This episode is all about skincare. Dr. Carole Keim MD walks you through the ways newborn skin is different from all other babies’ skin and goes into detail on birthmarks, jaundice, baby acne, eczema, cradle cap, and diaper rash. She explains why newborn skin is prone to dryness and peeling, what milia is and how it will go away on its own, the causes and helps for jaundice, and shares much useful advice. 

One of the first things to know about newborn skin is that because they’ve basically been in a bath for nine months, their skin will be dry and peely as it adjusts to the outside world. Have you heard of stork bites, angel kisses, Mongolian spots, or port wine stains? These are all types of birthmarks that Dr. Keim explains in detail. She also details how hemoglobin from extra red blood cells converts to bilirubin in the body, and bilirubin causes the yellowish tint we know as jaundice. Dr. Keim tells exactly what to look for and what to do for your baby.

Covered in this episode: 

• Newborn skin
• Newborn rash
• Pustular Melanosis / normal rash
• Milia
• Birthmarks
• Hemangioma
• Jaundice
• Baby acne
• Seborrhoeic dermatitis / cradle cap
• Eczema
• Diaper rash

Newborn skin / newborn rash 0:33

• Dry and peely is normal 
• Newborn rash looks a little like chickenpox: red spots all over
• Newborn rash is not itchy or painful and happens usually within first 3 days of life
• No lotion or product required - only a greasy emolient if dry and cracking at wrists or ankles

Pustular Melanosis / normal rash 1:51

• Tends to happen in babies with darker skin tone
• Looks like newborn rash but tiny blisters are smaller - tiny pustules with yellowish fluid inside
• When they pop they leave behind a little freckle
• Freckles go away on their own
• Should go away in a week - if persists beyond week, talk to doctor

Milia 2:44

• Looks like pimples on nose, upper cheeks, forehead
• Is not pimples but is tiny white, pinpoint size, dots
• Do not pick or squeeze, could hurt baby or scar if you do
• It’s essentially skin cells trapped under the skin that form tiny white bumps - almost like clogged pores but not quite
• Will go away on its own and is not dangerous

Birthmarks 3:24

• Present either at birth or a few days or weeks after birth - normal
• Salmon patches - also called stork bites or angel kisses - can show up anywhere on body and usually fade within the first year of life 
• Sometimes scalp and back of head salmon patches never fade
• Sometimes when babies cry, especially with patches on forehead or eyelids, they’ll get redder and brighter - this is normal
• Mongolian spots - also called slate grey nevus or dermal melanocytosis - are light blue grey in color, almost like bruises
• They show up frequently from birth in low back area but can really be anywhere
• They tend to fade within the first five years of life
• More common in babies with darker skin tone, normal, and kids outgrow them
• Port wine stains - dark red, flat area of skin - usually on face or upper body, but not always
• Not dangerous but sometimes associated with other conditions
• If your baby has a port wine stain your doctor may want to do a genetic workout but many times it’s nothing
• Treatment is not necessary for port wine stains but some families opt for it for cosmetic reasons

Hemangioma / infantile hemangioma 6:00

• Similar looking to port wine stains but are raised and lumpy
• Are a collection of blood vessels
• If you press on it, it may go lighter colored or white then turn back to red
• Tend to grow quickly - within first 6 months of life - then start to involute or crumble within themselves and shrink back down
• Typically by age four there might be a bit of color left, might not, might be different texture to skin area or might not 
• Hemangiomas are often not treated but depending on location may require treatment - hemangioma on eyelid or near airway (“beard distribution” area) could overlay vital structures and cause baby to not see out of affected eye or close airway
• Doctor can check for internal hemangioma with ultrasound
• Treatment may be beta blocker or laser therapy - consult doctor

Jaundice 8:16

• Yellowish color of skin and eyes and is common among babies
• Reason: babies are born with extra red blood cells, some maternal red blood cells release hemoglobin when broken down which converts to bilirubin
• Bilirubin is what causes the yellow color of skin and eyes: jaundice
• Bilirubin can be checked for with tests via light and special device (transcutaneous bilirubin) or blood test (serum bilirubin)
• Phototherapy is bright light therapy that breaks bilirubin down into form that can be peed out
• Normally bilirubin just leaves the body via eating and evacuation
• You can feed them more - you can expose baby to sunlight indoors (not outside) in patch of sunlight while feeding
• Jaundice needs to be treated either at home or by doctor because high bilirubin levels can actually be dangerous
• High bilirubin (levels 20 to 25) can get into the baby’s brain and cause brain damage, seizures
• You can always catch bilirubin before it’s at that level - always watch for it, you can see the yellowish tint by level 10 or 12
• No association between Vitamin D and jaundice - sunlight breaks down bilirubin which decreases jaundice but Vitamin D does not treat jaundice, no association there
• Vitamin K shots do not treat jaundice either
• If your baby had delayed cord clamping or cord pumping, it is not related to Vitamin K or jaundice but can be related to less anemia - that is a separate thing and an OBGYN conversation
• Risk factors for jaundice - Coombs positive antibody which comes from mom and baby having different blood types resulting in baby making antibodies for mom’s blood - Coombs positive can cause bilirubin to rise
• Baby not eating well is also a risk factor for jaundice because if they are dehydrated, bilirubin can go up - preemies are also at risk

Baby acne 14:14

• Can happen on face, chest, back - looks like little red dots or sometimes pimples like regular teenage acne
• Typically related to hormones, sometimes in breast milk - not a reason to stop breastfeeding
• Baby acne is completely cosmetic, doesn’t hurt baby, doesn’t itch, and goes away by itself
• Do not use adult products on baby’s skin - no acne medications, they will dry out baby’s skin and possibly burn - just bathe normally, once or twice a week

Seborrhoeic dermatitis / cradle cap 15:05

• Happens on the scalp - greasy, flaky, yellowish whitish plaques stuck to skin
• Most common in first 6 weeks of life but can be seen in two or three year olds
• Cosmetic; skin thinks it’s too dry so overproduces sebum
• Treat it by putting something greasy on top of it - olive oil or Vaseline or aquifer in petroleum - apply to scalp - tricks skin into thinking it produced enough already, stops overproduction, and loosens plaques so they can be gently brushed away with baby brush
• It can come back - it’s cosmetic and not dangerous

Eczema 16:40

• Common in babies
• Tends to run in families that have history of asthma, allergies, and eczema
• Starts as dry patch of skin, typically on areas that rub like cheeks and backs of arms and legs
• Eczema is itchy and does bother them, they may be fussy or rubbing
• They may scratch with baby nails - scratching releases more histamine which makes you more itchy which can lead to worsening and a flare up
• Treatment - keep skin really moisturized - only bathe them once or twice a week with unscented soap or just plain water bath - after bath put something greasy like emmalin petroleum aquifer or unscented lotion and reapply throughout day
• If eczema is really bad, check with doctor - may need medicated cream or food allergy test

Diaper rash 18:28

• Irritation in diaper area because of moisture and friction
• Use over the counter diaper cream
• A lot of diaper creams contain zinc oxide which helps heal the skin but if those also irritated baby’s skin - if diaper rash isn’t improving with zinc oxide diaper cream - try petroleum-based cream or calendula cream (Aqua, AMD, Vaseline)
• Greasy ones work by creating a barrier and preventing more moisture from getting in
• Diaper rashes can get infected with yeast or bacteria - candida infections are common
• Candida infections look like bright pink or reddish rash in pale skin babies, and deep pigmentation or pink and through with satellite lesions in darker skin babies
• First treatment for candida infection is dry area out - leave off diaper as much as possible
• Also antifungal cream - ringworm cream or jock itch cream, or best idea is medicated cream from doctor
• If rash lasts more than two or three days or has boils or pustules, that is typically a bacterial infection - needs special treatment with ointment and if it recurs over and over, treat entire family
• Diaper free time is encouraged - wipes only for poop, water wipe or wet washcloth is fine for just urine
• Consider potty training from birth - addressed in Episode 9 about Tummy Troubles

Dr. Carole Keim hopes this guide to normal baby skin care is useful and helps alleviate regular questions or concerns. All of this information is also in The Baby Manual book. But remember: it is always ok to call your doctor’s office with questions if you’re worried.  

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• Episode 9 - Tummy Troubles

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