The cord, the skin and the first bath

Newborn skin care has moved decisively towards doing less, and most of the products marketed for it are solving problems that do not exist.

The cord

The stump dries, blackens and separates, usually between five and fifteen days.

Current guidance in most high-income settings is dry cord care: keep it clean and dry, fold the nappy below it, and leave it alone.

Antiseptics are not routinely recommended in these settings, though chlorhexidine is recommended by the World Health Organization in some low-resource settings where infection risk is higher.

A small amount of sticky discharge or a little bleeding as it separates is normal.

Do not pull it, even when it is hanging by a thread.

Signs of infection requiring urgent review: redness spreading into the surrounding skin, swelling, pus, a foul smell, or a baby who is unwell or feverish.

Umbilical granuloma — a small persistent moist lump after separation — is common and is easily treated.

The first bath

Later than tradition suggests.

Guidance now generally recommends delaying the first bath, commonly by at least six hours and frequently by twenty-four, which supports temperature stability, blood glucose and breastfeeding.

Vernix, the white coating, is protective and can be left to absorb rather than washed off.

Babies do not need daily baths.

Two or three times a week is ample in the early months, with topping and tailing — cleaning the face, neck, hands and nappy area with cotton wool and water — on other days.

Water temperature should be around thirty-seven degrees, tested with an elbow or a thermometer, and the room should be warm.

Never leave a baby unattended in water for any length of time, not even to answer a door.

Products

Where less is genuinely better.

Plain water is sufficient for the first weeks in most guidance.

Where a cleanser is used, a pH-neutral, fragrance-free one designed for infants is appropriate, since ordinary soap is alkaline and disrupts the skin barrier.

Bubble baths, fragranced products and wipes containing alcohol or fragrance are best avoided in the early weeks.

Baby powder is not recommended: talc carries an inhalation risk and it does not prevent nappy rash.

Oils are a mixed picture — olive oil in particular has evidence of damaging the skin barrier in infants and is no longer recommended, while some other oils have been studied more favourably.

Where the skin is dry, a plain fragrance-free emollient is the reasonable choice.

Common newborn skin findings

Most of which need nothing.

Milia: tiny white cysts on the nose and cheeks, which resolve.

Erythema toxicum: a blotchy red rash appearing in the first days, which comes and goes and disappears within weeks.

Neonatal acne: small red spots on the face at a few weeks, resolving without treatment.

Cradle cap: greasy yellow scale on the scalp, which is harmless and improves with gentle emollient and soft brushing.

Dry, peeling skin, particularly on hands and feet.

Mongolian spots, more accurately called congenital dermal melanocytosis: blue-grey patches most common in babies with darker skin, entirely benign and worth having documented to avoid later misinterpretation.

Stork marks and salmon patches on the eyelids, forehead and nape, which fade.

And strawberry haemangiomas, which appear in the first weeks, grow, then involute over years — most need no treatment, though some locations do.

Nappy rash

Common and largely preventable.

It is caused by moisture, friction and the interaction of urine and stool with skin.

Prevention: frequent changes, thorough but gentle cleaning, allowing the skin to dry, nappy-free time, and a thin barrier preparation.

Where it is persistent, bright red with satellite spots and involving the skin creases, thrush is likely and needs antifungal treatment.

Where there is blistering, ulceration, or the baby seems unwell, it should be reviewed.

Eczema and what predicts it

Atopic eczema commonly begins in infancy.

Management is generous, frequent emollient use and topical steroids of appropriate strength when there is a flare — undertreatment from steroid anxiety causes more problems than the steroids do.

Trials of routine emollient use from birth to prevent eczema have produced disappointing results, which changed earlier advice.

Guidance on food allergy prevention has changed substantially, with early introduction of allergenic foods now recommended rather than avoidance, which is covered elsewhere on this site.

General information only, not medical advice. Consult your health visitor, midwife or a qualified clinician about your baby's skin, and seek urgent care for signs of cord infection.