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Skin Sense

There's a reason people can't resist stroking babies' faces and nuzzling the tops of their heads. After all, what can compare with that clean, milky fragrance of innocence? What else feels as soft and plump with life as a baby's cheek? An infant's skin is the ultimate blank slate, free of scars, wrinkles, blemishes  -- all those marks we accumulate over a lifetime. When we touch the smooth, clear curve of a baby's forehead, we are filled with a sense of newness and possibility.

From that moment on, though, it's all downhill  -- at least as far as the skin is concerned. Sun, wind, pollutants, and the very process of living slowly take their toll. But by providing thoughtful care and observing a few safety precautions, you can keep your baby's skin perfect for as long as possible.

Susan Freinkel is a freelance writer and mother of three who lives in San Francisco.

Skin Deep

The living sheet that wraps your little one from head to toe is one of the body's largest and most complicated organs. (By the time a baby reaches adulthood, her skin will measure, on average, 20 square feet, and weigh 7 to 9 pounds. Its thickness will range from one-eighth of an inch on her palms and the soles of her feet to a mere one-twenty-fifth of an inch on her eyelids.) Not only does skin protect your baby's insides from the outside, it regulates her internal temperature and enables her to discover the world through touch  -- allowing her to learn that fire is hot, a thorn is sharp, and a kitten's fur is soft.

What we call "skin" actually consists of three complex layers, each with its own function. Uppermost is the epidermis, which is about as thick as a piece of paper and serves as a shield against the elements. Here, over the course of a few weeks, is where new cells will be born, migrate to the skin's surface, die, and be shed. The epidermis also contains the cells that produce melanin, the agent responsible for skin color.

Below the epidermis is the dermis, home to the proteins collagen and elastin, which ensure that your baby's cheeks regain their shape after Great-Aunt Sadie pinches them. The dermis is packed with a dense network of blood vessels that nourish the skin and help maintain body temperature by constricting and dilating in response to cold and heat. Finally, below the dermis is the subcutis, which contains fat and muscle that insulate the internal organs and act as an energy reservoir for the body.

The Bare Facts

While many of an infant's organs develop early in pregnancy, it takes almost the full nine months in the womb for a baby's skin to mature. "What we think of as normal skin is formed in the last trimester," explains Seth Orlow, M.D., Ph.D., director of pediatric dermatology at New York University Medical Center. "The skin of a baby born at 26 weeks is transparent, thin, and a poor barrier."

Even parents of full-term infants are often dismayed by the appearance of their newborn's skin. As much as you'd expect that Ivory Snow baby, chances are that at first she'll look more like she's crawled out of a Clearasil ad. Patty Orsini of Maplewood, NJ, remembers her son's less-than-beautiful skin: "When we came home from the hospital, Zeke got little red spots on his face and body," she says. "I thought that I'd used the wrong detergent or that he was allergic to something." Instead, it was a newborn rash, and, like most, it was harmless and painless, and needed no treatment. "It came and went for a couple of weeks, and then it was gone for good," Orsini says. Here are some other conditions you may spot on Baby's skin:

  • Vernix caseosa is a white, cheesy substance that acts as a kind of natural cream to protect the skin from amniotic fluid. It washes off after birth.

  • Mottling and bruising may appear from the trauma of delivery; both of these fade in a few days.

  • Jaundice, which gives Baby's skin a yellowish tinge, results from the build-up of bilirubin, a blood by-product that sometimes accumulates after birth because a newborn's immature liver can't metabolize it all. Jaundice often goes away on its own, but it should always be checked out by a doctor as soon as it's noticed.

  • Peeling across the chest, as well as on the palms of the hands and soles of the feet, is common in babies who were overdue. In most cases, it will clear up without treatment, but a fragrance-free cream can help cracked skin.

  • Whiteheads and pimples are thought to erupt as a result of maternal hormones that circulate in a baby's body, or because of a benign fungal infection. They should disappear within a few weeks.

  • Birthmarks appear on many babies. While some will fade or are removable, others are permanent.

Newborns are prone to skin conditions partly for physiological reasons and partly because they've logged less time on the planet. Their sweat glands are not yet fully functional, and their skin is thin and sensitive. So when it comes to everyday care, "the basic rule is don't do anything to aggravate it," says Nelson Lee Novick, M.D., author of Baby Skin. "The less you dry and irritate her skin, the better."

Skimp on the Soap

Ours is a culture obsessed with cleanliness, which means that parents tend to overdo it when it comes to bathing their babies. Baths can be enjoyable social events, but dips in the tub aren't advised for newborns until their umbilical stump falls off. A gentle sponge bath of the bottom and genitals is plenty, says Dr. Novick: "You're basically dealing with a little lint and spittle on the baby's skin."

When tub time does roll around, go easy on the suds, especially if your little one has a rash of any kind. Soap can be a skin irritant, so if you use it, do so sparingly and try to save it for the end of the bath so that Baby isn't sitting in sudsy water the whole time. Try to use mild products, and if your child's skin is a little dryer than usual, moisturize it with a fragrance-free lotion or cream.

Baby That Skin

Since new skin is sensitive, be careful about what you expose it to. Infant products are generally formulated to be free of irritating additives, but don't buy a product just because it has "baby" on the label. In fact, the fragrance in many baby products can irritate some infants, so you may want to look for fragrance-free preparations. In most cases, "using sensitive-skin products made for adults is also fine," says Dr. Novick. Just be extra careful to keep these products away from your baby's eyes, because they lack the "no-tears" ingredient found in many children's soaps and shampoos.

Whatever product you use, "stick with it to limit the variety of chemicals you expose your baby to," advises Alfred Lane, M.D., professor of dermatology and pediatrics, and chair of the department of dermatology at Stanford University School of Medicine. Some experts believe that an infant's skin is much more absorbent than an adult's. One reason may be that a baby has three times more skin surface per pound. In addition, an infant's immature liver and kidneys may not be able to efficiently flush out chemicals that are absorbed through the skin.

Delicate baby skin can also be irritated by the residue left on clothing by laundry detergents. While many babies can tolerate a variety of detergents, if yours is especially sensitive, you may want to wash her clothes with a gentle product. In addition, buy clothes in soft fabrics (such as cotton) because the fibers in wool and synthetic materials "can be like barbed wire to a sensitive baby," Dr. Orlow says. And avoid clothing with rough, raised seams and scratchy tags.

Diaper Duty

Few things cause infants, and their parents, more distress than that patch of real estate known as "the diaper area." The skin here gets rough treatment, thanks to the tropical climate inside a diaper. The alkaline content of a baby's urine and stool are the major culprits behind the dreaded diaper dermatitis, commonly called diaper rash. Friction also plays an important role, which is why the peak period for rashes occurs when a baby's at the crawling stage  -- generally at around 9 to 12 months. And if the diaper area remains irritated and moist long enough, yeast can cause a secondary infection.

It isn't clear why some infants are more prone to diaper rash than others, so the best way to prevent it is to keep Baby dry. Change her as frequently as possible  -- at least eight times a day, say skincare experts.

Applying a protective cream  -- either a zinc-oxide paste like Desitin or Balmex, or a petroleum-based ointment like A and D  -- can inhibit a rash or keep it from worsening. Baby powder, on the other hand, provides little benefit: "It decreases friction until it gets wet, and then it doesn't do anything," says Dr. Lane. Indeed, doctors no longer recommend baby powder because of the danger of inhaling its main ingredient, talc, which can irritate and inflame the lungs. If you must use powder, choose one made from cornstarch, which is thought to be much safer.

If your child does develop a tender tush, experts say air is the best cure. "Get the baby naked," suggests San Francisco dermatologist Kathy Fields, M.D., but be prepared to clean up a few messes. It's also a good idea to temporarily stow the wipes, since they can irritate the skin, and use a damp washcloth instead. Ask your doctor about a cortisone cream to reduce inflammation, and if a yeast infection sets in, an antifungal cream may be prescribed.

Sun Smarts

The most important measure you can take to guard your baby's skin: Keep her out of the sun. A single blistering sunburn in childhood doubles the risk of melanoma later in life, says Joyce Ayoub of the Skin Cancer Foundation, in New York City. And a tan, despite its "healthy glow," is a sign that the skin has been permanently damaged.

"Keep your baby well-protected or out of the sun completely," says Dr. Novick. Although there is no evidence that sunscreen is harmful for infants, the American Academy of Pediatrics recommends using it only on small, exposed areas of Baby's skin, such as her face and hands. Try to keep the rest of her body covered in light clothing when you go outside. Dress her in wide-brimmed hats and long-sleeved, long-legged togs made from tightly woven fabrics; keep her shaded with a canopy or an umbrella; and install sunshades in your car to filter light that shines through the windows. Finally, be careful even when she's in the shade, warns Dr. Novick, because as much as 80 percent of the sun's rays are reflected there.

This may sound like a lot of work, but if you start healthy routines now, protecting your baby's precious skin will become second nature not only to you but to her. After all, the habits she learns today may well help her enjoy baby-soft skin for years to come.

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