The first month: plain water and nothing else
NHS advice is unusually blunt on this point. No liquid cleansers are needed, because plain water is best for a baby's skin in the first month, and lotions and oils are best avoided until the baby is at least a month old. That is the whole of it. The large range of newborn washes, lotions, oils and bath products on sale exists because it sells, not because a newborn needs any of it.
Two or three baths a week is enough for a newborn. Daily is fine where both parties enjoy it, but there is no hygiene argument for it; what does need attention every time is the face, the neck folds and the nappy area. Washing with bowls of warm water instead of a bath — topping and tailing — suits many people for the first few weeks and is a perfectly adequate substitute.
For the bath itself: fill to about 8 to 10 cm, mix the water so there are no hot patches, and test it with an elbow rather than a hand, which is less sensitive. It should feel neither hot nor cold. The room wants to be warm, because a baby cools quickly. A baby is never left alone in the bath, not for a moment, and not in the care of an older sibling. Straight after a feed, or when a baby is hungry or tired, is the wrong moment to start.
The cord stump
Older guidance said to avoid immersing a baby until the umbilical stump had dropped off, and put that at up to a month. Both halves of that have been superseded.
The stump usually dries and separates between about five and twelve days. It needs no special treatment: clean around it with tap water only, dry it, keep it outside the nappy so it stays dry and clean, and leave it alone otherwise. NHS trust guidance is explicit that there is no need for wipes, powders or creams on it, and antiseptics are not part of current practice. Bathing is not something to postpone on the stump's account.
What does warrant a call to a midwife is a cord that looks red or inflamed, or any smell or discharge from it. A baby who is unusually sleepy, feeding poorly or becoming more jaundiced should be seen regardless of what the cord looks like.
Oils and creams, and why the advice changed
For decades the standard recommendation for dry patches and for massage was olive oil or sunflower oil, both on hand in any kitchen and both assumed to be gentle. A trial in Manchester tested that on 115 newborns, randomised to olive oil, sunflower oil or nothing, twice daily for four weeks. Both oil groups finished with better-hydrated skin and with a measurably delayed development of the skin barrier compared with the babies given nothing. The researchers concluded that the hydration did not justify the possible cost, and would not recommend either oil for healthy UK babies.
Olive oil has a further problem: it is high in oleic acid, which in controlled testing reduced the integrity of the outer skin layer. It now appears on NHS lists of oils to avoid on babies, alongside mineral and paraffin oils and anything scented. Peanut and other nut-derived oils carry a separate caution because of allergy risk.
The practical upshot is that a healthy newborn needs nothing applied at all. Where an older baby has genuinely dry skin, a plain unscented emollient from a pharmacist is the sensible choice rather than a kitchen oil or a fragranced lotion. The same reasoning applies to massage oil, which is covered under baby massage.
Peeling, milk spots and baby acne
Three things alarm new parents and need no treatment whatsoever.
Peeling and flaking in the first week or two is normal, particularly in babies born a little late, and is simply the outermost layer coming away. It does not need moisturising.
Milk spots — tiny firm white or pearly spots, usually across the nose and cheeks — are blocked pores. They are extremely common and clear on their own over a few weeks.
Baby acne is different: small red or pustular spots, typically appearing at a few weeks old and settling over a few more. Washing the face with water as usual is the entire treatment. Acne creams are not appropriate, and the spots are never to be squeezed. Anything that persists for months, or looks inflamed and widespread, is worth showing to a GP or health visitor.
Heat rash
Small red bumps on the chest, neck or back usually mean a baby has been too warm — more often from being dressed or wrapped too heavily than from the weather. A newborn's sweat glands are immature and its surface area is large relative to its body, which makes temperature a genuinely tricky thing for a baby to manage and an easy thing for an adult to get wrong in either direction.
Removing a layer and improving the airflow is normally the whole answer. A cool damp cloth on the patches can help if the rash lingers, but overcorrecting into a chill is the real risk and is worth more concern than the rash itself.
Cradle cap
The greasy yellow scaly patches that appear on the scalp, and sometimes behind the ears, in the eyebrows or in the nappy area, are infant seborrhoeic dermatitis. Three things about it are commonly got wrong.
It is not eczema. It is sometimes described as a mild form of eczema, and the distinction matters because the two behave differently: cradle cap does not itch and does not cause discomfort, where eczema does both. It is also not caused by poor hygiene, not an allergic reaction, and not catching.
Treatment, where any is wanted, is lightly massaging an emollient into the scalp to loosen the scales, washing with baby shampoo and then brushing gently with a soft brush. A pharmacist can advise which emollient. What to avoid: picking at the scales, which risks infection; olive oil, for the reasons above; peanut oil, for allergy reasons; and soap or adult shampoo. Hair sometimes comes away with the flakes and grows back.
Most cases clear on their own. Advice is worth seeking if it has not improved after a few weeks of treatment, if it covers the body rather than the scalp, or if the patches bleed, leak fluid or look swollen.
Nappy rash
Almost every baby gets it at some point. The usual cause is skin in prolonged contact with urine or stool, but nappies rubbing, a reaction to soap, detergent or bubble bath, harsh wipes, frequent loose stools, non-absorbent nappies, some medicines including antibiotics, and thrush all appear on the NHS list.
What helps:
- Changing wet and dirty nappies promptly, and keeping the area clean and dry — patting rather than rubbing.
- Nappy-free time whenever it is practical. Air does more than any product.
- Water, or fragrance-free and alcohol-free wipes, for cleaning.
- Absorbent nappies that fit well without being tight.
- A daily bath while the rash is being treated, though no more than twice a day.
- A thin layer of barrier cream at each change, on a pharmacist's recommendation, if the rash is uncomfortable.
What to leave out: soaps, baby lotion and bubble bath; antiseptic creams and lotions; plastic pants or covers over the nappy; and talcum powder, which is specifically advised against and which older guidance recommended freely. Alcohol swabbing, which also turns up in older writing, has no place here and dries the skin badly.
A rash that does not clear, spreads, or comes with a high temperature needs a health visitor or GP, who may prescribe a mild steroid cream, an antifungal if thrush is involved, or an antibiotic for a bacterial infection. Pus, boils or weeping skin should be seen without waiting.
Eczema
Eczema is common in babies and is not the same thing as any of the above. It itches, which is how it announces itself: a baby who is scratching, rubbing against bedding or sleeping badly with dry rough patches, often on the face, the scalp or in the creases of the elbows and knees, is a baby to take to a GP or health visitor rather than to treat from a shelf.
The mainstay of management is emollients, used generously and often, with a soap substitute in place of soap and bath products. Prescribed treatments beyond that are a clinical decision, and steroid creams in particular are not something to borrow or improvise. A family history of eczema, asthma or hay fever makes it more likely and is worth mentioning at an appointment.
The rash that is an emergency
Everything above is either normal or a nuisance. One pattern is neither, and it is worth knowing cold.
A rash that does not fade when a clear glass is pressed firmly against it is a warning sign of meningococcal infection and needs 999 or A&E immediately. Several points from the NHS guidance are easy to miss:
- The rash does not always appear. Its absence rules nothing out, and waiting for it is the mistake that costs time.
- It is harder to see on brown and black skin. The paler areas are the places to check: the palms, the soles, the roof of the mouth, the whites of the eyes and inside the eyelids.
- In a baby, the signs to act on are refusing feeds, an unusual high-pitched cry, a body that is stiff or floppy or unresponsive, and a bulging soft spot on the top of the head.
The guidance also says, in as many words, to trust instinct, because a seriously ill baby may not have every symptom on any list. Nobody is ever criticised for bringing in a baby who turns out to be well.
What to drop from older advice
Collecting the corrections in one place, since this is a subject where out-of-date instructions have had a long life:
- The cord does not take a month, and the first bath does not wait for it.
- Olive oil and sunflower oil are no longer recommended on newborn skin, in massage or for dry patches.
- Talcum powder is advised against in the nappy area, not recommended for it.
- Cradle cap is not eczema, and brushing does not work by moving oil out of the follicles.
- Good skin care does not strengthen a baby's immune system. It keeps the skin comfortable and intact, which is reason enough and is all that is being claimed.