MOMS AND DR. METZ TALK ABOUT BATHING BABY

A discussion with Brandie Jean Metz, MD, Assistant Clinical Professor of Dermatology & Pediatrics, Chief of Pediatric Dermatology, University of California, Irvine, CA.

MOM: What are my baby's special skincare needs?
Dr. M: Infants' skin is soft and can be five times thinner than adults' skin. That's why an infant's skin is more sensitive to chemicals and fragrances that are often used in toiletries. Parents should try to use pH-neutral products that are targeted specifically for babies and have no added dyes, fragrances, or unnecessary ingredients. While each infant has different specific needs based on individual skin conditions and characteristics (such as dry skin or eczema), every baby needs bathing, moisturizing, and sun protection.

MOM: What are the health benefits of bath time?
Dr. M: Bathing and cleansing are critical for removing dirt, bacteria, and any potential allergens that may be present on the skin. Frequent shampooing and gentle brushing of the scalp with a terrycloth towel can also help a baby's flaky skin.

MOM: How often should I bathe my baby?
Dr. M: Infants do not need a bath every day. In fact, two to three times per week is sufficient, as long as you cleanse your baby's bottom thoroughly following diaper changes and clean your baby after meals. Three to four times a week is acceptable if the baby doesn't like to be bathed. Traditionally, daily baths were not recommended to avoid drying babies' skin. However, it is now accepted as long as baths are gentle and moisturizer is applied. Hair should be washed once or twice per week.

MOM: What's the best way to bathe my baby?
Dr. M: Sponge baths are usually the best option at first. To reduce the risk of infections, parents should wait before using a tub until the umbilical cord stump dries out and falls and, if applicable, circumcision is healed. Infants should be bathed in warm water (only a few inches are needed in a small plastic baby tub or sink) using gentle motions with a clean, damp washcloth, or sponge. Only a small amount of mild, moisturizing cleanser specially formulated for babies and infants is needed. Pay special attention to diaper areas, folds of skin, feet, armpits, and under the neck and rinse all cleanser off thoroughly. Bubble baths and scented soaps should be avoided. And of course infants should never be left alone during bathing. Following a bath, pat your baby dry and apply moisturizer on damp skin right away (this helps to seal in moisture).

MOM: What's the best time of day for bath time?
Dr. M: While many parents make it a nightly ritual, there is no right or wrong time for bathing. Bathing your baby right before bedtime can be more relaxing and help your baby get to sleep. It's best to avoid baths just after or before meals because so much handling on a full stomach can result in your baby spitting up. At the other extreme, a hungry baby may not be very cooperative.

MOM: What are some tips for keeping baby clean between bath times?
Dr. M: Between bath times, wash your baby's face and hands frequently and change diapers as soon as they get wet or soiled. Keep the diaper area as clean as possible by cleansing using a wet washcloth, cotton balls, or baby wipes after every diaper change. Wiping should be done from front to back. When cleaning boys, cover the diaper area with a clean washcloth or diaper as exposure to air stimulates urination. It is important to clean between the folds and creases of skin where dirt and bacteria can collect. Lifting your baby's legs makes this job easier. After wiping, the area should be patted dry with a clean washcloth. To prevent diaper rash, apply a zinc-oxide or petroleum-based barrier before fastening the diaper.

MOM: How should I clean my baby's ears, eyes, and nose?
Dr. M: The baby's outer ears, eyes and nose should be cleaned very gently and carefully with a moistened cotton swab. Specifically:

• For the ears: Wipe behind and around the outside of each ear. Nothing should be introduced inside the delicate ear canal.
• For the eyes: Use a cotton ball or clean moistened washcloth to clean the corners of your baby's eyes by wiping gently from the inside to the outside corner.
• For the nose: Wipe gently around each nostril. Do put the swab inside the nostrils since this can damage the nostril lining. If congestion is severe, discuss using nasal drops or a rubber bulb syringe with a pediatrician.

MOM: Why is it so important to moisturize my baby after a bath?
Dr. M: Moisturizers help a baby's sensitive skin maintain moisture. Applying moisturizer should be a year-round practice. Given that your baby's skin is sensitive, use a light moisturizer. If dry skin or eczema continues to be a problem, a heavier moisturizer can be applied throughout the day and on non-bath days.

MOM: What ingredients should I look for in bathing products? What should I avoid?
Dr. M: Bathing and cleansing products for infants should be mild, have a neutral pH, and no added dyes, fragrances, or unnecessary ingredients. Because liquid cleansers are milder and can be used for washing hair, 2-in-1 products (such as a body wash and shampoo) are appropriate for infants. Look for natural elements such as oat extracts, which help soothe dry skin.

  MOM: What are your tips for an enjoyable bathing experience?

• Get everything you will need ready and accessible in advance.
• Dress in appropriate clothes, remove jewelry.
• Line the sink or tub with a towel or washcloth to prevent the baby from slipping around.
• Have a cup handy to rinse off soap.
• Run the water and check the temperature using the elbow, wrist, or a special bath thermometer; the water should be comfortably warm. Always test before placing the baby in a tub.
• Keep the baby's head out of the water. Use a cup or your cupped hands to get the baby wet.
• Use a soft washcloth or sponge to wash the baby with small amounts of mild soap that should be applied to dirty areas.
• To wash the baby's hair, lean him/her back and gently massage water into hair and scalp. Use a cup to pour water over the head. Baby shampoo can be used (use hand to create a "visor" to protect the eyes).
• Before rinsing, be certain that the temperature of the incoming water is not too hot.
• Ensure that all the soap has been thoroughly rinsed off before finishing the bath.
• Place the baby in a towel and damp dry. Make sure to dry gently behind the ears and in the skin folds, so that no excess moisture is left. Towel dry the hair as much as possible (do not use a hair dryer).
• Apply light moisturizer.