Skin DEEP

Your baby’s skin is very different from yours, and needs specialised care. Here’s why and how to look after very young skin

Skin is skin, right? And if your baby was born at full term, you probably thought her skin was pretty much like the rest of most of her organs: fully formed, and ready to take on the outside world. In fact, while it does act as your baby’s first line of defence (protecting her from harsh temperatures, microbes and infections), your baby’s skin is different from your adult skin.

Dermatologists now know that a baby’s skin as a whole actually continues to develop outside the womb, and specifically the skin’s ability to act as a water barrier continues to develop after birth for the first year of life.

The world inside the womb is a wet one. When in utero, your baby was surrounded by amniotic fluid and her skin prepared to protect her from that by forming a waxy substance, called vernix, to cover and insulate her. Some vernix will still be on her at birth – and you needn’t be in a rush to wash it off, by the way. Vernix has been found to contain antimicrobial substances (effective against group B strep and e.coli bacteria) similar to the immune-boosting, protective substances found in breastmilk, so leaving the vernix layer on to absorb into the skin and delaying a baby’s first bath for a day or two is a good post-birth option.

THE WORLD INSIDE THE WOMB IS A WET ONE. WHEN IN UTERO, YOUR BABY WAS SURROUNDED BY AMNIOTIC FLUID AND HER SKIN PREPARED TO PROTECT HER FROM THAT

IT’S DRY OUT THERE!

After birth, your baby’s skin has to adjust to a brand-new, relatively dry environment. Studies measuring the rates of transepidermal water loss (TEWL) found that three- to six-month-olds had the highest rates of infant TEWL, as did those babies with diseases that manifested in skin barrier abnormalities, such as atopic dermatitis. The reason for this water loss? Baby skin is structurally different to adult skin. The cells are smaller and the collagen fibres thinner. It contains fewer natural moisturising factors, fewer lipids and less melanin than adult skin, which also makes it lose water faster. Baby skin also has a higher ph than adult skin, leaving the skin barrier less mature and more prone to dryness than that of adult skin. An infant’s skin is able to absorb more water than adult skin, but it also loses that water at a faster rate, says dermatologist Dr Rakesh Newaj (go to dermatologistjohannesburg.com). “The ratio of the skin’s surface area to the body weight of the baby exposed to external environment is high,” he explains. “There is more heat exchange and water loss by conduction, convection and evaporation.”

As a baby’s immune system is still developing, she also has a greater chance of developing skin irritations and infections. Her skin is more vulnerable to the environment than adult skin. If not properly cared for, the skin becomes susceptible to diseases such as nappy rash, atopic dermatitis and other skin infections. This is why baby skin needs special care.

For all these reasons, says Dr Newaj, “of course it is essential to maintain a skin barrier. The skin barrier helps regulate the baby’s body temperature, maintain her water balance and also protect the internal organs from the sun and pollution [from the environment], as well as micro-organism invasion.”

You can help protect your baby’s skin by minimising water loss. That’s achieved by giving baby enough fluids, cleansing any dirt off with appropriate products, and keeping the skin hydrated using moisturisers and barrier creams which, as their name suggest, form a protective barrier between porous baby skin and the harsh environment outside of it, keeping water in and the bad stuff out. THE ATOPIC MARCH Allergic diseases often begin and progress in similar ways in different people – a process doctors call the allergic, or atopic, march. Atopic dermatitis is one of the first symptoms (the first step in the march), and most children with asthma or allergic rhinitis first showed symptoms of atopic dermatitis. Whether or not your child will join the atopic march depends on many aspects: environmental factors such as exposure to endotoxins, early infections, pets, pollutants, tobacco smoke, antibiotics and chemicals, as well as heredity components. Scientists are actually busy isolating the genes responsible for atopic diseases in an effort to understand it, and therefore treat it, better. Specifically mutations in the Filaggrin gene seem to play a part in atopic dermatitis.

Professor Michael Cork, a leading UK dermatologist, believes that the atopic march can be prevented by maintaining the skin barrier and preventing allergens and harmful substances from entering through the skin. The best way to do this is with routine skincare using products specially formulated for a baby’s delicate skin. While you may not be able to avoid it if your baby is prone to allergic diseases, you may well lessen her chances by taking very good, careful care of her skin. Environmental factors such as some skincare products, surfactants, air pollution, and food can have a positive or negative effect on the skin barrier. Harsh products can irritate or even break the thin baby skin and must be avoided. ALL SOAPS AND CREAMS ARE NOT CREATED EQUAL Avoid using adult skincare products on your baby for a start, says Dr Newaj, though luckily, “creams that are too harsh for a baby’s skin tend to have a warning on them.” Also avoid antibacterial or sterilising solutions, as well as creams that contain retinol, or chlorhexidine solutions. Exfoliant scrubs are, of course, a no-no.

Go simple. “The best is not to have perfumes, alcohol or strong detergents in creams,” says Dr Newaj. Alternative, natural skincare remedies are popular, precisely because additives cause concern for many parents. But bear in mind that products that are “natural” are also not necessarily ideal for baby. Olive oil, for instance, is not

a good skin barrier because it contains too much oleic acid, which can irritate and even break the skin. Some parents feel anxiety about using baby skin products with preservatives in them. However, it is very important to prevent products from becoming infected with micro-organisms, many of which can cause serious illness. There are proven safe preservatives that have been recommended for usage by global regularity bodies, and any water-based product must have preservatives in it to prevent spoiling.

The other option is to skip all artificial cleansers and just use water instead of soap. It’s the simplest, isn’t it? But water is not a good cleanser on its own. In fact, it dries out skin. Although water does hydrate the skin, the effect is temporary, lasting only about 30 seconds. Once the water evaporates, the skin begins to dry. Dirt particles on your baby’s skin are usually fatsoluble and so need to be removed by surfactants, which are agents that lower the tension between the skin and the water used to wash the skin. Water alone is less likely to “pick up” the dirt off the skin and carry it off.