Newborn Skin Care – A Review of Evidence and Practice


Skin Care Practices Bathing and Cleansing


The methods and regimens used for newborn skin cleansing vary between countries and cultures. However, it is important that any cleansing products and practices do not harm skin barrier function. Concerns have been raised regarding ingredients in some products.19 Additionally, many parents are choosing to avoid the use of products altogether or opt for organic alternatives. Soap and detergent use has been implicated as a trigger in the development of atopic eczema.14


Soap and detergents are known to increase the pH of the skin to levels outside of the normal range.20,21


Surfactants and foaming agents


such as sodium lauryl sulphate have been implicated in the breakdown of the skin barrier.21


Preservatives such as parabens, necessary for


safeguarding the shelf life of products, have been highlighted as being potentially harmful,19,22,23


although this is subject to considerable debate.


Product ingredients differ considerably, from soaps and detergents containing harsh surfactants to milder soap-free pH-balanced cleansers. Recent product development has led to the use of alternative and potentially less damaging ingredients; however, there is little guidance for women regarding product safety. In addition, many of the older generation formulations remain available. The difficulties that arise for women lie in interpreting product labels to determine the difference between products. While many women are concerned about the safety of products and the potential harm to their babies’ skin, others assume the safety of products if they are readily available for purchase.1


Recent reviews of existing literature have added to the growing body of evidence regarding skin cleansing.24,25


Crozier and Macdonald24 reviewed


two randomised trials comparing water and cleansers for newborn skin cleansing. They noted that the two studies were methodologically limited, concluding that further study is necessary. Blume-Peytavi et al.25 chose to review a wider selection of literature, looking at eight papers relating to skin maturation and adaptation as well as bathing and washing practices and products. They also noted a disparity in the quality of the studies and the need for further trials. They did, however, conclude that bathing with mild liquid cleansers is equal, or possibly superior, to bathing in water alone. However, it is difficult to incorporate such a conclusion into guidance in the absence of definitive empirical research. These reviews indicate that there is growing interest in the effects of skin care regimens and products on baby skin, although as yet no large-scale randomised controlled trials have been published.


The UK adopted a policy of recommending bathing of babies in water only, given the poor evidence available regarding the use of products on newborn skin.26


pH, raising it outside of the normal range.27


evidence suggesting the skin barrier is not mature until twelve months of age. Furthermore, while hospital guidance may suggest not using any products, women in the UK are routinely provided with free samples during the pregnancy and post-natal period. Compliance with bathing guidance has been shown to be an issue, as Lavender et al. found during their 2011 pilot trial comparing water with a bathing product.29


Over 50 %


of women began to introduce products into skin care regimens after three weeks of age, despite being asked to avoid their use for the period of the trial. This occurred regardless of trial arm allocation. It is suggested, therefore, that women are at least as likely to introduce products, possibly more and earlier, when they are not being monitored.


It is perhaps no surprise that women choose to use products on their newborn infant. Baby bathing is considered pleasurable and part of the bonding experience between the parents and the baby. It is important for health professionals to understand the importance of this aspect in the process of baby cleansing. Mothers are eager to ensure their newborn baby is clean and pleasant smelling, which many women believe is only possible with the use of cleansing products.1


Research into bathing practice itself is lacking, with suggestions that skin integrity can be impaired through friction by the use of wash cloths.30


Lund et al.31


suggested skin breakdown in well infants was due in part to friction. Furthermore, bathing by immersion is considered preferable to washing with a cloth, as it results in reduced heat loss and improved thermoregulation.25,32,33


This is of particular importance


for the care of newborns who are at higher risk of hypothermia. The duration of immersion in the bath is also subject to debate, but five minutes has been suggested as adequate with a water temperature not exceeding 37 ºC.34


Commencement and frequency of bathing is also subject to debate, with little evidence to guide practice. There are various recommendations relating to the timing of bathing following birth, including two to four hours,17 preference.32


six hours18 Blume-Peytavi et al.25 to only two36 and in line with cultural suggest bathing should occur no


more frequently than every other day. However, views vary widely, from daily35


or three times per week.18


around the frequency of bathing relate to the growth of skin organisms over time. Quinn et al37


Some of the concerns compared the frequency of bathing in pre-term


infants, finding no significant difference in growth of organisms whether babies were bathed every other day or every fourth day. Additionally, no difference in organism growth or type between babies bathed either in water only or with a mild soap product has been found.38,39


However, water is implicated in altering the skin’s Bathing in hard water, rich


in calcium, is thought to be an irritant on the newborn’s skin.28 Furthermore, water is thought to be drying on the skin. Both women and health professionals are sceptical about the properties of water alone as a cleansing agent.1


Findings from the 2009 study by Lavender et al.1 indicated that there is


much confusion between policy and practice. Many women are choosing to use various products despite advice to avoid them. Additionally, some health professionals continue to advocate the use of bathing products.1,17


This indicates that there is a lack of adherence to government guidance in this area, which may relate to the lack of convincing evidence. An additional issue may be the vague nature of the guidance provided to women. Inconstancies exist, with advice to introduce skin care products after the first month of life conflicting with


EUROPEAN OBSTETRICS & GYNAECOLOGY SUPPLEMENT Topical Applications


In addition to wash products and water, many different creams, lotions, oils and gels are marketed for use on newborns. The application of a product directly to the skin, rather than bathing in a diluted solution, may be potentially more damaging to the skin barrier. Topical applications of creams, oils and other substances can be absorbed readily into the thinner stratum corneum of the infant. In addition, newborns have a greater skin surface area through which topical applications may be absorbed.5


The associated risks include toxicity40 and skin breakdown such as blistering.41


Some products that have been traditionally used on newborn skin have subsequently been found to be damaging to either the skin or potentially the overall health of the infant. Examples include talcum powder and aqueous cream. Although the use of talcum powder has


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