Baby rashes – what’s normal and what’s not?

Most babies will have some type of skin rash at some stage.  Some babies are more prone to rashes than others and have particularly sensitive skin which easily becomes red and inflamed.   Rashes can look very different and can be flat, raised, red or pink, they can cause blisters, hives, welts or a combination of all of these. There are a number of causes for rashes, from the most harmless to the more concerning. Generally, a rash without any other symptoms is considered harmless. Rashes which appear when a baby has high temperature, is vomiting or has other concerning symptoms is always a sign of needing to be checked by a doctor.

 

 

Nappy rash

Nappy rash used to be more common before disposable nappies became so popular. Keeping the baby’s skin dry is the key to clearing most nappy rashes and disposable nappies do a better job of this than cloth.  Most nappy rashes clear up quickly after applying a good quality barrier cream to the baby’s skin which helps to prevent and treat most types of nappy rash. Frequent nappy changes, airing the baby’s bottom daily, using plain water or a sensitive skin nappy wipes at changes will also help.  If a nappy rash looks like pimples, thrush could be the cause. Anti-fungal creams are available at pharmacies and are very effective in treating monilial (thrush) infections.

 

Cradle cap

Cradle cap is caused by overactive sebaceous glands on the baby’s scalp which produce sebum. Olive oil can help to soften and lift the yellowish crusts.  Wash your baby’s hair and scalp with a gentle baby shampoo or bath wash. Dry their head with a soft towel and use a hairbrush to lift any remaining crusts.

 

Viral infections

Babies can sometimes develop a rash when they have a virus. Often, there is no special treatment for viral related rashes and they generally go away on their own. However, some rashes can be a sign of more concerning illnesses.

 

Be aware that:

Small, bright-red or purple spots or bruises which don’t turn white when pressed, can be a sign of meningococcal infection. Have your baby checked by a doctor immediately if they have this type of rash.

If your baby has a rash and they are unwell, it’s important to have them checked by a doctor as soon as possible.

 

Milia

Almost half of all newborn babies will have small white spots, called milia or ‘milk spots’ across their nose and sometimes their cheeks. These are simply blocked oil glands and need no special treatment. Milia do not cause any distress to the baby and with time, they settle on their own.

 

Erythema toxicum

This is a rash which often appears in the newborn period.  A withdrawal of maternal hormones contributes to this type of red rash which can appear worse after bathing and when the baby is hot.  Erythema does not harm the baby and is not contagious.  Generally, it clears within a few days to weeks without any special type of treatment.

 

Eczema

Eczema is a condition of the skin which often runs in families.  Skin affected by eczema is red, itchy and appears dry and cracked. The creases of the elbows, knees and ankles are more prone to eczema. Successfully managing eczema generally relies on keeping the skin moisturised which helps to avoid flareups. Sometimes steroid creams are used to help control inflammation.

 

Prickly heat

Another name for prickly heat is heat rash.  This is more common for babies who live in hot or humid environments.  Tiny red bumps and sometimes even blisters form on the skin and can be itchy and irritating to the baby. The best way to avoid and treat prickly heat is to cool the skin down with baths and to dress the baby in cool, loose clothing. Usually, prickly heat clears in a few days without any special treatment.

 

Roseola

Another name for roseola infantum is baby measles, though it’s not really measles at all, but is caused by a virus.  The symptoms of roseola are very similar to other types of viral infections, with a high temperature and cold like symptoms.  Generally, the child is miserable and contagious before the rash appears but once it does, they start to improve.  A rash caused by roseola tends to improve after 3-5 days. There is no specific treatment other than symptom relief for roseola.

 

Treatment for rashes

The treatment for rashes depends on the cause.  If it’s due to a virus, it’s important to be aware of the risk of contagion and to stay at home until the child is well.  Itchy rashes can be soothed by frequent baths, keeping the skin cooler rather than warmer and only dressing in natural fibres such as cotton, light linen or bamboo.  Paracetamol in the correct dose for a child’s age and weight can be useful to lower fever. Speak with your doctor or a pharmacist about dosing instructions.

 

When should I see a doctor about my baby’s rash?

If you are worried about your baby, it’s important to see a doctor as soon as possible.

Always trust your own judgement.

 

Take your baby to a doctor if they have:

  • A rash which is not resolving quickly.
  • A high temperature, are vomiting or have other changes in their feeding or sleeping.
  • They have symptoms of a cough or cold and/or seem to have a sore neck or swollen glands in their neck.

 

For more information

Check here  – The Royal Children’s Hospital Melbourne and  here – Pregnancy birth and baby.

Written by Jane Barry, Midwife and Child Health Nurse. September 2021.