Ask Dr. Doug: Baby Rashes

Q:  My newborn has a red rash on his cheeks and chest. I hear so much advice about what to put on them. What do I do about baby rashes?        

A:  Babies have lots of normal rashes after they are born, and almost none of them require any treatment.

One of the most common is called erythema toxicum, which is a rash of little white bumps on a flatter red base, pretty much anywhere on the body. It usually pops up when a baby is two or three days old. Even though it has a name that sounds like a Harry Potter spell, don’t worry — it’s harmless and goes away on its own within a few weeks. 

Some babies have peely skin on their bellies and chest in the first week. This is normal, and flakes off on its own. Sometimes the peeling is worse on the wrists and ankles, and I usually recommend moisturizing those areas once or twice a day. If parents have a history of dry skin or eczema, I would moisturize your baby twice a day even if their skin feels fine. There is some research this helps prevent eczema and may even prevent food allergies, since some develop by being sensitized through the skin. 

Look for plain moisturizers without fragrances or essential oils: Aquaphor, Vanicream and Aveeno Baby are my favorites. 

Babies of color may get a rash called transient neonatal pustular melanosis. While that’s a mouthful, it too goes away on its own and doesn’t need treatment. This rash looks like tiny, pus-filled bumps that pop and turn into darker flat areas. 

Many babies will get seborrheic dermatitis, or cradle cap. This is a greasy, scaly rash in the scalp that often comes down onto the cheeks and eyebrow areas. Sometimes it needs topical 1% hydrocortisone and moisturizer if it gets inflamed and itchy. But in general, gentle brushing after shampooing works best. Olive oil can feed skin yeasts and make it worse, so I usually recommend mineral or coconut oil if we have to soften up the flakes.

One rash that is never normal in a newborn is herpes. Anything that looks like a cluster of small, clear, fluid-filled blisters, or anything that looks like a cold sore, needs to be evaluated right away. Unfortunately, babies can get sick and even die from the herpes virus. 

Around four to six weeks, babies go through a mini-puberty. This means they start vaping and doing TikTok dances. No, I’m kidding. But they do often develop baby acne. This looks like reddish bumps, some that have a bit of pus, on their cheeks and often down onto their upper chest. No need for face washes — this one goes away on its own. 

In general, baby skin needs a gentle moisturizer when dry and lots of kisses, and that’s about it!

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Dr. Doug Lincoln practices general pediatrics at Metropolitan Pediatrics in Happy Valley. He is board-certified in both pediatrics and preventive medicine, with special interests in helping parents meet their breastfeeding goals, caring for neurodiverse children with behavioral health needs, and advocating for children via teaching and policy. As a dad of two boys, he understands the joy and hard work that comes with parenting. Find out more about Dr. Doug and Metropolitan Pediatrics at metropediatrics.com.