Monday 29 May 2017

Skin to skin - Caring for newborn's skin

How do you care for your newborn’s skin, especially if she is showing signs of nappy rash or eczema? Bernice Mulligan speaks to Dr Hilda Fennell-O’Shea

Bernice Mulligan

In the main, babies don’t need too many products and creams, says Cork-based GP Dr Hilda Fennell-O’Shea.

f moisturising products – that is the mainstay of their treatment. Products like E45 or Diprobase are very good.”

For flare-ups, she says children will often need the lowest dose of steroid cream, which is a 1pc hydrocortisone cream. “These days you can get it over the counter, for example Cortopin. It’s safe to use on babies, but you shouldn’t use it as a moisturiser, just when your child needs it.”

At the same time, Fennell-O’Shea says not to be afraid to use the ointment liberally when the need arises.

“It’s the ointment that will get the flare-up under control. Parents are often worried about skin thinning, but if you don’t use enough of the cream, the eczema persists. So use it in short, sharp bursts.”

Unfortunately, a steroid cream will not prevent eczema coming back, but it will get it under control for a period of time. Other ways to prevent flare-ups include avoiding dusty atmospheres, sand and chalk.

Bathing and medication

Fennell-O’Shea recommends add¬ing a moisturing oil to your child’s bath, such as something from the Oilatum or Johnson’s baby ranges. She also advises adding a litle bit of Milton (one teaspoon) if the skin looks infected. However she warns against using soap. “This will only dry out the skin. Instead use a soap substitute.”

Generally, children are not given tablets to treat eczema, says Fennell-O’Shea.

“We don’t like giving medication to the under twos, although sometimes we can give an anti-histamine.”

Diet and environment

According to Fennell-O’Shea there is no definite evidence linking eczema and diet. “There is also no point switching your child from cow’s to goat’s milk, as they both contain the same kind of protein.”

However, she says that environmental factors do play a part. “If your child’s bedroom is too dry, for example if the central heating is too high, this can exacerbate eczema. Other factors that can irritate include dust mites and pollen, so make sure you dust your child’s room with a damp duster, and keep the window closed if there is a high pollen count or someone is cutting grass nearby.”

However, the good news is that most children won’t have eczema forever. “A lot of kids will grow out of the condition by aged four or five,” she says. For some it persists longer. “Scientists think this is to do with a lack of a protein called filaggrin in their skin, and there is a lot of research being done around that at the moment.”

Dr Hilda Fennell-O’Shea, a GP with a special interest in dermatology, is based at College Road Medical Centre, Cork (see www.corkskincare.com). She is a member of the Primary Care Dermatology Society Ireland.

“Most babies can get away with just a few, maybe a moisturiser and a product for their bath - Johnson’s baby do a nice range – as well as something like Vaseline to prevent nappy rash.”

However, in certain circumstances, specific treatments and products are called for, such as when nappy rash erupts.

“Nappy rash affects most babies, and isn’t something to get too upset about,” explains Fennell-O’Shea. “It certainly isn’t a case of bad parenting or anything like that.”

Nappy rash

Nappy rash (or irritant napkin dermatitis as it is known medically) develops when skin is exposed to prolonged wetness, decreased skin pH caused by urine and faeces, and the resulting breakdown of the outermost layer of the skin.

“One of the main things here is to change the nappy frequently. And if you can, leave the nappy off for a little while. Even 20 minutes can help, and then apply lots of Vaseline. If this isn’t working, move up to something like Sudocrem or Bepanthen.”

Fennell-O’Shea says that sometimes the nappy rash can get infected by a fungus. “If this happens, you’ll see these little red spots developing away from the nappy rash and running down the legs. At this stage the child may need to see a doctor and get an anti-fungal/anti-steroid cream.”

Eczema

Atopic eczema is the most common type of eczema you will come across in young children, and it is inherited, says Fennell-O’Shea. It is connected with hayfever and asthma, (ie part of the same disease spectrum) and parents will often be asthmatic or have suffered from eczema in their youth.

She says it can be divided in mild, moderate and severe, with those in the latter group needing a lot of support. Children with very sensitive skin may have mild eczema.

“Atopic eczema usually doesn’t start till after three months, when it often presents behind the knees, elbows and neck, or on the scalp as cradle crap. It can be very itchy, and as soon as children can scratch (around four or five months) they will try to scratch it.”

To this end, Fennell-O’Shea advises keeping children’s hands covered and their nails short. “Children with eczema need a lot of moisturising products – that is the mainstay of their treatment. Products like E45 or Diprobase are very good.”

For flare-ups, she says children will often need the lowest dose of steroid cream, which is a 1pc hydrocortisone cream. “These days you can get it over the counter, for example Cortopin. It’s safe to use on babies, but you shouldn’t use it as a moisturiser, just when your child needs it.”

At the same time, Fennell-O’Shea says not to be afraid to use the ointment liberally when the need arises.

“It’s the ointment that will get the flare-up under control. Parents are often worried about skin thinning, but if you don’t use enough of the cream, the eczema persists. So use it in short, sharp bursts.”

Unfortunately, a steroid cream will not prevent eczema coming back, but it will get it under control for a period of time. Other ways to prevent flare-ups include avoiding dusty atmospheres, sand and chalk.

Bathing and medication

Fennell-O’Shea recommends add¬ing a moisturing oil to your child’s bath, such as something from the Oilatum or Johnson’s baby ranges. She also advises adding a litle bit of Milton (one teaspoon) if the skin looks infected. However she warns against using soap. “This will only dry out the skin. Instead use a soap substitute.”

Generally, children are not given tablets to treat eczema, says Fennell-O’Shea.

“We don’t like giving medication to the under twos, although sometimes we can give an anti-histamine.”

Diet and environment

According to Fennell-O’Shea there is no definite evidence linking eczema and diet. “There is also no point switching your child from cow’s to goat’s milk, as they both contain the same kind of protein.”

However, she says that environmental factors do play a part. “If your child’s bedroom is too dry, for example if the central heating is too high, this can exacerbate eczema. Other factors that can irritate include dust mites and pollen, so make sure you dust your child’s room with a damp duster, and keep the window closed if there is a high pollen count or someone is cutting grass nearby.”

However, the good news is that most children won’t have eczema forever. “A lot of kids will grow out of the condition by aged four or five,” she says. For some it persists longer. “Scientists think this is to do with a lack of a protein called filaggrin in their skin, and there is a lot of research being done around that at the moment.”

Dr Hilda Fennell-O’Shea, a GP with a special interest in dermatology, is based at College Road Medical Centre, Cork (see www.corkskincare.com). She is a member of the Primary Care Dermatology Society Ireland.

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