Baby skin is soft, smooth, plump and perfect, right? Not always. In fact, most of the time that fresh new skin has at least one problem, as most new parents will know.
One of those parents is the This Morning resident doctor Zoe Williams, who had her first baby, Lisbon Lion, nearly four months ago. Soon after his birth, Williams’ beautiful baby broke out in spots, which his medic mum was easily able to diagnose as newborn acne.
“His little face, bless him, was covered in red and white spots – we called him our little spotty teenager,” she says. “Lisbon didn’t know he had it and it wasn’t uncomfortable for him so he didn’t care – it’s more that as parents we want our babies to look perfect.”
She says most babies grow out of newborn acne after a few months, and it’s not harmful and doesn’t scar the skin.
But she adds: “When your newborn arrives, everybody always talks about silky smooth baby skin, so we have the expectation that’s what a baby’s skin is going to be like, and often it’s not, because their skin is likely to be affected by at least one of many common conditions.
“It’s probably quite rare for babies not to have any skin condition whatsoever.”
Here, Williams outlines the most common skin problems babies can have, and gives advice on how to deal with them…
1. Baby eczema
Williams says the dry, red, itchy skin condition eczema is very common in babies, and they’ll often get it on their cheeks, or around their chin. “The skin is a barrier between our bodies and the outside world,” she explains, “and sometimes when babies are born, the barrier isn’t working quite as effectively and they get eczema, so we want to support that barrier as much as possible by using emollients [soothing moisturising treatments].”
If emollients don’t work, or if the eczema’s severe, then it’s important to see your GP, stresses Williams, who says babies with eczema might sometimes be prescribed mild, topical steroids, although it’s not usually necessary.
“But as well as treating the skin, we have to think about preventing the eczema from getting worse,” she says, “so that means avoiding anything that can irritate the skin, like things that are perfumed, or contain any cosmetics that might dry the skin. Keep the nappy area clean and dry, and look for wipes that are as pure as possible and don’t have any alcohol or chemicals added.”
She says sometimes even bath water can irritate and dry delicate baby skin, and points out: “We don’t really need to bathe our babies more than three times a week. If a baby has eczema, then think about reducing how frequently you bathe them, and not using soap, but using emollients instead.”
2. Nappy rash
Nappy rash, which looks like pink or red patches on a baby’s bottom, or warm areas on darker skin, is often caused by a nappy rubbing or from prolonged contact with a damp or soiled nappy. It’s extremely common – WaterWipes research has found 88% of parents say their baby has had it.
Williams says parents should keep the nappy area clean and dry, and change nappies frequently if they’re soiled or wet. Use pure and natural wipes, and a nappy rash cream.
“Most babies will experience nappy rash at some point and, with the best will in the world, if you’re changing that nappy every time they wee, sometimes they’ll still get nappy rash,” says Williams. “If it’s mild and you’re doing everything you can, you can’t always completely eliminate it. But if it’s quite severe, if the skin’s blistering or your baby seems to be in a lot of discomfort and you’re concerned, get it checked by a healthcare professional.”
3. Newborn acne
Williams’ son Lisbon had newborn acne for around three or four weeks, and she says: “Newborn acne has the appearance of teenage acne, it’s bright red and is very common. But mostly they grow out of it after a few months, and it’s not harmful.
“Keep the area clean, but don’t overwash it and, importantly, don’t pick or squeeze the spots or use any acne treatments designed for older children or adults.”
She says it’s thought the acne occurs because glands in a baby’s skin aren’t fully mature, so they have an inflammatory reaction and the skin becomes red and spotty. Nothing more than a very light moisturiser or emollient should be used on it, she stresses.
Resist the urge to pop pimples! Baby acne is temporary and will resolve on its own
— Baby Rash HQ (@babyrashhq) May 12, 2017
4. Sensitive skin
Williams says that for sensitive skin, the advice is similar to that for eczema. “If they have itch or discomfort, try to find out what might be causing it – the bath, creams you’re putting on the skin, washing powder, clothing dyes, and if you can identify what’s causing it, then you can eliminate it.
“Otherwise it’s not using perfumes or strong cosmetics, using purified wipes, and using a non-bio washing powder.”
Understandably, many parents are terrified when their baby gets a rash, because their first thought is that it could be a sign of meningitis – although Williams points out: “It’s a good thing there’s a general awareness that minutes make a difference when it comes to meningitis, but luckily meningitis is now reasonably rare, especially in fully immunised children. But I’d encourage every parent to make sure they know how to do the glass test.”
She explains that to do the glass test, if a baby has a red or purply rash, push a glass over it and look what happens to the rash as you do it. If the colour disappears – or ‘blanches’ – it’s a reassuring sign. But if you apply pressure with the glass and the colour remains, that’s non-blanching – and your should get medical advice quickly.
She stresses: “With any rash that doesn’t blanch, even if your child seems reasonably well, it’s important to get it checked out by a healthcare professional.”
The so-called "meningitis rash" isn't raised or itchy, because it's not really a rash at all. It's actually damaged blood vessels leaking beneath the skin.
It's important to remember that the "rash" doesn't always appear. If you're concerned, do not wait for a rash. pic.twitter.com/pfKhp03SYw
— Meningitis Research (@M_R_F) January 30, 2020
Other rashes, that do blanche, may not be so concerning and Williams says of these: “It’s about a bigger picture than just the rash – if the child is completely well, with no other symptoms except the rash, there are so many common rashes. Often it’s a reaction to the child having a virus and it’s the immune system causing the rash, it could be a mild allergy, or just skin irritation.”
She says there are hundreds of different ways rashes can look – they can be red, white, purple, flat and smooth, or bumpy and rough, and may be accompanied by heat, or might even feel colder. “My advice is take a photo of it and maybe even a short video, run your fingertips over the rash and explain what you can feel – does it feel smooth, bumpy, hot or cold?” she asks. “Then, if you see a doctor about it, or if it comes back months later, you’ve got that documented.
“If you’re worried your child is seriously unwell, use emergency services, but if they have a rash and you’re just not sure, contact your GP or 111 to arrange to speak to someone to get it checked.”
Dr Zoe Williams is helping to launch the WaterWipes ABC of baby skin www.waterwipes.com/uk/en/community/abc-baby-skin, which aims to provide practical advice, checked by a dermatologist, on how to care for common baby skin conditions. The information provided should not be considered a diagnostic tool, and for any concerns, parents are advised to speak to their healthcare provider.