Don't Be Rash: How To Care For Newborn Skin, Cord, and Diaper Area

Welcome back to Don’t Be Rash!

Raegan D. Hunt, MD, PhD, a pediatric dermatologist, director of pediatric dermatology at Texas Children's Hospital, and an associate professor of dermatology and pediatrics at Baylor College of Medicine, recently joined the Don't Be Rash podcast to discuss newborn skin physiology and evidence-based skin care practices with host Andrew Krakowski, MD, a pediatric dermatologist and chair of dermatology at St. Luke’s University Health Network. Hunt and Krakowski reviewed skin barrier development, umbilical cord care, bathing, moisturizer selection, and diaper care for newborns.

Skin Barrier Development and Vernix Caseosa

At birth, skin transitions from a fluid intrauterine environment to a dry extrauterine one, establishing the acid mantle, a lower-pH environment supporting antimicrobial defense and barrier function, Hunt said. Transepidermal water loss is elevated during the newborn period, and skin continues maturing throughout the first year. Preterm infants have markedly thinner, more fragile skin and higher dehydration risk, while term infants have adult-like thickness but immature lipid organization.

"That special cheese is nature's moisturizer. It's called the vernix caseosa, and the experts recommend leaving the vernix caseosa, if possible, on the infant because that helps protect the maturing skin barrier in the early days of life," Hunt said.

Umbilical Cord and Microbiome Development

The umbilical cord typically separates within about two weeks, Hunt said; alcohol cleaning is unnecessary, and the area should simply dry out. Umbilical granulomas are common during separation and generally respond to in-office treatment. Fluid leakage after separation is rare but warrants prompt evaluation for a possible congenital connection to the urinary or gastrointestinal tract.

Skin-to-skin contact, rather than delivery mode alone, plays a central role in establishing the infant microbiome, Hunt said, reassuring families of infants delivered via cesarean section.

Bathing and Cleanser Selection

Hunt recommended bathing newborns daily to every other day in lukewarm water with a gentle, neutral-pH cleanser rather than true soap, which is harsher on epidermal lipids. Parents should pat skin dry and apply a bland emollient immediately after.

"Unscented doesn't have fragrance. Technically, it just means it has fragrances that offset each other, making it net neutral, and it still has chemical irritants that can really bother the skin," Hunt said.

Botanical extracts, essential oils, and preservatives common in adult formulations carry sensitization risk and should generally be avoided, Hunt said. Petrolatum remains her preferred emollient.

Krakowski noted pediatric atopic dermatitis guidelines emphasize consistent moisturizer use over a specific product.

"We know from the new pediatric atopic dermatitis guidelines we covered in a previous show, the recommendation for atopic derm was we don't care what moisturizer so much as you're using a moisturizer," Krakowski said.

Moisturizer Selection for Newborn Skin

"Petroleum jelly has been available for more than 150 years, and it is a very useful and very gentle topical emollient that can help the skin barrier function," Hunt said.

Petrolatum primarily traps water rather than adding moisture, so its benefit may be limited in very dry skin, Hunt said. Krakowski agreed, describing petrolatum as a sealant, locking moisture in rather than adding it directly. Thicker creams or ointments are generally preferable to lotions, and consistent use matters more than formulation, Hunt said.

Diaper Care and Barrier Protection

Hunt attributed declining diaper dermatitis rates largely to superabsorbent diaper technology, which separates moisture from the skin more effectively than cloth diapering. She recommended a zinc oxide barrier cream with each diaper change plus fragrance-free, water-based wipes, noting dyes and decorative diaper elements have been linked to localized contact dermatitis.

"There's real life, and there's the textbook, and real life is people are using these things, so we better be aware of that," Krakowski said, noting diaper dyes and decorative elements have also been linked to localized contact dermatitis.

When asked by Krakowski for a single takeaway for new families, Hunt said simplicity should guide newborn skin care.

"I would want to convey that really less is more, and we want to just keep it simple for the delicate baby skin," Hunt concluded.

Don’t Be Rash is produced in collaboration with the Society for Pediatric Dermatology. For more information on the society, its programs, and resources, check out their website.

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