Newborns come packaged in a thick protective skin lubricant called vernix caseosa. This thick “cheese sauce” protects and hydrates the skin and also has antibacterial properties. Vernix is not so appealing looking or feeling, especially covered in birth secretions, so it is quickly wiped away after birth and then washed away with the first antiseptic bath. Newborn skin is then left to its own defenses and is prone to drying and rashes.
Many pregnancies are celebrated with baby showers prior to the birth of new joy and one of the favorite gifts is luscious baby soaps, shampoos, and lotions. These delightful products enhance the smell of baby and create powerful fragrance memories of a delectable newborn. Unfortunately, these fragrances and other chemicals aren’t so good for baby’s skin.
My son left his new baseball mitt out in the yard and it was drenched by the sprinklers. After drying, the leather became rough and dry and began to crack (He gets to buy the next one!). The same wet-dry-cracking process happens with skin, especially the delicate skin of a newborn. Skin is dependent on hydration to maintain its integrity. It has natural lubricants to maintain moisture. One of the strongest lubricants that babies are born with is the vernix we wash away at birth. Soaps partially remove the oily lubricant barrier of the skin and water exposure, without lubricant application, has a drying effect. People who live in arid Utah are particularly susceptible to dry skin rashes due to low humidity.
ROUTINE SKIN CARE
- Don’t aggressively try to scrape off all the cheese after birth.
- Re-gift the baby skin products to someone else at their baby shower. Just kidding 🙂
- Use soap sparingly because any soap cleanser can dry the skin. My preference is Neutrogena transparent facial bar – fragrance free. My second preference would be Dove Sensitive Bar Soap – fragrance free. Bar soaps are usually less expensive than liquid soaps and contain fewer chemicals. Lather the soap in your hands and then apply it to baby’s skin. Bath sparingly or if you prefer to bath baby frequently, allow water exposure for 5 -10 minutes, and apply a moisturizer afterwards.
- The best moisturizer is pure Vaseline petroleum jelly because it lubricates well and has minimal chemical content. Aquaphor has less of a greasy feel than Vaseline and has a few more chemicals added, but is also very good. Don’t get anything that says baby on it because it likely has added fragrance. Avoid lotions because the alcohol base that creates the liquid consistency is also drying and irritating.
DRY SKIN CARE
- Dry skin becomes rough. At the first sign of rough skin, begin to apply lubricants. Once the natural moisture barrier is compromised it will take 3 – 4 lubricant applications a day to restore it. Thereafter, once a day lubrication can prevent further dryness.
- Stop any use of baby wipes until the skin is normal.
- Decrease soap use to once a week.
- Bathe mostly with water for 10 minutes to allow the skin to absorb moisture then pat dry and quickly apply lubricants after removing from the tub.
- Apply mittens to prevent facial scratches. No matter how short you trim the nails they can still scratch.
- Generally nail clipping is not necessary unless the nails become unpleasantly long. If you prefer to clip the nails be careful not to damage the delicate skin of the fingers.
- Consider using a fine emery board with gentle friction to shorten the nails.
- After the first three days of life the cord will begin to emit thick secretions from the base as it separates. Lift the cord and wipe out the drainage with a dry cotton swab.
- Avoid using alcohol or other cleansers on the cord as they prolong separation and increase the chance of infection.
DIAPER SKIN CARE
- Some babies have very sensitive skin and are prone to recurrent diaper rash. Routine bottom care with wipes containing alcohol for diaper changes will work for most babies.
- For mild irritation rashes use a lubricant with each diaper change to provide a mild barrier to urine and stool until the skin heals. Clean the skin with a wet washcloth and avoid baby wipes until the skin is normal. Once the skin heals, apply lubricant to the diaper area a few times a day.
- For severe irritation rashes use a thicker barrier paste with zinc oxide such as Desitin Maximum Strength. Apply a thick layer every hour (don’t awaken at night) until the skin heals.
- Bathing once a week is sufficient unless the baby is notably dirty or emits a foul smell.
- The umbilical cord or recent circumcision don’t preclude bathing, but this skin should not be soaked in the water as it can macerate the tissue and delay healing or increase the risk of infection.
- Make the temperature just slightly warmer than your skin. About 100.4 degrees Fahrenheit if you want to measure.
- If you bathe once a week or less and your baby is not prone to rashes you probably don’t have to routinely apply lubricant because babies natural skin oils will do the job.
- If you bathe more often than once a week, especially if you use soap frequently, you will likely need to apply lubricants after bathing.
- If your baby’s skin becomes dry, soak in the tub for 10 minutes to increase skin water, then trap the water in the skin immediately on emerging from the tub with Vaseline or Aquaphor.
- Any baby with a rash who acts ill or has a fever 100.4 rectal or greater should be seen immediately.
- If your baby acts well but has rough skin with a mild rash she probably has dry/sensitive skin. It is fine to lubricate a few times a day and decrease soaps and wipes.
- Any rash that is worsening or not improving will need to be evaluated by one of the Pediatricians at Canyon View Pediatrics. Most rashes are common and straightforward. Some are rare and indicate more serious underlying illness.
Congratulations on the birth of your new baby. Hopefully skin care will be one of those things you don’t have to worry too much about while you are enjoying your little one.
John Bennett MD FAAP
The AAP healthy children has some helpful ideas on skin care. https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/default.aspx