Sharon Trotter RM BSc
Midwife, Breastfeeding Consultant and Neonatal Skincare Advisor
Skincare for the newborn: exploring the potential harm of manufactured products
The full reference for this draft article is: Trotter S (2002) Skincare for the newborn: exploring the potential harm of manufactured products. RCM Midwives Journal 5 (11): 376-8
The way we bath our babies may not appear to be important in the big scheme of things. However, I would like to give you a better understanding of why this could be an important factor to the health of baby's skin.
As the mother of four children aged 15, 13, 5 and 2 years, I, along with most others, bathed the older two, in a solution of Baby Bath product. They both suffered from rashes, spots and cradlecap. These were not serious conditions, but did cause concern and required treatment.
Over the years, I became more aware of research into Neonatal Skincare and was profoundly affected by a short article in the 'Midwives' journal by Brennan, 1996. I decided to change my blinkered attitude and attempt to re-educate others. As you can imagine, this did not go down too well. People just thought I was being alarmist and over-cautious. Shortly after reading the article in question, I became pregnant again and decided I would carry out my own research.
After delivery my son was bathed in plain water, using only cottonwool to wipe the skin. The vernix was left to absorb naturally. A baby's comb was gently used to remove any debris, from his hair. He didn't smell of baby bubbles, but he smelt gorgeously of New-Baby. After the first month, I gradually introduced Baby Bath products. My youngest son, who is now 2 years old, also had the same skincare regime and they both have perfect complexions. They did not suffer from the rashes, spots or cradlecap and although I was pleasantly surprised, it was not an unexpected outcome.
My small research study may not have been groundbreaking, but it did spur me on to look further.. The more I thought about it, the more determined I became to bring about change. The time has come for an independent review of neonatal skincare and the introduction of National Guidelines. These need to be standardised research based and will hopefully avoid the early sensitisation, which can go on to develop into allergies and skin conditions.
Nowhere, on any of the 'Instructions for use' of Baby Products, does it warn of the possible dangers of early overuse. In fact, on one leading brand, it actually says: 'mild enough for newborn babies'.
I would like to spend some time explaining how the skin of the newborn differs from that of the adult and how, as a result, we can use this knowledge to protect our babies.
The skin is the largest organ in the body and is made up of three main layers. The Epidermis, the Dermis and the underlying Subcutaneous fatty tissue. Within these layers lie the blood vessels, nerves, sweat/oil glands and hair follicles. The Epidermis, or outer layer, is further divided into the; Stratum Corneum, Stratum Granulosum and Stratum Germinatium. The latter of these is at the junction of the Epidermis and Dermis and is where the renewal of the Basal Cells is carried out. These cells constantly divide and are called Keratinocytes. Simplistically, these can be thought of as analogous to the bricks in a wall, with the mortar between, made up of lipids (fat cells).
The Stratum Corneum itself, is made up of 10-20 microscopic layers in an adult and the term infant. In premature infants, this number drops to between 2-3 layers. In extremely premature infants, of less than 23 gestational weeks, this layer may be virtually non-existent. ( Holbrook 1982, Nonato 1998). Consequently, the risk to these babies is even higher.
Babies are born with an alkaline skin surface, with an average pH of 6.34 ( Behrendt and Green 1971). However, within days, the pH has fallen to about 4.95 (acid). This also occurs in premature infants, although the process may take weeks rather than days to complete( Eaglestein 1985). This is known as the 'Acid Mantle' and is the skins protector. The development of this 'Acid Mantle' takes between 2 and 8 weeks, depending on gestational age (Evans and Rutter 1986, Harpin and Rutter 1983), so it is even more important to avoid damage to the premature infant, in their early weeks of life.
The introduction of Baby Bath products, wipes and creams etc, along with the exposure to urine and faeces, could disrupt this delicate protective barrier and lead to problems, including eczema, or allergic reactions (Behrendt and Green 1971, Berg et al 1986, Peck and Botwinick 1964). [back to top]
A full term infant will be bathed using bath products within a few hours of birth, once the temperature has stabilised and there are no health worries. Babies in SCBU may be left for longer, depending on their condition. Once stable, they too, including extremely premature infants, will be washed in a solution of Baby Bubbles. Antiseptic wipes/sprays, iodine lotion and sticky-tape are all frequently used in order to attach the many leads, tubes and wires etc. These are a necessary by-product of the complex care that a neonate receives in a modern SCBU. This extra risk must be balanced against the long term needs of the infant. Skin damage is common and can include; nappy rash, pressure sores/ulcers, burns, infections and adhesive removal grazes. These can prove difficult and expensive to treat. However, the cost in physical and emotional pain is incalculable. Anything we can do, to help reduce these risks, can only be for the good.
We must also ask ourselves; what is the concentration of the Baby Bath solution that we are using on the neonate?
American Paediatric units have now implemented their new guidelines, which were published in 2001 (Washington 2001).
Although we have no such guidelines in the UK, it would seem sensible to inform women of the possible risks involved, when using Baby Bath Products too early. Prior to discharge, Midwives, need to re-enforce the message that anything placed 'On', 'In' or 'Around' the newborns skin has the potential to harm.
These could include:
First baths should be carried out using only plain water and cottonwool for cleansing. A baby comb can be used gently to remove any debris from thick hair. Vernix should always be left to absorb naturally.
If you have a history of atopic eczema in your family, Professor Michael Cork (2002), suggests it would be wise to take these further precautions:
Carolyn Lund et al (1999a, 1999b, 2001a, 2001b) is the most comprehensive study to date, into the treatment of neonatal skin. However, other similar studies are ongoing. I am quite sure that in, the not too distant future, these subjects will be investigated in more depth. This will create interest and be associated with the usual media attention.
Two such projects that have been in the news recently, are worthy of a mention:
Firstly, Prof. Michael Cork (2002), who is based at Sheffield University. He, and his team have concentrated on the alarming rise in childhood Atopic Eczema and its possible causes.
As Midwives, it is essential to keep up to date with current research projects, which may have an impact on how we carry out, even the simplest of tasks.
So, next time you reach for the bubbles, STOP, think and put them back. This small change of habit, could make a huge difference to the health of our babies skins. If the supply of these products were removed from Maternity Units, then the temptation to use them would also be removed.
The distribution of free samples by various companies could still continue. However, women must be re-educated, so that they are aware of the potential risks associated with early overuse. In this way, the products can still be used, but at a time, when their effect is less likely to cause any harm. Their skin, will consequently be stronger and will hopefully not become sensitised. This in turn could avoid the development of allergic conditions that can cause so much distress to infants and children. This is an excellent opportunity, where the power of research can, at last, change the way we care for our newborns skin, for the better. [back to top]
Behrendt H, Green M. (1971)
Berg R, Buckingham K, Stewart R.
Brennan, G. (1996) Opinion:
Cetta F, Lambert G H, Ross S P.
Cork Michael J et al (2002) The rising prevalence of atopic eczema and environmental trauma to the skin. Dermatology in Practice. 10(3): 22-26
Eaglestein W H. (1985) Experiences with Biosynthetic Dressings. Jo Ame Acad Dermatology 12: 434.
Evans N J, Rutter N. (1986)
Halton G. (1990) Sensitive Matters,
Harpin V A, Rutter N. (1983)
Holbrook K A. (1982)
Lund C, Kuller J, Lane A, Lott J W, Raines D A. (1999a)
Lund C H. (1999b)
Lund C H, Kuller J, Lane A T, Lott J W, Raines D A, Thomas K K. (2001a)
Lund C H , Osborne J W, Kuller J, Lane A T, Lott J W, Raines D A. (2001b)
Nonato L. (1998)
Parsonage S, Clark J. (1981)
Peck S, Botwinick J. (1964) The Buffering Capacity of Infants Skin Against an Alkaline Soap and Neutral Detergent. Journal of Mt. Sinai Hospital 31: 134.
Sheriff A, Golding J and the ALSPAC study team (2002a). Archives of Disease in Childhood, 86: 30-35 + 87: 26-29. (ALSPAC: Avon and Somerset Longitudinal study of Parents and Children: www.alspac.Bristol.ac.uk ).
Washington (DC). (2001) Association of Womens Health, Obstetric and Neonatal Nurses (AWHONN) January.[back to top]
|© Sharon Trotter 2013|