Rashes in infants: what’s normal and when to call a doctor

1. Common rashes and what to expect

Most rashes in infants are harmless and may appear in the first few weeks of life. Here are a few common ones that are typically not cause for concern:

• Erythema toxicum (newborn rash): this is a very common rash that appears in the first few days after birth. It usually presents as small, red spots or bumps, often with a white centre, typically on the face, chest, arms, and legs. Erythema toxicum usually resolves on its own within a week or two without treatment.
• Milia: these are tiny white bumps that can appear on a newborn's nose, chin, or cheeks. They occur when dead skin cells become trapped in the skin’s pores and are completely harmless. Milia often disappears within a few weeks without any intervention.
• Cradle cap: a type of seborrheic dermatitis, cradle cap is a scaly, yellowish rash that typically appears on the scalp but can also be found on the eyebrows or behind the ears. While it can look concerning, it is non-infectious and usually resolves on its own. A gentle wash with baby shampoo or applying a mild moisturiser can help.
• Nappy rash: one of the most common rashes in infants, nappy rash can be caused by irritation from moisture, friction, or exposure to urine and stool. It often appears as red, inflamed skin in the nappy area. Keeping the area dry, changing nappies frequently, and applying barrier creams can help prevent or treat nappy rash.

2. When to call a doctor:

While most rashes are harmless and go away on their own, there are some situations when you should seek medical attention. If your baby’s rash exhibits any of the following signs, it’s important to contact a healthcare professional:

• Fever with rash: if your baby develops a rash along with a fever, it could indicate an underlying infection, such as chickenpox, measles, or a viral illness. A fever above 38°c (100.4°f) combined with a rash should be evaluated by a doctor.
• Rash spreads quickly or is severe: if the rash is spreading rapidly, causing swelling, or appears very severe, it may be a sign of a more serious condition that requires immediate attention.
• Purple or red spots (petechiae): if you notice small purple or red spots on your baby’s skin that don’t fade when you gently press on them, this could be a sign of a bleeding disorder or infection, such as sepsis, and requires urgent medical evaluation.
• Blisters or sores: rashes that develop into open sores, blisters, or lesions could indicate a viral infection, such as hand, foot, and mouth disease or impetigo. It’s best to consult a healthcare provider to assess the rash and provide appropriate treatment.
• Unusual behaviour or lethargy: if your baby seems excessively tired, is crying more than usual, or has trouble feeding, this could indicate that the rash is part of a larger health issue. Contact your doctor if your baby’s behaviour changes significantly.

3. Home care and treatment:

For rashes that aren’t serious and are part of the natural development of your baby, here are some simple care tips to help ease discomfort:

• Keep the skin clean and dry: gently wash your baby’s skin with warm water and a mild, fragrance-free soap. Be sure to dry the skin gently after washing to avoid irritation.
• Use hypoallergenic products: choose gentle, unscented lotions, creams, or baby wipes to reduce the risk of skin irritation. Avoid products with fragrances that can exacerbate the rash.
• Apply barrier creams for nappy rash: if your baby has nappy rash, applying a barrier cream with zinc oxide can help protect the skin from further irritation. Change nappies regularly and give your baby some time without a nappy to allow their skin to breathe.
• Avoid overheating: keep your baby’s room at a comfortable temperature and avoid overdressing them. Overheating can sometimes worsen a rash, especially in conditions like heat rash.

4. Prevention:

While some rashes are unavoidable, there are steps you can take to prevent certain types of rashes:

• Avoid excessive friction: make sure your baby’s clothes aren’t too tight, and opt for soft, breathable fabrics to reduce irritation on the skin.
• Practice good hygiene: regular handwashing, keeping your baby’s skin clean, and changing wet nappies promptly can help reduce the likelihood of rashes caused by irritants or infections.
• Monitor for allergies: if you suspect your baby’s rash may be due to an allergy (such as from a new detergent or food), try to eliminate potential allergens and speak to your doctor about allergy testing.

5. When in doubt, seek medical advice:

It’s always better to err on the side of caution. If you’re ever in doubt about your baby’s rash, or if it’s causing your child distress, don’t hesitate to call your healthcare provider. Even mild rashes can sometimes indicate an underlying condition that may need treatment, so having a professional evaluate your child’s skin is always a good idea.

Rashes are common in infants, and most of them are not serious. Understanding what’s normal and when to seek medical help will give you peace of mind as you care for your little one. For more information on rashes and other infant health topics, visit the NHS website.

Sources:

• NHS website: Skin problems in babies and children.
• NHS inform: Infant rash and symptoms.

Disclaimer: the information provided in this article is for educational purposes only and should not replace medical advice. Always consult with a healthcare professional for personalised guidance and treatment.