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Seborrhoeic Dermatitis in Babies (Cradle Cap)

Seborrhoeic dermatitis in babies causes bad dandruff (cradle cap). It sometimes causes a rash on other areas of the skin. Treatment is not usually needed as it does not normally cause any discomfort and usually clears on its own.

What is seborrhoeic dermatitis?

Seborrhoeic dermatitis in babies is a type of skin inflammation which mainly affects the scalp and face. The exact cause of seborrhoeic dermatitis is not known. It is thought that babies who develop this condition may produce more sebum from the sebaceous glands in their skin. A type of fungal germ called Malassezia furfur(previously called Pityrosporum ovale) may also be involved. However, it is not just a simple skin infection and it is not contagious (you cannot catch this condition from others). The fungal germ lives in the sebum (oil) of human skin and some babies may react to the germ in some way which causes the skin inflammation.

Many babies have a mild form of this condition within the first six months of life, but it usually goes away on its own after a few months. In most children, it has cleared by the age of 12 to 24 months. It does not usually occur in older children. Some teenagers and adults have a related condition which causes bad dandruff and a rash.

What are the symptoms of seborrhoeic dermatitis in babies?

Symptoms include:

• Cradle cap. This is areas of greasy, yellow, scaly patches on the scalp. In some cases a thick scaly layer covers the whole scalp. Over time the scales may become flaky and rub off easily. The condition is not usually itchy and, in most cases, the baby is not aware of any problem or discomfort.

• Rash. In addition to cradle cap, some affected babies develop a mild red rash on the eyebrows, on the skin next to their nose, or in the creases of the skin such as around the neck, behind the ears, in the armpits or behind the knees. The condition most commonly develops around about three months of age, but can develop sooner. It tends to last a few weeks or months, and then goes.

What is the treatment for seborrhoeic dermatitis in babies?

Treatment is not usually needed as the condition is usually mild, is not serious, and does not usually cause any discomfort to the baby. The condition will usually clear by itself eventually. However, the appearance of the scalp can be improved by daily washing with a baby shampoo followed by gentle brushing with a soft brush to loosen scales. Alternatively, soften the scales with baby oil first, followed by gentle brushing, then wash off with baby shampoo.

If needed, a medicated shampoo or an antifungal cream such as ketoconazole cream may be prescribed by your doctor. This will usually clear the rash. Sometimes, if inflammation is more severe, a mild steroid cream may be prescribed by your doctor.


Oral Thrush in Babies

Oral thrush is an infection in the mouth caused by a yeast germ called Candidaspp. Oral thrush in babies is not usually serious and can generally be cleared with treatment.

What is oral thrush?

Thrush is an infection caused by a yeast germ called Candida spp. The mouth is a common site where Candida spp. causes infection. Candidal infection in the mouth is called oral thrush. Other common sites for thrush to develop are the vagina, nappy area, and nail folds.

Why do some babies get oral thrush?

Small numbers of Candida spp. commonly live on healthy skin and in a healthy mouth. They are usually harmless. However, an overgrowth of Candida spp. can occur in the mouth of some babies. This can cause a bout of oral thrush.

This overgrowth may happen because the baby's immune system is still quite immature and so cannot control the Candida spp. levels. Another possible cause for oral thrush infection is if your baby has had a recent course of antibiotics. This is because the antibiotics can kill off healthy bacteria that live in your baby's mouth. These healthy bacteria normally help to control the levels of Candida spp. in your baby's mouth. If there are less healthy bacteria around, candidal overgrowth can occur. Also, if you are breastfeeding and you have recently been on antibiotics yourself, the levels of your healthy bacteria can be affected. This can make you, or your baby, more likely to develop thrush.

About 1 in 7 babies develops a bout of oral thrush at some point. It is most common in babies younger than 10 weeks, but it can occur in some older babies too. Oral thrush is not usually due to poor hygiene, and it does not usually mean that your baby is ill in any other way. Some babies have recurring bouts of oral thrush.

What are the symptoms of oral thrush?

White spots usually develop in your baby's mouth and on their tongue. The spots may join together to form larger spots called plaques. They may become yellow or grey. Your baby may not be bothered by the infection. However, sometimes their mouth becomes sore. Some babies may drool saliva, or refuse to feed properly because of soreness.

Note: if you are breast-feeding, it is possible that your baby can pass on thrush infection from their mouth to your nipples. This can be very painful for you. Your nipples can become cracked and sore. See your doctor if you think that you may have thrush infection of your nipples. Your doctor may suggest some cream to apply to your nipples to clear up the infection.

What is the treatment for oral thrush?

In some babies, no treatment is needed. Many mild cases of oral thrush only last for a short time - just a few days or so - and clear without any treatment.

If treatment is started, your doctor will usually prescribe a gel that contains an antithrush drug called miconazole. You smear this gel on to the affected areas in your baby's mouth, using a clean finger, as often as prescribed by your doctor. Follow the instructions carefully. Use the gel after a feed. To avoid the very small risk of choking, apply a little at a time and not to the back of the throat. The drug works by killing the candidal germs within the inside of your baby's mouth. Strictly speaking, miconazole gel is not licensed to be used in babies under four months old. However, many doctors are happy to recommend its use in babies of all ages.

An alternative treatment for oral thrush is drops which contain an anti-thrush drug called nystatin. You use a dropper which comes with the drops to place the liquid on to affected areas within your baby's mouth. Nystatin drops tend to be used if miconazole is not suitable for your baby for some reason, or if miconazole gel has not been effective.

You should continue with the treatment that your doctor prescribes, for two days after the thrush has cleared. See your doctor if the thrush has not cleared within seven days of starting treatment.

Can oral thrush be prevented?

Most bouts of oral thrush occur for no apparent reason. However, the following tips may help to prevent some bouts:

• Regularly sterilise all dummies and other mouth toys used by your baby.

• If you bottle-feed, regularly sterilise all feeding equipment, especially teats.

• Some people suggest giving a baby a drink of sterilised water after a feed. This rinses away any residual milk in the mouth which Candida spp. may thrive on.


Tear Duct Blockage in Babies

In some newborn babies one or both eyes become watery and sticky, particularly after a sleep. This is common and usually goes without any treatment.

Normal tear production

To avoid damage to the sensitive surface of the eye it needs to be kept moist. To do this and to help remove debris, the eye produces a tear film. The tear film is made up from three layers - the main middle watery layer, the thin outer lipid (oily) layer, and the thin inner mucous layer.

The watery fluid of tears comes from the lacrimal glands which are just above, and to the outer side, of each eye. These glands constantly make a small amount of watery fluid which drains on to the upper part of the eyes. When we blink, the eyelid spreads the tears over the front of the eye.

Tiny glands in the eyelids (meibomian glands) make a small amount of lipid (oily) liquid which covers the outer layer of the tear film. This layer helps to keep the tear surface smooth and to reduce evaporation of the watery tears.

The tears then drain down small channels (canaliculi) on the inner side of the eye into a tear sac. From here they flow down a channel called the tear duct (also called the nasolacrimal duct) into the nose.

What causes the blocked tear duct in babies?

Eyes can become watery either because you make too many tears (for example crying), or because the tear duct is blocked. The usual cause of a watering eye in a newborn baby is a delay in the normal development and opening of the tear duct. It is just that it is not quite developed fully at the time of birth. About 1 in 5 newborn babies will have a tear duct that is not quite fully developed. It can affect one or both eyes.

Rarely, other abnormalities of the eye or eyelids can cause a blockage of tears in babies.

How does it get better?

In time, the tear duct usually finishes developing and the problem goes. This typically happens within a few weeks after birth. In some babies it can take several months.

So, you will normally be advised just to wait and see if the problem goes. If the tear duct is still blocked by about 12 months of age, your doctor may refer your baby to an eye specialist. An option is for a specialist to perform a procedure where a very thin instrument is passed into the tear duct to open up the duct. The procedure is usually successful.

Sometimes referral to a specialist may be done sooner if the problem is particularly troublesome, or if a rare abnormality is suspected to be the cause.

Is it serious?

Usually not. A typical case is as follows: tear production in newborn babies may take a week to start, so you may not notice watery eyes at first. You may then notice one or both eyes becoming watery. The baby is usually not bothered. Sometimes after a sleep the affected eye looks sticky. You may have to wipe away some glue-like material. The eyeball looks healthy and white. After the problem seems to have gone, if the child has a cold, the watery eyes may return for the duration of the cold. This is because the newly opened tear duct may become blocked by mucus.

What should be done?

Usually nothing, as it normally goes away without treatment. If gluey material develops then wipe it away with some moistened cotton wool. Ideally, moisten the cotton wool with sterile water (cool water that has previously been boiled). It may help if you massage the tear duct six times a day. To do this, use gentle pressure on the outside of the nose. This may help to clear pooled tears in the blocked duct. It may also help the tear duct to develop.

Possible problems

Slight redness of the eyeball may come and go. This is due to mild inflammation, and no treatment is needed. Sometimes this may develop into a conjunctivitis (infection of the outer part of the eye). The eye may then look inflamed and red. This is not usually serious. Antibiotic eye drops are sometimes prescribed to help clear conjunctivitis.

As mentioned, rarely, a watering eye in a baby is due to other eye problems. With the typical problem where the blockage is due to a late-developing tear duct, the eyeball is usually white and the baby is well and not bothered by the watering eye. The following symptoms may indicate a different problem. If they occur, see a doctor:

• If the eye becomes inflamed, angry or red.

• If the baby rubs the eye a lot or seems in pain.

• If the baby does not like to open their eye, or light seems to hurt the baby's eye.

• If the structure of an eye or eyelids does not seem right.


Blocked Nose in Babies ('Snuffles')

A blocked nose (snuffles) is common in babies under six months old. It is usually due to normal mucus that collects in the nose, which is difficult for the baby to clear. No treatment is required if the baby is otherwise well and feeding well.

What causes snuffles?

Baby snuffles are usually due to the normal mucus that may collect in a baby's nose. Snuffles are not caused by colds or infections - although an infection can make things worse. A baby who just has snuffles will be otherwise well, but may snort when breathing. However, feeding can sometimes become difficult if the baby cannot breathe very well through his or her nose.

What can I do?

General measures

Nothing needs to be done if the baby is happy and able to feed. However, the following may help if feeding becomes difficult:

• Try placing a bowl of warm water in the room where the baby sleeps. This raises the humidity which may help to loosen thick mucus.

• Try giving smaller but more frequent feeds.

• Saline (salt water) nose drops

Saline drops may be useful if the above measures do not help. Saline drops thin out the mucus and so make it easier for the baby to clear the mucus from the nose. (Saline seems to work better than just plain water.) You can buy saline drops from a pharmacist who can also advise on how to use them. Only use the drops just before feeds, and only if the nose is blocked. If saline is used too often, the skin around the nose may become a little sore.

• Advice from a health visitor or doctor

Most babies with snuffles come to no harm and feed well, but perhaps more slowly and with more difficulty than you would like. If you are concerned that feeding is a problem then see your health visitor or doctor. For example, as a last resort, your doctor may prescribe a decongestant nasal drop to use for a few days if feeding is particularly difficult. However, do not give your baby decongestant nose drops unless advised to do so from a doctor, and only for the time prescribed. (Decongestant drops used for too long can cause problems.)

Nasal aspirators

It is not possible to give any advice on whether to use a nasal aspirator (little sucker) or not. Some parents buy one to suck mucus from the baby's nostrils before feeds. (They are advertised on some websites.) There are no research trials to show how effective they are, and there is some concern that they may do some harm if not used carefully.