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Rash - child under 2 years


Definition:

A rash is a change in the color or texture of the skin. A skin rash can be

  • Bumpy
  • Flat
  • Red, skin-colored, or slightly lighter or darker than skin color
  • Scaly
Alternative Names:

Baby rash; Miliaria; Prickly heat

Considerations:

Most bumps and blotches on a newborn baby are harmless and clear up by themselves.

The most common skin problem in infants is diaper rash. Diaper rash is an irritation of the skin caused by dampness, urine, or feces. Most babies who wear diapers will have some type of diaper rash.

Other skin disorders can cause rashes. These are most often not serious unless they occur with other symptoms.

Home Care:

DIAPER RASHES

Keep the skin dry. Change wet diapers as quickly as possible. Allow the baby's skin to air dry as long as is practical. Launder cloth diapers in mild soap and rinse well. Avoid using plastic pants. Avoid irritating wipes (especially those containing alcohol) when cleaning the infant.

Ointments or creams may help reduce friction and protect the baby's skin from irritation. Powders such as cornstarch or talc should be used cautiously, as they can be inhaled by the infant and may cause lung injury.

If your baby has a yeast diaper rash, the health care provider will prescribe a cream to treat it.

OTHER RASHES

Heat rash or prickly heat is best treated by providing a cooler and less humid environment for the child.

Powders are unlikely to help treat heat rash and should be stored out of reach of the infant to prevent accidental inhalation. Avoid ointments and creams because they tend to keep the skin warmer and block the pores.

Erythema toxicum is normal in newborn babies and will go away on its own in a few days. You do not need to do anything for it.

White or clear milia/miliaria will go away on their own. You do not need to do anything for it.

For hives, talk with your provider to try to find the cause. Some causes require prescription medicines. Antihistamines may help stop the itching.

BABY ACNE

Normal washing is all that is necessary to treat baby acne most of the time. Use plain water or mild baby soap and only bathe your baby every 2 to 3 days. Avoid acne medicines used by adolescents and adults.

CRADLE CAP

For cradle cap, wash the hair or scalp with water or a mild baby shampoo. Use a brush to remove the flakes of dry skin. If this cannot be removed easily, apply an oil to the scalp to soften it. Cradle cap most often disappears by 18 months. If it does not disappear, it becomes infected, or if it is resistant to treatments, consult your provider.

ECZEMA

For skin problems caused by eczema, the keys to reducing rash are to reduce scratching and keep the skin moisturized.

  • Keep the baby's fingernails short and consider putting soft gloves on the child at night to minimize scratching.
  • Drying soaps and anything that has caused irritation in the past (including foods) should be avoided.
  • Apply a moisturizing cream or ointment immediately after baths to avoid drying.
  • Hot or long baths, or bubble baths, may be more drying and should be avoided.
  • Loose, cotton clothing will help absorb perspiration.
  • Consult a provider if these measures do not control the eczema, (your child may need prescription medicines) or if the skin begins to appear infected.

While the majority of children with eczema will outgrow it, many will have sensitive skin as adults.

When to Contact a Medical Professional:

Call your child's health care provider if your child has:

  • A fever or other unexplained symptoms associated with the rash
  • Any areas that look wet, oozing, or red, which are signs of infection
  • A rash that extends beyond the diaper area
  • A rash that is worse in the skin creases
  • A rash, spots, blister, or discoloration and is younger than 3 months
  • Blisters
  • No improvement after 3 days of home treatment
  • Significant scratching
What to Expect at Your Office Visit:

The provider will perform a physical exam. The baby's skin will be thoroughly examined to determine the extent and type of the rash. Bring a list of all the products used on the child's skin.

You may be asked questions such as:

  • When did the rash start?
  • Did symptoms begin at birth? Did they occur after fever was relieved?
  • Is the rash related to skin injury, bathing, or exposure to sunlight or cold?
  • What does the rash look like?
  • Where on the body does the rash occur? Has it spread to other areas?
  • What other symptoms are also present?
  • What type of soaps and detergents do you use?
  • Do you put anything on the skin (creams, lotions, oils, perfumes)?
  • Is your child taking any medications? How long has the child taken them?
  • Has your child recently eaten any new foods?
  • Has your child been in contact with grasses/weeds/trees recently?
  • Has your child recently been sick?
  • Do any skin problems run in your family? Does your child or anyone in your family have allergies?

Tests are seldom required but may include the following:

Depending on the cause of the rash, antihistamines may be recommended to decrease itching. Antibiotics may be prescribed if there is a bacterial infection.

The provider may prescribe a cream for diaper rash caused by yeast. If the rash is severe and not caused by yeast, a corticosteroid cream may be recommended.

For eczema, the provider may prescribe ointments or cortisone drugs to decrease inflammation.

References:

McFarlin AK, LeGros TL, Murphy-Laoie H. Approach to the pediatric patient with a rash. In: Adams JG ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 18.


Review Date: 2/5/2015
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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