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Ask Dr. Sears: Persistant Cradle Cap

Q. My 5-month-old twins have very bad cradle cap and dry patches all over their bodies, especially under their necks, behind their legs, and in the creases of their arms. The pediatric dermatologist we went to said they don't have eczema. My babies have reflux, so I've been mixing a little rice cereal with their formula (Enfamil Lipil) since they were 2 months old. Could they have an allergy to the cereal? What can I do to cure the cradle cap?

A.
Your babies' cradle cap, also known as seborrheic dermatitis, is likely caused by the overproduction of the oil glands in the skin of the scalp. The glands produce an oily substance called sebum, which cakes on the skin. The good news is that while it may be unsightly, it's usually not irritating or bothersome to babies. Eczema has a similar appearance to cradle cap but can be intensely itchy and uncomfortable. It tends to be located in the spots you've described. But since your pediatric dermatologist has ruled out eczema, the most likely cause of your babies' dry patches is an allergy, and the culprit is probably the milk-based formula your babies are on, rather than the rice cereal. It's important to note, however, that formula allergy rashes are usually more pronounced on the face. Also, if a baby has an allergic reaction to formula, intestinal discomforts are typical, namely bloating, colicky abdominal pain, and diarrhea. Try this step-by-step plan to clear your babies' skin.

Use a hypoallergenic formula. Consider switching to a formula that has less allergenic proteins, such as Alimentum or Nutramigen. If the dermatitis is indeed due to a formula allergy, you should see improvement within a couple of weeks. Be sure to consult your babies' doctor before making this change.

Oil your babies. To cure cradle cap, massage a vegetable oil into the crust-like scales. Let the oil soak in for fifteen minutes to soften the scales, then remove them with a soft baby hairbrush. To completely get rid of the scaliness, use an over-the-counter tar-based shampoo once a week. The omega-3 fats found in fish oil are another effective remedy due to their anti-inflammatory properties (the dermatitis that you've described is most likely due to a generalized inflammation of the skin). While omega-3s are now added to the latest infant formulas, they may not be present in high enough doses to efficiently work as an anti-inflammatory on your babies. Ask your doctor to recommend a pharmaceutical-grade fish oil. Add no more than 500mg a day to your babies' formula: Simply open a 500mg capsule and squirt it into the bottle. Once the dermatitis has cleared, gradually wean your babies off the added fish oil but keep them on an omega-3-enriched formula. If there's a recurrence, simply resume the fish oil. If the dry, scaly skin persist throughout their toddler years, I suggest you feed your growing twins at least 3 ounces of wild salmon a couple times a week.

Hydrate the skin. The dermatitis you described may also be due to the inability of the skin to retain moisture. Try this trick: After bathing your babies with a mild, moisturizing soap such as Dove, rinse the soap off well. Gently pat the skin partially dry, leaving a slight layer of water on the skin  -- just enough so you can feel the moisture. Apply an emollient ointment (such as Soothe and Heal by Lansinoh) over the affected areas. The ointment seals in the water above the crusted areas and hydrates the skin. Also, offer each baby an extra 8-ounce bottle of water to drink daily. Using these hydration methods, you'll water the skin from the inside out.

Humidify the air. Dry skin loves humidity. Central home heating during the winter months robs the skin of much-needed moisture. Run a warm-mist vaporizer in the nursery. Vaporizers not only moisturize the skin, but they act as a heat source, allowing you to turn down the drying heat in your home.

Babies who begin life with sensitive and irritated skin are likely to retain this quirk throughout childhood. This means you'll need to keep a diary to identify the dry-skin triggers, such as food allergens, irritating clothing, or detergents. Through trial and error you will gradually formulate your own personal skin-care program, arriving at the a diet and environment that's just right for your twins.

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