After nine anxious months, you look down at your beautiful perfect newborn and see—a misshapen head, blotchy skin, bruising, flaking skin, and God forbid, even pimples! “Where is my perfect baby?” you may wonder. Newborns develop all types of rashes, most of which are transient, and almost all are causes of needless concern for parents.
Some of the infant’s appearance can be directly attributed to the “trauma” of delivery – molding of the head, bruising of the scalp, swelling of the eyelids, flattening of the nose and mild hemorrhages on the whites of the eyes. Soon after delivery, the infant’s skin can appear ruddy at times, and mottled at others; this is due to the immature thermoregulatory system. Additionally, from “sitting” in amniotic fluid for nine months, the skin normally becomes dry and flaky after 1-2 weeks of life outside the uterus. Mild jaundiced or yellowing of the skin occurs on around the second or third day of life, peaking on the fifth to seventh day and gradually disappearing. This is due to extra bilirubin the baby is born with, which his body needs to break down and excrete. Your health care provider will monitor your baby’s bilirubin level.
Within the first few days of life, more than 50 percent of newborns develop a red blotchy rash with white bumps in the center which resemble insect bites. This is called Erythema toxicum, a rash of unknown etiology that usually disappears by two weeks of age. Milia are tiny white bumps on the nose and cheeks of newborns - these are blocked sebaceous glands or skin pores that disappear by 1 to 2 months of age. No creams or ointments are needed; they resolve without treatment.
Of course, just as milia and Erythema toxicum are disappearing, newborn acne is starting!! Neonatal acne starts around 1 month of age and can persist for several months. The cause appears to involve the transfer of maternal hormones before birth. Again this will also disappear in a few months without treatment. In fact creams, oils or ointments will make it worse. Babies may have a variety of birthmarks; the most common is a flat pink birthmark often over the bridge of the nose and eyelids and on the back of the neck. This is a capillary hemangioma or stork bite. These birthmarks often disappear by 1 to 2 years of age, although when the infant is crying, they may appear to deepen in color. Additionally some babies have extremely sensitive skin. Rashes that resemble a pimply prickly heat rash can develop just by rubbing against clothing, bedding or blankets. As the infant matures, the skin can become less sensitive, although some children may be “rashy” their entire lives.
Rashes that are true fluid filled blisters or those that resemble broken blood vessels under the skin are worrisome and should be evaluated by your health care provider. For more information, visit www.essehealth.com.
By Karen Diehl, CPNP, CLC
Esse Health Tesson Ferry Pediatrics
13303 Tesson Ferry Road, Suite 150
St. Louis, MO 63128