The skin has a fundamental role of barrier covering the body. This function of the skin develops in utero but continues after the birth, to be completed towards the age of one year. This is why it is necessary to provide skin care adapted to this period of life.
The baby’s skin care helps keep the skin healthy and clean. They also prevent cutaneous (or cutaneous) infections, as well as certain dermatological conditions, irritation and / or dryness of the skin. The provision of skin care also aims to provide the child with comfort and well-being and to promote physical contact with his parents. There is no consensus regarding infant skin care and there are various practices, depending on the age of the child and cultural traditions.
Many products with multiple ingredients.
There are a large number of hygiene products available, making complex choices for family and doctor’s advice. In recent years, hygiene products intended for the child have experienced a real boom. Moms are tempted to use too many products and change often. Thus, a mother uses on average 8 different products per child, the latter containing 48 chemical components on average.
These products are not always adapted and can cause skin reactions to type of irritation or sensitization. The products used are: physiological saline for the face wash, detergents (soap or shampoo), antiseptics, emollients, protective products for the prevention of the dermatitis of the seat. These products must preserve the integrity of the skin, they should not be toxic or sensitizing.
Care at birth.
THE FIRST TOILETS.
After delivery, the baby should be wiped or washed with water to remove the vernix caseosa (a yellowish greasy substance all over the body). The moment of the first bath may take place within the first hour or later, provided the axillary temperature is stable. If the toilet is made by the nursing staff, they must wear gloves to avoid contact with maternal blood.
The following baths can be given prior to the fall of the umbilical cord, even if in some cultures the parents await the fall of the cord. Compared to a simple toilet with the glove out of the bath, the bath has the advantage of being pleasant for the child and calming it, causing less heat loss and trans-epidermal water. There is no increased risk of infection in a bath.
CARE OF THE CORD.
The stump of the cord dries out and falls in 7 to 15 days. During this period, the umbilicus is a potential entry point for cutaneous or cutaneous infections. The type of care provided is not coded. Antiseptics are commonly used. The use of chlorhexidine in 4% aqueous solution has been shown to decrease omphalitis (infection of the navel, umbilicus). Lower concentrations or other antiseptics are likely to be effective.
Antisepsis is recommended until the cord is dropped. A compress soaked with 5% aqueous chlorhexidine should be applied twice daily in all folds after gentle cleaning. The umbilicus should then be covered with a dry compress held in place by an elastic net. However, the use of antiseptics for cord care is controversial. For some experts, it could delay the fall of the cord by reducing the inflammatory phenomena.
Care from birth to one year of age.
BATH AND TOILET.
The bath may be daily or carried out only twice a week. If it is spaced a few days, certain areas such as the seat, cord or folds should be washed daily. The bath water should be at 35-36 ° C and the air temperature at 21 to 28 ° C. The bath should last 5 to 10 minutes maximum. If the bath is too long, the skin too hydrated becomes fragile. In this case, friction can lead to trauma. The toilet can be done gently with the hands or a washcloth washed hot after each toilet.
The bath should be given in safe conditions: place the bath in a stable and safe place or use a fixed bath, keep the child under continuous supervision, check the temperature of the water after stirring the bath. Wet the child regularly to prevent it from cools. Bath toys or floor mats are sources of infection and must be disinfected before use.
After the bath, the child should be immediately covered with a dry and dabbed towel (not rubbed) for drying. Then it must be immediately dressed to avoid hypothermia.
A toilet in the evening before bedtime can help to calm the child.
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Products to use for bath and toilet.
The toilet is generally made with a detergent, i.e. a substance capable of cleansing the skin by removing the impurities (dust, body fat, secretions and microorganisms). Washing with water, without detergent, is possible but seems to present disadvantages with respect to the use of a detergent. In fact, the toilet with water is accompanied by more erythema and dryness of the skin. There is more atopic dermatitis if the toilet is washed with water.
The detergent to be chosen must be non-aggressive, contain no toxic substances (especially preservatives) and if possible be non-perfumed. It is best to use products without soap. Liquid products would be preferable over solid loaves, which may include products containing an emollient. Beware of oils that may contain harmful substances (toxic or allergenic). Bubble baths should be avoided as they are too irritating. In general, the more foaming the product is, the more aggressive it is. The cleanser must have a neutral or slightly acid pH (pH 5.5 – 7) and do not irritate the skin or eyes. To wash the hair, it is possible to use the same cleanser as for the body or to use a shampoo that must be chosen according to the same criteria as the product of the body. Detergent should be used in small quantities to prevent improper rinsing. The use of a pumped bottle could make it possible to quantify the dose to be used.
Sometimes oil in water, sometimes water in oil, they are composed of a fatty phase and an aqueous phase. They contain surfactants to ensure the emulsion and additives (perfumes and preservatives).
They should not be used systematically but are useful in case of dryness of the skin or irritation. Improper use of the seat may promote seat dermatitis by increasing occlusion.
There is a risk of contact allergy (lanolin, Peruvian balm, preservatives: benzoic acid, perfumes and plant extracts). It is therefore advisable to privilege the products without perfume, without natural essence and without lanolin. It is necessary to privilege products of reliable brand having studies of tolerance and safety in the child.
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The care of the headquarters.
This area is frequently the seat of irritation due to prolonged contact with urine and stool. The urine has an alkaline pH and contains ammonia, the stool contains bacterial ureases. The layers induce friction and a phenomenon of occlusive maceration. They should ideally be changed as soon as contaminated, that is to say about 10 times a day.
In case of contamination by urine, a toilet with water is sufficient. In the case of stools, a detergent should be used. Hygiene products used for the toilet seat should not irritate the kid. Use the same cleanser as that used for the toilet or a cleaner in the form of milk. Toilet milks are oil-in-water emulsions. Unlike the manufacturer’s instructions, they must be rinsed. Their price is high. The same rules of choice as the cleaner apply. The safety of non-rinsed wipes is not proven.
Drying after rinsing should be careful, especially increases.
In case of irritation there is a gluteus erythema, that is to say respecting the folds and sitting in the zones of friction. Risk is complication in the form of a mycotic (candida albicans) and / or bacterial skin infection. In the case of diaper rash, aqueous eosin is commonly used and has shown satisfactory results. Water pastes or zinc oxide pastes can be used on skin imperatively clean and dry. They isolate the skin from urine and stool.
Concerning topical medicines, it should be borne in mind that the maceration caused by the wearing of layers increases the permeability and can induce a significant systemic absorption.
The use of cotton swabs is not recommended in the conduit as it may lead to plug formation. A rolled compress can be used to clean the ear, the duct with water, not to mention the retro-auricular zone.
They must be cut short. A file can be used in case there is a pointed end with which the child could scratch.
They are intended to destroy or inhibit micro-organisms. Their use should not be systematic. They are useful for cord and for disinfecting a wound. Biguanides and amidines should be preferred. Dyes, alcoholic antiseptics, mercurial derivatives, halogens, iodates (potential systemic hazard) should be avoided. There is a risk of bacterial colonization of the vials which must favor the minidoses.
TALC AND OTHER POWDERS.
These products provide moisture absorption due to maceration. They are still used. They are not risk-free. Indeed, accidental inhalations have been reported. In addition, their accumulation in folds promotes infections.
Special case of child with atopic dermatitis.
The same rules as those mentioned above are in order.
The toilet does not aggravate the atopic dermatitis. It makes it possible to decrease the bacterial colonization of the skin because the latter is very increased compared to a normal subject. The use of moisturizing cleansers containing no allergenic substances is even more imperative.
The use of emollients is recommended after bathing. A liquid cleaner containing emollient or bath oil may be used.
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