Your newborn's skin: what is normal

What it is

A newborn's skin changes a great deal in the first weeks. Common, harmless findings include: toxic erythema of the newborn (blotchy patches with small bumps or pustules in the first days, each spot lasting about a day); milia (tiny white spots on the nose and cheeks); peeling skin on the hands and feet; heat rash; and, on darker skin especially, transient neonatal pustular melanosis and congenital dermal melanocytosis (sometimes called Mongolian blue spots).

How it works

A baby's skin is adjusting from fluid to air: it sheds its outer layer, its sweat glands are still immature, and maternal hormones are still active. Congenital dermal melanocytosis happens when pigment cells stay deep in the skin during pregnancy instead of moving to the surface, so the patch looks blue-grey through the skin above it.

Why it matters on darker skin

Transient neonatal pustular melanosis is more common in Black babies: small pustules present at birth, on skin that is not red, that break and leave brown freckle-like marks which fade over weeks to months. Blue-grey birthmarks on the lower back and buttocks are very common in African babies and usually fade before school age. Because they can look like bruises, ask the midwife or doctor to write them in your baby's health record, so no one mistakes them for injury later. On darker skin, toxic erythema may look darker or purplish rather than red.

Causes and triggers

Most of these are part of normal development. Heat rash is made worse by overdressing and heavy creams; peeling is more noticeable in babies born after their due date.

What helps — and why it works

Usually nothing is needed. Bathe your baby in plain lukewarm water for the first weeks, pat dry and keep skin folds dry. If skin is dry or peeling, a small amount of plain, fragrance-free emollient is enough. Dress your baby in light cotton layers in hot weather so sweat can escape. Leave milia, pustules and birthmarks alone: they clear by themselves. Expected timeline: toxic erythema within days to two weeks; milia within about four weeks; brown marks after pustular melanosis within months; blue-grey birthmarks over years.

What to avoid and why

Do not squeeze spots, scrub peeling skin or apply herbal mixtures, shea blends with fragrance, menthol, kerosene, toothpaste or 'toning' creams. A newborn's skin absorbs far more for its size than an adult's, and irritants can cause rashes or poisoning. Avoid talc and powders near the face (they can be breathed in).

Common mistakes

• Treating harmless newborn spots as an infection and applying antibiotic or steroid creams without advice.
• Overdressing a baby in hot weather.
• Not recording blue-grey birthmarks, then facing worrying questions about bruising later.

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.