Skin findings in newborns Information | Mount Sinai
Newborn skin characteristics; Infant skin characteristics; Neonatal care - skin
A newborn infant's skin goes through many changes both in appearance and texture.
Newborn infants may have Erythema toxicum, a rash that is characterized by patchy redness with central vesicles. The rash is temporary, and the location may move (transient). (Image courtesy of the Centers for Disease Control and Prevention.)
It is common for a newborn to have fine, soft, light-colored hair called lanugo covering the forehead, cheeks, shoulders and back. Some newborns also have enlarged sebaceous glands appearing as small white dots on the face called milia. Both of these characteristics are normal and will disappear after a few weeks.
Milia is seen in a newborn infant as tiny, white, elevated spots in the skin. On occasion, there may be a narrow red halo around the base. This is a normal and self-limiting condition of the newborn and disappears over a period of months.
Cutis marmorata is a common phenomenon in newborn infants. It consists of alternating areas of dilated and constricted blood vessels, which gives the skin a red and white marbled appearance. It is most obvious when the skin is cool.
Miliaria crystallina occurs when sweat is retained in the pores in the skin. This close-up photograph shows the tiny, clear blisters that rupture easily. There is no associated inflammation, so no redness is present under or around the blisters. This condition often occurs in newborn infants.
Miliaria crystallina occurs when sweat is retained in the pores of the skin, producing tiny, clear blisters that break easily. There is no associated inflammation, so no redness is present under or around the blisters. This condition often occurs in newborn infants and can cover an extensive area of the body.
Miliaria crystallina occurs when sweat is retained in the pores in the skin, producing tiny, clear blisters that rupture easily. There is no associated inflammation, so no redness is present under or around the blisters. This condition often occurs in newborn infants and can cover an extensive area of the body.
The skin of a healthy newborn at birth has:
Deep red or purple skin and bluish hands and feet. The skin darkens before the infant takes their first breath (when they make that first vigorous cry).
A thick, waxy substance called vernix covering the skin. This substance protects the fetus's skin from the amniotic fluid in the womb. Vernix should wash off during the baby's first bath.
Fine, soft hair (lanugo) that may cover the scalp, forehead, cheeks, shoulders, and back. This is more common when an infant is born before the due date. The hair should disappear within the first few weeks of the baby's life.
Newborn skin will vary, depending on the length of the pregnancy. Premature infants have thin, transparent skin. The skin of a full-term infant is thicker.
By the baby's second or third day, the skin lightens somewhat and may become dry and flaky. The skin still often turns red when the infant cries. The lips, hands, and feet may turn bluish or spotted (mottled) when the baby is cold.
Other changes may include:
Milia, (tiny, pearly-white, firm raised bumps on the face) which disappear on their own.
Mild acne that most often clears in a few weeks. This is caused by some of the mother's hormones that stay in the baby's blood.
Erythema toxicum. This is a common, harmless rash that looks like little pustules on a red base. It tends to appear on the face, trunk, legs, and arms about 1 to 3 days after delivery. It disappears by 1 week.
Colored birthmarks or skin markings may include:
Congenital nevi are moles (darkly pigmented skin markings) that may be present at birth. They range in size from as small as a pea to large enough to cover an entire arm or leg, or a large portion of the back or trunk. Larger nevi carry a greater risk of becoming skin cancer. The health care provider should follow all nevi.
Mongolian spots are blue-gray or brown spots. They can emerge on the skin of the buttocks or back, mainly in dark-skinned babies. They should fade within a year.
Café-au-lait spots are light tan, the color of coffee with milk. They often appear at birth, or may develop within the first few years. Children who have many of these spots, or large spots, may be more likely to have a condition called neurofibromatosis.
Red birthmarks may include:
Port-wine stains -- growths that contain blood vessels (vascular growths). They are red to purplish in color. They are frequently seen on the face, but may occur on any area of the body.
Hemangiomas -- a collection of capillaries (small blood vessels) that may appear at birth or a few months later.
Stork bites -- small red patches on the baby's forehead, eyelids, back of the neck, or upper lip. They are caused by stretching of the blood vessels. They often go away within 18 months.
Bender NR, Chiu YE. Dermatological evaluation of the patient. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 664.
Narendran V. The skin of the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 94.
Walker VP. Newborn evaluation. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 25.
Last reviewed on: 12/10/2021
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Newborn Skin 101 | Johns Hopkins Medicine
Odd rashes, suspicious crusting and bumps that crop up from out of the blue are all common afflictions of newborn skin that rarely portend something ominous and are easy to treat. Yet, they have scared many first-time parents into calling their pediatrician after hours or rushing to the emergency room.
“Neonatal rashes tend to develop suddenly and have a dramatic appearance that can easily frighten a rookie parent, but luckily most of these are completely benign,” says Johns Hopkins Children’s Center dermatologist Kate Püttgen, M.D.
Offering her dual expertise as a mom and pediatric dermatologist, Püttgen discusses newborn skin care and the most common skin problems in newborns.
What is it? Neonatal dandruff, also known as seborrheic dermatitis, is extremely common but the cause isn’t fully known. It tends to occur in areas rich in oil glands in the first three months of life.
How to treat? Most cases of cradle cap require nothing more than gentle washing and observation and clear up on its own. Petroleum jelly or olive oil can help relieve some of the crusting.
When to call the pediatrician? If crusting persists or gets worse over time, your pediatrician may prescribe an antifungal cream or shampoo.
What is it? Skin irritation marked by red inflamed patches or bumps on baby’s buttocks and genital area. Fungal infections can cause diaper rash . Another common cause is skin inflammation caused by exposure to stool and urine. Harsh soaps, sweat, moisture or diapers that are too tight can also cause a rash or worsen an existing rash.
How to prevent and treat? Change diapers often and as soon as the baby urinates or has a bowel movement. Wash your hands before and after you do so. Always dry baby’s skin thoroughly. Applying petroleum jelly or zinc oxide-based cream with each diaper change can be helpful. Never use talcum powder. Avoid perfumed baby wipes or wipes that contain alcohol. Keep the diapers loose. An antifungal or mild corticosteroid cream used for short periods can speed up healing.
When to call the pediatrician? If the rash doesn’t get better within a few days, spreads further, becomes oozy or if your baby develops fever — a sign of infection — it’s time to see a doctor. A fungal infection should be suspected in all babies taking antibiotics, which can disrupt the balance between good and bad bacteria and cause yeast overgrowth.
What is it? A benign condition that affects the majority of newborns in the first days and weeks of life. Hallmark signs of the condition are yellowish papules surrounded by red skin on the face and trunk, upper arms and thighs.
How to treat? Typically no treatment is needed. The rash will clear up on its own within a few weeks.
When to call the pediatrician? If your baby has signs of erythema toxicum, an exam can confirm the diagnosis and provide reassurance.
The basic rules of neonatal skincare, Püttgen says, are “less is more” and “bland and simple.”
Less is more
Babies don’t need an elaborate skin care regimen and barely any products. Keep bathing to a minimum to avoid stripping the skin of its protective natural oils. A bath twice or three times a week is sufficient.
Bland and simple
Baby skin is highly absorbent so it’s critical to use fragrance-free, hypo-allergenic products. Avoid perfumes and dyes, which can seriously irritate newborn skin.
Extra-fragile preemie skin warrants special attention. Premature skin does not hold moisture well, which makes it thinner, drier and breakage-prone, Püttgen says. She recommends applying petroleum jelly daily to lock in moisture and strengthen the skin’s barrier function.
Sun protection is another topic that causes a lot of confusion, Püttgen says. “Parents know that sun protection is critical, yet many are hesitant to use sunscreens,” she says.
Avoiding sun exposure is the best protection, Püttgen says. Use physical barriers like clothing, hats and stroller covers anytime you take baby outside. Sunscreens, though generally harmless, should be avoided when possible because the Food and Drug Administration has not studied their safety in infants under 6 months of age.
If sun exposure cannot be avoided, opt for fragrance-free, hypo-allergenic sunscreens that list zinc oxide and/or titanium dioxide as active ingredients. Known as physical sunscreens, these two ingredients block UV rays. By contrast, chemical sunscreens with active ingredients like octylcrylene, avobenzone, octinoxate, mexoryl and octisalate, tend to absorb and “disarm” UV rays before they can damage the skin.
How a newborn baby changes - articles from the specialists of the clinic "Mother and Child"
Mother and Child Clinic South-West, Mother and Child Clinic Kuntsevo,
The baby was born, and we expect him to look like beautiful and pink babies from advertising pictures. And he is some kind of red, then suddenly turned yellow, on the skin or a rash, or peeling. In addition, the weight is still unstable, the chair is incomprehensible - is the child healthy? Healthy, and all these changes are the so-called transient (transitional) states. Where do they come from, what do they look like and what to do with it all?
The child sat in the mother's stomach for nine months, swam in the water and received oxygen through the placenta. As soon as the baby was born, his world immediately became different: instead of water around him, air, the ambient temperature dropped from 36.6-37 ° C to 22-25 ° C, plus gravity, sounds, smells, bright light. And now you have to breathe (lungs) yourself, eat differently, and then also remove metabolic products. And just like that, it is not easy for a newborn to immediately switch from one lifestyle to another, it takes time. That is why, from the point of view of physiology, in the first month of life, “something happens all the time” with children, and much more often and brighter than in later life. These are the transitory (transitional, boundary) states. All of them surprise and even frighten young parents, especially since transition states appear and disappear very quickly. But for newborns, they are completely natural. What moms and dads see most often are transitional states of skin, stool, weight, plus or minus a couple more conditions.
How the skin changes
The child was born, and we see that he is all sort of bluish-purple, and then his skin color immediately turns red. On the second day after birth, the baby "blushes" the brightest. Doctors call this redness "erythema simple" and it appears due to the fact that the skin adapts to a new environment. Then the child's skin turns pale and by the end of the first week of life it becomes the pale pink color we are used to.
But that's not all. On the third or fifth day of life, the baby's skin may begin to peel off, especially on the abdomen and chest. What's this? Does the child lack vitamins, something with nutrition, is the air too dry in the house? No, this is also a transitional state - physiological peeling, and it is also associated with the fact that the skin is adapting to a new life. The skin flakes for about a week, and then everything goes away. You don't need to do anything with it. Of course, you can treat the skin with various softening lotions and creams, but there will be no significant effect from them. Very soon, the baby's skin will become smooth and soft on its own.
Most of all, parents are afraid of a rash on the baby's skin, which does not often, but sometimes still appears in the first week of life. This is the so-called toxic erythema - spots with grayish-yellow seals in the center. The rash is most often located on the extensor surfaces of the arms and legs around the joints, on the chest. Less often, such spots can be on the whole body (except for the palms, feet and mucous membranes). “Maybe it’s chickenpox, rubella, or some other disease?” parents are afraid. No, this is a kind of reaction of the skin of a newly born baby to its environment, especially to hypothermia, overheating, contact with clothes, food. Within one to three days, new spots may appear, but more often two or three days after the onset, they all disappear without a trace. At the same time, the child’s well-being is not disturbed, the body temperature is normal and he does not need any medication. The only thing is that you need to take care of the bubbles on the skin: for example, gently blot them after bathing. And you also need to make sure that the bubbles do not rub and they do not burst (otherwise an infection may join them).
The changes that are visible on the skin do not end there. Very often (in 60-70% of children) on the second or third day of life, the skin turns yellow, the maximum of yellowness occurs on the third or fourth day, and by the end of the first week it disappears. This is how physiological jaundice of a newborn is manifested - a condition in which the amount of bile pigment, bilirubin, increases in a child. In some children, jaundice is similar to a light tan (parents may not notice it), while in others, the skin will turn bright yellow. Very quickly, the level of bilirubin returns to normal and the skin color becomes normal again. If jaundice is mild and passes quickly, then no additional treatment is needed. But if jaundice does not disappear or the skin color is intense yellow, you should consult a doctor.
Do you think the baby will immediately be born well-fed, with folds and cute roundness? No, right after birth, this is still far away. In the first days of life, an already not too well-fed newborn will lose even more weight. Such weight loss is a natural process, the so-called physiological weight loss. Weight decreases because immediately after birth, the baby loses part of the water through the skin, its umbilical cord dries out, meconium (the first feces) and urine are excreted, and also because the baby still eats a small amount of milk. Maximum weight loss usually occurs by the third or fifth day and is normally no more than 6-8% of birth weight. At this time, mother and baby are usually discharged from the hospital, but there is no need to worry. By the seventh or tenth day of life, a healthy baby will restore its previous parameters.
On the first or second day, all newborns pass the original stool (meconium): it is thick, viscous and dark green in color. Time passes, the baby begins to receive colostrum, and on the third or fourth day of life, a transitional stool appears. Now areas of dark green color alternate with greenish and yellow ones, and some lumps, mucus are also visible in the stool. It all looks like some kind of intestinal disorder, but it's not. It's just that the gastrointestinal tract is moving to a new job, now it's ready to digest food. By the end of the first week of life, the stool in most children is yellow, similar to gruel, and it will continue to be so.
A typical fear of all grandmothers is that the child is freezing! Yes, indeed, in newborns, the body temperature regulation processes are still imperfect, so babies easily cool down, but they also overheat just as easily. For example, if a newborn is dressed too warmly or placed next to a heating battery, he will quickly overheat, even if this is the usual temperature in the room. At the same time, the child easily loses heat when he is undressed for a long time or he lies in wet clothes. Therefore, in the room where there is a newborn, the air temperature should be adequate - 20-22 ° C. And if she rises higher, and the child is warmly dressed, then this will also not be good.
Sometimes, very rarely (in 1% of newborns), body temperature on the third or fifth day may temporarily rise to 38–39 °C. There are no other symptoms of the disease, the body temperature quickly returns to normal, but the parents have time to get scared. It’s difficult to figure out what it is - temporary hyperthermia or still a disease - it’s difficult, so it’s better to call a doctor.
An uncommon occurrence, but it also occurs occasionally. In some children, on the third or fourth day of life, the mammary glands become engorged (in both girls and boys). They increase as much as possible by the seventh or eighth day, and liquid discharge may even appear from them. Some girls have very little bloody discharge from the vagina for a very short time. This is the so-called hormonal crisis - it occurs due to the action of maternal hormones - estrogens (they penetrate through the placenta during childbirth). At the peak of estrogen action, the signs of a hormonal crisis are maximum, then the hormones are removed from the body and the symptoms gradually disappear. Therefore, you don’t need to apply a cabbage leaf to your chest, make compresses with camphor or something else: everything will pass by itself.
Usually, all these transitional states are pronounced in the first week of life, less often, but it happens that they drag on for up to three to four weeks. One more thing - it is not necessary that the child will show all transitional states, but almost everyone has physiological weight loss and transitional stools. And many of the transitional states are completely invisible to parents, but they also exist, they can simply be identified only by laboratory methods.
So we are not in a hurry to be frightened, noticing that the child’s skin suddenly began to peel off or he turned slightly yellow. We remember that he must adapt to a new life, that in the first time after birth, the baby has the right to some changes. Especially if, with all this, the baby is cheerful, calm and eats well. Well, if you are still somehow anxious, ask your pediatrician questions. He will definitely be able to put everything in its place.
The maximum weight loss in a newborn usually occurs by the third or fifth day and normally amounts to no more than 6-8% of body weight at birth.
From the point of view of physiology, in the first month of life, “something happens all the time” with children, and much more often and brighter than in later life. These are the transitory (transitional, boundary) states.
In infants, the body temperature regulation processes are still imperfect, so they easily become overcooled and overheated. In this regard, in the room where there is a newborn, the air temperature should be about - 20–22 ° C.
Physiological jaundice of the newborn:
occurs on the 2-3rd day of the baby's life, reaches a maximum on the 4-5th day, and disappears by the 10th day;
the general condition of the child does not suffer;
the level of bilirubin in the blood does not exceed 180 µmol/l.
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Newborn Skin Care - AMAE Clinic. Reception of children's doctors in Chelyabinsk
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Baby's skin is a unique natural barrier that provides protection from the effects of aggressive environmental factors. To maintain these functions of the epidermis, parents must pay close attention to the care of the skin of a newborn baby. But before that, it is necessary to study its features and common pathologies. Physiological features of the skin of a newborn The skin of infants is not much different from the skin of an adult. It also consists of the dermis and epidermis, which, in turn, is divided into five more layers. However, children's skin has some peculiarities:
due to the fragile connection between the epidermis and dermis, it is much more susceptible to infectious processes, signs of which are blisters and blisters;
in the first days after birth, she is distinguished by a neutral pH, which changes to acidic by 2-3 months;
due to the immature nervous system, the sweat and sebaceous glands of the skin are inactive, so during bathing it quickly becomes wrinkled;
weak resistance of the skin to microbes is explained by the low bactericidal properties of the secretion secreted by its glands;
the skin contains a large volume of water and many permeable vessels, which explains the low resistance to skin allergic reactions.
Despite this, the skin of young children manages to cope with protective, excretory, thermoregulatory and other functions. In the future, with proper care and normal physiological development, her abilities increase many times over.
Baby skin problems Due to physiological characteristics, infant skin is less resistant to certain diseases. In order not to worry about the well-being of the baby, parents should properly care for her, paying attention not only to the umbilical wound, but also to other parts of the body. In the absence of proper care for the skin of a newborn baby, the following processes develop:
Crusts on the head (gneiss, milky crusts) are dense and not very scaly growths localized in the scalp, ears, eyelids, nose and even groin. The reason for their appearance is excessive secretion of sebum.
Prickly heat is a small rash usually located in skin folds or areas of greatest friction "where the skin sweats". It may be accompanied by itching, redness, which does not affect the general condition of the child. It usually goes away on its own after a change in skin care, but sometimes a secondary infection joins it, in which case you just need to see a doctor.
Diaper rash can occur in neck folds, axillary and inguinal folds due to friction, contact with moisture in the absence of air circulation. In a mild form, it does not affect the general well-being, but without proper care it provokes ulcers, pustules, itching and malaise, and in this case it is also necessary to see a doctor.
Urticaria is a skin reaction accompanied by swelling, redness and blisters all over the body. This is how the skin usually reacts to allergens. They are eliminated with the help of antihistamines prescribed by a doctor (usually emergency care).
Neonatal acne - this rash is provoked by hormonal changes, which are affected by an excess of corticosteroids and testosterone in the mother's body. It does not require treatment and resolves within two weeks. Another such rash is called "blooming of newborns", it begins closer to a month and gradually disappears on its own. Rules for caring for the skin of a newborn.
As with adults, newborn skin care is different.
To keep her healthy, it is recommended:
make sure that the skin does not come into contact with urine and feces for a long time; do not use wet wipes when it is possible to wash the baby under running water
put on the child clothes made of natural materials with a minimum of seams;
control that the child is not exposed to high temperatures for a long time (dress according to the weather, do not wrap a blanket in a stroller from head to toe)
use baby cosmetics without preservatives, dyes and fragrances; do not use soap, even "Baby". Despite the name, it also dries out the skin.
practice air baths so that the baby’s skin can “breathe” normally: after washing, you need to blot (just blot) the baby’s skin with a towel and hold it in the air without clothes and a diaper for 10-15 minutes
put on a diaper 15-20 minutes after water procedures;
By following the basic rules of baby skin care, you can enhance all its functions and maintain that delightful feeling of gentle touch, comparable to the touch of silk or flower petals.
Choosing care products Newborn skin care should include special baby cosmetics, hypoallergenic, with a light texture that absorbs quickly and allows the skin to breathe. It is better to give preference to mild surfactants, as soap dries out the skin. Cosmetics for moisturizing children's skin should, in addition, soften it and strengthen the protective properties.
Pigeon. The funds are intended for bathing a newborn from the first days of life. Thanks to the exclusive formula and amino acid components, Pigeon cosmetics perfectly moisturizes and cleanses the skin, protects it from adverse external factors.
Mustela. Cosmetics restores, soothes irritated skin, normalizes skin balance. The microelement complex accelerates skin regeneration by stimulating cell renewal. The formula of the cream cleanses the skin, limiting the growth of bacteria. The natural active ingredient BioEcolia helps to maintain the protective microflora of the skin.
Weleda. The unique formula helps not only cleanse the skin, but also soothe a sensitive child, relax him and set him up for sleep. The product contains extracts of calendula, thyme and other medicinal herbs. With their help, you can accelerate the regeneration of the skin, cleanse the respiratory tract, strengthen the protective properties of the skin.
Natura Siberica. The soft formula is specially designed for the little ones, it does not irritate the eyes and nose when bathing. Organic burdock extract contains vitamin C and carotene, has anti-inflammatory and healing effects.
Merries. Merries lotion and cream moisturize delicate skin, protect it from dryness and irritation, including on the cheeks and around the mouth. It contains Cetyl-PG Hydroxyethyl Palmitamide, which acts like ceramide, it has a moisturizing effect, keeps delicate skin smooth and healthy.