Expert baby skincare advice: your questions answered

We held a webchat on baby skincare with an expert to help you help your children.

Julie Van Onselen is an Independent Dermatology Nurse, and consultant expert* kindly offered to be available to answer your questions.

For those that missed it, here’s Julie’s baby skincare expert advice:

For the best baby skincare, is it true that you should bath your baby in water only?

Water only is not necessarily the best way, water alone (especially hard water) has been shown to irritate and dry the skin. This is because water has a neutral pH, which is alkaline, compared to the normal acid mantle of baby skin. However, a midwife-led research study looked at whether water only was best and found no differences between using water only or a suitable pH balanced baby cleanser.  On a practical level, sometimes water only may not be an effective cleanser, especially for the genital area. So whether you use water alone or a pH balanced baby cleanser is totally up to you.

Is it true that vernix should be left to absorb naturally after birth?

The vernix caseosa is a white cheesy substance that covers and protects the skin of the foetus, from 18 weeks and is still all over the skin of a baby at birth. Vernix caseosa is composed of sebum (the oil of the skin) and cells that have sloughed off the foetus’ skin. After birth, it helps to hydrate skin, so can be left to absorb naturally, so it is not necessary to remove it. However, this should not prevent the newborn being bathed or wiped with water. There are also cultural preferences regarding the removal or absorption of the vernix, which should be respected.

Because my little one was born late, her skin is very dry and cracked. What’s the best way to treat this?

If your baby’s skin is dry and cracked, you should use emollients for washing, bathing and moisturising. Avoid all soap and bubble baths. I would suggest you take your baby to see your health visitor and ask her to recommend and prescribe emollients for your to apply liberally to your baby’s skin, a bath oil and a medical moisturizer (which can be used as a soap substitute). Keep using the moisturizer at every nappy change. If your baby’s skin does not improve, the dryness and cracking does not resolve, or if your little starts itching and rubbing, do take your baby to see your GP for further assessment.

What are the best products to use for baby massage?

The traditional olive oil is commonly recommended for baby massage but there is no evidence to support this practice. A research paper in 2012 showed that olive oil could potentially damage the skin barrier and promote the development of atopic eczema, due to high levels of oleic acid. Further research is required on other vegetable oils but the olive oil study suggests that in general oils with low levels of oleic acid and high levels of linoleic acid, such as sunflower oil may be more preferable. A good choice is mineral oil, as it is highly purified and manufactured to pharmaceutical-grade and as effective as other massage oil. If you have a family history of eczema, asthma or hay fever or your baby has already developed eczema, I would advise medical moisturisers (emollients) are used for baby massage, do ask your health visitor for more advice on emollients.

My 6 week old is suffering from baby acne – what is the best way to treat it?

Baby acne generally affects the cheeks, and sometimes the forehead and chin, it is thought to be genetic in origin. It is more common in boys and is usually mild to moderate in severity. In most babies it settles down within a few months, so often it is best to leave alone. However, if you are concerned or the acne is not resolving, do discuss with your GP, as occasionally treatment may be prescribed.

My son’s neck has become very sore from dribbling milk, how can I help to prevent this and to treat it?

This is such a difficult area due to neck folds combining with milk dribble. Try and keep your son’s neck clean and wipe with a cotton pad and water after each feed. Then apply a thick layer of greasy emollient as a barrier; perhaps try a medical paraffin based moisturiser (do ask your health for advice on what she would recommend). Apply a fresh dry bib or bandana to try and catch dribble and change these throughout the day. If his neck is red and sore, I suggest you seek advice from your GP, who may prescribe a treatment cream (or ointment). Don’t be afraid of using a prescribed cream, as this will reduce the redness and soreness and short bursts of treatment won’t do any harm, even to a delicate area. Your son’s neck will improve (and she will dribble less) – especially when he has stopped teething too, so his neck will improve in time.

My daughter has started to develop cradle cap, is there anything I can do to stop it developing any further and to get rid of the scaly skin?

Firstly cradle cap will generally resolve by six months, but you may be able to reduce the scaling, by firstly using a mild baby shampoo and tepid water with finger tip gentle massage to loosen loss scales and crusts. Then massage mineral oil or a greasy emollient ointment into the scalp and leave in overnight and then shampoo out again, repeating 2-3 times a week. If your daughter’s cradle cap doe not clear, consult your health visitor or GP since it may be due to some other skin problem.

My twins have just come down with chicken pox! Help!! What do you think is the best way to relieve the itching and help recovery?

Chickenpox in babies and children is considered a mild illness, but this depends on the child and I am sure your twins are pretty miserable and irritable, especially as the spots are incredibly itchy. It’s important for children to not scratch the spots, to avoid future scarring. Calamine lotion is always recommended but actually a bland moisturising cream kept in the fridge and applied cool, is more soothing and what I would recommend. Do cut their fingernails put long socks over your twin’s hands at night to stop them scratching as they sleep. If they are not sleeping and scratching at night, do discuss sedating antihistamines with your GP. Once the pox have crusted over, usually in 5-7 days, the itch should subside; but keep moisturising to remove scale and keep the skin comfortable.

My baby has really sore nappy rash that I just can’t seem to get on top of with the usual barrier creams – is there anything else I should be doing?

If your daughter’s nappy rash is very sore and problematic, firstly do ask your GP or health visitor to examine her nappy area, as it is possible that she may need some prescribed treatment for a diagnosed skin condition or bad nappy rash. I would advise using very bland medical emollients rather than barrier creams, until the very sore skin has resolved. So, my advice would be to wash and cleanse her bottom with a bland medical moisturising ointment. Use the moisturiser on cotton pads for cleaning her nappy area and apply all around her bottom before bathing, which may also help stop the water from stinging. Moisturise her bottom at every nappy change, use generously. Do ask your health visitor or pharmacist to recommend a moisturising ointment. Avoid all soap (although you can use pH balanced baby cleansers) and any perfumed moisturisers or one’s containing SLS. When her bad nappy rash has settled, you can return to using a nappy barrier preparation, to try and prevent further nappy rash.

How often should I bath my baby?

Babies do not necessarily need to be bathed daily, the Royal College of Midwives recommend twice –weekly baths until the baby is crawling. However, lots of parents find the nightly bath a special bonding time for them and their young baby and research has also shown that a evening bath is associated with as calming effect and helps settle the baby for the evening and improve sleep. So, how often you bathe your baby (and the timing of the bath) is totally up to you – bathing practices also vary between cultures too. Remember to bathe your baby with either water alone or a pH balanced skin cleanser, avoiding soaps and bubble baths.

My 7 month old has eczema and we have prescribed creams etc to help treat it, but is there anything else you can recommend?

I am sorry to hear your baby has eczema. It is important to use your prescribe eczema creams when eczema is flaring (red and sore skin) for short periods; and use lots of emollients on a constant daily basis, to control dry and itchy skin. There are several trigger factors for eczema, which are often individual, common ones includes soap, detergents and bubble baths, changes in season and temperature, especially going into to autumn and turning on the heating, so learning about common trigger factors may help. On a practical level, if you are not sure about the prescribed creams, do ask your health visitor to run through how to use all the creams, where to apply, how much to use and when to stop the eczema treatment creams. Sometimes knowing how to exactly use prescription creams can make all the difference. You should use lots of emollients everyday, several times a day for washing, bathing and moisturising. If you would like more eczema advice, I highly recommend The National Eczema Society, they have a helpline where you can speak to an adviser on 0800 089 1122 and a website with lots more practical advice and information.

I’m 7 months pregnant and struggling with extreme itching all over my bump – it’s driving me crazy is there anything I can do about it?

If you have extreme itching at 7 months, you should discuss with your midwife and see your GP for assessment. Itching in pregnancy does occur due to skin conditions or sometimes cholestasis (a build-up of bile). There is an itching condition of pregnancy called Pruritic Papules and Plaques of Pregnancy (PUPPP), a transient itching condition of pregnancy, which develops in the third trimester. I would advise your itching is diagnosed. In the meantime, do use lots of medical emollients, and apply liberally, creams are probably better and you can keep then in the fridge, which makes then more cooling. If the itching getting worst and your skin is becoming red and sore, your GP may prescribe you eczema treatment cream and possibly a sedating anti-histamine to take at night, both are fine to use in pregnancy and may help reduce redness and itching. The good news is that once your baby is born the itch and the rash will resolve quickly.