Janet L. Antonioni, MD Neil Beneck, MD Alice W. Newton, MD Diane L. Pigula, MD CRADLE CAP What is it? Cradle cap is a common condition in newborn and young infants. It is a collection of dried skin cells and oils that form a crust over the scalp, usually over the back of the head. Newborn infants’ skin is still trying to “settle down” and make the right amount of oil in the right places after nine months of soaking in a perfect moist environment. This means that infants can tend to have dry skin in some areas and too much oil in others. Cradle cap happens when infants make too much oil on their scalp. The same condition in older children and teenagers is called “seborrhea”. Because infants cannot scratch their heads and do not move around much, the excess oil combines with the normal shedding of skin cells to form a yellowish, scaly or caked up crust that we call cradle cap. Skin oil and dead skin cells can cause mild irritation or inflammation of the healthy skin n the scalp, which can produce some redness and itching. Cradle cap is not an infection and it is not a sign of poor hygiene or bad care. What is the biggest concern? Most parents are mainly concerned about the appearance and feeling of the baby’s scalp, as well as the baby’s comfort. In more severe cases, or if someone digs or picks at the crust too hard, the skin on the scalp can become infected. How do we treat it? Strangely, the solution to a scalp that is too oily is to add oil! One of the simplest treatments you can use for cradle cap is to gently rub some warm mineral oil onto your baby’s scalp. You can warm the oil by putting the bottle into a bowl of lukewarm water for 15 minutes (please never use the microwave for this). Leave the oil on the baby’s scalp for about an hour, and then gently wash the scalp with a cloth or a soft brush. If you do this every two days for a week or so, you should be able to get most of the crust off without injuring the delicate scalp. In more severe cases, some doctors recommend a tar-based shampoo (T-gel® and others) or a dandruff shampoo such as Head-and-Shoulders® or Selsun Blue®. Some doctors also recommend using hydrocortisone cream, 0.5%, applied once a day, on the scalp for one week. Please check with your doctor before using any of these treatments – they can be too harsh for babies’ skin. If you see the scalp becoming red, raw, or sore-appearing, please stop using the products immediately and check with your doctor. Please do not scratch or pick at the crust with your fingernails! This can damage the scalp and make infection likely. Beaver Brook Pediatric and Adolescent Medicine, PC 411 Waverly Oaks Road ◊ Building 3, Suite 302 ◊ Waltham, MA 02452 Phone: 781.891.3706 ◊ Fax: 781.891.3564 Janet L. Antonioni, MD Neil Beneck, MD Alice W. Newton, MD Diane L. Pigula, MD When should I be worried? Cradle cap is a very normal and mild condition. The only real danger is if it becomes infected, which is unusual. Infected skin appears red, may be swollen or tender, and may ooze yellow, cloudy, or blood tinged material. Please call your doctor if any of these things happen or if the cradle cap seems to be getting worse rather than better. A fever over 100.4° F or 38° C is a reason to call your doctor immediately at any time. Other points of concern While you are using mineral oil on the baby’s scalp you will want to change the bedding frequently and wash it separately from other items. This will keep the baby’s bed fresh and clean, and prevent the oil from spreading through other items in the wash. Please avoid using harsh soaps or shampoos to clean cradle cap. These usually only make the situation worse. Other Conditions that Might Be Present Cradle cap is a condition we only see in infants under a year of age. If an older child develops sores or crust on the scalp, this is not likely to be cradle cap. It could be seborrhea, which is a similar condition, though usually seborrhea does not form such large crusts in older children. A fungal infection such as ringworm is very likely the cause. Some children’s scalps have a very strong reaction to the fungus that causes ringworm, and they develop a swollen, boggy, and often crusty area on the scalp. This is called a “kerion” (kerry-on). If your child has a kerion, s/he will need treatment with an anti-fungal medicine taken by mouth, and may need some steroid treatment as well. Please check with your doctor if you think your child has a kerion or ringworm of the scalp. www.pediatricplanet.com Beaver Brook Pediatric and Adolescent Medicine, PC 411 Waverly Oaks Road ◊ Building 3, Suite 302 ◊ Waltham, MA 02452 Phone: 781.891.3706 ◊ Fax: 781.891.3564