Transcription:
Newborn Baby Skin Care

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Nikhil Menon. He's an assistant attending pediatrician at New York Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Clinical Pediatrics at Weill Cornell Medical College Cornell University. We're talking today about newborn skin, infant eczema, so many things about newborn skin. I'm so looking forward to this.

Dr. Menon, welcome to the show. As we get into this topic and before we start talking about little babies, tell us a little bit about yourself and about your new practice at the Long Island City location.

Dr Nikhil Menon: Great. Thank you so much for having me. My name is Nikhil Menon. I'm a primary care pediatrician at Weill Cornell Medicine. We have a relatively new location in Long Island City where we, in our pediatric practice, see children of all ages. But in the practice, we also have adult and family medicine, OB-GYN, orthopedics, and radiology. It's a really beautiful space with great people. So I encourage anyone in the area to come check us out.

Melanie Cole (Host): Well, thank you so much for sharing that. So let's talk about those babies I love so much. What should a newborn look like? Tell us a little bit, Dr. Menon, about their appearance as it relates to skin.

Dr Nikhil Menon: Sure. Newborn skin is very sensitive. Just imagine, it's been surrounded by a very stable mix of water and nutrients for nine months, and then suddenly is exposed to a comparatively dry environment with dust and pollen and other things. So the first thing to know is that rashes are very common in newborns, even in the first few days of life. Luckily, these rashes tend to be transient and harmless and usually do not require any treatment to resolve.

The second thing to know, is that newborn skin tends to peel a bit, especially at the hands and feet. This is totally normal, especially can be more pronounced in babies born after 40 weeks and is completely harm. It often looks like dry skin, but it's not usually dry. And typically, the skin peels away over a course of a week or two, revealing a nice healthy layer underneath.

Melanie Cole (Host): I remember those days and those little rashes that show up here and there. And you're like, "What is that? What is that?" But I'm so glad that you cleared that up for new parents, that it's normal. And before we get into other newborn skin conditions, I just want to ask you about creams. Because a lot of times, when we're bathing our new babies or we're using those creams, when I asked my pediatrician about Baby Soft or one of those creams, she goes, "Well, it's pink," you know? And that was all she had to say about it. She's like, "No, there are other creams much better." For parents that are looking for those creams, for those things, do you have some recommendations?

Dr Nikhil Menon: I think the biggest recommendation that I have is to get whatever cream has the fewest number of ingredients and especially to avoid anything that has scents or typically anything that is scented. So things that I tend to recommend are plain Vaseline or Aquaphor or Eucerin, something that tends to be a very thick moisturizer that you get out of a tub and doesn't have a scent. Those tend to be the easiest on sensitive newborn skin.

Melanie Cole (Host): Thank you for saying that. So now, other newborn skin conditions. We've heard about cradle cap and, of course, we all know about the dreaded diaper rash. There's baby acne. There's all kinds of things. Can you tell us about some of those and if we can prevent them and your best recommendations if we do? I mean, diaper rash, wow.

Dr Nikhil Menon: Definitely. And I'll talk about all of those. So first step, because we see it the earliest, is neonatal acne, which is often called baby acne. It's very common. I see it almost every day. And typically, this occurs between two and six weeks old, and can last for a couple of weeks. For this one, no treatment is needed as it will usually resolve on its own. But sometimes for babies who have a bit more baby acne, we recommend daily washing with a gentle cleanser that may help speed the recovery. I also, as I mentioned earlier, recommend avoiding any scented cleansers or lotions as sometimes these can irritate the skin further.

The next one is cradle cap, and the medical term for this is seborrheic dermatitis. This occurs frequently on the scalp and tends to look like a dry, scaly area on the skin or dandruff. It's completely harmless as it is in adults and often will go away, but can take a much longer time, sometimes even months. For those cases that are mild or moderate, we either do nothing and just let it run its course. Or sometimes we recommend applying some baby oil and combing out the flakes with a soft brush, although this is usually more cosmetic and not really a medical benefit for the baby. For those uncommon cases that are more severe, I do recommend using a mild steroid cream or an antifungal shampoo to help alleviate symptoms. But these are only things that should be done under the guidance of a pediatrician.

And then, the last thing of course I have to mention is diaper rashes. So diaper rash is extremely common and it has two main cause. The first one, which is the most common, is too much moisture. The moisture-type rash can be prevented by doing frequent diaper changes and using a zinc-containing diaper cream in between changes. That zinc cream acts as a barrier between a wet diaper and the baby's sensitive skin, and this helps to prevent any skin breakdown.

But once a rash is present, the most effective treatment is exposure to open air rather than doing as much diaper cream as possible. So in those cases, once a rash has already developed, I usually recommend leaving the baby diaper-free for a while, or as long as parents are willing to risk it after each change. And if these measures aren't working, consider a visit to the pediatrician as we may have other things that may help and also may able to diagnose a second cause of diaper rash, which is a fungal infection. This is much less common, but does require a prescription cream to get better. And if you're ever in doubt, we're happy to take a look and help figure out the best treatment plan.

Melanie Cole (Host): Of course, you are, because we love our pediatricians. You guys help us to raise our children happy and healthy and safe. And that's what it's about. And parents, I remember those days with the diaper cream, just load that stuff up, man, and keep it from starting in the first place. I remember how thick we used to load that up. Wow. Now, pediatric eczema, that's a whole different thing. Tell us a little bit about what atopic dermatitis is, if we know what causes it. Tell us a little bit about that, doctor.

Dr Nikhil Menon: Definitely. Pediatric atopic dermatitis, which we often use interchangeably with eczema is a common skin rash of infancy and childhood. It's a chronic inflammatory skin condition that can lead to dry or scaly patches of skin that are often red and itchy. It can appear as early as a few months old. So sometimes, I see babies in the clinic who are just two or three months old who have eczema, and commonly occurs before age five, although it really can appear and affect children at any age.

Melanie Cole (Host): Do we know really anything about the triggers or diet or causes or genetics or any of that stuff?

Dr Nikhil Menon: We do. And the good news is that eczema has been researched by experts for decades. So what we do know is that eczema is caused by skin barrier dysfunction, meaning that the junctions between those skin cells don't hold together quite as tightly as they should. This means that moisture inside is allowed to escape through the areas between the skin cells and also irritants from the environment are allowed to enter. But as to what causes the dysfunction, this is a bit up to a person's genetics and the environment as well as chance.

And to go to your point about triggers, eczema is a very variable condition in that it affects everyone differently. It has many triggers, none of which cause eczema, but the triggers can make existing eczema flare up. Triggers are different for everyone, but these can include chemical irritants, like some ingredients in common soaps or detergents or sunscreens or lotions, as well as environmental irritants, like pollen or dust mites. And some other things that can cause it are heat or sweating and heat rashes.

And the last one, which I think you mentioned, is diet or food triggers. And this is a question that I get very frequently, is parents wondering if any foods cause eczema. But this is a common misconception because, as far as we know, there are no foods that cause eczema. But sometimes children do have a food trigger that may cause existing eczema to flare up. This is similar to children with asthma who have environmental triggers like dust mite or pollen. But again, the triggers do not cause the disease. In these cases where there's a potential food trigger, we often work closely with the pediatric allergist or dermatologist to identify the cause rather than eliminating foods from the diet, as sometimes that approach can be difficult to do and sometimes can do more harm than good.

And one last related note, I often get questions about whether breastfeeding moms can alter their diet to prevent food allergies or eczema in the baby, but this too has been studied and there's no evidence to suggest that maternal dietary restrictions during pregnancy or breastfeeding will reduce that risk.

Melanie Cole (Host): Well, thank you for adding that in and pointing that out. What a great point that is. And I remember the days my daughter had eczema on her hands and I remember loading up with Aquaphor, just Aquaphor, Aquaphor every day, and that worked pretty well for us. Now, how do you recommend parents manage eczema when they notice it, maybe they've gotten it diagnosed, maybe they've seen a pediatric dermatologist or their pediatrician? What do you recommend for management?

Dr Nikhil Menon: Every kids' eczema looks different, so we do have variety of recommendations for treatment. But this is where your general pediatrician comes in. We typically use a stepwise approach, meaning that we start with small interventions like Aquaphor and build up to see what will work. So the two initial steps that we do are we initially focus on avoiding triggers and strengthening the skin's protective barrier to prevent inflammation. This includes short daily baths with a gentle fragrance-free cleanser and warm water and moisturizing the skin at least twice a day, especially after bathing to help seal in that moisture. As I mentioned, thick moisturizers, like petroleum jelly or Aquaphor, tend to work better than thinner lotions. So those are the first two things, avoiding triggers and strengthening the skin's protective barrier.

But when flareups do occur, topical medications can be very helpful in quieting that inflammation by helping to reduce redness and itching. We usually start with a very mild topical steroid like hydrocortisone, which actually can be purchased over-the-counter. So that's why I start with those, they're quite mild. But sometimes a stronger prescription medicine is needed to get flareups under control.

And while we're talking about management, I do want to mention one question I get very frequently from parents, which is about the side effects of steroid medicines. Steroids tend to have a bad name for many reasons. But when used responsibly, they are quite safe and effective even in young infants as young as two or three months old. The steroids we use for eczema are in a class called corticosteroids, which are quite effective in decreasing inflammation and keeping kids comfortable. The side effects that most parents are worried about tend to be seen with long-term use of steroids and specifically with oral steroids, meaning medicine that's taken by mouth. But in most cases for eczema, we're prescribing short courses of topical steroids, meaning creams, which minimizes the chance of any side effects. And even so, they can cause issues when used for long periods of time, such as lightening of the skin or thinning of the skin. So we definitely recommend checking with your pediatrician before using even the over-the-counter medications.

Melanie Cole (Host): So then what? Then what is next? Do we see a pediatric dermatologist or does our pediatrician then switch us to that little bit higher medication? Because I remember those days of taking that cortisone and mixing it with a little Aquaphor and putting it right on that eczema, and it worked pretty well. But then what if it doesn't?

Dr Nikhil Menon: Exactly. So general pediatricians see eczema frequently. I see it many times a day and we're comfortable prescribing mild to moderate strength steroid medications. But sometimes these medications aren't quite enough to keep eczema under control. So at that time, we do refer to our dermatologist colleagues for additional guidance. The dermatologists tend to see more severe or refractory cases of eczema. And they're able to recommend either stronger topical steroid medicines or additional non-steroid therapies.

Melanie Cole (Host): So doctor, what an informative podcast this is. You're just giving us a wealth of great information about newborn skin. What about bathing and bathing those babies, with newborns? When is the first bath and the safest way to give that bath?

Dr Nikhil Menon: Sure. So in general, for babies without eczema, and this typically applies to all newborns because eczema doesn't typically show up for a couple of months, we recommend doing sponge baths right after birth until the umbilical stump has fallen off. Once the umbilical stump has fallen off and it's not oozing anything at all and it's completely dry, that's when parents can start with a full immersion bath. These baths should be in just plain warm water. You can use a gentle cleanser if you'd like, but it's not necessary. And I usually recommend baths a couple of times a week. It doesn't have to be every day.

For kids with eczema, it's actually a really interesting question because in the past, we used to recommend avoiding daily baths because we thought it might dry out the skin. But now, it does seem like there is a benefit to daily bathing for infants with eczema. But for them, it's important to keep bath times short and to use a very mild cleanser and avoid any irritants like bubble bath. Afterward, make sure to pat the skin dry and apply a thick moisturizer like we talked about all over.

Melanie Cole (Host): What great advice. Wrap it up for us, Dr. Menon. What would you like parents to know about newborn skin and eczema and looking to our pediatrician when we have questions about any little rash?

Dr Nikhil Menon: So one question I get often is will it go away? And for many children, eczema does eventually resolve. And in these kids, we see symptoms fading around age four. But as I mentioned, eczema is a really wide spectrum and so some children have their eczema resolve completely. While for others, it may improve a bit or not at all. And it's quite hard to predict which children will fall into each category.

The last thing I wanted to mention is that childhood eczema has been studied extensively for decades. And one thing is clear, there's no single quick fix for eczema. Having a good skincare plan, avoiding environmental triggers and using medicine when needed will all contribute to minimizing symptoms and keeping your children comfortable.

Melanie Cole (Host): Thank you so much, Dr. Menon. What an informative educational podcast this was. Thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify and Google Podcast. For more health tips, go to weillcornell.org and search podcast. And don't forget to check out our Back To Health. I'm Melanie Cole. Thanks so much for joining us today.

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