Kid Doc — Good Job Being the Mom!
A fun and informative podcast for all the challenges parents face in raising their brood!
Kid Doc — Good Job Being the Mom!
Skin Part 3--Baby Skin
In this episode we cover care for newborn and infant skin.
SKIN PART 3—BABY SKIN
IN THIS LAST EPISODE ON SKIN, WE COVER ALL THINGS RELATED TO BABY AND INFANT SKIN. ISN’T BABY SKIN JUST THE BEST?!
ARE THERE ANY CHALLENGES TO START OFF AS WE TALK ABOUT BABY SKIN?
SO THIS WOULD INCLUDE ALL LOTIONS, SOAP, SHAMPOO, DETERGENTS, FABRIC SOFTENERS AND THEY NEED TO BE HYPOALLERGENIC.
LET’S START WITH THE BRAND-NEW NEWBORN. THEY HAVE BEEN UNDERWATER FOR 9 MONTHS SO THEY WILL LOSE THEIR FIRST LAYERS OF SKIN.
WHAT CAN PARENTS DO FOR MANAGEMENT—ESPECIALLY WHEN THEY HEAR IN THE NURSERY TO NOT PUT ANYTHING ON THE BABY’S SKIN?
ARE THERE ANY OPTIONS FOR PARENTS TO USE CONSISTENTLY?
WHEN SHOULD THE FIRST BATH TAKE PLACE?
THEN GOING FORWARD, HOW OFTEN SHOULD A CHILD BE BATHED?
WHAT TYPE OF PRODUCTS SHOULD WE THINK ABOUT REGARDING THEIR HYGIENE?
LET’S MOVE NOW TO DIFFERENT SKIN FINDINGS THAT PARENTS MAY WONDER ABOUT. LET’S START FROM THE NEWBORN PERIOD AND WORK OUR WAY BACK.
WHAT IS MILIA ?
HOW ABOUT THE ANGEL KISSES AND STORK BITES?
AND THEN YOU HAVE THE COMMON
RASH THAT HAS THE NAME THAT YOU DON’T LIKE--ERYTHEMA TOXICUM
YOU DESCRIBE IT AS LOOKING LIKE FLEA BITES.
WHAT OTHER BIRTH MARKS SHOW UP EARLY?
WHAT ABOUT THE BIRTH MARKS FORMALLY KNOWN BY THE NAME "Mongolian spots”
NOW LET’S MOVE TO PROBLEMS THAT ARISE WITH CARING FOR INFANT SKIN. THE FIRST TOPIC WOULD HAVE TO BE DIAPER RASHES.
LET’S START WITH COMMON IRRITANT DIAPER RASH AND GO FROM THERE.
BECAUSE THIS RASH COMES FROM IRRITATION, THE SOLUTION TO FIXING IT IS TO HAVE A GOOD ENOUGH BARRIER.
YOU LIKE THE ANALOGY OF PUTTING ON THESE PRODUCTS “AS THICK AS WEDDING CAKE FROSTING”
WHAT ABOUT CLEANING THE SKIN?
SO WE HAVE A MNEMONIC USING A-B-C-D-E FOR SKIN MOLES BUT THIS ALSO APPLIES TO DIAPER RASH CARE:
Air
Barrier
Cleansing—mild, hypoallergenic products
Diaper—change as often as every 2 hours
Education
ANY PRODUCTS FOR EXTRA SEVERE CASES?
Coloplast Brand
Critic-Aid Skin Paste
Product #1944
ANY PRODUCTS TO AVOID?
ARE THERE DIAPER BRANDS TO AVOID?
ONE THINGS THAT MIMICS COMMON IRRITANT DIAPER RASH IS A DIAPER YEAST INFECTION. HOW DOES A YEAST INFECTION APPEAR DIFFERENT FROM DIAPER RASH?
WHERE DO YEAST INFECTIONS COME FROM?
HOW DO YOU TREAT IT?
ANY STEPS UP IF NOT IMPROVING?
LAST ON DIAPERS IS BACTERIAL INFECTIONS. HOW DO THESE LOOK?
ANOTHER VERY COMMON PROBLEM IS CRADLE CAP.
SO WE CAN TREAT IT THE SAME WAY?
THE KEY AS YOU SAID IS THE AMOUNT OF TIME THAT THE MEDICATED SHAMPOO IS IN CONTACT WITH THE SKIN
ANY OTHER PRODUCTS THAT ARE HELPFUL?
AND THEN WE HAVE A SKIN CONDITION THAT SHOWS UP JUST IN TIME FOR BABY PICTURES—BABY ACNE
WHAT DO WE NEED TO DO TO MANAGE BABY ACNE? ANYTHING?
HOW LONG DO WE EXPECT THIS TO LAST
SKIN PART 3—BABY SKIN
IN THIS LAST EPISODE ON SKIN, WE COVER ALL THINGS RELATED TO BABY AND INFANT SKIN. ISN’T BABY SKIN JUST THE BEST?!
It really is amazing this baby skin that is so dynamic.
ARE THERE ANY CHALLENGES TO START OFF AS WE TALK ABOUT BABY SKIN?
It is important to note that although baby skin is just the best—it is THINNER than adult skin and more prone to irritation from products that touch their skin
SO THIS WOULD INCLUDE ALL lotions, soap, shampoo, detergents, fabric softeners AND THEY NEED TO BE HYPOALLERGENIC.
Yes. This theme will come up this entire episode—everything that touches their skin should be hypoallergenic, all products should be fragrance-free and made for sensitive skin
LET’S START WITH THE BRAND-NEW NEWBORN. THEY HAVE BEEN UNDERWATER FOR 9 MONTHS SO THEY WILL LOSE THEIR FIRST LAYERS OF SKIN.
I plan on some peeling for 2-3 weeks with the worst cracking and bleeding at wrist and ankles.
And this can be tremendous flaking since they have been underwater for 9 months—those first layers of skin are coming off not matter what while they look like they have leprosy
WHAT CAN PARENTS DO FOR MANAGEMENT—ESPECIALLY WHEN THEY HEAR IN THE NURSERY TO NOT PUT ANYTHING ON THE BABY’S SKIN?
I think the advice is well-intentioned because we can find baby products that are not tolerated well. We just don’t want potential irritants and having babies absorb the chemicals in the products. I find it INTERESTING that Products made for babies can be the worst for babies
ARE THERE ANY OPTIONS FOR PARENTS TO USE CONSISTENTLY?
We can safely use the hypoallergenic, fragrance- free products. Especially when there is a Family History of eczema—we see some benefit from daily use of heavy petrolatum-based product or heavy hypoallergenic cream
in the first several weeks to help prevent eczema
WHEN SHOULD THE FIRST BATH TAKE PLACE?
Recommendation is for the first bath after 24 hours to prevent getting them cold too early and to maintain their protective layer of vernix for a little longer
THEN GOING FORWARD, HOW OFTEN SHOULD A CHILD BE BATHED?
Bathing only as frequently as needed—usually no more often than 2-3 times each week.
WHAT TYPE OF PRODUCTS SHOULD WE THINK ABOUT REGARDING THEIR HYGIENE?
Know that there are many products that are used on their skin for cleaning, for bathing, for skin care—these can have fragrances, alcohol on wipes and scented lotions—if anything seems to irritate then move to a space that is hypoallergenic, with sensitive skin products with nothing to irritate. Clothes washing products should be “Free” products—Cheer Free, Tide Free, and Dreft
LET’S MOVE NOW TO DIFFERENT SKIN FINDINGS THAT PARENTS MAY WONDER ABOUT. LET’S START FROM THE NEWBORN PERIOD AND WORK OUR WAY BACK.
WHAT IS MILIA ?
Milia is the little while bumps that shows up in the newborn and lasts 3-4 weeks, it is retained keratin or clogged pores around the nose usually. It resolves on it’s own.
HOW ABOUT THE ANGEL KISSES AND STORK BITES?
These are a nevus simplex—we see them as angel kisses on face, and stork bites at neck; they fade in the first year or two. Interestingly the angel kisses fade well from the face but stork bites may stay for longer at the neck. Later in life, we can still see them with hard exercise or maybe when the child gets mad.
AND THEN YOU HAVE THE COMMON RASH THAT HAS THE NAME THAT YOU DON’T LIKE.
Erythema Toxicum is a terrible name for this rash—it just sounds toxic and scary but it isn’t.
This is a normal newborn rash that comes from trapped white blood cells—shows up in the first few days
YOU DESCRIBE IT AS LOOKING LIKE FLEA BITES.
Yes and I promise parents that there are no wild dogs with fleas in the nursery.
It will last about two weeks and then resolve.
It will go down in some spots and come up in others.
It does not bother the baby at all--it only bothers the parents
You don't need to treat the rash in any way.
WHAT OTHER BIRTH MARKS SHOW UP EARLY?
An Hemangioma which is a collection of immature blood vessels that become more obvious and raised up by a couple months of age and will get larger until about 1 year of age and usually involutes at that time.
Observation only--no intervention needed.
WHAT ABOUT THE BIRTH MARKS formally known by THE NAME "Mongolian spots”
These last until about age 1-2, dark bluish and are frequently on the back and lower extremities. I like to document these to prevent a parent from being judged by others as they can look like abusive lesions
NOW LET’S MOVE TO PROBLEMS THAT ARISE WITH CARING FOR INFANT SKIN. THE FIRST TOPIC WOULD HAVE TO BE DIAPER RASHES.
LET’S START WITH COMMON IRRITANT DIAPER RASH AND GO FROM THERE.
With common diaper rash it is located where stool can get on their skin. Seen mostly with increased number of stools OR if the skin is sensitive and needs more frequent diaper changes and some babies skin is more sensitive than others.
BECAUSE THIS RASH COMES FROM IRRITATION, THE SOLUTION TO FIXING IT IS TO HAVE A GOOD ENOUGH BARRIER.
I can’t emphasize enough the importance of providing a good barrier on the skin while it is healing. There are various barrier options to help with healing.
Petrolatum and Zinc are the mainstays of barrier products. Zinc is my favorite (antibacterial and anti fungal, alternate with petrolatum, I like that it is opaque so you know where the protection / barrier is);
petrolatum—non-allergenic, about 40%
CeraVe Healing Ointment, Aquaphor
YOU LIKE THE ANALOGY OF PUTTING ON THESE PRODUCTS “AS THICK AS WEDDING CAKE FROSTING”
As a barrier we need to go big and really protect the skin so that no stool can come in contact with the skin. Everyone understands the simile of being thick like wedding cake frosting. If you can see baby's skin between diaper changes then it isn’t being protected and the skin can get worse every time they get stool on their skin.
WHAT ABOUT CLEANING THE SKIN?
Try to keep the area clean and dry with frequent diaper changes— just remove the soiled area of zinc and then apply more
Wash bottom with water at least once daily and give some air time out of the diaper
SO WE HAVE A MNEMONIC USING A-B-C-D-E for skin moles but this also applies to diaper rash care:
Air
Barrier
Cleansing—mild, hypoallergenic products
Diaper—change as often as every 2 hours
Education
ANY PRODUCTS FOR EXTRA SEVERE CASES?
Coloplast Brand
Critic-Aid Skin Paste
Product #1944
ANY PRODUCTS TO AVOID?
No baby powder—talc lung
Have recommended antacid like mylanta or Mallox mixed with desitin—no data that it is more helpful
Have stayed away from essential oils out of concern for contact dermatitis but some may tolerate them well—if you
ARE THERE DIAPER BRANDS TO AVOID?
Interesting that there isn’t one diaper brand that causes the most problems—some diapers are just bad for some babies and a change of brand can be helpful. Also interesting that a positive change usually is away from name brands and toward generic diapers. There can just be something in some diapers that irritates that child.
ONE THINGS THAT MIMICS COMMON IRRITANT DIAPER RASH IS A DIAPER YEAST INFECTION. HOW DOES A YEAST INFECTION APPEAR DIFFERENT FROM DIAPER RASH?
When yeast is complicating a diaper rash you can tell some by the Color—beefier red, and with satellite lesions. Often they will have thrush as well
WHERE DO YEAST INFECTIONS COME FROM?
Yeast is everywhere—it likes a warm damp area which is the definition of the diaper area. It doesn’t have to spread from any place else.
HOW DO YOU TREAT IT?
Will treat topically with Lotrimin / clotrimazole OTC 3-4x/day until resolved. The 3-4 times daily is important—we can see failures from treating too infrequently. Also can use topical ketoconazole as a prescription.
ANY STEPS UP IF NOT IMPROVING?
I ask parents to follow-up if rash persists or worsens. I will add an oral anti-yeast medication—Fluconazole / Diflucan — for a couple of weeks
LAST ON DIAPERS IS BACTERIAL INFECTIONS. HOW DO THESE LOOK?
Typically we see individual sores or blisters with staph after having a diaper rash for awhile.
And these need topical or oral antibiotics to help them resolve if not improving with a parent’s good care at home.
With strep we will see Perianal strep which is a bright red target right around their anus
ANOTHER VERY COMMON PROBLEM IS CRADLE CAP.
Cradle cap is essentially a baby version of dandruff
SO WE CAN TREAT IT THE SAME WAY?
Essentially. I recommend using a dandruff shampoo of your choice. There are a few marketed as tear-free. Just be sure you don’t use a product with salicylic acid which is absorbed through the thin scalp skin.
But the key is that you cannot just wash their hair with it—it needs to be in contact with the skin for a long enough time to make a difference. Massage in at the start of bath, leave on for duration of bath, rinse off at the end.
THE KEY AS YOU SAID is the AMOUNT OF time that the medicated shampoo is in contact with the skin
And then it takes about 4-6 weeks to see resolution. And I recommend continued use maybe once a week for maintenance.
ANY OTHER PRODUCTS THAT ARE HELPFUL?
For resistant cases I will recommend either OTC hydrocortisone or up to 2.5% Rx hydrocortisone
AND THEN WE HAVE A SKIN CONDITION THAT SHOWS UP JUST IN TIME FOR BABY PICTURES—BABY ACNE
We all know from teenage years that acne is all about hormone changes. Because a baby has the mother’s hormones going through them and then when the cord is clamped the adult hormones rapidly go away and then the acne comes on.
WHAT DO WE NEED TO DO TO MANAGE BABY ACNE? ANYTHING?
Observation is probably the best recommendation. We can use the lowest strength adapalene to help with clogged pores if needed and lasting longer.
Because eczema frequently runs along with this, go ahead and treat the dry, flaking areas with hydrocortisone OTC strength.
HOW LONG DO WE EXPECT THIS TO LAST
Last from about 3 weeks until 3 months of age with a peak at about 6-8 weeks
WELL THIS WRAPS UP OUR THREE EPISODES ON SKIN. WE WILL HAVE MORE MULTI-PART EPISODES TO COME
