Should Your Child See a Doctor?
Newborn Rashes and Birthmarks
- This guideline discusses the most common questions asked by parents about normal skin rashes and normal birthmarks.
If your newborn is healthy, go directly to the number of the topic that relates to your child for specific care advice.
- Acne: small red bumps on the face
- Drooling rash
- Erythema toxicum: red blotches with small white "pimple" in the center
- Forceps or birth canal injury
- Milia: tiny white bumps on the nose and cheeks
- Mongolian spots: bluish-green birthmark, usually on buttock
- Stork bites (pink birthmarks): on back of neck or bridge of nose
- Strawberry hemangiomas: raised red birthmarks
- Port-wine stains: dark red or purple flat birthmarks
Herpes Simplex: Serious Newborn Rash
- Appearance: Several water blisters or pimples grouped in a cluster. They look like the cold sores (fever blisters) that adults get on their lip. After several days, they crust over.
- Location: Just one part of the body, usually the scalp or face.
- Redness: While the base can be pink, the pinkness does not extend beyond the cluster of vesicles.
- Onset within first 4 weeks of life.
- Importance: Early treatment with anti-viral drugs can prevent serious complications. If you think your newborn's rash looks like herpes, call your child's doctor now.
- Imitator: Although herpes can be confused with erythema toxicum, they look very different.
When to Call Your Doctor for Newborn Rashes and Birthmarks
Call 911 If…
- Your child is not moving or very weak
Call Your Doctor Now (night or day) If
- Age under 1 month old and looks or acts abnormal in any way
- Age under 12 weeks with fever above 100.4 F (38.0 C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
- True blisters (little bumps containing clear fluid)
- True pimples (little bumps containing pus) (Exception: looks like description of erythema toxicum)
- Skin looks infected - Call your doctor within 24 hours
- Rash is painful to the touch - Call your doctor within 24 hours
- Lump with soft center - Call your doctor within 24 hours
- You think your child needs to be seen
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
Parent Care at Home If
- Normal newborn rashes or birthmarks and you don't think your child needs to be seen
Home Care Advice for Newborn Rashes and Birthmarks
- More than 30 percent of newborns develop baby acne of the face -- mainly small red bumps.
- This baby acne begins at 3 to 5 weeks of age and lasts until 4 to 6 months of age.
- The cause appears to be the transfer of maternal hormones just prior to birth.
- Since it is temporary, no treatment is necessary. Baby oil or ointments make it worse.
- Many babies have a rash on the chin or cheeks that comes and goes. This is often due to contact with food and acid that has been spit up from the stomach (especially prolonged contact during sleep).
- Other temporary rashes on the face are heat rashes in areas held against the mother's skin during nursing (especially in the summertime.)
- Rinse the face with water after all feedings or spitting up. During hot weather, change the baby's position more frequently and put a cool washcloth on the area.
- More than 50 percent of babies get a rash called erythema toxicum on the second or third day of life.
- It's a harmless baby rash that doesn't need to be seen.
- The rash is composed of ½ inch to 1 inch (1 to 2.5 cm) red blotches with a small white or yellow "pimple" in the center.
- They look like insect bites, but are not. Red blotches are the main feature.
- They can be numerous, keep occurring, be present anywhere on the body surface (except the palms and soles), and look terrible.
- Their cause is unknown, but they are not an infection.
- They resolve by 2 weeks of age.
- No treatment is necessary; ointments or baby oil make it worse.
Forceps or Birth Canal Injury:
- The pressure of a forceps on the skin can leave bruises, scrapes, or damaged fat tissue anywhere on the head or face.
- Skin overlying bony prominences (such as the sides of the skull bone) can become damaged even without a forceps delivery by pressure from the birth canal.
- Fetal monitors can also cause scrapes and scabs on the scalp.
- The bruises and scrapes will be noted on day 1 or day 2 and disappear by 1 to 2 weeks.
- The fat tissue injury won't be apparent until day 5 to 10. A firm coin-shaped lump, under the skin and sometimes with an overlying scab, is the usual finding. This lump may take 3 or 4 weeks to resolve.
- For any breaks in the skin, apply an antibiotic ointment such as Polysporin (no prescription needed) 4 times per day until healed.
Call Your Doctor If:
it becomes tender to the touch, soft in the center, or looks infected.
- Milia are tiny white bumps that occur on the faces of 40 percent of newborn babies.
- The nose and cheeks are most often involved, but milia are also seen on the forehead and chin.
- Milia are many in number and occur equally on both sides of the face.
- Although they look like pimples, they are much smaller (pinhead size) and not infected.
- They are blocked-off skin pores and will open up and disappear by 1 to 2 months of age.
- They do not look like water blisters.
- No ointments or creams should be applied to them.
- A Mongolian spot is a normal bluish-green or bluish-gray flat birthmark that is found in over 90 percent of Native American, Asian, Hispanic, and African American babies. They are also seen in 10 percent of Caucasians, especially those of Mediterranean descent.
- They occur most commonly over the back and buttocks, although they can be present on any part of the body.
- They vary greatly in size and shape.
- They have no relationship to any disease.
- Most fade away by 2 or 3 years of age, although a trace may persist into adult life.
Stork Bites (Pink Birthmarks):
- Flat pink birthmarks occur over the bridge of the nose, the eyelids, or the back of the neck ("stork bites") in more than 50 percent of newborns. The ones in front are often referred to as "an angel's kiss".
- All the birthmarks on the bridge of the nose and eyelids clear completely. Those on the eyelids clear by 1 year of age; those on the bridge of the nose may persist for a few additional years. Those on the forehead that run from the bridge of the nose up to the hairline usually persist into adult life. Laser treatment during infancy should be considered. Most birthmarks on the nape of the neck also clear, but 25 percent can persist into adult life.
- Red birthmarks that are raised or increasing in size (strawberry hemangiomas). These usually start after 3 weeks of age.
- They become larger for 1 year, then fade away over 6 to 8 years without any treatment.
- They run a small risk of bleeding with trauma. Any bleeding should stop with 10 minutes of direct pressure. Discuss with your child's doctor on next regular visit (sooner if concerned).
Port-Wine Stain Birthmarks:
- Present at birth in 0.5% of newborns
- Deeper in color (dark red or purple) than stork bites (salmon patches)
- Flat, smooth surface
- Natural course: do not fade or disappear like stork bites. May become darker.
- Grow with the child, but cover the same area
- Treatment: May refer to dermatologist for laser treatments early in infancy.
Call Your Doctor If:
- Your baby starts to look or act abnormal in any way
And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.
- Boralevi F. Erythema toxicum neonatorum: still a problem in 2005? Dermatology. 2005;210:257.
- Dohil MA, Baugh WP, Eichenfield LF. Vascular and pigmented birthmarks. Pediatr Clin North Am. 2000; 47: 783-812.
- John RH and Schchner LA. Neonatal dermatologic challenges. Pediatr Rev. 1997; 18:86-94.
- Mendenhall AK and Eichenfield LF. Back to basics: Caring for the newborn's skin. Contemp Pediatr. 2000;17(8):98-114.
- Morelli JG. Hemangiomas and vascular malformations. Pediatr Ann. 1996;25:91-96.
- O'Connor NR, McLaughlin MR, Ham P. Newborn skin: common rashes. Am Fam Physician. 2008;77:47.\
- Vasiloudes P, et al. A guide to rashes in newborns. Contemp Pediatr. 1997;14(6);156-166.
This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 8/1/2010
Last Revised: 10/1/2010 3:36:39 PM
Copyright 1994-2011 Barton D. Schmitt, M.D.