soap you use on and around baby can cause eczema to flare up because of the harsh chemical components in these products.

• Who is more prone to eczema?

If you have a family history of atopy illnesses such as eczema, allergies and asthma, there is a 50% chance of your child inheriting it. Babies with dry and sensitive skin are also prone to eczema.

• Treatment

Eczema is treatable with over-the-counter liniment such as a mild topical steroid like hydrocortisone cream. Steroidal creams helps soothe the itch and reduce the redness by reducing inflammation but this should be used sparingly as it can lead to thinning of the skin if overused. Hydrocortisone should generally be avoided for use on children under 10 years old so use only as directed or prescribed by doctors and use sparingly. If you are unsure, always check with the doctor. For more serious cases of eczema, antibiotics may be recommended if there is an infection. Your doctor may also prescribe oral antihistamine to relieve the itch.

• Prevention

1. Taking a bath once a day helps keep baby cool but be careful not to use water that is too hot as high temperature can cause eczema to flare up. Keep bath time under 10 minutes using only lukewarm water.

2. Choose bath products wisely and use only those that are mild, unscented, and hypoallergenic. You may also use an oatmeal-based bath lotion to help relieve the itch. Bubble baths are not suitable for babies in general.

3. When drying off baby, simply pat down with a towel as rubbing causes friction which may aggravate the skin problem. Pay extra attention to the folds of the skin.

4. Daily moisturising helps keep baby's skin well-moisturised as it dehydrates easily. Pick a good moisturiser containing petroleum jelly for best effect and apply immediately after a bath while the skin is still wet for best absorption.

5. Dress baby comfortably. Loose-fitting - but not oversized - cotton garments are best in minimising skin irritation caused by chaffing. New clothes should always be washed prior to first wear.

6. Scratching can aggravate existing rash. To prevent baby from scratching, trim and file baby's nails regularly.

7. When putting baby to bed, dress baby sensibly to keep him cool and comfortable. Fleece blankets and quilts make nice gifts but are often unsuitable for the high humidity of equatorial countries.

8. Clean baby's bedroom and play areas regularly, especially if you have a pet, and sun baby's bedding often. Dust mites and pet dander are common triggers of eczema. Remove objects like a fluffy stuffed toy or a carpet that trap dust readily.

9. Avoid bringing baby from a cold place to a hot one (and vice versa) as abrupt changes in temperature can cause eczema to flare up.

• When to see the doctor

Severe eczema can result in scaly skin and rashes with pus-filled bumps. This is an indication of bacterial infection and requires proper medical treatment. You should also avoid having baby come in physical contact with persons with open wounds and cold sores (also known as oral herpes).

Diaper Rash 

Diaper rash is a mild form of skin irritation associated with diaper-wearing. It results in reddish patches limited to the diaper area and is common amongst diaper-wearing babies and infants, and even those on cloth nappies. Symptoms of a diaper rash are usually mild and should clear up by practicing good hygiene.

• Symptoms

The first sign of a diaper rash is red patchy skin on and around the genitalia and buttocks. This may erupt into small bumps if not treated promptly.

• Causes

Diaper rash ensues for a variety of reasons, the most common being prolonged wearing of a wet and soiled diaper. Diaper rash arise due to moisture and bacteria that harbour within the diaper and on the skin. Wet skin breaks down easily and is prone to chafing, and yeast and bacterial infections. Skin irritation can also occur when a diaper is worn too tightly, causing the elastic bands to cut the skin of the baby.

• Who is more prone?

Babies who are on antibiotics may suffer from a bout of diarrhea which will increase the chances of contracting diaper rash. Some babies may also be more sensitive to particular brands of diaper, laundry detergent, and wet wipe that you use.

• Prevention

Diaper rash may cause discomfort to the baby but it is a fairly mild condition which does not require a visit to the doctor. It should heal nicely if you pay attention to the following:

1. Always wash your hands with soap before and after changing baby's diaper to prevent transmitting more bacteria to baby's bottom.

2. Change a wet or soiled diaper promptly.

3. Cleaning baby's bottom with cotton wool and warm water is sufficient. If you are using wet wipes, choose one that is free from fragrance and alcohol as these are drying agents. Over cleansing can cause irritation as baby's skin is very gentle.

4. Always pat dry baby's bottom thoroughly before putting on a fresh diaper.

5. 15 minutes of daily airing is beneficial in keeping baby's bottom fresh and dry.

6. Applying a good barrier cream, such as one with zinc oxide or petroleum jelly, will help soothe the rash. Barrier creams are readily available at pharmacies.

7. Diaper should be fitted on snugly - not too tight that it cuts into the skin or too loose that causes leakage. 8. Adults' and baby's clothes should be washed separately using appropriate detergent. Baby laundry detergent is gentler and free from chemicals that may cause irritation to baby's skin.

• When to visit the doctor

Diaper rash rarely requires a visit to the doctor unless the bumps become yellowish and filled with pus or if fever follows.

Heat Rash

Heat rash, also known as prickly heat, is a very itchy form of skin rash that is caused by a blockage of the sweat glands due to excessive perspiration. It may recur from time to time, particularly when the weather is hot and humid, but it is not known to have any long term ill effects.

• Symptoms

Tiny red bumps appear all over the skin when babies develop heat rash. Lesions of rashes commonly appear around the neck, folds of the arms and legs and the armpits where most perspiration takes place, though it may also be widespread across the body.

• Causes

As its name implies, heat rash is typically caused by high humidity. Hot weather puts a strain on your baby's underdeveloped sweat glands as he is unable to regulate his body heat efficiently. An overdressed baby can also suffer from heat rash.

• Treatment

It is not necessary to give your child any medication for heat rash. The key treatment is in keeping your baby cool and comfortable by removing excessive clothing and minimising body heat.

• Prevention

1. Taking a bath twice a day helps keep baby cool but be careful not to use water that is too hot as high temperature can cause rashes to flare up. Keep bath time under 10 minutes using only lukewarm water.

2. Choose bath products wisely and use only those that are mild, unscented, and hypoallergenic. You may also use an oatmeal-based bath lotion to help relieve the itch. Alternatively, add some household table salt to a tub of water and dissolve it completely before bringing baby to the bath. Salt has anti-bacterial effects but take care not to scrub the skin.

3. When drying off baby, simply pat down with a towel as rubbing causes friction which may aggravate the skin problem. Pay extra attention to the folds of the skin.

4. Daily moisturising helps keep baby's skin well-moisturised. Pick a good moisturiser containing petroleum jelly for best effect and apply immediately after a bath while the skin is still wet for best absorption.

5. Do not use talcum powder - or snake powder - to relieve itch on your baby as he may breathe in the fine particles of the powder.

6. A post-bath or pre-bedtime massage is great for relaxing your baby and improving blood circulation. Simply apply some baby oil and gentle strokes to help baby calm down and sleep better.

7. Dress baby comfortably. Loose-fitting - but not oversized - cotton garments are best in minimising skin irritation caused by chaffing. Do not over swaddle your newborn.

8. New clothes should always be washed prior to first wear. Remember to remove clothes tags that may irritate the skin. Check for embellishments and stitching that may also irritate the skin.

9. Scratching can aggravate an existing rash. To prevent baby from scratching, trim and file baby's nails regularly and put on mittens. If your baby has outgrown the mittens, try putting on a pair of comfortable, snugly-fitted long socks on the hands so baby can't pull them off.

10. Dress baby sensibly for bed to keep him cool and comfortable. Fleece blankets and quilts make nice gifts but are often unsuitable for the high humidity of equatorial countries.

11. Keep your baby in a cool environment with ample air circulation and breeze. If you have to bring baby out in the day, remember to put on a hat and slap some sun screen on baby's face, hands and legs.

• When to visit the doctor

Heat rash may be mild but infection can set in when there is excessive scratching. Broken skin from incessant scratching can lead to bacterial infection. This may result in the development of pus-filled blisters, swelling, or crusting of the skin, which calls for a visit to the doctor. Watch out also for signs of increased irritability, crying, lethargy, loss of appetite and fever.

Jaundice

Jaundice is a common occurrence amongst newborns because of their inability to remove a chemical known as bilirubin, a byproduct of the red blood cells. This results in a yellowish tint on the baby's skin and eyes. Jaundice typically shows up from the second day onwards. In many cases, the condition is mild and eventually goes away by itself by the second week but if severe, immediate treatment is required.

• Symptoms

Checking for jaundice is routinely performed by the pediatrician prior to baby's discharge from the hospital and again 3 to 5 days later when bilirubin level is at its peak. Yellow coloration on the face and eyes is the first telltale sign of jaundice. This coloration will spread down to the feet when there is an increase in bilirubin level.

• Causes

Before a child is born, bilirubin in the foetal blood is removed by the mother's liver. However, a newborn's liver takes a couple of days to reach maturity and is hence unable to process bilirubin fully. Excess bilirubin in the blood stream causes the skin to turn yellow.

• Who is more prone?

Asian babies are more prone to jaundice compared to non-Asians. Within the population, however, jaundice occurs regardless of race or ethnicity. Some babies are more susceptible to the condition because of a variety of reasons, such as:

 Family history of jaundice

 Prematurity

 G6PD deficiency

 Poor feeding (especially if breastfed)

 Breast feeding

• Treatment

Especially in the first few days of birth, breastfed babies should be nursed frequently in order for bilirubin to be passed out of the body in the stools. (Baby's stools should look bright yellow.) This also helps the mother establish her milk production.

High levels of bilirubin can lead to brain damage. Babies with jaundice may need tubes or treated using phototherapy. While administering the light therapy, the baby is dressed only in a diaper and eyeshades.

• Prevention

There is no known prevention for jaundice. However, you should never self-treat and place baby in direct sunlight.

• When to see the doctor

You should revisit the pediatrician if jaundice does not go away after two weeks or if your baby is extremely fussy or appears listless and has poor appetite.

Cradle Cap

Cradle cap is a form of skin inflammation known as seborrheic dermatitis. It typically appears on a newborn's scalp but may also show up elsewhere on the face, particularly around the eyes, nose, and ears, and also around skin folds. This is a harmless skin condition that should go away on its own without any - or little - treatment within a couple of months.

• Symptoms

Cradle cap is characterised by a yellow scaling of the skin and may appear oily, crusty, and patchy. It may be mistaken for dandruff because of the dry, flaky skin, and may result in itchiness of the scalp.

• Causes

Although seborrheic dermatitis inflammation is the result of overactive oil glands, maternal hormones have often been blamed for the cause of cradle cap. Excessive oil formed in a newborn's scalp show up as a buildup of waxy, dead cells but this can also develop into a rash.

• Treatment

Cradle cap seldom requires any treatment because it is a relatively mild condition. There is no need for off-the-shelf products or medication as it will eventually resolve on its own. However, you can improve the condition by observing the following when washing baby's hair: 18

1. 15 to 30 minutes prior to bath time, apply a moderate amount of baby oil, olive oil, mineral oil, or petroleum jelly to the affected areas. Massage the scalp gently, taking care to avoid the eyes.

2. Leave the application on for at least 15 minutes to ensure that it is absorbed by the scaly skin.

3. During bath, exfoliate the scalp by wetting it and gently brushing away the top layer of dead skin using a soft bristled hair brush or toothbrush. Do not attempt to peel off the crusty bits with your nails.

4. For facial area, use a damp cloth to clean away the application, again taking care to avoid the eyes.

5. Use a regular baby shampoo to wash baby's hair as per normal. You may wish to purchase a mild anti-dandruff shampoo suitable for baby.

6. Rinse thoroughly and pat dry. Do not rub.

7. Ensure that you do not leave traces of oil on baby's head and face as this may clog up the pores and worsen the condition.

• When to see the doctor

It is not necessary to see the doctor unless the cradle cap causes an itch or spreads to other sites apart from the scalp. You should seek a doctor's advice if there is no marked improvement or if the condition worsens after self-treatment. This could be an underlying case of deeper infection where the doctor may suggest a cortisone cream or a special seborrhea shampoo as part of the treatment.

Milia

Milia are tiny white bumps that commonly appear on a newborn's face, usually on the cheeks and nose, but can also be found on the gums. Apart for aesthetics, these spots are harmless and do not pose any health problems.

• Symptoms

Milia appear as tiny white bumps, mostly on the face and occasionally on the gums. These pimple-like bumps usually disappear within weeks of birth.

• Causes

Milia is the result of your baby's oil glands becoming blocked by skin flakes (or dead skin) near the skin surface. It is not a symptom of any underlying skin disease.

• Treatment

No treatment is required for milia. They usually fade away within weeks of birth when the dead skin wears off and when your baby's oil glands gradually open up. You should not attempt to squeeze the bumps, apply any ointment or scrub your baby's face as these may result in scarring and skin irritation.

Sun Burn

Sunburn is the result of overexposure in the sun and can take place within 30 minutes of exposure. It happens when harmful ultraviolet (UV) radiation penetrates the skin, causing a skin inflammation. Sunburn is also responsible for the premature aging and wrinkling of the skin. In severe cases, it can cause skin cancer.

• Symptoms

The first sign of sunburn is redness of the skin. This usually shows up within two hours of being in the sun without any protection. Within 24 hours, the skin may start to sting, peel, and itch.

• Causes

Sunburn is caused by prolonged unprotected exposure in the sun.

• Who is more prone?

Newborns and infants under six months old are extremely sensitive to the sun as they tend to burn easily. Persons of white skin tone, as well as those living close to the equator and in places of high altitudes are also more likely to get sunburns.

• Treatment

1. For mild sunburns, sponge down the sunburned areas using a damp cloth for about 15 minutes regularly throughout the day. Do not rub the skin and ensure that baby does not catch a chill in the process.

2. A cool bath can also help soothe baby's skin. Avoid adding salt, bubble bath, and any harsh body wash as these may aggravate the condition. Apply moisturiser immediately after a bath.

3. Ensure that baby is breastfed often or given water to keep hydrated following sunburn.

• Prevention

Regular protection against the sun should begin early. Even on a cloudy day, UV radiation is at its strongest between 10am and 5pm. Infants should never be exposed to direct sunlight and if the need arises to bring baby out of the house during midday, you should take the following precautions:

1. Apply sunscreen generously on baby, (minimum more than 6 months old), 20 minutes before stepping out of the house, paying extra attention to the nose, cheeks, and forehead. Choose a sunscreen that is broad-spectrum, of SPF 30 and above, one that blocks out both UVA and UVB rays, and contains zinc oxide as the active ingredient.

2. Sunscreen should be reapplied every two hours as activities such as perspiring and swimming can wear off the protection from the skin.

3. Ensure that baby is sufficiently - but not overly - clothed before going out. Choose cotton clothes that are loose-fitting.

4. Even with sunscreen slapped on, it is advisable to stay in the shade under an umbrella, a wide-brimmed hat that shades the neck, or in the shade of the pram.

5. Try to walk under shady spots. Stay away from the road or sand as the sun can reflect off floor surfaces.

• When to see the doctor

If fever, vomiting, or blisters result following a sunburn, see the doctor immediately.

Refer :

• 10 Tips For Breastfeeding Parents
• Baby`s Daily Massage
• Bathing Your Baby
• Switching From Breast To Cow Milk
• Baby Sleep Tips
• Breastfeeding FAQs