By Dr. Eddie Valenzuela

To pick or not to pick that is the question.  Let me give an example as we prepare to answer this question. Many who are pondering what to do with the scale on their infant’s scalp may have dealt with acne as an adolescent and still even now. The advice given with acne is leave it alone. Picking at acne lesions can lead to changes in coloration of the skin that are worse than if you just left it alone, and also can lead to other deeper scaring.  The short answer as we prepare to answer can I pick my babies cradle cap, is avoid the urge. There are better ways to deal with cradle cap, such as medicated shampoos for cradle cap.

Why does cradle cap happen?

Cradle cap is the excess production of skin cells in areas of the skin that produce large amounts of sebum. Sebum is a protective oil secreted by the skin. See here for reference:

Treating Seborrheic Dermatitis

Yeasts, present on everyone’s scalp (not just YOUR baby), metabolize this oily substance into irritants that cause the skin to slough.

Options for removing scale on scalp and eyebrows

If you start to see scales and crust on your baby’s eyebrows and scalp I would suggest using whatever shampoo you currently are using and work up a nice lather and massage the product gently but thoroughly onto the affected areas.

Pro tip #1!–Soft spot technique:

The crusts like to hang out on the soft spot, technically called the anterior fontanelle. Many caretakers of infants have a fear of rubbing on this area. It is a delicate area but fear not. When you are massaging, you are NOT pushing down on the soft spot you are just gently agitating the shampoo’s lather with your fingers to try and loosen the scales.

How often can or should I wash my baby?

You can wash your baby daily without hesitation. Some babies really like baths, some as you may already know do not enjoy being bathed.

Cradle Cap Brushes

Many times, just doing the above techniques will not help. Searching Amazon or going to the baby aisle will reveal a plethora of cradle cap brushes and scale removal products. Some people swear by them. You can add this to the above technique instead of massaging with your fingers. I personally prefer just using digits 1 through 5 to take care of your baby’s scalp.

My baby’s hair is falling out now?!?

Many babies will lose their hair as the crusts and scale fall off—this is normal. Even WITHOUT scale and crust, generalized hair loss is a normal process as children approach 4 months of life.  Many parents have come to me with concerns about hair loss in the back part of their scalp—the point of maximal contact with the sleeping surface—hair loss in just this area is normal.

Other names for “cradle cap”

Most healthcare providers will refer to cradle cap as “cradle cap” but the actual technical name of this entity is seborrheic dermatitis. Seborrheic Dermatitis is a more intense version of skin flaking than the dandruff you yourself may suffer from.

Coconut oil?

You will read across the internet and hear from friends and family to try any number of oils or petroleum jelly. You can try, olive, coconut, almond, or mineral oil—some kids improve with these things. However, sometimes these greasy products many make the situation WORSE. The oils may give the yeasts more substrate to use to cause further irritation.  Some folks will advocate trying breast milk if you have any left over—this will not hurt but may not help.

 

Should I pick at it then?

Picking at individual flakes would be very time consuming, and picking at flakes not ready to fall off could lead to a breach in the skin barrier and lead to possible infection or pain. It is not recommended to pick at your baby’s cradle cap.

Pro tip #2!–What do pediatricians recommend?

About 20-30% of pediatricians suggest to do nothing or to try one of the above oil based products to loosen the scale.  Some families are fine with doing nothing, but many moms and dads get tired of looking at and smelling the aesthetically displeasing cradle cap.

The other 70% of providers will suggest a medicated adult dandruff shampoo which targets the root of the problem—the Malassezia. Most pediatricians suggest a pyrithione zinc, or selenium sulfide-based product. The problem with these adult products is that they are laden with potential skin irritants like scent and color, which can further dry out the skin.  We would recommend a product that avoids the use of harmful ingredients such as parabens and sulfates, a safe medicated baby shampoo for cradle cap.

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