Expert Q&A: Bathing and Soothing Baby’s Skin

An interview with Jeremy F. Shapiro, MD .

From the WebMD Archives

Guidelines for baby skin care can seem complicated -- full of recommendations about using this and avoiding that. But caring for baby’s skin isn’t really that difficult.

Sometimes new parents overdo it with products that aren’t necessary for babies.

To understand some of the best ways to care for your newborn baby’s skin, WebMD talked with Jeremy F. Shapiro, MD, MPH, FAAP. This California pediatrician and father of three discussed some of the top baby skin care questions he hears from new parents and what he recommends when caring for a newborn’s tender skin.

What are the three most common baby skin care problems, and how can parents solve them?

Diaper Rash: Never a day goes by without an office visit or phone call about diaper rash! There are many reasons for diaper rash. The most common include fungi or bacteria, pooping a lot, and dietary changes in the diet of the baby or breastfeeding mother.

No matter what the cause, I typically recommend that parents stop using baby wipes and instead use a warm-water cloth to clean the baby, then air-dry after each diaper change. I also recommend using a non-scented barrier cream to treat the rash. If the diaper rash gets worse, it’s important to talk with your pediatrician about further treatment.

I always remind parents to take comfort that diaper rashes will ultimately be gone forever because one day your child will no longer need diapers -- though it usually it takes a little time to get there!

Cradle cap: This is another common skin care problem and a very normal part of your baby’s skin development. Cradle cap doesn’t have a very pleasant appearance, but other than a little itching, it typically won’t bother your baby.

The No. 1 thing I do for cradle cap is to provide reassurance. Cradle cap will eventually go away. But if you really want to use something, try applying a little olive oil twice a day, let it sit for a few minutes, then brush off the flakes. If the cradle cap persists, a very low strength topical corticosteroid might be used, but definitely talk to your pediatrician before going further.

Baby acne : This occurs because of the transfer of maternal hormones across the placenta at the end of pregnancy, which increases the oil gland production on your baby’s skin. The acne itself typically occurs around four weeks of life. To treat baby acne, all I recommend is warm water and a clean cloth. Like cradle cap, baby acne also goes away in time.

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Are there common baby skin care mistakes parents tend to make?

Sometimes parents simply try to do too much. Doing less when caring for baby’s skin is very often more.

The thing to remember is that babies go from a fluid-filled environment to a much drier one. So during the first month, I prefer no creams or ointments be used on a baby’s skin. Even if baby acne appears, almost always nothing needs to be done. Parents just need to give their baby’s skin time to adjust to its new environment.

Also, although fragrances can leave a very nice scent, your baby’s skin can actually be very sensitive to them. This can result in a rash or increased nasal congestion. And be careful of “natural” creams or ointments -- just because it says “natural” doesn’t mean your baby’s skin will not be sensitive to it.

What sort of skin care does baby’s umbilical cord stump need, and what should parents do if the stump doesn’t fall off?

There is some debate about caring for the umbilical cord stump. One school of thought says that swabbing the cord with a triple dye right after the clipping and cutting is all that’s needed. The other school of thought suggests applying rubbing alcohol (70% isopropyl alcohol) to the base of the stump a couple times a day to keep the area clean and dry it out sooner. And a recent study says there may be no difference between the two treatments.

I recommend that alcohol be rubbed around the base of the stump a few times a day. I also recommend that parents:

  • Don’t pull on the umbilical cord stump at any time. You don’t want to cause a premature tear or bleeding.
  • Fold the top of the baby’s diaper away from the umbilical cord stump until the stump falls off.
  • Contact your pediatrician immediately if there’s odor, redness, or swelling at the stump site; if the baby has a fever; or if you see red streaking on the skin going toward the liver (the upper left). These may be a signs of infection.
  • When the stump does finally fall off, expect that the area will not look so great. In fact, a fleshy portion -- also known as an umbilical granuloma – may remain. If you have any concerns, always contact your pediatrician.

If the umbilical cord stump doesn’t fall off by four weeks, let your pediatrician know, as a follow up evaluation may be in order.

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What kind of baby skin care do you recommend after circumcision?

In the first few days following a circumcision, it’s important to follow the instructions of the person who performed the procedure -- whether it be the pediatrician, obstetrician, urologist, or mohel. Typically, you’ll put Vaseline or a similar ointment, or a topical antibiotic, around the circumcised site during diaper changes to keep the area nice and moist during the healing process. This will also prevent the circumcision site from sticking to your baby’s diaper.

After your son’s bowel movements, clean the circumcision site gently with warm water, but it’s best not to use washcloths or baby wipes during the healing period. Also, don’t give a bath to your newborn until the circumcision area has healed. And keep in mind that as it heals, it may not be the prettiest site. As long as there’s no odor or fever and the baby has a good urine stream, all is well with the healing process.

After the area has healed, gently pull back on the baby’s foreskin to prevent penile adhesions. It’s important that you see the glans (head) of the penis and the corona (the base of the penis head).

Which baby skin care products should parents avoid, and which are OK to use?

After the baby is about a month old, it’s OK to use a daily moisturizer, depending upon the dryness of the baby’s skin. Sometimes ointments are more effective than creams in keeping the skin moist.

I also prefer non-scented mild soaps and laundry detergents, avoiding fabric softener, and being careful with alcohol-based wipes and soaps.

How often should a baby be bathed and what’s the safest way to do it?

Before the umbilical cord stump falls off and if a circumcision is still healing, give just a sponge bath. Using a washcloth, gently wipe the entire body with warm water -- no soap or shampoo. And remember to keep the room an adequate temperature and have a towel nearby.

After the umbilical cord stump has fallen off and the area is dry, and after a circumcision site has healed, it’s OK to give your baby a bath in a baby tub. I’d love for both parents to partake in the first bath, as it really is an enjoyable experience and something you don’t want to miss out on.

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A few tips on the baby bath:

  • Fill the baby tub with just two inches of warm water.
  • Make sure there is always at least one adult there at all times. Even though the water is low, it’s very important to realize it doesn’t take much for the baby to slip and slide.
  • Use any body-stabilizing inserts that come with the baby tub. And don’t use a regular-sized bathtub until your baby outgrows the baby tub and is sitting stably without support.
  • Wash your baby with a gentle, mild soap and a tear-free shampoo.

Bathing babies every three days or so is just fine. But I’d let a couple factors determine how often your bathe your baby: whether or not you want to make it a daily ritual and whether the baby’s skin can handle it. If the baby’s skin dries out easily, every three days may be all that’s necessary. If the skin is tolerating a daily bath and it’s an enjoyable ritual (such as a way to prepare your baby for bedtime), then by all means continue it.

Are many parents concerned about parabens and phthalates in baby skin care products?

Yes, and there are two points of debate.

Parabens can be found in baby lotions, shampoos, and other baby skin care products. They function as preservatives to fend off bacteria and fungi. The concern lies in the fact that parabens can act like estrogen in lab experiments, raising a possible association with breast cancer.

Phthalates are more of an issue in toys than in skin care products, as they’re often used as a plasticizer. But they’re also found in a wide range of products, including detergents and perfumes. The concern is that they may affect hormone levels. In the U.S., bans are now being put in place for some but not all products containing phthalates.

WebMD Feature Reviewed by Brunilda Nazario, MD on June 09, 2009

Sources

SOURCE: 

Jeremy F. Shapiro, MD, MPH, FAAP.

© 2009 WebMD, LLC. All rights reserved.

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