Infants Skin Conditions

When it comes to your baby's skin, you can depend on one thing: It's bound to erupt into a rash during the first year. Why? The human skin acts as a protective barrier against all sorts of elements, from sun to bacteria, but it takes about a year for that epidermis to get up to speed and function effectively, says Bernard Cohen, M.D., director of pediatric dermatology at Johns Hopkins Children's Center. It starts out thinner, has less pigment, and doesn't regulate temperature as well as the skin of bigger kids and adults. Of course, no baby escapes the most common skin issue--diaper rash. The diaper area is warm and moist, which breaks down the skin on that tender tush. Add irritating poop and pee and you've got the perfect environment for breakouts. Keep diaper rash under control by changing your baby often, using petroleum jelly or a barrier cream with zinc oxide to protect his bum, and letting his naked bottom air out occasionally (put a sheet on the floor and let him loose). Protect the rest of that fragile birthday suit with mild products, such as hypoallergenic and fragrance-free soaps, washes, and lotions. Once your baby turns 1, you can relax a little--his skin will be thicker and more rash-proof.

Intertrigo

What It Is: A rash found mainly in a baby's skin folds, especially in the neck. It usually appears in chubby babies under 6 months.
What It Looks Like: A red, raw, weepy rash that looks worse inside the skin creases. Your baby may not notice it at all or it may cause some pain, depending on the amount of skin-to-skin friction in the affected area.
What Causes It: Excessive moisture from drool and spitup that collect in your baby's creases, which don't get any air.
What to Do: Wash out the inside of your baby's skin folds with water and apply a zinc-oxide barrier cream or petroleum jelly to protect them, recommends Dan Brennan, M.D., a pediatrician in Santa Barbara, CA. As babies get older and more mobile--they crane their necks-intertrigo goes away.

Prickly Heat

What It Is: Also known as miliaria, prickly heat rash may occur on the face, neck, back, or bottom.
What It Looks Like: Tiny red bumps.
What Causes It: Since a baby's skin isn't able to regulate heat well, says Dr. Cohen, just about anything that overheats your little one--hot, humid weather; overbundling him in tight clothing; or a long, hot car ride while strapped in a car seat--can set off a prickly heat rash.
What to Do: Get your baby out of the heat and dress him in loose, cool clothing. The rash should look much better in about 30 minutes

Seborrhea

What It Is: A rash that can appear on the scalp and eyebrows (where it's known as cradle cap), behind the ears, or on the neck, cheeks, and chest. It's most common in babies under 6 months.
What It Looks Like: On the scalp and eyebrows, seborrhea looks like dandruff, although it can also appear like thick, yellow or crusty scales. Behind the ears, seborrhea tends to look cracked and scaly; on the chest and neck, it may be pimply, and on the cheeks, it's red and bumpy. It can be unsightly but probably won't bother your baby at all.
What Causes It: No one knows.
What to Do: The traditional remedy is to rub a little olive or baby oil on your baby's scalp to loosen the scales, then gently brush them off. Dr. Brennan also recommends washing the scalp, behind the ears, and any other spots with a small amount of anti-dandruff shampoo.

Eczema

What It Is: Eczema can appear anywhere on a baby's body starting around 3 or 4 months, though it's not usually found in the diaper area. Up to 20 percent of babies will develop this very itchy rash.
What It Looks Like:  In its mildest form, eczema erupts in dry, patchy areas on the skin. It can also look like a bad case of windburn and cause the skin to turn red, ooze pus, and crust over.
What Causes It: Anything can be a trigger for babies prone to eczema (those with a genetic predis-position or a family history of allergies). Hot weather can cause sweating, which irritates the skin; cold weather can dry it out. Soaps and clothing, especially wool, can also spark an outbreak.
What to Do: Wash the skin with a gentle, fragrance-free cleanser--ask your pediatrician or dermatologist for a recommendation--and then slather moisturizer onto damp skin twice a day. For a more severe case, talk to your doctor about a steroid ointment, which will reduce the inflammation.

Contact Dermatitis

What It Is:  A skin reaction to something your baby came in contact with--from soaps and detergents to grass and other plants.
What It Looks Like: Red, itchy bumps at the contact site.
What Causes It: If the rash is all over your baby's body, then soap or detergent is probably to blame. If the chest and arms are affected, the culprit could be a new, unwashed shirt. Rashy legs? For some super-sensitive infants, all it takes is the unfamiliar texture of a rug or grass.
What to Do:  If the rash looks dry, moisturize it. If it's not bothering your baby, just remove the trigger (roll up the rug, wash the shirt, try a milder soap, a gentler laundry detergent). If the rash is itchy, talk to your doctor about a hydrocortisone cream or an antihistamine.

Refer:

• Baby Skin
• Baby Skin : FAQs
• Baby Skin Care : Sun Protection
• Newborn Skin : Common Issues
• Baby Skin : Sensitive Products
• Bathing And Soothing Your Baby`s Skin
• Diaper Rashes : Causes And Treatment
• Some Common Skin Rashes In Babies

Normal Health Issues in babies

Is It Normal for Baby to Cry for Hours Every Night?

It's not breaking news that babies cry -- a lot. But when it's your baby, in your arms, screaming for hours at a time, you can't help but wonder if something is terribly wrong. "For the first three months, every night at about 5 p.m., Gavin would get really fussy," says Tricia Heiserman, of Bala Cynwyd, Pennsylvania. "You couldn't put him down. It made me depressed because I thought I was doing something wrong."

Nearly all babies, no matter how placid, get downright cantankerous as night falls and the "witching hours" begin. "Inconsolable fussiness between 4 p.m. and 7 p.m. is natural," says Benjamin Danielson, MD, medical director of Odessa Brown Children's Clinic, at Seattle Children's Hospital. This crying typically starts within the first two months, heightens between weeks five and eight, and is usually gone by the third month. While crying sprees are upsetting and inconvenient, they're entirely normal. Put your baby down for naps throughout the day to make sure he doesn't get overtired; if all else fails, try a walk outside, which many moms swear by for soothing cranky kids. You may be wondering if your baby has colic -- which Dr. Danielson says is a somewhat more intense version of the crying that most babies go through, and the same tactics that soothe a crying baby may soothe a colicky one.

And remember, it won't last forever. "Meredith cried for hours every evening from the time she was 7 weeks old, and we'd do anything to try and stave it off," says Caroline Warthen, of Greenville, South Carolina. "Then at 3 months, it ended, and all of a sudden we had a smiley baby."

How Much Spit-Up Is Too Much?

The word "spit-up" brings to mind something small, like drool. But there's nothing minute about massive spit-ups that splatter all over the floor. These usually start immediately after birth and crescendo at around 3 months. "From the time my milk came in, my son was spitting up huge puddles that covered everything, about 10 times a day," says Kimberly McCreight, of Brooklyn, New York. "The sheer volume was so startling that I asked about it every time I went to the doctor."

It's not the volume that matters, says Gregory Germain, MD, associate clinical professor of pediatrics at Yale School of Medicine. There's no need to worry about a baby who's steadily gaining weight and seems happy even when she's spitting up a lot. "It's shocking," Dr. Germain adds. "A baby can spit up so much that it covers the floor, but when you measure the amount, it's just a fraction of what she ate." Your baby has a problem, such as acid reflux, if she seems to be in pain during or directly before or after spitting up; if she's gaining weight very slowly; or if she has recurrent respiratory problems, such as wheezing or pneumonia. Otherwise, trust that by about 6 months, the spit-up saga will be behind you.

Is Baby Constipated?

In your newborn's first few weeks, it can seem like all you're doing is tallying wet and dirty diapers and hoping the daily sum adds up to the normal six wet and six soiled. And it probably will, at first. But as your baby gets older, there may be something of a shake-up in the poop department.

"When Blake was about 6 months, he went from pooping once every four days to once a week, and it put me over the edge," says Cindy Myers, of Gatlinburg, Tennessee. "He wasn't disturbed by it at all, but I was."

Although it can be hard to imagine, Dr. Danielson says infrequent stools in infants usually aren't a worrisome sign. "Somewhere around 1 month, most babies go through a sudden slowdown in terms of bowel movements," he explains. "So they will be perfectly healthy, but they may have a bowel movement only once every seven days -- and that's fine, if what comes out is soft and mushy and not difficult to pass."

You'll know your baby is truly constipated if he cries or screams while trying to poop and if his bowel movements are hard, round balls. In these cases, you should talk to your pediatrician, who may suggest giving your baby foods such as prunes that act as a mild stimulant, massaging the anal area with a Q-tip to relax the muscles, or using glycerin suppositories to lubricate the area.

How Can I Teach Baby to Eat Solid Food?

Your baby's first bite of real food is one of the biggest milestones of her first year. But it may not always go smoothly.

"Babies have very varying degrees of responsiveness to solids," says Claire Lerner, director of parenting resources at Zero to Three, a nonprofit educational organization in Washington, D.C. "There are babies who will eat anything, and then there are discriminating eaters who have very specific preferences."

It can be demoralizing to continue offering spoonfuls of oatmeal or peas only to have the food flung across the room. But there's little chance that your picky eater will starve. Dr. Germain assures that, except in rare cases, as with children who have anemia or acid reflux, babies don't need anything besides breast milk or formula for their entire first year. So if your baby is protesting, it's best to back off.

"When I give Gavin rice cereal, he just spits it out," Heiserman says of her 4-month-old son. "But the pediatrician says that right now feeding is more of a play activity to teach him how to eat."

Take pleasure in experimenting with tastes and textures, and keep the process fun and relaxed. "Getting into power struggles is detrimental because nobody wins and mealtime becomes fraught with tension," Lerner says. "If the baby is pushing away the spoon and arching her back, one option is to put away what you've offered and offer it again an hour or two later." If she doesn't take to new foods at breakfast, try again at dinnertime.

Why Is Baby Waking at Night Again?

For moms and dads with a newborn, sleep deprivation is unavoidable. But few parents expect a reprise when their child is nearly a year old.

"Meredith was sleeping through the night at 12 weeks, but then, a few months later, she started waking again at night, screaming," Warthen says. "We'd have to go in and calm her down, put the pacifier in her mouth, sometimes a couple of times a night."

Alas, even the dreamiest sleeper will experience plenty of setbacks during her first year. "At about 2 months, there's a honeymoon period with sleep where you feel like you're getting into a real rhythm with your child. But that starts to wane at about 4 months," Dr. Danielson says. Even little life disruptions can have a big impact on sleep, so things such as traveling, being sick, teething, growth spurts, or nearing a developmental milestone can make your baby start waking again, temporarily. In these instances, stick to your bedtime routine and soothe your child with comfort but not over involvement. (Pat her on the back, but don't pick her up and bring her into bed with you.)

One of the most common stumbling blocks parents encounter pops up at about 9 months. "Children start to understand the concept of object permanence, that things still exist even though they can't see them," Lerner says. "So they know that when you're not in the room, you're out there somewhere. And they know they can use their voice to make you come back."

While it can feel like your baby is backsliding, try to remember it's just the opposite -- she's taking huge developmental leaps forward. And as long as you don't pay too much attention to the protesting, your baby will sleep soundly again before too long.

"If you start getting very involved again in nighttime interactions, it can perpetuate the waking," Lerner says. "So respond, but keep the interaction brief. Peek your head in, just for 15 seconds, to let your baby know you're there but that nighttime is for sleeping."

What Temperature Indicates That Baby Needs to See a Doctor?

Like it or not, by the time he's a year old, your baby is bound to burn up. And when he does, the thermometer's readout may make you gasp. Fevers of 102, 103, even 104 degrees F. are common in children. While they may merit a call to the doc, they shouldn't cause a panic.

"Fever and the symptoms that accompany it, such as congestion or vomiting, are your baby's way of fighting infection," Dr. Danielson says. "Babies tolerate high fever -- 104 degrees plus -- a lot better than we do, and duration is usually a much better indicator of illness than how high it is."

Here's when to bring your baby to the pediatrician, Dr. Danielson says: if the fever lasts more than a day, if other symptoms interfere with baby's ability to get rest and eat well, or if your parental instinct tells you something is wrong.

If your baby is younger than 2 months and comes down with a fever, you'll need to take it more seriously and get him checked out immediately -- with newborns, it's much trickier to figure out which infections might be brewing.

When Should Baby See a Doctor for Upper Respiratory Infections, Ear Infections, and Stomach Viruses?

Dr. Danielson weighs in on the most common maladies of baby's first year. Here's when to wait it out and when to see a doctor.

Upper Respiratory Infection

Watch and wait if baby has a cough, increasing congestion, fever for one to two days, fussiness, or poor appetite. Ease congestion with a humidifier or a nasal aspirator, or by raising the head of the crib mattress (place a pillow underneath the mattress).

Visit the doc if fever lasts past the third day, if baby doesn't have any "up" periods when her mood is better, or if she won't drink. These symptoms may indicate a secondary infection such as a sinus infection or bacterial pneumonia.

Ear Infection

Watch and wait if you notice fussiness, fever, trouble sleeping, or pulling at the ear that lasts for one to three days following congestion or an upper respiratory infection.

Visit the doc if these symptoms last for more than three days or if baby seems to be in severe pain and younger than 6 months. Doctors prefer to let baby's immune system fight an ear infection at first, but antibiotics may be in order if he isn't better after three days.

Stomach Virus

Watch and wait if baby is fussy, has a fever for a day or two, vomits for one to two days, or has diarrhea that starts after the first or second day. As long as your baby is getting fluids and urinating consistently, she'll be fine without solids for a few days.

Visit the doc if vomiting or fever lasts more than two days, if baby doesn't want to drink, if she goes for six hours or more without urinating, or if there's blood in her stool. Your baby might have a serious infection such as salmonella or E. coli, which may require treatment with an antibiotic. And if she is seriously dehydrated, she may need IV fluids.

Originally published in the June 2008 issue of American Baby magazine.

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