Spots and rashes are very common in newborns, and most are harmless. The NHS guide to getting to know your newborn says they may come and go. Milia, baby acne, erythema toxicum, heat rash, cradle cap and dry, peeling skin usually clear without treatment, and most don't need creams at all.
A few rashes need help fast. A rash that doesn't fade when you press a glass against it is an emergency, and so is a temperature of 38°C (100.4°F) or higher in a baby under 3 months, with or without a rash. Tiny blisters or pus-filled spots in a newborn need a doctor the same day. This guide covers how to tell common rashes apart, what to do and not do, birthmarks, and when to get help.
Which newborn rashes are normal?
This table brings together the NHS guide to rashes in babies, the AAP's newborn rash checker and DermNet.
| Rash | What it looks like | When | What to do |
|---|---|---|---|
| Milia | Tiny white or yellow bumps on the nose, cheeks or chin | From birth or the first few days; usually gone within weeks | Leave alone; no creams |
| Baby acne | Small red bumps or pimples on the cheeks, forehead and chin | Within the first 6 weeks | Plain water; no oils or creams |
| Erythema toxicum | Red blotches, some with a white or yellow center | Day 2 or 3; fades in 1 to 2 weeks | Nothing; it settles by itself |
| Heat rash | Tiny raised spots where your baby sweats | When hot or overdressed | Cool your baby down |
| Cradle cap | Greasy yellow or white scales on the scalp | Varies | Gentle washing; don't pick |
| Dry, peeling skin | Flaky, cracked or peeling skin | First days, more in overdue babies | Plain water; usually no cream |
| Diaper rash | Red, sore skin in the diaper area | Any time | No soap, talc or antiseptic cream |
| Eczema | Dry, red, itchy patches, often on the face | Usually in the first year | See your doctor |
On brown and black skin, redness can be harder to see. The NHS says heat rash spots may look gray or white on darker skin.
What are milia and baby acne?
Milia are tiny white or yellow bumps, usually on the nose, cheeks and chin. The NHS says they often appear when a baby is a few days old and usually go away within a few weeks without treatment. DermNet's newborn skin page says about half of babies have them. The Royal Children's Hospital Melbourne in Australia notes similar harmless spots can appear inside the mouth. The AAP says creams or ointments can make milia worse, so leave them alone.
Baby acne (neonatal acne) looks like small red pimples on the cheeks, forehead and chin. The NHS says it can appear up to 6 weeks after birth, doesn't need treatment and usually gets better after a few weeks or months. The AAP says it often starts at 2 to 4 weeks and can last until 4 to 6 months.
- Do wash your baby's face gently with plain water and pat it dry.
- Don't squeeze or scrub the spots.
- Don't use baby oil, ointments or acne products. The AAP says oils and ointments can make baby acne worse.
The Royal Children's Hospital Melbourne suggests a doctor's review if acne-like spots haven't cleared within a few weeks, because some need different care. Any treatment should come from your doctor, not the pharmacy shelf.
What is erythema toxicum?
Despite the alarming name, erythema toxicum is a harmless newborn rash. The AAP describes red blotches with a small white or yellow pimple in the center, starting on day 2 or 3 and fading by 1 to 2 weeks. DermNet's page on toxic erythema says it affects as many as half of full-term babies, is less common in premature babies, and can start as late as 2 weeks.
The rash moves around: DermNet says each spot rarely lasts more than a day, while new ones come and go over several days. It usually starts on the face and spreads to the body, arms and legs, and the palms and soles are not usually affected. The baby is otherwise well, and no treatment is needed. The AAP says ointments or baby oil can make it worse.
How do I treat heat rash in a newborn?
Heat rash (miliaria) happens when sweat glands get blocked. The NHS heat rash page says babies are prone to it because they can't control their temperature as well as older children. DermNet's miliaria page says newborns' immature sweat ducts play a part, and the AAP says heat rash shows as pink, blotchy patches with tiny bumps, mainly on the face, neck and chest.
- Move your baby somewhere cooler and take off a layer.
- Dress them in loose cotton and use light bedding.
- Avoid scented washes and creams, as the NHS advises.
- Expect it to settle. The NHS says it usually gets better in a few days, and DermNet says many cases clear within a day or two in a cooler place.
See your doctor if it hasn't improved after several days or you're worried. For safe ways to dress your baby, see hot weather and dressing your baby for sleep.
Why is my newborn's skin dry and peeling?
Peeling skin is normal. The AAP's guide to how your newborn looks says it usually needs no treatment, whether a baby is born early, late or on time. The NHS says overdue babies often have red, dry, peeling skin because they've lost their vernix, the white coating that protects skin in the womb. Its 41-week pregnancy guide says not to moisturise rough skin, as it could make it worse, and that the outer layer peels off by itself within a few days.
The NHS also suggests bathing your baby in plain water only for at least the first month, without skin lotions or medicated wipes, and leaving any vernix on. Advice differs on moisturisers: the Royal Children's Hospital Melbourne's newborn skin guideline for nurses suggests a plain, unperfumed emollient at the first sign of dryness or cracks, and says oils such as olive oil can harm a newborn's skin barrier. If your baby's skin is cracked or bleeding, ask your midwife, pediatrician or doctor. See bathing a newborn.
What about cradle cap, diaper rash and eczema?
- Cradle cap. The NHS describes yellow or white, greasy, scaly patches on the scalp that aren't itchy and don't bother your baby. Don't pick the crusts, because that can increase the chance of infection. See cradle cap.
- Diaper rash. Red, sore skin in the diaper area. The NHS says not to use soaps, baby lotion, bubble bath, talcum powder or antiseptic creams on it. See diaper rash.
- Eczema. The Royal Children's Hospital Melbourne eczema fact sheet says most eczema starts before a child is one, often as a dry, red, itchy rash on the face, scalp or body. It isn't contagious. The NHS says to speak to a doctor if you think your baby has eczema. Keep anyone with a cold sore from kissing your baby, as the RCH advises, because eczema can become infected with the cold sore virus.
Which birthmarks are normal?
| Birthmark | What it looks like | What usually happens |
|---|---|---|
| Stork marks (salmon patches) | Flat pink or red patches on the eyelids, forehead or back of the neck | Face marks usually fade by age 2; neck marks can last longer |
| Blue-gray spots (Mongolian blue spots) | Flat blue-gray patches, often on the lower back or buttocks | Usually fade by about age 4 |
| Strawberry marks (haemangiomas) | A raised red lump that may appear in the first weeks | Grow for 6 to 12 months, then shrink by about age 7 |
The NHS birthmarks page says blue-gray spots are most common on babies with brown or black skin and can look like bruises. DermNet says they are present at birth and need no treatment, so it's worth making sure they're noted at your baby's checks. The AAP says stork marks are present in more than half of newborns.
The NHS suggests seeing a doctor if a birthmark is close to the eye, nose or mouth, gets bigger, darker or lumpier, or is sore. It says strawberry marks may need treatment if they affect vision, breathing or feeding. The AAP's birthmarks page suggests talking with your baby's doctor about any birthmark or rash you notice.
When is a newborn rash serious?
How to do the glass test
Press the side of a clear glass firmly against the rash and look through it. The NHS meningitis page says a rash that doesn't fade under the glass is a reason to call 911. On brown or black skin, check paler areas such as the palms, soles, inside the eyelids and the roof of the mouth. Not every seriously ill baby has a rash, so don't wait for one if your baby seems very unwell.
Call 911 now if your baby
- has a rash that doesn't fade when you press a glass against it
- is under 3 months and has a temperature of 38°C (100.4°F) or higher
- is 3 to 6 months old and has a temperature of 39°C (102.2°F) or higher
- is floppy, much sleepier than usual, hard to wake or not responding like they normally do
- is much sleepier than usual and not feeding
- has a weak, high-pitched or continuous cry
- is breathing very fast or struggling to breathe, or has blue, gray, pale or blotchy skin, lips or tongue
- has sudden swelling of the lips, mouth, tongue or throat
These come from the NHS urgent help guide and meningitis page. Australia's healthdirect also says to call an ambulance for a rash that doesn't fade when you press it, and to take a baby under 3 months with a fever to the emergency room. The NHS rashes page lists fever under 3 months for an urgent doctor appointment or NHS helpline advice instead, and the RCH fever fact sheet says to go to hospital under 1 month and see a doctor under 3 months; we use the stricter step. See fever in babies.
Get medical help today if your baby
- has tiny blisters, pus-filled spots, a painful rash or skin that looks infected (the AAP says to call your baby's doctor now)
- has a rash you think could be herpes (cold sores), which the AAP says needs a call to the doctor now
- has new purple or blood-colored spots that do fade under a glass
- has blistering skin (not from sunburn), or a rash that is getting worse, with skin around it that's red, swollen or hot (NHS)
- has weepy, crusted or broken patches of eczema (RCH)
- is under 1 month and looks or acts unwell in any way, or is feeding less than usual (AAP, NHS)
- has a rash you're worried about and you're not sure what to do; call your doctor or your pediatrician's after-hours nurse line
The AAP says all blister-like rashes in newborns should be checked by a doctor to rule out infection. DermNet's page on newborn blisters and pustules lists staphylococcal bacteria, the herpes simplex virus and thrush (candida) among the infections that can cause them.
Talk to your doctor or pediatrician if
- baby acne hasn't settled after a few weeks, or looks red and inflamed
- heat rash hasn't improved after several days
- you think your baby has eczema
- a birthmark is near the eye, nose or mouth, or is growing, darkening, lumpy or sore
- dry skin is cracked, bleeding or bothering your baby
What's worth noting down?
A quick photo each day in good light, with a note of when the rash started, where it is, your baby's temperature, and how they're feeding and sleeping, helps you see whether it's spreading or settling. Note any new product, wash or detergent. These notes and photos help your doctor or pediatrician, especially for a rash that comes and goes.
