Blotches, Spots, and All: Caring for Your Baby’s Brand New Skin

New babies often develop little yellow spots known as milia. They may look nasty, but panic not: They’re usually harmless and clear up without treatment.

One of the most common forms of milia are yellow pinprick spots over the nose and forehead. Rather charmingly (not!) they’re also known as neonatal acne. They are caused by an excess production of oil (sebum) stimulated by your hormones during pregnancy. As the effects of these hormones fade, so will the spots.

A light sprinkling of creamy-white spots on your baby’s face or body may be tiny cysts containing a protein called keratin. As long as you leave them alone, the cysts will pop open and disappear within six weeks.

Apart from keeping your baby’s skin clean with warm water and cotton wool, you don’t need to do anything to treat these little blemishes. Never try to burst, pick, or pop spots, because this can cause nasty infections. The spots will fade gradually as your baby’s skin settles down in its new environment.

Regarding rashes

Babies in baby magazines seem to have perfect skin but this has more to do with photographic techniques than nature – most babies have at least a few imperfections on their skins, and rashes of all sorts are very common. Fortunately, most rashes are nothing to worry about, and disappear on their own over time. As long as your baby is well in all other respects, doesn’t have a fever, and is feeding normally, you don’t need to rush for help. Get advice from your doctor or health visitor if the rash doesn’t settle after a few days, or if your baby is unwell.

It’s absolutely vital that you know how to recognise the rash caused by the meningococcus bacteria, which causes meningitis (thankfully, meningitis is very rare, despite all the media coverage). The rash of meningococcal infection usually causes a deep red, blotchy rash, associated with a very poorly baby. As a rule, any rash that fades when you press a glass against it is not the meningitis rash. If it doesn’t fade, or if your baby is drowsy or generally unwell, get medical help immediately – a delay could be fatal.

Erythema toxicum
Around half of all newborn babies develop erythema toxicum, a rash that appears in uneven red patches over the skin, especially on the back, chest, and stomach, in the first two or three days after birth. At the centre of each patch, you may notice a little blister, which may look sore or infected. The cause of this rash is not known – it’s probably just your baby’s skin adapting to its new environment – but it’s harmless and will disappear on its own within a few days.

The best thing you can do is leave the rash alone. Creams and ointments may irritate your baby’s skin, so steer clear unless your doctor advises you otherwise.

Cooling down heat rash
A bright red bumpy rash in the folds of your baby’s skin or where his clothes fit tightly is probably a heat rash. This develops when your baby becomes so hot that his pores clog up, causing irritation. Although heat rash isn’t serious, it’s very itchy and a sign that your baby’s too warm. Try the following to soothe your baby’s heat rash:

• Give your baby a cool bath, place damp flannels over the irritated areas, and leave him naked for a while.
• Use calamine lotion to soothe your baby’s itching skin, but avoid other lotions and ointments, as they can clog the pores even more.
• Don’t let your baby get too hot. Stay in the shade on hot days and dress him in loose, light clothing. If he develops a high temperature (37.5°C/ 99.5°F), you can give him infant paracetamol, but always follow the instructions. If his temperature stays high, contact your GP.
• If your baby’s skin flares up, remove a layer of his clothes to help him cool down.

Focusing on birthmarks

Birthmarks are incredibly common: About one in three babies is born with a birthmark, but no one quite knows why. Birthmarks come in a huge assortment of sizes and colours, ranging from pale yellow to deep blue, but they rarely need medical attention: Only around one in 100 birthmarks needs treatment. Here are some of the most common birthmarks:

• Stork bites. About one in 40 babies is born with these small, pinkish marks, often on the back of the neck. The marks (also called salmon patches or angel kisses) usually disappear by the age of two years.
• Strawberry naevi marks. These bright red raised marks can change shape and size and can feel quite lumpy. They tend to appear around two to three weeks of age and grow rapidly up to the age of six to nine months. Strawberry naevi often appear on the face and neck, but they may also appear on the trunk and groin. Strawberry marks fade away untreated by the age of six or seven years. Rarely, if the mark is in a dangerous place, such as the throat or the eye, your doctor will want to treat it, perhaps with steroid treatments or surgery.
• Port-wine stains. These flat marks are purple-red in colour and often appear on the face. They are usually present at birth and can cover a large area of skin. Port-wine stains may grow with the child, but they don’t alter radically in shape or size. The only treatment for port-wine stains is removal by laser. This usually starts before the age of two years. Up to six treatments, spread over three years, may be needed to remove the port-wine stain completely.
• Mongolian spots. These bluish-grey patches of skin, found on the lower back and buttocks, are particularly common in Afro-Caribbean, Asian, and Southern European babies. They are completely harmless and usually disappear in early childhood.

If you’re worried about a birthmark, get medical advice. Your GP can tell you whether you need to worry, or whether you can let the mark disappear in its own good time.

Dealing with dry areas
Some babies, particularly those who are born late, have an outer layer of skin that looks shrivelled like a raisin and peels off unaided shortly after birth. Many parents worry that this dried skin is a sign of eczema, but this is rarely the case.

On the whole, it’s better not to use anything on this sort of dry skin unless your baby is irritated or troubled by it – dry areas usually settle down on their own. If you must use a moisturizer, make sure it’s unperfumed.

Tackling cradle cap head-on
Cradle cap is characterized by thick scales of skin on the head. The scales may be yellowy-brown in colour or may just look like dead skin. Sometimes the whole head is covered, but cradle cap often affects only a small patch of the scalp. Many parents worry unnecessarily about cradle cap. Cradle cap may be unsightly, but it’s not serious: It doesn’t harm your baby and, contrary to popular opinion, isn’t a sign that your baby has eczema. Cradle cap usually clears up on its own within a few days or weeks, although it may recur. When your baby’s hair has grown and thickened, you’ll probably no longer notice any of those scales.

Cradle cap is though to be caused by overproduction of sebum, an oily substance secreted by the sebaceous glands in the scalp that keeps the skin oiled and healthy. If cradle cap spreads beyond the scalp, it is known as seborrhoeic dermatitis.

You don’t need to treat cradle cap, but if you want to try to remove it, the following can help:

• Soften the skin on your baby’s head by gently rubbing olive oil or petroleum jelly into his scalp after his evening bath. Leave overnight to allow the dry skin to soften. In the morning, wash his hair with a gentle baby shampoo and rinse thoroughly: Shampoo will dry the skin if you leave any behind. Towel-dry your baby’s hair and then brush or comb it with a soft brush or round-toothed comb, gently removing the scales of cradle cap. Repeat this treatment every day until all the scales have gone.
• A number of shampoos available from high-street pharmacies have been specially formulated for treating cradle cap. If you do try one of them, stop using it immediately if you notice your baby’s skin becoming red or irritated.