Introduction: Cradle cap is an extremely common and harmless condition that affects about 50% of all babies.

What is cradle Cap? Infantile seborrhoeic dermatitis or cradle cap is a condition that affects the scalp of newborn babies during the first three months. It usually presents as a yellowish, scaly, crusty rash on the scalp. In more severe cases the condition can spread to the eyebrows, the area behind the ears, skin creases; the forehead and to the nappy area. 

Risk factors:

The following factors make babies more prone to seborrhoeic dermatitis:

• Genes: Seborrhoeic dermatitis appears to run in families. 
• Stress: There seem to be a relationship between stress and the incidence of cradle cap
• Fungus infections: Pityrosporum ovale (a fungus) may be involved in the development of the condition.
• There may be an association with HIV-disease, Parkinson’s disease and epilepsy

Cradle cap is not contagious and it is not caused by poor hygiene or inadequate washing.

Signs, symptoms and complications of cradle cap:

Cradle cap has the following signs and symptoms associated with it:

• Mild cradle cap: Flaky, dry scales that looks like dandruff.
• Severe cradle cap: These are marked by thick, oily, yellow or reddish crusts on the scalp. 
• No itch

The causes of cradle cap:

The exact cause of cradle cap is still a mystery, but it is definitely not caused by poor hygiene, allergies or infections.

One possibility is that it has to do with the overactive oil glands (sebaceous glands) in the skin of newborn babies. The glands release a greasy substance that makes the dead skin cells attach to the scalp.

 The treatment of Cradle Cap:

Cradle cap is a self-limiting condition and will disappear on its own. The following can be done to help with the baby’s appearance:

• Shampoo the scalp daily with a mild baby shampoo. Johnsons & Johnsons’ Baby shampoo can be recommended.
• The scalp can be massaged with a soft brush to loosen the plaques. It is important to instruct the mother not to remove the crusts forcefully. 
• Apply baby oil or mineral oil to the scalp a few hours before washing. This will assist to lift and loosen the scales. Follow up with baby shampoo and rinse well.

When to refer to a doctor:

The following cases should be referred to the health care practitioner:

• Itch associated with the rash. A yeast super-infection can cause the itching and should be treated with an anti-fungal cream.
• Inflammation and cracks: The affected skin can become red and painful cracks may develop with bleeding.
• If no improvement is seen after frequent shampooing after seven days.
• When the rash spreads to the face, neck and crease areas.

Conclusion:

Cradle cap is a harmless, self-limiting condition that can be treated with frequent shampooing.

References:

Available on request

L Crause (M.Pharm)

The wonderful day the parents have always dreamed of has arrived! The beautiful, healthy baby has come home. Grandmother comes over for a first visit describes in detail about the horrible colic that the baby’s father had as an infant. Sure enough, at 6 pm on the dot, the little angel launches into a three-and-a-half hour episode of uncontrollable screaming

All babies cry, but sometimes a baby will cry for hours at a time, no matter what action the parents take.

Baby colic (also known as infant colic, three-month colic, infantile colic and colic) is a condition in which an otherwise healthy baby cries or screams frequently and for extended periods without any discernible reason. Colic affects as many as 25 percent of babies.

The condition typically appears within the first three weeks of life and almost invariably disappears, often very suddenly, before the baby is three to four months old. Some sources are of the opinion that it is more common in bottle-fed babies, but it also occurs in breast-fed infants.

Having ruled out other causes of crying, a common rule of thumb is to consider colic if the baby cries intensely more than three days a week, for more than three hours, for more than three weeks in a month.

Causes

There is no commonly accepted explanation for colic. Traditionally, colic was ascribed to abdominal pain resulting from trapped gas in the digestive tract. This theory is not yet discredited and some recent scientific evidence seems to support it, yet it is no longer universally accepted as the general cause.

Researchers have explored a number of possibilities, including allergies, lactose intolerance, an immature digestive or nervous system, a baby’s sensitive temperament, maternal anxiety and differences in the way a baby is fed or comforted.

Infants of mothers who smoke during pregnancy or after delivery have a greater risk of developing colic.

There is mounting evidence that the causes are related to gut flora; multiple studies have shown that babies with colic have different gut flora patterns, which includes a lack of Lactobacillus acidophilus. New studies at the Colic Clinic at Brown University demonstrate that nearly half of babies with colic have mild gastroesophageal reflux.

Many parents have also discovered a link between food and colic – and if the child is breastfed, it could include the food ingested by the mother. Dairy products seem to top the list as possibly problematic. Most babies will begin to become much more tolerant of mother’s diet by about 3 months of age.

It is certainly known that amongst all babies with colic, there are factors that may worsen the symptoms:

• overfeeding in a futile attempt to lessen the crying
• feeding certain foods, especially those with high sugar content may increase the amount of gas in the intestine and worsen the situation
• the presence of excessive anger, anxiety, fear or excitement in the household.

Symptoms

In an otherwise healthy, well-fed baby, signs of colic may include:

• sudden onset of crying or fussing about the same time every day, often after a feeding
• loud and continuous crying
• crying spells lasting from one to four hours
• a bowel movement or gas near the end of the colic episode
• flushed or red face
• distended or prominent belly
• legs alternating between flexed and extended positions
• cold feet and clenched hands.

The episodes, while they can occur at any time of the day or night, typically begin in the late afternoon or early evening.

Tests and diagnosis

It is very important to exclude several other causes of sudden-onset screaming in a newborn. These conditions include intestinal blockage or obstruction, abdominal infection, hernia, a scratch of the baby’s eye, ear infection, bladder infection and others. The doctor will do a physical exam to identify any possible causes for the baby’s distress. If a baby is otherwise healthy, the diagnosis may be colic.

If the crying is accompanied by symptoms such as vomiting or a fever, laboratory tests or X-rays could be used to find the cause.

Treatment

Doctors usually prescribe dimethicone (Telament) which treats trapped gas that causes colic in some babies.

Some studies have found success with probiotics (Infantiflora) which were intended to reduce gas. It is worth noting that probiotics occur naturally in breast milk and that a breastfed baby and a formula fed baby have very different gut floras.

Alternative therapies, particularly those that include fennel, along with dill, chamomile and other herbs with purported digestive health benefits, have been applied. These are primary ingredients in gripe water, which is believed by some to relieve the symptoms associated with baby colic, teething and gas.

There is general agreement that soothing measures, such as pacifiers, listening to white noise and rocking are often effective in calming the baby during crying periods. This is also known as the cuddle cure or 5S’s:

• swaddling
• placing the baby on their side or stomach
• swinging the baby in a rhythmic steady motion
• making a shhh sound or singing in the baby’s ear
• giving the baby something to suck on.

Before expected crying times, limit visitors, keep noise and lights low and touch the baby only if needed. It is important to discover what works best for the baby, even if it changes from day to day.

Do not overfeed the baby and avoid fruit juices in babies younger than 6 months. Babies should not have more than one cup of fruit juice per day and it should never replace a milk feeding.  It could also be helpful to carry the baby in a front-pouch-style carrier with his legs drawn up and pressure off of his belly.

Effect on the family

Colic can place an enormous strain on parents and other family members. The feeling that they are not providing something their child desperately wants or needs can induce stress, depression, feelings of helplessness and low self-esteem. If crying is prevalent during night time hours then these problems can be aggravated by the resulting sleep deprivation or interruption to sleep patterns; exhaustion may also result.

Conclusion

It is important to take a break from the crying when possible and leave the baby in the care of a spouse or family member. Remember that colic is not the result of poor parenting, it is only temporary and will improve by the age of 3 months.