What should we do if our baby has cradle cap

A scalp with cradle cap is not the most pleasant sight. With hairier babies we often only notice it once it covers a wider area. At first it can be tricky to spot, and is easiest to see when the light catches it.
Right at the start, it is important to emphasise that this condition is not an illness, and it is very common in babies. Treatment is usually straightforward, and it only tends to be a problem if there are signs of a secondary infection. With proper care the chance of that is small.
Let’s look at what causes it, how it appears, how it feels for the baby, and what we can do about it.

What causes cradle cap?

A baby’s scalp produces sebum more actively. The skin cells that naturally die and are ready to shed get stuck in the excess sebum and form small continuous plates that adhere to the scalp. Trying to remove them can cause sore spots.

Despite the name, cradle cap, or infant seborrhoeic dermatitis, has nothing to do with hygiene and it is not contagious, so children cannot pass it to each other and can attend nursery or playgroups as usual. It appears quite commonly even in babies a few weeks old, and in milder form can persist up to preschool age.

As parents we should not feel embarrassed or uncomfortable when we see the symptoms, because cradle cap is not due to a lack of parental care and it is not the parent’s fault.
Girls and boys can be affected in equal measure, although children with family members who have eczema or asthma may be more prone to cradle cap.

Does cradle cap bother the baby 

This symptom is completely harmless. It does not cause pain, inflammation or itching, so the baby is not aware of it on their scalp. They may only notice the treatments, which, if done gently, will not cause any discomfort. The issue is more of a cosmetic one.
Cradle cap often disappears on its own over weeks or months, but some children remain prone to it until a few years of age. For them, hair washing follows an established routine with prevention in mind, which can keep cradle cap away entirely once it has been removed. Symptoms that persist for a long time are worth showing to your GP or health visitor.

Does cradle cap bother the baby 

This symptom is completely harmless. It does not cause pain, inflammation or itching, so the baby is not aware of it on their scalp. They may only notice the treatments, which, if done gently, will not cause any discomfort. The issue is more of a cosmetic one.
Cradle cap often disappears on its own over weeks or months, but some children remain prone to it until a few years of age. For them, hair washing follows an established routine with prevention in mind, which can keep cradle cap away entirely once it has been removed. Symptoms that persist for a long time are worth showing to your GP or health visitor.

What does a scalp with cradle cap look like 

It usually appears on the baby’s already hairy scalp as a yellowish, brownish or reddish greasy layer that looks like a deposit. Its surface may be smoother, or drier and lifting like scales. It develops gradually. It is usually most extensive on the crown, but it can also appear on the face, around the eyebrows and near the ears. In these areas it is typically not thick, rather brownish patches that resemble dense freckles. The affected areas may be sparse, but if we do not treat it, it can spread across larger parts of the baby’s head in a thicker layer.

When these dry little scales fall off, the skin underneath can look red, even raw, and you may notice hairs in the flakes that shed. Do not worry. Hair lost with cradle cap will grow back.

Remove cradle cap gently 

Because this is not an aggressive problem and has no harmful effect on health, treatment can be gentle and unhurried. The best solution is to loosen and remove it with oil.

How to do it:

You will need an oil suitable for babies, ideally with a natural composition, and a small hat you do not mind oiling for the purpose. Before your baby’s bath, apply oil generously to the cradle cap areas, then pop the hat on to help the oil work and keep the head warm. The oil loosens the greasy cradle cap, especially the top layer.

Leave the oil on the baby’s head for 20 to 30 minutes. Make sure the room is warm enough, as the baby’s head will be damp. Then, during the hair wash, very gently wipe the cradle cap away from the scalp with a soft cloth, a cotton muslin, or an even softer flannel muslin. Be careful around the fontanelle in babies under one year.

There are various cradle cap combs available. You can try one if you can choose a reliable product that is gentle on the baby’s head. You can also choose over-the-counter creams against cradle cap, which work similarly to oils. Ask your GP or health visitor for advice when choosing the right product.

Do not be surprised if not all the layers come off straightaway. That is fine, as established cradle cap needs a few such sessions to lift slowly. Never scrub or force the stuck scales to come away, and do not cause injuries to the scalp.

Cradle cap does not damage the baby’s hair 

It can be alarming to find hairs in the flakes you have removed. Rest assured, there is no problem. Your child’s hair will not thin or grow more slowly. Cradle cap does not damage the hair follicles. It only sits on the surface of the skin and, because it is sticky, hairs can get caught in it. They will grow back later.

What should we avoid doing with a scalp that has cradle cap 

Do not pick off the dry pieces. The skin underneath can be injured, and your child would let you know, as it is uncomfortable for them too. Do not cause unnecessary sore patches on the scalp, because they can be painful and give germs a way in.

Do not try to remove everything during the very first hair wash. Be patient. With proper oil treatment, the scalp usually becomes completely clear after three to four sessions.

What is the difference between cradle cap and eczema 

It is worth noting that the two conditions have similar symptoms. Eczema also causes reddish flaking, but it brings itching that is hard for the baby to tolerate and pain if the child scratches the skin. At first glance the two can look similar, but in reality they are unrelated.

When should we definitely see a doctor 

Rarely, cradle cap can become secondarily infected, and a fungal or bacterial infection can develop on top. This is more likely if it is not removed in time. The scalp can become sore, although even then it does not usually itch. Most parents ask their health visitor or GP for advice even for harmless symptoms, so this is rare.

In severe or long lasting cases that cause inflammation, the doctor may prescribe a steroid cream, an antifungal, a shampoo or a cream. If cradle cap does not improve, has an unpleasant smell or bleeds, infection is a real possibility.

You might also see swelling, redness, widespread patches on the body or itching. If it persists beyond 12 months of age, contact your GP as well.

Can the development of cradle cap be prevented 

Until you see signs of cradle cap, there is nothing to be done and no point trying to prevent it. It simply is not possible. Once it appears, prevention essentially means stopping it from coming back after treatment. This requires continuous attention to the baby’s scalp, and repeating the oil treatment as soon as you notice new brownish specks. In such cases the thin layer can be removed during one hair wash.

Sources:

NHS — Cradle cap: symptoms, care and when to get help

Cleveland Clinic: Cradle Cap (Seborrheic Dermatitis in Infants