The Care and Protection of Your Premature Baby's Skin

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Skin is a barrier that provides protection from infection, helps control body temperature, and prevents water loss. A preemie is at a greater risk for infection and the loss of heat and water through the skin. That's why it's important to keep your preemie's skin healthy and intact. A premature baby's skin is not as fully mature as a full-term newborn, so a preemie's skin needs extra care. Delicate skin is at risk for injury from tape, electrodes, and adhesives.

And, it's more sensitive to irritation and breakdown from the chemicals in soaps, detergents, or lotions. While you're in the hospital, the nurses and other members of the health care team will evaluate and monitor your baby's skin regularly. But, once you leave the hospital, it's up to you to check your child's skin and keep it healthy. Here's how to care for and protect your premature baby's sensitive skin at home.

Bathing Your Preemie

Before you take your preemie home from the hospital, your child's nurse will most likely give you a bath demonstration. You should also have the opportunity to return the demo to your nurse. After that, ask if you can bathe your baby when you're visiting so that you can become comfortable with it. Once you're home, you don't have to give your child a bath every day. Newborns and young infants don't get that dirty, plus frequent bathing can dry out their skin.

Of course, it's up to you, but every other day is perfectly OK.

You can choose to give your preemie a sponge bath or a tub bath. Either way, use plain water or a gentle baby soap. Stay away from scented soaps, soaps with a lot of chemicals, or antibacterial soaps. These can dry out your baby's skin and kill off the natural bacteria that's suppose to stay on the skin to help prevent infection.

Plain water or water and a mild soap will do just fine. When the bath is over, wrap your baby in a blanket and gently pat him dry to remove all the water from his skin and prevent his body from losing heat. You can use a safe moisturizer after the bath, but avoid using baby powder or cornstarch. Cornstarch and baby powder have small particles that can get into the air that your child breathes which is not good for your preemie's lungs.

Caring for the Umbilical Cord Area

Depending on how early your child arrived, he may already have a completely healed belly button area by the time you take him home. However, if your preemie still has his cord or the area is still healing when you get home, you just want to keep it clean and dry. Check the cord area each time you change your baby's diaper and when you give your child a bath. When you change the baby, be sure to fold the top of the diaper down in the front to keep the cord uncovered and outside of the diaper. Some disposable diapers have this area already cut out. During the bath or if the cord becomes soiled from a dirty diaper, you can clean the umbilical area with a mild soap, rinse it with clean water, and dry it gently. As you clean and check your baby's cord, look for any signs of infection.

If you see redness, swelling, or drainage, or your child gets a fever, call the doctor.

Keeping Your Baby's Diaper Area Clean and Clear

When moisture sits on the skin for a while, especially from a bowel movement, it can cause a red, bumpy rash on your baby's bottom. The overgrowth of yeast in the diaper area can also lead to a diaper rash. That's why you want to keep your little one's diaper area as clean and dry as possible. Now, you don't have to change your child constantly or wake her up to change her diaper. But, you should change her at least every 1 to 3 hours and as soon as you notice a poopy diaper.

To clean your baby's bottom, use a soft, wet washcloth with plain, lukewarm water. You can use a mild baby soap, too. If you want to use baby wipes, just be careful to read the labels because sometimes they contain ingredients that can irritate your baby's skin. As you're cleaning, be gentle. You don't have to wipe vigorously or scrub the area.

If your preemie does develop a diaper rash,  don't worry. You can apply a thick layer of a safe diaper rash ointment or cream to protect the skin and help it heal. Diaper rash usually goes away in a day or so. If it doesn't get better in a few days, it may be a yeast-related rash so see the doctor. The doctor may prescribe an anti-fungal diaper rash ointment to help it heal.  

Fingernails and Your Baby's Skin

Caring for your child's fingernails is an important part of caring for your child's skin. Little fingernails are sharp, and they can scratch the skin on your baby's body or face. Not only is it painful for the baby, but any opening in the skin can be an entryway for infection. Therefore, you want to try to keep those tiny fingernails from causing damage. One way to keep scratching under control is to cover your baby's hands. Some baby shirts or outfits have sleeves that fold over the hands. You can also use infant hand mitts or your child's little socks. Another way to care for your preemie's nails is to keep a baby nail file on hand to gently file away any sharp edges.

Cradle Cap

Cradle cap is a skin condition called seborrheic dermatitis. It's a build up of oil in the baby's sebaceous (oil-producing) glands. Cradle cap is just a baby version of dandruff, so it's not an infection, and it's not contagious. When you see it, it might look like a rash, or thick, crusty, white, yellow, or brown patches on your baby's head. If you leave it alone, it could go away in a few months time. But, if you'd like to try to help it along, you can wash your baby's head with a mild baby soap and gently brush the area with a soft baby brush. You can also massage a little bit of baby oil into the cradle cap then gently loosen the flakes with a fine tooth comb before washing and rinsing your child's head. Cradle cap is not dangerous. However, if it looks infected, becomes red, swollen, or begins to bleed, take your child to the doctor to have it checked. 

Baby Eczema

Eczema (atopic dermatitis) is a dry, itchy, red, scaly rash. It's the result of an allergic reaction or a food sensitivity. It can be hard to figure out the cause of eczema, but you can try to eliminate anything that may be irritating such as lotions, shampoos, and laundry detergents. Talk to your baby's doctor about a safe skin moisturizer to ease the dryness and itchiness, and try to keep the irritated skin from becoming infected. Your child's pediatrician may prescribe a steroid cream or an antibiotic if there's an infection. If the doctor thinks the eczema is related to a food allergy, you may have to change the baby's formula (if he's taking formula) or try to eliminate some of the common allergens in your diet (if you're breastfeeding).

Washing Your Baby's Clothes

Laundry detergent can irritate delicate baby skin, so try to use chemical free laundry soaps for all the clothing and linens that your preemie touches. That includes your child's clothes, bedding, and blankets, but it also means your clothes and bedding since your baby will come in contact with those items as well. If you find that even the gentle detergent is irritating your child, you can try putting the laundry through two rinse cycles. The extra rinse will help to remove any detergent that the first rinse cycle leaves behind. You can also skip the fabric softener in the wash and the dryer since it's just another product that can contain irritating chemicals. And remember, if you change your laundry soap, be sure to watch for a reaction in your child.

Dealing With Tape or Other Adhesives for Medical Equipment

Tape and the sticky electrodes and probes from monitors, IVs, feeding tubes, or respiratory equipment can all damage the delicate skin of a preemie. You'll definitely want to pay attention to the skin under and around these sticky items. If your baby's skin is not irritated, you can leave the adhesive on as long as possible. Then, when it's time to remove it, don't pull it off. Instead, soak the tape or sticky material with some water to loosen it and help it come off more gently and easily.

How to Care for Your Baby's Skin Outdoors

Whenever possible, try to keep your baby out of the direct sunlight, especially during the summer months between the hours of 10 am and 4 pm when the sun is the strongest. While your baby is very young, a sun hat and light clothing work well to keep his body covered. You can place a sun visor or a light cover over the stroller or play yard while you're outdoors. But, before using sunscreen, talk to your baby's doctor. She may recommend that you wait until your child is a little older.

A mosquito net is the best option to keep the bugs away and protect your baby's skin from insect bites. Bug sprays have chemicals that can get absorbed by your baby's skin, so it's better to avoid them. Your child's pediatrician can recommend a safe insect repellent once your child gets a bit older.

Where to Find More Information About Your Baby's Skin

While your baby is in the hospital, try to ask as many questions as you can. And, when possible, try to do as much as you can to participate in your baby's care while the nurses are around to help. The more you learn and do before you get home, the more confident you'll feel.

Once you get home, you'll begin to take your baby to the pediatrician for regular checkups. Write down questions as you think of them, and bring them along to your appointments. And, of course, if there's something that just can't wait, you can always call the doctor's office.

Sources:

Afsar FS. Skin care for preterm and term neonates. Clinical and experimental dermatology. 2009 December 1;34(8): 855-858.

Balk, SJ. Policy Statement – Ultraviolet Radiation: A Hazard to Children and Adolescents. Council on Environmental Health and Section on Dermatology. Pediatrics. 2011 March; 127 (3): 588-597.

Lund C, Brandon D, Holden C. Neonatal skin care Third Edition: Evidence-based clinical practice guideline. 2013.

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