What is the BEST practice?
By Dr. Joanne Lee Guey Feng
Consultant Paediatrician & Lactation Specialist
KPJ Sabah Specialist Hospital | Tel: 088-211 333
For most parents whom I came across, have different ideologies in caring for the delicate skin of their
newborn babies. For some new parents, bathing a baby can be a huge task with lots of ‘EXCITEMENT’ and ‘ANXIETY’ (more so if you have to bath a crying baby in a tub of water, who is just a few days old). How stressful! What a struggle!
Parents Frequently Asked Questions (FAQ) would be:
• Does a newborn baby who has just delivered truly need a shower? Do they need a bath time after coming out from labour room?
• Must you bath your young baby every day?
• How many times do you need to shower your baby in a day?
• Can I use plain water to clean them? Or must I use a baby shampoo/ body cleanser?
Surprisingly, the approach to skin care for newborn babies has created some confusion among neonatal staff from 9 nurseries in United Kingdom, and even in our local setting among the confinement ladies of Sabah. So, what is the best practice that we can refer to?
World Health Organization (WHO) and National Institute for Health and Clinical Effectiveness (NIH) published a statement in 2006 with recomendations for the issue of caring for the newborn skin.
Below are the guidelines adapted by North Trent Neonatal Network, United Kingdom:
1. Leave Vernix Caseosa to absorb into the skin. Do not rub it off.
2. Only bath a baby when he/ she is physiological stable.
3. If necessary, bath a ‘well’ baby when his/her temperature has been within an acceptable range for 2-4 hours after delivery, but preferably delay the first bath until the second or third day of life to assist with skin maturation.
4. Ensure the temperature of bath water is maintained at 37°C. Use a bath thermometer.
5. Avoid baby toiletries and other cleansing products until the baby is at least a month old—use plain water to cleanse baby’s skin.
6. Only bath baby 2-3 times a week—‘top and tail’ in between bathing.
7. Use the best quality nappy available to the baby—changed soiled nappies frequently and cleanse the nappy area with plain water or unperfumed, alcohol-free baby wipes.
8. Expose the nappy area as often as possible and consider using a thin layer of barrier ointment in nappy area to protect the stratum corneum –ensure ointment is preservative-free and does not contain
anti-septic, fragrance or colourings.
9. Avoid the use of ointments/ lotions/ talc powder on the baby’s skin unnecessarily.
10. Ensure the umbilical cord is kept clean and dry, allowing it to be exposed to air as frequently as possible.
Dr. Joanne’s Q & A
Q: What is Vernix Caseosa?
A: Vernix is the sticky, whitish covering on the outer skin of a newborn baby. It is formed from the skin epithelial cells during the last trimester (6 months of pregnancy). It is said to be the ‘Natural Skin Cleanser & Moisturizer’ for the baby with important protective functions, preventing the invasion of harmful bacteria attaching to the skin as well as preventing excess water/ temperature loss to the environment.
Q: Do we need to remove this Vernix immediately after birth?
A: No need to. You could just wipe it off from baby’s eyes and mouth, but leave the Vernix on the skin over 24 hours.
Q: When would be the best time to give a newborn baby his/ her ‘FIRST’ bath?
A: Recommend to bath baby after day 2 or 3 post-delivery, when the baby’s temperature is more stable with less risk of hypothermia (low body temperature). For premature babies or a baby who is ill, it is best to delay the bathing until baby is more stable.
Q: What is ‘Top-Tail’ bathing?
A: Most hospital baby nurseries or neonatal units adopted this method to clean the baby’s skin, mainly cleaning baby’s face and buttocks.
i. Before starting, wash your hands clean with soap and running tap water.
ii. Place baby is a safe and flat changing mat or changing table.
iii. Soak some cotton balls into a bowl of warm water. Then squeeze the cotton balls dry.
iv. First, wipe the inner part of the eyes softly and spread to the outer eyes. Using seperate cotton buds for each eye.
v. Take another cotton ball to wipe the face, nose and mouth.
vi. Wipe the earlobes, back of the ears and neck area.
vii. You can then wipe the baby’s hands and feet with cotton balls or a piece of towel.
viii. Lastly, use a cotton ball to wipe the baby’s buttocks clean. You can apply a layer of the nappy barrier cream to the buttocks before changing a new diaper.
Q: If we bath our babies 2 to 3 times a day, will it give any effect to baby’s skin?
A: For the first 1 month of life, it’ll be enough to just bath a baby 2 to 3 times per week (once every 1 or 2 days). Babies don’t tend to sweat as much as a normal grown-up toddler. If we bath them too frequently, their delicate skin will lose the acidic protective barrier and its moisture.
Q: How do I make choices between different brands baby body cleanser in the market?
A: A good baby skin product should be non-fragrant without chemical ingredients that can irritate the skin. However, during baby’s first month of age, bathing with plain water will be sufficient.
Q: Is there any difference between cloth diapers versus disposable diapers in the prevention of nappy rash?
A: 17 collective reports in the Cochrane Review reported no difference between the usage among these two. Frequent changing of diapers and strong absorptive diapers are proven to reduce the risk of
nappy rash.
Q: Which nappy rash cream should I consider buying?
A: From my personal experience, I actually kept 3 different nappy rash creams for my little one. It’s more of preference with affordability of the purchase, there’s no one magic cream to suit all ‘bum bums’. The main factor is to consider having is a good habit of frequent washing of the buttocks each time your baby wees or poops (my boy poops up to 8 time per day!) remember to change their diaper before you go to sleep.. ZZzz
Please feel free to call KPJ Sabah Specialist Hospital 088-211 333 should you need more information or advice regarding to this topic.
