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Everything You Need to Know about Your Baby's Skin

Many parents expect their newborn to have perfect skin. Yet while a baby's skin is soft and delicate, many young infants have rashes or blemishes in the early weeks. Get to know some of these common skin conditions and learn how to treat them.

Picture the popular image of a baby's skin: soft, smooth, maybe a little wet around the chin. Yet, all of us, babies included, have lumps, bumps, spots, and dimples. It's part of being human.

Learn about some of the common skin conditions your newborn may face in the weeks and months ahead.

Milia

About half of all newborns have tiny, pearl-like bumps called milia. About the size of a small freckle, milia are usually found on and around the face. They represent trapped skin proteins and debris and are harmless and painless. With no treatment, milia disappear in weeks to months.

Nevus Simplex

These marks are present at birth and have many popular nicknames: salmon patches, angel kisses, or stork bites. Found in up to 40 percent of newborns, the marks are also harmless and are located on the nape of the neck, the forehead, the eyelids, forehead, or around the nose. They come from a collection of dilated capillaries and can appear darker with crying. Over the first few years of life, nevus simplex will gradually fade, except those at the nape of the neck.

Mongolian Spots

Another type of birthmark, Mongolian spots are flat, deep brown or bluish-black, and more likely found on the lower body. Usually found on the buttocks, lower back or shoulders, they can be very large. Mongolian spots are badly named, as they are very common in many ethnic subtypes: 90 percent of African-Americans, 81 percent of Asians, 90 percent of Native Americans and 10 percent of Caucasian babies have these markings. These too will gradually fade throughout childhood, but can cause trouble if they are mistaken for bruises and child abuse is suspected.

Acne

There are two forms of baby acne: neonatal and infantile. Neonatal is more common, appearing in the first few weeks of life as small red bumps and tiny whiteheads on the nose, forehead, and cheeks. In fact, it looks a lot like a case of teenage acne, only milder and usually without the blackheads. Acne in this age group is also a result of hormones, again, similar to the teens, but in this case the hormones come from the mother, having been passed to the baby's system through the placenta before birth. During the several weeks it takes those hormones to naturally return to low levels (since they are not replaced by the baby's body once they degrade), the acne can persist. Once gone, however, the acne will resolve.

Infantile acne, lasting beyond the newborn period, is not common. Rarely, it is treated with acne medicines, but not before being evaluated by a pediatrician or other specialist.

Physiologic Jaundice

Up to 50 percent of newborns will get some degree of jaundice in the first week of life. This is a yellowish hue to the skin that comes from a buildup in the body of a molecule called bilirubin. It is rare (and worrisome) before 24 hours of life, and usually begins to appear at 48 to 72 hours.

Extra red blood cells needed by a baby before birth but not after begin to break down shortly after birth. This process releases bilirubin molecules into the bloodstream. It is the liver's job to clear this away, but, being only a few days old and somewhat immature, the liver can't process the whole load. Bilirubin piles up, and jaundice begins, first appearing in the whites of the eyes, then face, and working its way down the body as the jaundice becomes more severe.

Though most babies never build up a dangerously high level, severe jaundice is a serious condition that needs to be treated in the hospital. Less severely affected babies can become sleepier, though, and more difficult to feed. After peaking in the first week, uncomplicated physiologic jaundice will begin to fade over the next few weeks.

Diaper Dermatitis

No discussion about infant skin conditions would be complete without a mention of the diaper area. At any one time in America, up to 15 percent of infants will have some type of a diaper rash. Irritant diaper dermatitis is caused by contact with urine and stool. The acidity, frequency, and consistency of the stool, as well as the pH of the urine all play a role in the development of red, often painful areas on the skin. The areas most likely to be affected are those most directly in contact with urine and stool, thus, the hidden creases between legs and groin are often spared.

The long debate over whether cloth or disposable diapers were more protective against rashes seems to be settled. Improved technology used in disposables makes them more absorbent and better able to hold moisture away from the skin.

In contrast, candida diaper dermatitis, a yeast infection, grows most readily in creases and the places hidden from fresh air. This rash often starts in creases and grows outward, with small, isolated red bumps at its outer boundaries. Other possible causes of diaper rashes are contact allergies and bacterial infections, the latter sometimes requiring antibiotics.

Simple measures can be taken to help prevent diaper dermatitis. Change diapers often and soon after they are soiled. Avoid harsh cleaning agents and chemicals, and use a thick, (usually white) ointment containing zinc oxide (e.g. Desitin, A&D) to create a barrier between skin and stool and urine. Yeast infections are less likely if the diaper area is allowed to air dry occasionally.

Seborrheic Dermatitis

Another very common rash appearing in the first few months of life, seborrheic dermatitis is popularly known as cradle cap. It is a flaky, dry rash with greasy scales that affects the scalp, but sometimes also extends to the eyebrows and face. This rash usually bothers parents more than it bothers their babies, but it can become quite unsightly. It is eventually outgrown, but there are two strategies that are easy and offer some help. The first is to use a diluted anti-dandruff shampoo containing selenium (e.g. Selsun Blue, Tegrin) twice a week. The other involves massaging mineral oil gently into the scalp, them combing it through. A mild steroid cream prescribed by a doctor can help in more severe cases.

Though most infant rashes and skin conditions aren't dangerous, any rash that seems severe, is very bothersome, or is accompanied by a fever or an ill-appearing child should be seen promptly by a healthcare provider.

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