It is ironic that so many people envy the softness of a baby's skin when the skin of a baby is frequently afflicted by all sorts of strange rashes and blisters. This contradiction in people's perception can cause parents to become alarmed when their baby's smooth skin gets blotchy and discolored. It is especially a source of concern when these rashes appear in unusual patterns — these often have no equivalents in adult skin ailments.

Peeling Skin

Most babies are born with relatively smooth skin, but almost immediately that smoothness gives way to significant peeling. The skin around the feet and the abdomen is especially prone to this peeling, but it can happen to skin all over the body. This is particularly common for babies who are born after their due dates; it is rare in premature infants.

Faced with a skin problem like this, the first natural impulse of most parents is to put gobs of moisturizer onto the skin because the peeling skin appears dry. Pediatricians, however, recommend against such practice. Even though the peeling skin is unsightly, the underlying skin is not really dry. It does not need to be moisturized.

Indications of a Serious Condition

There are two common skin conditions in the newborn that are particularly dangerous. You need to seek medical attention immediately if you notice a rash that fits the following descriptions.

The first condition is caused by a widespread bacterial infection in the body called sepsis. The rash that may be present with this condition appears as pinpoint red dots all over the body. There is a simple way to test whether a red rash is the result of sepsis. If you press your finger against these red dots, they will not temporarily turn white, as most other rashes tend to do. Occasionally, you may also notice larger red or purple blotches along with these small pinpoint red dots. These are signs of a very dangerous infection, and you need to bring your baby to a medical facility immediately.

The other condition is caused by the transmission of genital herpes from the mother to the baby during delivery. This type of rash appears as clusters of white or yellowish blisters. The individual blisters are small, and they may pop in a few days. They may occur anywhere on the body, but they are especially concerning when they are located on the head or the face.

If you notice a rash that fits these descriptions, contact your doctor immediately. This is especially important if your baby is not feeding well, which could mean that the infection has spread to the brain or all over the body.

Roseola

Roseola is a common childhood rash that is caused by a type of herpes virus. Fortunately, this type of herpes virus is not the same as the ones that can cause serious infection of the brain. Unlike the other type of herpes virus, it is not a sexually transmitted infection and it does not cause genital herpes.

Infants between the ages of six months and a year old are most likely to get roseola. The infection typically causes a high fever and a rash. The rash of roseola is often described as small red dots, but they are usually not pinpoint in size. While the appearance of the rash can vary quite a bit in different individuals, it generally occurs all over the body, including the face.

Fortunately, roseola is not a dangerous infection. All it causes is fever and rash. The fever always precedes the rash, which lasts about three to four days. As soon as the fever goes away, the rash appears. Once the rash manifests itself, the fever should not return. The rash should resolve in two to three days as well. There is no known complication from this infection, aside from issues that are related to a high fever itself (as described on pages 55–57).

Besides fever control, there is no specific treatment for roseola. Since it is caused by a virus, antibiotics have no role in its management. If the fever lasts more than four days, or comes back after the rash appears, your child should be seen by a physician.

Jaundice

Jaundice is when an overabundance of a yellow pigment accumulates under the skin, resulting in a yellowish hue. Many babies become jaundiced, especially those of Asian descent. This is usually a harmless condition, unless the level of jaundice becomes too high.

The yellow pigment is a waste product of broken-down blood cells. Babies are likely to have a higher level of this pigment because at birth they have a disproportionately high number of blood cells in their bodies. After birth, the baby's body starts to break down these excessive blood cells, and the pigment begins to accumulate as a by-product.

This by-product needs to be processed by the liver before it can be eliminated from the body. Unfortunately, an infant's liver is not as active as an adult's, and infants consequently cannot process the by-product pigment as fast as an adult would. The yellow pigment therefore piles up in the body and gets distributed to all the organs, including the skin.

Under normal circumstances, the body tolerates a low level of this yellow pigment. However, as the pigment level builds up, it can have detrimental effects on some organs, primarily the brain. If an excessive amount of the pigment gets stuck in the brain, it can lead to permanent brain damage. This type of disability can be devastating and may include hearing loss and the inability to walk.

If you notice that your newborn baby's skin is yellow and his bilirubin level has not been determined in the past two or three days (a test that is normally performed in the hospital), you need to contact your pediatrician. This is particularly important if your baby's bilirubin level has never been evaluated. Sometimes if the initial bilirubin level is determined to be within a safe range, it may not be necessary to recheck it until a few days later. After the first week of life, the risk of jaundice is significantly lower.

Some people believe that breastfeeding makes jaundice worse. As long as the breastfeeding baby is ingesting an adequate amount of breast milk, this is not the case. In some situations, such as that when the baby has a hard time latching onto the nipple and maintaining suction, inadequate breastfeeding may contribute to a higher degree of jaundice. If your baby is not breastfeeding with enough frequency and duration, and if he has significant jaundice, you should consult your doctor about whether it is better to pump the breast milk out and feed your baby through a bottle.

Most importantly, parents must monitor their baby closely for increased yellowing of the skin. Make sure you observe the skin under natural indirect sunlight, as an artificial light source might exaggerate the yellowness of the skin. If the baby appears more and more yellow, you should contact your doctor without delay. The doctor might check the baby's blood to measure the exact level of the pigment in the body.

Red Spots All Over

About one in three babies develop a peculiar rash during the first week after birth. The rash first appears a day or two after birth, and it starts out as small pimples with a yellowish head in the center of each red spot. The rash can be quite extensive, in some cases covering almost the entire body.

Luckily, this entirely benign condition does not require any medical intervention. It's neither an allergic reaction nor a type of infection. This rash causes no discomfort to the baby, and after a week or so it fades away on its own.

Diaper Rash

Virtually all babies end up with a diaper rash at one time or another. No matter how frequently you change your baby's diaper, the very fact that she wears one makes her susceptible to diaper rash.

Not all diaper rashes are created equal, however. Rashes typically start when the baby's ultrasensitive skin reacts to moisture in the diaper. This type of rash appears as an indistinct spread-out redness over areas of the skin covered by the diaper. It typically resolves with topical barrier creams and ointment designed to treat diaper rash.

Another type of diaper rash is caused by a common form of yeast that grows in the moist environment of the diaper. This rash appears as small, raised red dots, usually in the moist part of the skin covered by the diaper. Some of the dots can be fused with adjacent dots, forming one continuous patch of redness. The redness is usually significantly more intense than the typical non-yeast diaper rash.

The diaper rash that is caused by yeast does not respond to most over-the-counter medications. However, it does improve quickly with a prescribed antifungal cream or ointment. If you are not sure which type of diaper rash is afflicting your baby, consult your doctor — especially if a diaper rash fails to improve after using medication for more than a few days.