Milia are small, white bumps under the skin that are most common in the newborn but can occur at any age. They usually develop across the baby's nose, chin and sometimes, the cheeks. No treatment is required because they usually disappear spontaneously after a few weeks.
You should wash the baby’s face gently each day with a mild soap taking care not to irritate the bumps. Avoid oily face products and the use of rough fabrics (i.e. for washers, towels, bedding and clothing) which may also irritate the skin. Seek a medical opinion if concerned or if the condition doesn’t settle within a few months.
Erythema Toxicum Neonatorum
Erythema toxicum is a condition that only occurs during the neonatal period – usually about two to five days after birth. It presents with yellow to white coloured vesicles surrounded by a blotchy red halo on the skin. The lesions are transitory often disappearing within an hour or two of being noticed and appearing elsewhere on the body.
No treatment is required and the condition will settle completely by about two weeks.
Baby acne is characterized by small red bumps on the baby's cheeks, nose, chin and forehead and usually develops about two to four weeks after birth. The skin may be reddened around the bumps and white pustules may also develop. The cause is thought to be the presence of residual maternal hormones within the baby. The condition is quite common and usually heals spontaneously within a few months leaving smooth, normal skin.
You should wash the baby’s face gently each day with a mild soap taking care not to irritate the bumps. Avoid oily face products and the use of rough fabrics (i.e. washers, towels, bedding and clothing) which may irritate the skin. Seek a medical opinion if concerned.
Nappy rash is common in babies and can be caused by not changing the nappy often enough. The rash will be generalised and red and may cause quite some discomfort particularly if the nappy is dirty as well as wet, due to rubbing on the delicate skin.
Wash the affected area in warm water and gently dry thoroughly. Allow baby some time without a nappy for the area to completely air dry. Avoid wipes at this stage as they may irritate the damaged skin further. Use a moisturizing, waterproof cream to form a barrier against further damage. Suitable ointments include Sudocrem, Lanolin and Bepanthen. Change the nappy at each feed (about every three to four hours) or more often if dirty. Choose fragrance and alcohol free wipes.
Cradle cap is a common condition found during the first few months although it may be present in older infants as well. It appears as a crusty, yellow deposit, particularly across the top on the baby’s head and there may also be some redness associated with it. It is sometimes the result of parents’ reluctance to adequately clean the fontanel area for fear of damaging the ‘soft spot’.
The crusty matter is easily softened with baby oil applied some hours before bathing. Gently shampoo and massage the affected area, firmly rub dry then brush with a soft brush to loosen any remaining cradle cap. This treatment may need to be repeated several times to remove the deposits however avoid shampooing the hair too frequently as it may dry the scalp.
Eczema, or atopic dermatitis, usually appears during the first six months if it is going to occur (infantile eczema). It presents as a rash anywhere on the cheeks, forehead, ears and scalp and the signs may include redness, dryness, oozing and itching. It often settles by the age of about two but in some children the rash may become more generalised effecting the elbows, knees, and skin creases (childhood eczema). While some infants will outgrow their eczema others will always have dry, sensitive skin and may develop allergies. Flare ups may occur when the skin is particularly dry or when it comes into contact with an allergen such as house dust, strong detergents or household cleaners.
Treatment involves keeping the skin as moist as possible by applying a thick moisturizer twice a day. Use gentle soaps and laundry detergents and avoid contact with dust mites, animal dander and cleaning products.
Thrush is caused by a fungal microorganism called Candida Albicans. It is easily spread between mother and baby and both parties must be treated to prevent reinfection occurring. It may at first be noticed in the baby’s mouth as white spots firmly adhered to the mucosa and/or a white coating on the tongue that doesn’t rub off. It commonly occurs in the weeks following discharge from hospital.
Another sign may be that the mother’s nipples are cracked, crusty and extremely sore during and after breastfeeding, despite good attachment. The mother may have had thrush during pregnancy and this is even more relevant if the baby was delivered vaginally.
Thrush may also be noticed in the nappy area where the rash will be well defined and very red, with slightly raised borders.
Visit your doctor to arrange for the appropriate anti-fungal treatment for both mother and baby. It is important to continue the treatment even after all signs have cleared, as instructed by your physician. Good hand hygiene following toilet visits and nappy changing is also most important to avoid reinfection.
Hand Foot and Mouth Disease
Hand foot and mouth disease is a viral illness particularly common in infants attending care facilities. It presents with rashes and sores on the hands, feet, limbs and face as well as sores in the mouth and throat and is generally preceded by a fever, food rejection and irritability.
Treatment is symptomatic so encourage fluids and treat fevers as appropriate. Children remain contagious while they have sores and these can take a week or two to heal. The disease can be contracted more than once but most children eventually develop an immunity.
Cold sores are caused by a virus - Herpes Simplex. Once infected with the virus the person will have it forever but it may remain dormant. While the virus can be acquired from shared toys or eating utensils one of the most common causes is direct contact with someone with a cold sore. Ensure that family and friends never kiss or cuddle your baby if they have active herpes.
If your baby becomes infected seek medical treatment immediately as it can be dangerous in newborns.
Umbilical Pyogenic Granuloma
An umbilical granuloma is an overgrowth of tissue in the umbilicus. It presents as a soft, red mass at the base of the umbilicus after the umbilical cord has separated, so it is usually noticed during the first few weeks. It may be moist and as a result, leave some serous discharge on the baby’s clothing.
It is important to keep the area clean and dry and to be alert for any signs of infection including surrounding redness, odour or increasing discharge. If the baby develops a fever consult your doctor urgently. Air dry when possible and fold the nappy down below the umbilicus, as done when the cord was still attached, to assist drying.
Consult your doctor to formulate a plan of treatment. Salt treatment is often recommended and can be given at home with good results by about one week. Other treatments are available if this does not complete the healing process.
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