Adjusting to life outside of the womb takes time and while it is best to talk to a paediatric dermatologist about specific concerns it is well known that the skin of your new-born, while robust and fairly similar to that of a child, still has a way to go to fully mature. It is estimated that it takes around a year for infant skin to fully develop its barrier functionality and barrier-immaturity is a huge concern for pre-term infants who are at a far higher risk of microbial invasion than your average full-term bub. Infant skin is fairly close to adult skin in its ability to prevent moisture loss (Trans Epidermal Water Loss) but as infant skin typically has a higher water content than adult skin, it is able to absorb more water and loses excess water faster than an adult. Because of this it is best to avoid giving babies very long baths or time in swimming pools, especially for babies whose skin is already on the dry and itchy side. In addition to their developing barrier functionality and higher-water content, babies have a thinner stratum corneum and papillary dermis than adults. The stratum corneum is our dead cell layer designed as our 'coat of armour' to keep things out and help us become less sensitive to the outside world while the papillary dermis supplies nutrients to layers of the epidermis and helps to regulate our body temperature.
Another factor the differs between baby and adult skin is in their subcutaneous fat. While the fat layer is not really a target of cosmetic formulators, it is relevant to how the skin of a baby looks and feels. New-born subcutaneous fat contains more palmitic and esteric acid than adults. These fats have higher melting points than adult fats thanks to their saturated structures - adult fats are largely unsaturated. This means that the fat under a new-born babies skin can freeze more easily than that of an adult and is why, a baby's skin can often look quite red and sore after being out in in cool weather or in the wind and is why avoiding extreme temperature changes is recommended for young babies.
In addition to these points a baby has a higher surface-area-to-volume-ratio which means it has a larger skin surface relative to its size than the average adult. This has implications for toxicity, especially when paired with an immature skin barrier, extra water permeability and thinner stratum corneum and is why it is best to buy or formulate products specifically for babies rather than just use adult products, even in lower doses. Simply put, the toxic dose of a material is much likely to be lower, relatively speaking, for a baby than for an adult and this would apply to all types of ingredient and/or finished product regardless to whether they are natural or not.
So how should babies skin be treated?
Your midwife is best placed to advise you on specific skincare regimens at this time as what you can/ should try/use should be tailored to the health, birthweight and specifics of your baby's immediate health, your family environment and your family genetic profile. Babies from highly allergic families will probably do best to avoid any product for as long as possible while those from families with no history of dermatological issue might well tolerate a gentle baby wash, wet wipes or shampoo, even as a newborn. The main take-home message here is to discuss with your health care provider during the first few weeks and months of life.
New-borns can present with a variety of skin conditions over the first few weeks of life including milia or milk spots and a rash that resembles acne. While there is currently no agreement on exactly what causes these things in new babies, there is agreement that in most cases, while unsightly for a period of time, these pimples and rashes will resolve themselves.
Milia are small white cysts that form on baby's skin - some babies are even born with them and one study into new-borns recorded facial milia in 16% of new-borns which the most common location for their occurrence being the cheek followed by the chin then the forehead. These should always be left alone - not squeezed and again, if in doubt about what these small cysts mean for your baby's health a visit to your health care professional should help get to the bottom of that.
Some new-borns develop a rash around the mouth from their milk, whether breastfed or bottle fed. In some cases, breast milk can help relieve the rash whereas in other cases it may not. As we have mentioned above, any blistering, sore rash should be discussed with your health care professional who can then recommend a barrier cream/ treatment suitable for your unique situation.
Babyhood and into toddling - From around 3 months to three years.
Once the new-born stage is passed it is likely that you have got to know your baby and their skin a little better and can better predict what is being caused by what you are doing on the outside vs what might be coming from inside (over-heating/ irritated tummy/ sickness etc.). That said, babyhood, especially young babyhood is still a confusing time and your health-care professional should still be your first port of call if you have any concerns. At somewhere between 3-6 months some babies start weening and most babies start grabbing things and shoving them into their mouths. This new-found interest in the world, including textures and tastes can mean more mess which can require more than just water to clean and as such, it is sometime around now that consumer or home-made products start to feature in your baby's life.
In terms of skin conditions, cradle cap is one of the most common. Cradle cap is characterised by greasy scaly patches on scalp within first weeks of life but persisting throughout the first year. The condition usually disappears its self but can look quite unsightly or even irritating for the baby in some cases. Some 42-70% of infants can get this and it is no need for concern as in the vast majority of cases it resolves without treatment. It originates in the sebaceous glands and its medical name is 'seborrheic dermatitis'.
In some cases, the skin can become infected, picking it can increase the risk of this so it is always best to leave it alone. If infections occur a health-care professional will prescribe a treatment. In other cases, treatment options include just leaving it to resolve its self or the use of an emollient.
Emollients come in many forms including formulated massage oil-type products to regular vegetable oils or creams. The application of these can help loosen the scales which can then be removed by gentle hair brushing or scalp massage and /or use of a baby shampoo.
Eczema and/or other skin rashes.
There are a number of reasons why babies skin might become red and irritated and it is important that the primary care giver keeps an eye on the skin to avoid it becoming infected. While very young babies are less able to scratch and move themselves into 'dirty' environments, older babies and especially toddlers can do both and this can present problems! Again, it is essential to see a health care professional to get to the bottom of the cause of any rash or eczema patches before self-treatment as in some cases, applying products, whatever they may be, might make the situation worse, especially in very allergic families.
If baby just has a little dry skin or an abrasion, such as mild nappy rash, it may be appropriate to use a gentle baby balm, cream, lotion, oil or barrier product. Making sure these are formulated for babies is key to a safe and effective treatment.
While nappy rash can occur from day one of your baby's life, it is often once they start eating and doing more that nappy rash can become more of an issue. Baby bottom balm creams can come in many different shapes and sizes, some provide just a physical barrier in the form of an emollient oil blend such as petrolatum (Vaseline) or a natural equivalent while others may have some anti-fungal or other chemical barrier agent present (zinc oxide is common). Barrier creams are designed not to penetrate the skin and instead to form a physical layer of protection between the skin and the abrasive surface - in this case the nappy.
Nappy Rash creams are regulated in different ways in different countries with some countries requiring their listing as a medical device if the formula contains certain actives. The listing - as a cosmetic, therapeutic or medical device - is decided by looking both at the ingredients and the product claims and for this reason it is important for anyone looking to market nappy rash creams to understand the regulations of the countries they are planning to sell into before they go ahead and start selling. For baby's nappy rash can be very unpleasant and sore and may even require medical intervention. It is always important to monitor your baby's reaction to what you apply to them and to remember that home-made or simple may not be best for all babies just as store-bought and even medically certified may not work for all babies either.
The Bottom Line for Babies Skin.
There are many important things to remember when looking at a product range for your baby or your business (if you want to market a baby range):
Babies can't talk. Ok so this seems obvious but baby can't tell you that when you put that cream or product on it stings and while they can cry, you might not know if they are crying because of the sensation of rubbing, because the skin you are rubbing into is sore or because the product is stingy. Remember to take your time with any new product, even home-made-one-ingredient solutions. Use one thing at a time, observe the reaction, observe changes to the skin and don't swap between products too quickly.
Babies skin is different to ours. Baby formulations are usually ultra-mild and will often completely avoid known allergens but this doesn't guarantee that there will be no problems, it is more a case of risk minimisation. It is probably impossible to have a baby range that suits everyone and works in every situation.
Babies have different lifestyles to us! It's hard work being a baby and babies skin care must be formulated to take account of these differences including nappy wearing, food allergen exposure, crawling and sucking non-food items and skin barrier development issues including cradle cap.
The most important thing to consider when looking for a product for your baby or looking to create a product range in this space is that, like adults, babies are not all the same. Some are more likely to become irritated or develop allergies than others and some are more sensitive to textures, touch and temperature changes than others. The number one mistake you can make when looking after or advocating for babies is that they are all the same. The only similarity is in their skin physiology - the less developed barrier function, different fat profile and higher surface area and all of that requires a mild and gentle base but beyond that, the needs of one individual baby can be quite different to the needs of another and while breast milk may work on one to clear up each and every skin condition, on another it may look like it is burning the skin.
A starting Point - The New Directions mum and bub range.
New Directions have developed a basic range to demonstrate the types of ingredients and formulations suitable to use as a base for baby.
Our baby bottom balm is a physical barrier containing a range of oils in a soft balm formula base. This is nut-free and suitable for vegans.
The baby bath oil is a gentle oil-to-milk product that helps to restore the moisture content of baby's skin post washing. It can be massaged on and rinsed off. The bath oil uses only a gentle, natural surfactant to cleanse the skin to avoid stripping it.
Baby Head-to-Toe gentle wash contains ultra-mild surfactants for use when baby needs a bit more than just a rinse over. The product is lightly fragranced with Chamomile oil prized for its soothing properties and safe profile.
Finally, our Baby Daily Moisturiser Lotion has been formulated to be nut-free and gentle with a light texture for easy spread ability and skin breathability. It can be used all over the body to help maintain the skins moisture balance and support barrier functioning.
The last word.
Living with and caring for your baby or working within this market segment can be deeply rewarding and for many the bath and bedtime routine can be a magical time of bonding and relaxation. While we do recommend taking care and appreciating the differences in the needs and skin concerns of babies, we also believe that the experience should be enjoyable and fun for all. If in doubt, consult a health care professional rather than Dr google as the health and wellbeing needs of YOUR baby are likely to be as unique as you are but most of all relax and enjoy this magical time of development.
7 February 2018