Pearls of Wisdom: Newborn Skin Conditions

shutterstock_28299541We’ve all seen pictures in books and magazines of the perfect newborn, swaddled in a hospital blanket, nestled into her parents welcoming arms. She is as perfect as a rose, with a tiny upturned nose and lovely, clear skin. It’s no wonder that parents are often surprised when their newborns present with a variety of rashes and skin conditions. The Majority of these rashes are harmless and self-limiting, and will resolve on their own or with appropriate treatment.

Normal newborn skin is thin and less hairy than older children and adults. Also, the ratio of skin surface to body volume is high which leads to increased absorption of topical medications.  Frequent manipulation, hot water and harsh soaps are some of the factors that lead to irritation and skin breakdown. Once there are breaks in the skin, these become portals of entry for bacteria, leading to serious skin infections.  Frequent use of moisturizers helps re-hydrate the skin and prevents excessive dryness and skin infections.

There are a number of benign skin changes that are seen in the first few weeks after birth. The more common ones include the following:

* Salmon Patches (also known as “stork bites”) are vascular stains frequently found on the nape of neck as well as the glabella (space between the eyebrows and above the nose) where they are called “angel’s kisses.”  They are found in 70% of white babies and 59% of African American newborns. Although these lesions may fade over time, 25-50% may persist into adulthood.

* Hemangiomas initially appear as flat red patches that darken and spread with time. They may be elevated , bright–red or violet in color, depending on how deep they are. Rapidly growing lesions may require steroids and/or laser therapy, although many will just fade and regress with age.

shutterstock_113526559* Infantile or Neonatal Acne usually appears at 2-4 weeks of age and resolves by 6-8 months. Experts believe that this is an inflammatory response to an organism called Pityrosporum yeasts.  This skin condition usually does not warrant therapy unless very severe in which case, a 2.5% benzoyl peroxide treatment as well as topical antibiotics may be prescribed.

* Atopic Dermatitis (Eczema) is an extremely common itchy scaling disorder that appears between 4-6 weeks of age. It may present on the cheeks, trunk, in bends of elbows and behind knees. Many babies either have a family history of eczema and/or allergies. A good 60% of babies who have eczema or atopic dermatitis outgrow it. Medications can help control flare-ups but does not cure it. I usually recommend avoiding long, hot baths and applying moisturizers daily. Sometimes, we recommend non-steroidal or steroidal creams and antihistamines for itch.

shutterstock_56934568* Seborrheic Dermatitis is the most common scaling skin disorder in infants. It appears immediately after birth, usually affecting the scalp (called “cradle cap”), behind ears, and on the face. It appears like well-demarcated, confluent red patches with greasy scales. This type of dermatitis does not itch and usually resolves by 3-6 months of age. Treatment depends on severity; usually your doctor may prescribe antiseborrheic shampoos that contains zinc and selenium sulfide. Using mineral oil before shampooing may help remove the scales. In the presence of a superimposed fungal infection with Candida, an anti-fungal may be prescribed.

* Diaper Dermatitis is a nonspecific term that pertains to all skin eruptions in the diaper area. Irritant diaper dermatitis is secondary to a variety of factors that include fecal enzymes that erode the skin barrier, prolonged exposure of skin to moisture, and the presence of ammonia in the baby’s urine. Babies with diarrhea and those taking antibiotics also are at risk. Mild cases can be treated with topical zinc oxide paste or a petrolatum emollient which acts as a protective barrier against soiling elements. Frequent changing of diapers is recommended to reduce moisture and time exposed to extrinsic factors. In severe instances, 1% hydrocortisone cream applied after diaper changes may be given.

Plain water with or without a mild soap should be used to gently clean the baby’s skin. Your infant does not require frequent bathing if you wash the diaper area thoroughly during diaper changes. Bathing babies too frequently dries out their skin especially if soap is used. Patting her dry opposed to rubbing hard, followed by application of a fragrance-free, hypoallergenic, moisturizing lotion immediately after bathing can help prevent dryness and eczema. In other words, be gentle with your baby’s skin and avoid substances that have triggered skin rashes or irritations in the past. When in doubt, do not diagnose and treat baby without visiting your pediatrician, who can decide whether the rash is a harmless, benign lesion or something that needs referred to a dermatologist.

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

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Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Emotional Bonding- Part 1: Birth to 12 Months

We hear the term “bonding” so often in modern culture that it’s easy to minimize its importance and impact. But the bond between parents and children is so critical that immediately after delivering a baby, barring complications, a mother will be given some time to spend holding, stroking and looking at her baby. During this sensitive period when the newborn is very alert and responsive, the very first exchanges of touch, eye contact and sounds between a mother will occur; these first interactions are all part of the bonding process.

Many of the basic core emotions you feel for your child will begin during the period right after birth. Watching your baby look back at you, mirroring your facial expressions and following your movements, you will feel a wonderful surge of awe, protectiveness, and limitless love. This initiates what is called the attachment process. Moms who are sedated or who have babies requiring immediate medical attention may not be able to spend this time but should not worry. This will have no long-term repercussions on their relationship since bonding has no time limit. Once your baby is stable and you have recovered from the stress of labor, you will have this opportunity and achieve the same heightened connection.

shutterstock_78150679Parents have an active role in the infant’s state regulation, by alternately offering stimulation or soothing to lengthen the social interaction. Likewise, the parents are regulated by the baby’s signals, responding, for instance with a bottle or breast to answer cries of hunger. These interactions comprise a system directed toward developing the infant’s normal physiologic homeostasis and physical growth. This also forms the foundation for the budding relationship between parent and child. Your baby learns that you as the primary caregiver can alleviate her stress or tension by feeding and shows this preference by calming down quicker for the mom or dad than for a stranger. In turn, this gives Mom a sense of validation and strong connection with her infant. Breastfeeding is a wonderful means by which mothers feel fulfillment and joy from the physical and emotional connection they experience while nursing. These warm feelings are augmented by the release of the hormone prolactin, producing relaxation and the hormone oxytocin, which promotes the sense of love and attachment between mother and infant.

Babies learn basic trust when they realize that their urgent needs are met. The presence of an adult who provides consistency creates the scenario for a secure attachment. Studies show that infants who are consistently picked up and held in response to distress cry less at 1 year and show less aggressive behavior at 2 years.

shutterstock_130586048By the age of 2 months, infants have their first voluntary social smiles and their amount of eye contact increases, marking a change in the parent-child bonding and also giving the parents a sense of being loved back. The baby interacts with increasing sophistication and range, expressing varied emotions of joy, anger, fear, interest and surprise by different facial expressions. When interacting with a trusted adult, the infant and the caregiver have matching expressions about 30% of the time; the eye-widening, laughing and lip-puckering rises and falls together. If the parent turns away, the baby leans forward and reaches out to get the adult involved again. Infants of depressed parents have a different pattern and spend noticeably less time in coordinated movement with their parents, and make less effort to re-engage. They show sadness, apathy and a loss of energy when the parents are not available. This face- to- face behavior demonstrates a baby’s ability to share emotion and expectation from the relationships, which is the initial step in communication.

Babies 6-12 months old show advances in cognitive understanding and communication ability, with new tensions around themes of attachment and separation. Babies look back and forth between a stranger and a parent, as if to contrast a familiar versus an unfamiliar, and may cling or cry. At the same time, there is an emergence of asserting independence; hence, they attempt self-feeding and refuse to take the spoon from the caregiver. This is when temper tantrums arise as the desire for autonomy comes into conflict with parental control.

The unique emotional relationship that forms between you and your baby is key to him feeling safe, and also influences your child’s social, emotional, intellectual and physical development. A secure bond ensures that your baby will have a firm foundation for life, which includes a healthy sense of self-awareness, eagerness to explore and learn, and trust and respect for others. When babies develop a secure attachment bond, they are better able to enjoy interacting with others, develop confidence, handle disappointment, loss or stress, form mature intimate relationships and maintain emotional balance.

How do you bond with your children? Share your stories in the comments or on our Facebook page!

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: What to Expect On Your Baby’s First Doctor’s Visit

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Post By. Dr. Pearl Cenon

In my 15 years as a pediatrician, I’ve had the pleasure of being one of the first faces (outside of family) that new babies meet! A baby’s first visit to the pediatrician is always an exciting one: parents are full of questions about their precious little one. Even if it’s not a firstborn, each baby has her own unique personality so parents find themselves seeking new and different advice or trying to remember how things worked the last time around! Whether you are expecting your first or fifth child, this is a basic summary on your newborn’s first visit to the pediatrician.

New moms and dads should expect to see their family pediatrician the most during baby’s first year. Right after the baby is born, an appointment should be made for a visit. It’s a good idea for two people to accompany baby so that one parent can focus on the discussion with the doctor, while the extra caregiver attends to baby. This will give parents an opportunity to get to know their pediatrician and exchange questions and answers. Questions can range from medical issues to common childcare topics, parental support groups, and any other practical matters.  From this very first visit, a good pediatrician will make parents comfortable and assist them in every possible way.

Initially, your baby’s weight, height and head circumference will be measured and plotted on a growth curve that shows how your baby compares to other babies the same age. These measurements will be taken at all subsequent infant visits because they help track your baby’s growth.  Interesting fact: generally speaking, (though your baby’s milestones may vary; check with your doctor if you have questions), babies will double their birth weight by their sixth month of life and triple it by the age of one. Imagine if we tripled our weight within a year?!

Provincial health department, Bolu, Turkey Photo: Simone D. McCourtie / World Bank

Provincial health department, Bolu, Turkey Photo: Simone D. McCourtie / World Bank

Next comes a thorough, head-to-toe physical examination. In the head exam, the doctor examines the soft spots — called fontanelles – that are normally open and flat in the first few months. The posterior (back) fontanelle usually closes at two to three months while the anterior (front) fontanelle closes before the second birthday.

Though most newborn nurseries perform hearing tests before the baby is discharged, baby’s ears will be examined again during this visit. To assess hearing, the doctor may ask how your baby reacts to your voice or loud sounds. The doctor will use an otoscope that provides a good view of the ear canal and eardrum.

Everything Checks Out!- Lab212

Everything Checks Out!- Lab212

Using a bright light such as an ophthalmoscope, the doctor will examine your baby’s eyes to detect cataracts that sometimes form early in life. He or she will also track eye movements and check the pupil’s response to light.  Next is an exam of the mouth and neck, followed by use of a stethoscope to listen to the heart and lungs. The doctor is listening for murmurs, abnormal heart rhythms, and breath sounds.

The doctor will also gently apply pressure to your baby’s abdomen to check for any abnormal masses or tenderness. If your baby still has the umbilical stump, he or she will show you how to clean and keep the area dry until it falls off.  Genitalia are also checked for abnormal lumps or signs of infections. In baby boys, the doctor will examine the penis (and healing, if a circumcision was performed) and ensure that the testes are both down in the scrotum.

To assess for problems in the hip joints, your doctor will move your baby’s legs to detect any abnormalities such as congenital hip dysplasia; early detection of this condition is critical for correction later in life.

Lastly, your pediatrician will ask about your baby’s feeding, sleep patterns, and bowel/urinary frequency. It is crucial that you learn to recognize developmental milestones that your baby will reach; hence the doctor will discuss when you can expect your baby to smile, roll over, sit up, walk, and how he or she uses her hands and arms. During this visit, your pediatrician will also test the baby’s reflexes and muscle tone.

Prior to baby’s birth, consider asking your family members, friends, and even your ob/gyn for their recommended pediatricians; then make appointments to meet several.  Just as you would interview childcare providers, you will want to ensure that the pediatrician you choose for your baby is someone that you trust and with whom you have a good relationship.  You and your child will be in close contact with the family pediatrician for almost two decades… that’s good reason to be choosy!  A good pediatrician is one whose reputation is excellent, but also someone who can clearly answer your questions, is a good listener, instill confidence in you, and someone who always makes you feel welcomed!

Warm Wishes,

Dr. Pearl

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She’ll write basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

The NICU Journey

A Neonatal Intensive Care Unit (NICU) is a nursery within a hospital that specializes in caring for sick and preterm newborns. Most babies who spend the longest times in the NICU are born too early and for most families, like mine, this will be a sudden and unexpected experience. The days, weeks, and months to follow are emotionally draining. Families must endure waves of emotional highs and lows as their newborn goes through “good days” and “bad days”. Coping with these triumphs and setbacks can be difficult, but the NICU journey is an opportunity for immense bonding with your newborn. Here, I will share some tips to hopefully help someone get through this time.

  • The most important thing for you, as a mother, is to take care of yourself; physically and mentally. You cannot help your baby if you are not well.
    • Follow your provider’s orders for after-delivery care, especially if you had a cesarean. Do not drive, climb stairs, or carry heavy bags. You risk re-opening the incision.
    • Set a routine and stick to it. Include your meals, adequate time for sleep, and general hygiene in your schedule. This will help you rebuild your strength and maintain your physical and mental health. Also, set reminders to take your medications, if any.
    • Talk to someone about your emotions. A professional can help you understand your feelings (and once I was comfortable enough to talk with the nurses and social workers, I learned that most families of NICU babies deal with the same feelings of shock, helplessness, anger, guilt, and fear that I was experiencing). Talk to other families in the NICU, or join online forums or support groups to share stories. These “strangers” can be most comforting to you.
  • While you remain a patient in the hospital, you may want to request a private room. You may find it difficult to be around mothers with healthy newborns.
  • Get to know the staff and your baby’s caretakers, and make an effort to develop a rapport with them. There will be nurses, doctors, specialists, surgeons, social workers, lactation consultants, and more. Ask questions about the equipment, your baby’s condition, and procedures. These people are there to help. Become informed.
  • You are a crucial member in the team of providers for you baby’s care. Be involved. You will have almost 24-hour access to the nursery. You can also call at any time you desire. Once your baby is stable enough, you will be able to hold, bathe, feed, change, and dress him. You can coordinate these tasks with your baby’s nurse. Communicate your schedule to them, however, participation will all be based on your baby’s response and tolerance at the time, so be prepared for plans to change. I am a very reserved person, so I initially took a back-seat approach here. I felt uncomfortable in the beginning…like a stranger or just a visitor. I was not sure of what was expected of me or what was allowed of me. I was nervous to even put a blanket or cap back on my daughter if she wiggled out of it. Once I developed that rapport with the nurses, I felt more comfortable and was able to appropriately participate in her care.
  • Keep a calendar of dates and/or a journal. Record information on your baby’s health, progress, and treatments, special moments/events, and difficult times. In the future, you will want to remember all of the moments during this special time. I carried a notebook with me everywhere during the 44 days my daughter was in the NICU. No matter where I was, when I received information, I recorded it. My husband was not always with me, so rather than letting my stressed mind fail me, I could turn to my notebook and give him a complete run-down on our daughter’s day. A journal can also be a place for you to express your feelings to relieve stress and anxiety.
  • Take advantage of Kangaroo Care (skin-to-skin contact). This method of contact has been proven beneficial to parents and newborns. It has an overwhelming calming effect and is the ultimate bonding experience between the mother/father and baby. It can help alleviate symptoms of mood disorders. The newborn’s growth rate can increase, overall health has been seen to improve, and the baby is able to regulate their heart rate, breathing, and maintain a proper body temperature.
  • It is OK to not be at your baby’s crib-side 24-hours a day (as long as your schedule is communicated to the nurse). I struggled with this. Even when my daughter was in stable condition, I did not want to leave her side (I felt like I was abandoning her). I wanted to spend every waking minute with her. However, I did have another child at home that needed me as well. At our hospital, siblings (children) were allowed to visit once per week, between certain hours, so on that day every week, my husband and I gave our time and attention to our older daughter. We visited the baby as a family, and spent the rest of the day doing something special with her.
  • Know that only your baby can determine when he will be going home. The doctors and nurses cannot give you a date or time. More than likely, you will be told only hours before discharge. Rather than asking the doctor, “When can he come home?”, ask, “What are the tasks he needs to achieve before he can come home?” Expect your baby to be in the hospital until his actual due date, at least. My daughter was born 9 weeks early, so we planned on her being in the hospital for 9 weeks.

Our NICU journey was one of the most trying times in our lives. My daughter and this experience has changed my life forever. Through this journey, miracles were witnessed, faith was restored, and doors were opened. Her fight has been such an inspiration to me. Due to complications with pre-eclampsia, my daughter was born at 31 weeks gestation. She weighed 3 pounds, 12.8 ounces, and was 17.5 inches in length. We were able to bring her home on April 15, 2009, when she was 44 days old. She is now a beautiful, healthy, 2 1/2 year-old, with the same strong will she was born with. We are so very blessed.


About the Blogger:

Hi! My name is Tanya. I am a stay at home mom and a full time nursing student from South Jersey. I am married and have been blessed with 2 beautiful and healthy little girls, aged 2 years and 7 years. I love gardening, baking, crafting, and a good belly laugh!