Teething and drool rash

What it is

Drool rash is irritated skin on the chin, cheeks, neck folds and chest where dribble sits. It is common from around three months, as teething begins, and often comes and goes with each new tooth.

How it works

Saliva contains enzymes and keeps the skin constantly wet then dry. That wet-dry cycle and rubbing from bibs and wiping break down the skin barrier, so the skin becomes rough, sore and inflamed. Food, juice and dummies add to it.

Why it matters on darker skin

On darker skin the rash may look darker brown, purplish or greyish rather than red, and the rough texture is often easier to feel than to see. After it settles it can leave darker or lighter patches for a few weeks; these fade on their own once the skin is protected.

Causes and triggers

Teething (more dribble), dummies, wet bibs and clothes, frequent wiping with wipes or rough cloths, acidic foods and juices, hot weather and sweat in neck folds. Eczema makes it more likely.

What helps — and why it works

Pat (do not rub) dribble away with a soft cotton cloth through the day. Change wet bibs and tops promptly. Apply a thin layer of a plain barrier such as petroleum jelly or a fragrance-free nappy barrier ointment to the chin and neck before naps, feeds and bedtime, so saliva sits on the ointment instead of the skin. Clean the area with plain water after meals. For sore gums, gently rub with a clean finger or offer a chilled (not frozen) teething ring. Expected timeline: the skin usually improves within a few days of keeping it dry and protected.

What to avoid and why

Avoid fragranced wipes, scented baby lotions and home remedies on the rash. Do not use amber or other teething necklaces or bracelets: they are a choking and strangling risk. Do not use numbing teething gels or adult pain relief without asking a pharmacist; some are not suitable for young babies.

Common mistakes

• Wiping the chin many times a day with wipes.
• Blaming high fever, diarrhoea or a runny nose on teeth and waiting too long to see a doctor.
• Using steroid or mixed creams bought over the counter.

Caring for children's skin

Children's skin is thinner, loses water faster and absorbs more of what is applied to it relative to body size, so simpler is safer. For most children a short lukewarm bath, a fragrance-free soap substitute and a plain emollient are all that is needed, plus shade, clothing and sunscreen from six months of age. Avoid adult products, essential oils, antiseptics in bath water, bleaching or 'toning' creams, and cosmetic treatments such as relaxers and gel nails. Medicines and medicated creams should be used only as a doctor, nurse or pharmacist advises, and in children Melanin & Me does not offer photo checks: a clinician should see the child. Trust your instincts as a parent: a child who is unusually sleepy, floppy, not feeding, breathing fast or has a rash that does not fade when pressed with a glass needs urgent care. Keep a simple record — photos and dates — of rashes that come and go, as this helps the doctor.

Products, medicines and when to worry

When choosing products for children, look for fragrance-free formulas with short ingredient lists, and avoid adult acne, anti-ageing or lightening products, essential oils and talc. Medicated creams — including steroid creams, antifungals and antibiotics — are safe and helpful when prescribed for the right condition and used for the right length of time, but mixed creams sold over the counter can contain strong steroids that are unsafe for children. Sunscreen is suitable from six months of age; younger babies should be kept in the shade and covered. Do not give medicines intended for adults, and ask a pharmacist about the right medicine for a child's age and weight. Seek urgent care for any rash with fever and a very unwell child, a rash that does not fade under a glass, swelling of the face or lips, or blistering of the mouth or eyes.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.