Newborns and Dry Skin: How to Tell Normal from Not

You are standing over the change table looking at dry, flaking skin, and there is one question behind it: ordinary, or something else.

On newborns and dry skin, the Royal Children's Hospital Melbourne instructs a thick, non-fragranced moisturiser all over daily at the first sign of it. This article is about the half of that question a moisturiser does not answer: which dryness is ordinary, which patterns point somewhere else, and when to make the call.

It does not set out a daily routine. Our article on peeling skin on a newborn covers what to put on flaking skin and what to leave alone, and the newborn skin care guide covers the first six weeks in full.

Is dry skin normal on a newborn?

RCH regards dryness as something to moisturise at the first sign of it. Healthdirect describes dry skin generally, not newborn skin, as flaky and rough and not usually very itchy or red. RCH also advises that very dry, red skin may be eczema, and healthdirect notes that in people of colour eczema may look purple, grey or brown rather than red.

A handful of specific features are worth a phone call. Skin that is very dry and red, or showing the purple, grey or brown change healthdirect describes in people of colour, is one of them.

What to watch when a newborn's skin is dry

Three things to look at. None is a test on its own, and together they describe a pattern rather than settle the question.

What is underneath. Healthdirect's description above, flaky and rough and not usually very itchy or red, is of dry skin in general rather than newborn skin. Its hedge is about redness: healthdirect says nothing about how ordinary dryness looks in people of colour, and the eczema section below sets out what it records about eczema on skin of colour.
Whether your baby minds. On that same healthdirect description, dry skin is not usually very itchy. RCH lists a baby's skin being itchy as its own reason to see your Maternal and Child Health Nurse, GP or paediatrician, with nothing else needed alongside it.
Whether it comes back. Healthdirect describes eczema symptoms as tending to come and go, and RCH says the same thing, that it is normal for eczema to get better and then flare up. RCH advises speaking to your child's doctor if you think your child is getting eczema for the first time.

If the dryness is getting worse rather than better, have it looked at. Where the pattern does not fit, read on rather than waiting it out.

What is different about newborn skin

Three things worth knowing about a newborn's skin.

The first is the loss of vernix, the creamy coating some babies are born with, which RCH's clinical reference on infant skin records as helping maintain skin hydration, thermoregulation and skin acidification.

The second is a change in the skin's surface chemistry. The same RCH reference records that babies are born with an alkaline skin surface above pH 6.0, preterm and term alike, and that in term babies it usually falls below pH 5.0 within the first three days, giving the skin its acid mantle and its protection from external pathogens.

The third is the skin itself. RCH Kids Health Info describes infant skin as still developing through the first few months, thinner, more fragile and more sensitive than adult skin, and less resistant to bacteria, irritants and allergens.

Pregnancy, Birth and Baby, the healthdirect service, records that a baby who was overdue may have skin that is slightly dry and cracked, because the vernix was absorbed before they were born. If your baby went past their due date, that is worth knowing before you read anything else into it.

It does not cover everything, though. Flaking that is still going after three to four weeks, or dry red patches, are worth a GP visit. Peeling skin in a baby who has a fever, is drowsy or feeding poorly, or has a rash that does not fade when pressed is a different matter: call 000.

Dry skin and dehydration are different questions

This is the mix-up worth clearing up. Dry skin is not one of the signs of dehydration that RCH or healthdirect list. The signs they do list are mostly about fluid.

The picture RCH gives runs in three tiers.

Mild. Thirsty, weeing less than usual.
Moderate. Thirsty, less active and quieter than usual, cool hands and feet, a dry mouth, lips and tongue, weeing less often, darker urine.
Severe. Cold hands and mottled (patchy, reddish-blue patterned) skin, lethargic and very sleepy, sunken eyes, weeing a lot less often and smaller amounts than usual, or not at all.

RCH's own words on that last group are that severe dehydration is serious, can worsen quickly, and that you must seek medical help fast: call 000, or go straight to the nearest emergency department if that is faster. Cold hands or feet together with any other change, such as a baby who is quieter than usual, pale or blotchy, or off their feeds, is also a 000 call rather than a sign to watch.

Most of those are about fluid in and fluid out, and nappies are the easiest place to watch that part of it. Our article on how many nappies a newborn goes through a day sets out what a normal count looks like week by week.

RCH is direct about the threshold for young babies. If your baby is under six months old and shows any signs of dehydration, take them to see a doctor, because they can get sicker very quickly. RCH also lists a child being under six months old on its own, with no other sign attached, as a reason to see a doctor or health professional. That is a separate question from anything you are seeing on their skin.

When dryness looks more like eczema

The clearest cue sits on RCH's skincare fact sheet for babies: if your baby's skin is very dry and red, they may have eczema. Colour and itch are what shift the picture, not the amount of flaking. Redness is not the only way that colour change shows: healthdirect records that people of colour may get purple, grey or brown areas or irritated skin rather than red, along with scaly skin and round areas of inflammation. In people of colour, look for the change in the skin's own colour, the scaliness and the itch rather than for redness.

The RCH eczema fact sheet fills in the rest. Eczema makes patches of skin dry, itchy, red and scaly, and those patches can develop blisters or sores that ooze watery fluid and crust over if they become infected. In babies it tends to show as a dry, red rash on the face, and can also appear on the scalp, body, arms, legs or behind the ears. RCH notes the rash is often very itchy and can keep babies awake at night.

Two changes on eczema skin are not ordinary eczema. A cluster of small blisters or punched-out sores, especially with a fever, can be a herpes infection called eczema herpeticum: go to the emergency department straight away, and do not wait for a GP appointment. If your baby is floppy, drowsy, hard to wake or seems very unwell, call 000. Don't let anyone with a cold sore kiss your baby.

Patches that weep, crust over or have pus-filled spots may be infected and need a GP the same day.

Two more things from those pages matter at the change table. The first is that eczema comes and goes: healthdirect describes eczema symptoms as tending to come and go, and RCH says it is normal for eczema to get better and then flare up. The second is that RCH lists dry skin itself among the things that set an eczema flare off.

Moisturiser is what you start either way. On eczema specifically, RCH advises a thick, plain, fragrance-free moisturiser once or twice a day, even where there are no eczema patches, and notes that thick creams tend to control eczema better than lotions. What decides whether to ring is the picture rather than the response: skin that is very dry with a colour change in it, itchy, or keeping your baby awake is worth a GP or child health nurse conversation. If eczema is confirmed and it flares often or is hard to manage, RCH advises asking your doctor to create an Eczema Action Plan.

If that is where you are heading, our baby eczema guide covers what eczema is, what sets it off and what an Australian management plan actually involves.

The rarer causes, and what they actually look like

Two things sit outside the ordinary picture. One is present at birth rather than developing later, and the other is an infection, which is a different thing again from dryness getting worse.

The first is a collodion membrane, sometimes called collodion baby. DermNet describes a baby born encased in a skin resembling a yellow, tight and shiny film, often in babies born premature, with the membrane peeling away over the first two to three weeks. It is present at birth rather than appearing later.

DermNet records that the membrane is usually an autosomal recessive congenital ichthyosis, a scaly skin condition, and that 10 per cent of collodion babies have normal underlying skin, a mild presentation it calls self-healing collodion baby. Either way it is present at birth, and DermNet says managing it requires the expertise of a dermatologist and the paediatric team.

The second is a serious staph skin infection. Healthdirect describes staphylococcal scalded skin syndrome as a serious infection that usually affects children under two, in which the skin peels off as though it has been burned with boiling water. Its instruction is specific: symptoms of a serious staph skin infection include a high temperature and painful red skin that looks like it has been scalded or is peeling off, and if your child has these symptoms, call triple zero (000) and ask for an ambulance. Red skin that looks scalded, blisters or peels off in sheets is an emergency, with or without a fever: call 000.

When to get help: 000, hospital or GP

Some signs need an ambulance or the emergency department straight away. Some need a doctor as soon as possible, and some a GP today. Others are worth a GP visit this week. If you're not sure which group your baby fits, treat it as the more urgent one, and call 000 if your baby seems very unwell.

Call 000 or go straight to the emergency department

Signs of severe dehydration: cold hands, mottled skin, sunken eyes, a baby who is lethargic and very sleepy, or far fewer wet nappies or none. RCH's instruction is to call an ambulance immediately or go to your closest hospital emergency department.
Cold hands and feet together with any other change: pale, blotchy or blue skin, drowsiness or floppiness, fast or difficult breathing, poor feeding, a fever, or a baby who just doesn't seem right to you.
A baby under one month whose back or tummy feels cold, or whose temperature is below 36.5°C taken under the arm, even if they seem otherwise well. In newborns, a serious infection can cause a low temperature instead of a fever.
Blue or grey lips, tongue or face, a baby who suddenly turns pale, blue or grey, or skin on your baby's body that looks pale, blotchy, grey or blue. Don't wait to see whether warming helps, and don't wait for other symptoms. In babies with darker skin the change can look grey or white rather than blue, so check the lips, tongue and nail beds.
Trouble breathing, a baby who is floppy, drowsy or hard to wake, or a seizure.
A fever together with drowsiness, trouble breathing, a stiff neck, a seizure, very pale or blue skin, or a rash that does not fade when you press on it.
Red skin that looks scalded, blisters or peels off in sheets is an emergency, with or without a fever: call 000.
Peeling skin in a baby who has a fever, is drowsy or feeding poorly, or has a rash that does not fade when pressed.
You feel something is seriously wrong.

Go to the emergency department now

A fever of 38°C or higher in a baby under three months, even if they seem otherwise well. healthdirect advises taking a baby under 3 months with a fever to the nearest hospital emergency department immediately. Do not wait for a GP appointment.
A baby under six months with moderate signs of dehydration: no wet nappy in six hours, a dry mouth and tongue, a sunken soft spot, or a baby who is irritable or less active than usual. If their hands or feet are also cold, or their eyes look sunken, call 000. RCH says a baby under six months with any sign of dehydration can get sicker very quickly.
If your baby has eczema and gets a cluster of small blisters or punched-out sores, especially with a fever, go to the emergency department straight away. Do not wait for a GP appointment. If your baby is floppy, drowsy, hard to wake or seems very unwell, call 000. Don't let anyone with a cold sore kiss your baby.

See a doctor as soon as possible

That means the same day, not a routine booking. If no GP can see your baby within hours, go to the emergency department.

Fewer wet nappies or darker urine than usual in a baby under six months. RCH advises taking a baby under six months with any sign of dehydration to a doctor, and lists a child being under six months old as a reason to see a doctor on its own. See a doctor the same day, and do not wait to see whether it settles.
Itch that keeps your baby unsettled, feeding poorly or not sleeping, in a baby who is otherwise alert and responsive. A baby who is not feeding at all, or is drowsy, floppy or hard to wake, needs 000.

See a GP today

Eczema patches that weep, crust over or have pus-filled spots, which may be infected. See a GP the same day.

Book a GP visit this week

Book with your child health nurse or GP if the dryness is getting worse rather than better, which is the kind of thing RCH's eczema fact sheet has in mind when it says to see your doctor if you are worried about your child's skin or general health for any reason, if there are dry patches that look red, purple, grey or brown, if the skin is cracked and one of those colours, if the flaking is still going after three to four weeks, or if your baby seems itchy. RCH puts an itchy baby on its own list of reasons to see your Maternal and Child Health Nurse, GP or paediatrician.

Speak to your child health nurse or GP if anything about your baby's skin is worrying you. RCH advises speaking to your child's doctor if you are worried about your child's skin or general health for any reason. If a sign from one of the tiers above is present, act on that tier first.

Common questions about newborns and dry skin

Is dry skin on a newborn's face normal?

What changes the picture on a newborn's face is colour and itch rather than flaking. Healthdirect's description of dry skin, which is not scoped to newborns, is flaky and rough, and not usually very itchy or red. RCH advises that skin which is very dry and red may be eczema, and in babies eczema tends to show as a dry red rash on the face, so a rough, itchy cheek with a colour change in it is worth a GP or child health nurse visit. In people of colour that colour change may be purple, grey or brown rather than red, which is what healthdirect records.

How long does newborn dry skin last?

RCH advises a thick, non-fragranced moisturiser all over daily at the first sign of dryness, so the answer that matters more is what you do than how long you wait. RCH also advises speaking to your child's doctor if you are worried about your child's skin for any reason. Watch the direction rather than the calendar: if the dryness is getting worse rather than better, or comes with dry patches that look red, purple, grey or brown, or cracked skin in one of those colours, or if the flaking is still going after three to four weeks, have it checked by your child health nurse or GP. Skin that weeps or crusts over needs a GP the same day.

Should I moisturise my newborn's dry skin?

RCH advises applying a thick, non-fragranced moisturiser all over daily at the first sign of dryness, and notes that thicker creams are more effective than lotions and that moisturiser can be applied more often if the skin always seems dry. RCH also advises avoiding moisturisers containing botanicals, food and fragrance, because these may disrupt the skin barrier. One small thing it asks you to do from the start is to keep the moisturiser itself clean, spooning cream out of the tub or using a pump pack rather than dipping fingers back in.

Does dry skin mean my newborn isn't getting enough milk?

Dry skin is not one of the signs of dehydration that RCH or healthdirect list. The signs they do list are mostly about fluid, and the three tiers above set them out in full. If you're seeing any of those in a baby under six months, RCH advises taking them to a doctor: the severe signs, such as mottled skin, sunken eyes or a very sleepy baby, mean calling 000 or going straight to the emergency department, and the section on when to get help sets out the rest. If feeding itself is the worry, that is a conversation for your child health nurse or GP rather than something to read off the skin.

How can I tell dry skin from eczema on a newborn?

Look at whether it itches, whether the skin is scaly, and whether it keeps coming back. Healthdirect describes dry skin, again not specifically newborn skin, as flaky and rough and not usually very itchy or red. Eczema, as RCH describes it, is dry, itchy, red and scaly, tends to show on the face and can also appear on the scalp, body, arms, legs or behind the ears, and often keeps babies awake; healthdirect adds that on people of colour it may look purple, grey or brown rather than red, and that eczema symptoms tend to come and go. Itchy skin with a colour change in it that is keeping your baby awake is the one to have looked at.

Your cart is empty

Your cart

Estimated total