This article was written by:
La Terra Jackson | NCS, CLC, CIMT, BA Psychology and Human Development and
Laura Shiff | Copywriter
Published on April 15, 2019
I came across a frantic mom in one of my online groups whose son had gotten a diaper rash at three weeks old. She began bathing him every night, being sure to thoroughly clean his diaper area. A few days into this routine he also broke out with cradle cap, so she added a nightly shampoo to the regimen. The detail that stood out to me was her desire to prove she was a diligent mom. She mentioned that she’d been careful and persistent but still failed to prevent the suffering her baby was going through.
The fact is, skin issues are far more dynamic than that. Also, as one pediatrician told me, rashes are the common cold of neonatal dermatology. We are collectively either without blame or equally blamable; no mom needs to heap on any extra guilt. But, what may be helpful is to ask what she could do, given the likelihood that a skin issue will be part of her newborn experience.
In this post, I am going to cover some of the biggest skin issues newborns are at risk of having and what parents can do to prevent them. I am also going to look at the research behind common infant skin care products and what works best for newborns’ delicate skin.
Atopic Dermatitis in Infants
Skin conditions have reached epidemic proportions in children worldwide and are greatly increasing in prevalence. One of the most common is atopic dermatitis.
Atopic dermatitis, also referred to as eczema, is a chronic inflammatory skin disease that typically appears as a red, itchy rash on the cheeks, arms, or legs. Typically beginning in the first six months of life, atopic dermatitis is severe and long-lasting. While it may disappear as a child gets older, it will usually be a lifelong condition with flares throughout adulthood.
Once the barrier of the skin is disrupted, whether through genetics, environmental exposures, or simply dryness from cleansing, it can initiate a trajectory of atopic dermatitis that triggers the development of food allergies, asthma, and hay fever. This chain of reactions is typically referred to as the “atopic march”.
Emollient therapy is currently the best way to prevent atopic dermatitis from occurring in the first place as it not only improves the skin barrier but it also helps to block the inflammatory cascade. Emollients are moisturizers which come in various forms, including lotions, creams, ointments, and gels.
It is imperative to prevent infant skin problems because the progression is very hard to stop once the skin has been compromised.
There are a few different terms that are important to understand when talking about infant skin care and skin care products:
Essential oils: natural chemicals extracted from plants
Unscented: products formulated to have no scent, but can contain ingredients used to mask instead of imparting scent
Fragrance-Free: no ingredients added for the sole purpose of imparting scent, but can include fragrances added for another purpose such as a preservative
Natural: products composed of ingredients that come from natural products. They may be structurally identical to chemical ingredients so that they have the same properties
Organic: ingredients that are grown without the use of synthetic pesticides and fertilizers
Hypoallergenic: products that avoid ingredients that often cause an allergic reaction after exposure to the ingredient
When it comes to skincare, it can be difficult to filter through all of the information out there regarding what is true and what is just a myth. There are some common myths that new parents often hear when it comes to infant skincare:
Myth: Natural is safe.
Truth: Natural ingredients may have the same chemical structure as a chemical alternative and therefore have the same impact on skin health, whether positive or negative.
Myth: Natural or organic labeling is a safety standard.
Truth: An ingredient’s source is only one consideration of its safety; unfortunately, many natural and organic ingredients are commonly allergenic for adults, infants, or both. For example, coconut oil is a tree nut that may cause an allergic response, while peppermint and lavender are known irritants. It is important to look beyond whether an ingredient or product is organically soft and ask whether it is generally recognized as safe given neonate specific skin vulnerabilities.
Myth: Preservatives lack any protective function.
Truth: A common source of staph infection is contaminated changing table products. Preservatives serve to prevent bacteria growth from contamination on a parent’s hands.
Choosing what products to use for different skincare routines is oftentimes another challenge for parents and caregivers alike. Newborns and infants are known for their fragile skin, but that doesn’t necessarily mean that everything marketed “safe for newborns” is automatically a good choice.
Depending on the specific skin ailment, one might consider using a soap, a type of lotion or oil, or even diaper rash cream, but in what scenario is it best to utilize these and is it always safe?
Look for bath soaps that are mild, effective at removing soil, have a skin-comparable pH close to 7.0, have a pH and saline concentration similar to tears, and are made with minimal dyes and fragrance. Why: Babies have a slow blink reflex (20-60 seconds compared to an adult’s 11 seconds) which means they are less able to protect and clear harmful intrusions to their eye.
Lotions, oils, and moisturizers
In a recent pilot study, infants who received twice daily moisture therapy with an emollient like Aquaphor beginning in the first week of life were dramatically less likely to develop atopic dermatitis, perhaps by as much as 85%. Neonates who were given infant massage with oil were 50% more likely to make eye contact, three times more likely to have a positive expression, and had improved sleep quality and quantity when the massage was part of a bedtime routine.
Diaper rash ointments and barrier creams
Researchers in a NANN study (National Association of Neonatal Nurses) recommend only removing the soiled areas of diaper cream versus removing all of it each time a diaper is changed. Researchers warn that scrubbing diaper cream and ointment away might worsen the skin breakdown of the diaper rash. Instead, they suggested oil could be used to remove any feces fragments that are stuck to the skin, then reapply the diaper cream.
Few parents are familiar with barrier films even though they have been a popular subject of controlled trials. The same NANN study recommends Cavilon No-Sting-Barrier Film which can be used for newborns beginning at 28 days. It provides a protective film for the skin that prevents contact with urine and feces. Sureprep No-Sting Protective Barrier was recommended by researchers as a safe, water-based alternative without age restrictions.
Diaper wipes are a replacement for wash clothes and water that were once the common means of cleaning a newborn’s diaper area.
NANN researchers point to evidence that water alone may be insufficient to remove stool in the diaper area, whereas wipes have ingredients that are intended to help the cloth glide across the skin to minimize friction. More, the average wipe today was found to be alcohol-free and well within the pH range of healthy newborn skin, which may or may not be an advantage over water alone as the slightly acidic wipe may help to restore any pH imbalances contributing to diaper rash.
The popular brand WaterWipes has only two ingredients: water and grapefruit extract (for the acid). At the time of the NANN study, no controlled trials of Waterwipes had been conducted to determine its safety, however, the researchers did note that any wipe that is free of preservatives, like WaterWipes, should be used by the use-by date on the package because there is increased risk of microbial growth with contamination.
Diapering powders have proven to contribute to respiratory conditions in newborns when inhaled. More, powders feed the Candida bacteria responsible for yeast diaper rash. NANN researchers recommended discontinuing any use of talcum powders.
Another important factor for parents and caregivers to consider when thinking about infant skincare issues is the ingredients included in each specific product they have chosen to use. While many of the ingredients listed will have no direct effect on irritating baby’s skin, some of them can indeed be problematic and may trigger or even further exacerbate existing skin issues. Two of the ingredients people typically have the biggest concerns over are fragrances and preservatives.
There were the types of fragrances identified in the NANN study: Essential oils are derived from plants, natural fragrances are derived from natural sources, and synthetic fragrances are man-made.
One challenge parents encounter is the myth that essential oils and natural fragrances are inherently safe. As an example, the essential oils rosemary, peppermint, and bergamot have been labeled as allergens or irritants. Any essential oil applied directly to the skin can be an irritant given the concentration.
A second challenge for parents is the counterintuitive meaning of the terms ‘fragrance-free’ and ‘unscented.’ Neither term means a product is free of fragrance. Instead, a fragrance-free product is one that does not use any ingredient for the purpose of imparting a scent. Unscented products may contain fragrances that are added to mask the scent of the formulated product rather than for the goal of imparting a scent for the consumer.
As a rule of thumb, any product label including essential oils or fruit or flower distillate waters on the ingredient list is a scented product.
Skin care companies add preservatives to products in part to deter the microbial growth. Contamination can happen during the manufacturing process or during use. Products that contain water are especially vulnerable and often contain preservatives or use by timeframes.
Contamination can happen when dipping into the same container repeatedly, rubbing a palm against a tube opening, or touching a pump mouth. Preservatives are added to deter microbial growth in these cases. Some of the contaminants found in changing table products are Candida which is responsible for yeast rash, Staphylococcus aureus, which causes abscesses and boils to develop in compromised skin, and Pseudomonas Aeruginosa, responsible for fever and infection.
Preservatives have become a loaded topic, especially parabens that have been linked to a number of endocrine-implicated health concerns. The NANN study recommends parents choose products that are labeled ‘free-from’ or low in parabens and also have demonstrated safety with neonates and newborns. These products will typically have a shorter shelf life, however. Parents will need to pay close attention to the shelf life printed on the packaging and throw away the unused portion after the expiration.
Where to Learn More About Infant Product Safety
Oversight: Consumer Information Groups
- The Environmental Working Group/Skin Deep Database
- The Personal Care Product Council (pcpcouncil.org)
- Cosmetic Ingredient Review (cir-safety.org/ingredients)
- Cosmetics Info (cosmeticsinfo.org)
Oversight: The FDA
- At the time of the NANN study, the FDA had approved just 18 over-the-counter ingredients as skin protectants. For families wishing to judge whether a product meets FDA standards that list is a convenient gatekeeper to their child’s nursery.
Although there are no primary prevention strategies yet identified for skin issues like atopic dermatitis, proper moisturizing has been shown to be a secondary preventative effect. With this in mind, there are some best practices laid out by leading experts that parents and caregivers should keep in mind when taking care of infant skin.
- The relative moisturizing effects of different formulations are: ointments > creams > lotions.
- Fragrance-free products are best for patients with AD.
- Products should contain the least possible number of preservatives (but
still, be effective in the prevention of contamination).
- Preservatives can be natural or synthetic, as long as their safety profile is documented.
- Cleanse the skin with a fragrance-free non-soap cleanser prior to applying moisturizer.
- Moisturize twice daily, more frequently if appropriate.
- Apply immediately after bathing, i.e. while the skin is still warm and damp.
- Apply to the entire body irrespective of whether dermatitis is present.
- Use of a greasier moisturizer may be necessary in low humidity environments.
- Consider use of lighter moisturizers for heat-rash-prone areas (e.g. torso) in warm climates.
- Pay attention to high-risk areas, i.e. lower limbs, heels, and feet
Allergies are a common cause for concern in the spring. However, the focus on environmental contributors outside the house might cause parents to overlook things that can be done at home, on the changing table, that are more relevant to immediate prevention.
Bantz SK, Zhu Z, Zheng T (2014). The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma. J Clin Cell Immunol 5:202. doi:10.4172/2155-9899.1000202
Boralevi F, et al. Long-term emollient therapy improves xerosis in children with atopic dermatitis.
J Eur Acad Dermatol Venereol. 2014;28(11):1456-62.
Kuller J.M. Infant Skin Care Products: What Are the Issues? Adv Neonatal Care. 2016 Oct;16 Suppl 5S S3-S12. doi:10.1097/anc.0000000000000341. PMID: 27676112.
National Eczema Association. Atopic Dermatitis.
Retrieved from https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/ on April 1, 2019
Simpson E. L. et al. (2014). Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 134(4):818-23. doi: 10.1016/j.jaci.2014.08.005
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