Skincare for Babies and Toddlers
When it comes to babies and toddlers skin, anything out of the ordinary can feel overwhelming.
Although some skin conditions need to be treated by a GP or Dermatologist, there are plenty of ways you can look after your children’s skin at home, with over-the-counter products.
Babies have different skin
Babies and young children have more delicate skin than adults. There are three key differences:
The uppermost layer of the skin is much thinner, with the skin cells being smaller and widely spaced apart. This means the skin is more prone to damage from chemicals, the sun or bacteria.
The skin is less able to hold water meaning it is more likely to become dehydrated. Black skin is particularly prone as it tends to lose water faster due to lower ceramide levels.
There are lower levels of skin lipids and natural moisturising factors, leading to a higher chance of developing dry skin conditions such as eczema or dermatitis
Because of these differences, it is important to treat babies’ and young children’s skin more carefully than adults’ skin. Black Skin Directory professional and Consultant Dermatologist, Dr Mary Sommerlad notes that because the skin barrier is not yet fully developed, topical medication and skincare are readily absorbed. This will affect the type of products and medicines you can use on your children’s skin.
Common Skin Conditions
Babies and young children are generally more prone to dry skin conditions that can be transient and easily managed with over-the-counter products.For others, skin conditions may be longer-term and require further management throughout childhood.
Atopic Eczema
Eczema behind knee on Black child. Image credit - Allergy & Asthma Network
Atopic Eczema is the most common form of Eczema in children, and usually develops within the first year. Atopic means that it is usually caused by allergies, although it can sometimes occur due to genetics. In some cases, it is not possible to identify an exact cause. In the USA, Eczema affects around 20% of Black children in comparison to around 16% of Caucasian children. A study on London born children showed that 16.3% of Black Caribbean children were affected by Eczema, whereas only 8.7% of white children showed symptoms.
Atopic Eczema shows as dry, cracked and inflamed patches of skin which are often itchy. On darker skin tones, they may look dark brown, purple or grey. It can appear on any area of the body, but in children it is most common behind the knees, inside the elbows, and around the face and scalp. When Atopic Eczema is severe, it’s a good idea to keep a food diary of your child’s diet what to help identify any allergens. Allergy testing to rule out allergies to detergents or skincare products.
It’s normal to have calm periods where the symptoms are less noticeable, followed by phases where the symptoms are worse – known as a flare-up. If the symptoms of Atopic Eczema are caused by allergies, knowing your child’s triggers is important to avoid the skin flaring up.
Milk Spots
Also known as Neonatal Milia, Milk Spots are small cysts that form under the skin and are common in young babies. Research shows 40-50% of newborns will experience Milk Spots and they are usually seen at birth or shortly after.
Milia are caused by excess skin cells being lodged under the surface of the skin, showing up as small, hard, white or yellow lumps. They may be harder to see on Black skin, and will become paler in colour as they develop. They are not harmful and don’t cause any discomfort. In young babies, they are usually seen around the nose and cheeks.
Don’t squeeze them, use any specialised products or skin treatments and they usually resolve on their own within a few weeks.
Mongolian Blue Spots on Black Child. Image credit - Gzzz, 2016
Mongolian Blue Spots
These are blue/gray birth marks that are common in Black and brown skin babies, appearing anywhere on the body usually from birth, though must typically on the lower back. They are caused when melanin cells get trapped in the deeper layers of skin during development in the womb.
Although they can look like bruising they are harmless and sometimes fade over time, though can last into adulthood.
It’s important to have them noted by health professionals soon after birth and take your own photographs as there have been cases where health professionals unfamiliar with the condition make incorrect child abuse assumptions.
Nappy Rash
Nappy rash is one of the most common skin conditions seen in young children. It is caused by moisture in your baby’s nappy leading to irritation and inflammation.
The skin may look sore and inflamed and your child may be itching their nappy area or appear irritated by it. In Black and Brown skin, the rash may appear as dark brown, purple or grey. In some cases the area affected may lose pigmentation (known as hypopigmentation) and this should clear up as the rash resolves. The skin may also feel warm to the touch. More severe cases may have open sores as well and be caused by bacterial or fungal infections.
Nappy rash can be worsened by factors such as allergies or chafing if the nappy is rubbing around the thighs or abdomen. Most mild cases can be managed and treated with at-home care. If you’re worried about recurring nappy rash or think your baby may have an infection or severe nappy rash, speak to a medical professional as soon as possible.
Cradle Cap
Cradle Cap, also known as infant seborrheic dermatitis, is a common harmless skin condition, which occurs on the child’s scalp. It usually appears and resolves within the first year of their lives.
On Black skin, cradle cap shows as inflamed, scaly, flaky patches which may look greasy or yellow. They may also become lighter, losing pigmentation (hypopigmentation) but aren’t itchy and most babies aren’t affected by the condition – although it can look alarming.
The cause of cradle cap isn’t fully understood, although it is believed to be caused by excess oil being produced by the oil glands and hair follicles on the baby’s scalp and sometimes also the presence of a yeast called Malassezia which is found on the skin.
Impetigo
Impetigo on Black child. Image credit - DermNet NZ.
Impetigo is a highly contagious bacterial infection which is common in children aged 2-5 but can occur at any age usually because their immune systems aren’t yet fully developed. There are two types - Bullous and Non-Bullous which have slightly different presentations.
It’s most common around the nose and mouth, showing as bumps, blisters or crusty patches. On Black skin the blisters may show as dark brown or purple in colour and may be initially harder to see. As the blisters develop, they become a yellowish brown and may resemble cornflakes on the skin.
Impetigo is caused by bacteria entering the skin through a cut, graze or insect bite. It is also possible for skin which has been scratched due to another skin condition such as Eczema or Chickenpox to become infected. The bacteria growing in the skin causes inflammation and blisters to form, which can be uncomfortable.
You must seek treatment promptly if you think your child may have the condition as it will need prescription medications.
Treating Skin Conditions
Most common skin conditions will heal on their own or with some basic treatment. It is typical for skin conditions in Black babies and young children to cause hyperpigmentation (darkening of the skin) which usually resolves on its own in time. Some conditions like eczema can also result in depigmentation where skin goes lighter or totally white in patches.
If your child is struggling with dry skin such as mild nappy rash or teething rash, using a mild emollient such as E45 or Aveeno Baby Dermexa Cream will help to soothe the area and strengthen the skin.
It is important to keep the skin clean. Dr Sommerlad recommends using a soap-free cleanser before applying any emollient creams. CeraVe’s dedicated Baby Wash and Shampoo is gentle on skin and enriched with emollients to look after the delicate skin barrier
For cradle cap, look for dedicated skin products such as Dentinox Cradle Cap Treatment Shampoo which is formulated to gently remove the excess oil and skin cells without further irritating the scalp.
If the skin is broken, there is any sign of infection, or the skin condition isn’t improving, speak with your GP. They may suggest supervised targeted treatments such as steroid creams and ointments often containing hydrocortisone.
Everyday Skincare
As well as treating skin conditions if they occur, it is important to also look after your child’s skin generally to protect their delicate skin barrier. This may also help to prevent skin conditions from developing.
As well as soap-free cleansers, Dr Mary Sommerlad also recommends using a bath oil formulated for babies to help keep Black skin moisturised and prevent conditions such as Eczema. Weleda Baby Oil is formulated to gently cleanse and moisturise skin with Calendula oil.
Although in some Black communities it is normal to bathe babies as soon as they are brought home from the hospital, Dr Mary Sommerlad advises against this and to wait until the umbilical cord has healed over. It’s best to simply top and tail your baby in cooled, boiled water with no cleanser.
Overbathing can also be very drying on the skin, and it is important to use hydrating bathing products and emollient moisturisers to prevent trans epidermal water loss (TEWL), which will leave the skin feeling dry or dehydrated. Aveeno’s kids range contains colloidal oat which is soothing and hydrating, helping to trap water into the skin and also strengthen the delicate skin barrier.
Dr Sommerlad also advises avoiding any homemade skincare concoctions and especially olive and coconut oils which can irritate and even cause further dryness on children’s skin because they don’t hydrate.
Sun Protection for Babies and Young Children
Sunscreen can be used on children from 6 months old, especially hot sunny days, when you know your children will be outside a lot, and reapplied every 2-4 hours. For newborns and very young babies, keep them out of the sun to prevent sunburn and overheating. Children’s sunscreen is formulated for more sensitive skin to help prevent reactions and irritation. Invisible finishes like Avene’s Very High Protection Lotion for Children – SPF50+ and Evy Technology Sunscreen Mousse are great options - hydrating gentle and transparent.
Don’t forget other methods of sun protection too, such as staying in the shade, wearing a hat, and clothing which covers the body as much as possible.
Dr Sommerlad notes that young children find it harder to naturally regulate their body temperature so thin, light layers are more beneficial than one thicker layer. She also recommends long-sleeved swimwear which provides more coverage.
What Shouldn’t You Use on Babies’ and Toddler Skin?
Of course, it’s important to use gentle products, formulated for children but sometimes it’s hard to know exactly what you shouldn’t use. Avoid:
Any skincare with actives such as Vitamin C, retinoids or exfoliating acids as these aren’t needed and may cause a reaction
Any prescription skincare, without the supervision of a medical professional
Dr Sommerlad recommends avoiding plant or essential oils, such as olive and coconut oil which haven’t been formulated for use on a child’s skin
Any professional skincare treatments or procedures