Top Tips on Baby Skin Concerns by Professor John Harper, Consultant in Paediatric Dermatology

Top Tips on Baby Skin Concerns by Professor John Harper, Consultant in Paediatric Dermatology

Baby eczema

Eczema in a baby is common. The severity will vary from patches of mild dry scaly skin to a more significant problem with red inflamed areas anywhere on the body. Often it starts with “cradle cap” and involves the face. Eczema is a genetic disorder and usually there is someone else in the family with eczema, asthma or hay fever, but this is not always the case.

  1. First line treatment should be the use of a moisturising cream.
  2. If this is not sufficient and the eczema is progressing, go and see your GP. A more active approach to treatment may be necessary.
  3. If there are any symptoms of reflux, loose stools and not gaining weight adequately, then an associated cow’s milk allergy should considered.


Nappy rash

Nappy rash is very common and usually due to the irritant effect of skin contact with urine and stools. Prolonged nappy rash is often complicated by secondary Candida infection. As this is a potential problem in all babies, it is important to try and prevent this happening in the first place and if it does occur to seek medical advice on treatment.

  1. Ideally use the newer super absorbent nappies (diapers) and for them to be changed frequently.
  2. To use a proprietary nappy cream as a barrier preparation each time the nappy is changed.
  3. If despite doing this a nappy rash appears, then go and see your GP, who may feel it necessary to prescribe an anti-inflammatory cream, usually 1% hydrocortisone in combination with an anti-fungal agent.


Cradle cap

Some mild scaling of the scalp is seen in the majority of babies and nothing needs to be done. It will resolve with washing the scalp with a recommended baby shampoo. More severe “cradle cap” is often seen in a child with a susceptibility to eczema.

  1. Gently massage a recommended “baby” oil (avoid nut based oils) into the thick scaly areas on the scalp prior to washing with a mild baby shampoo.
  2. Do not pick or pull off the adherent scale to avoid pulling out any hair roots.
  3. In children with eczema elsewhere, ask your GP, who may feel it necessary to prescribe 1% hydrocortisone in combination with an anti-fungal agent, to be applied to any red sore areas on the scalp, after the bath.


Dry skin

Some babies have transient dry scaly skin, in particular those babies born post-term. Other babies naturally have mild dry scaly skin which is ongoing, often similar to the skin type of one or both parents.

  1. Use a moisturising cream applied to all the skin once or twice daily. Ideally use a moisturiser with a high water content, which is more compatible with the normal physiology of the skin.
  2. The addition of a regular daily bath with an oily bath additive can be highly beneficial.
  3. More persistent patches of dry scaly skin may be an early indicator of eczema, which will need a more pro-active approach to treatment and a recommended visit to your GP.


Bathing a baby with normal skin

  1. Make sure the room is warm
  2. The temperature of the water should be tepid and not too hot.
  3. Use a recommended baby soap
  4. Wash and clean all the skin creases, in particular behind the ears, the neck, armpits and nappy area.
  5. Coming out of the water swaddle the baby in a towel and dry all areas of the skin thoroughly.


Baby sun protection

  1. Try to avoid direct sun exposure as babies are more prone to sun-burn.
  2. When out and about in the sun and on holiday, use a recommended total sun block cream specifically for infants and children.