Guidelines for Pediatric Skin Care by Indian Academy of Pediatrics

Indian Academy of Pediatrics has developed standard recommendations for skin care in neonates, infants and children to aid the pediatrician to provide quality skin care to infants and children.Though skin is the largest organ in the body with vital functions, skin care in children especially in newborns and infants, is not given the due attention that is required. There is a need for evidence-based recommendations for the care of skin of newborn babies and infants in India.

The guidelines have been published in the journal Indian Pediatrics.

Massage promotes circulation, suppleness and relaxation of the different areas of the body and tones of the muscles.It relieves the physical and emotional stress in the baby and supports the baby's ability to fulfill the individual developmental potential. Massage increases the activity of the vagus nerve which results in increased levels of gastrin, insulin and insulin like growth factor 1 that enhances the food absorption, weight gain contributing to increase growth. There is greater bone mineralization, more optimal behavioral and motor responses in infants who were given massage. It has been observed that preterm infants who were given massage had reduced cortisol level and parasympathetic response, reduced stress response, increased vagal activity and gastric motility, release of gastrin, improved weight gain and enhanced motor development. Massage of hospitalized preterm or low birth weight babies resulted in improved daily weight gain, reduced length of stay in the hospital and had positive effect on postnatal complications and weight at 4 to 6 months. In summary, benefits of massage are improved barrier function, decreased TEWL, improved thermo-regulation, stimulation of circulatory and gastrointestinal systems, improved sleep rhythm and enhanced neurological and neuromotor development.

Massage may be given by mother, father,grandparents, caregiver or nurse. Full body massage will need fifteen to thirty minutes of uninterrupted time and is to be given when the baby is quiet, alert and active, preferably one to two hours after feed. Massage is to be given in a warm room. Massage provider should avoid having long nails or wearing any jewelry in the hands.Massage should be slow and gentle but firm enough for the baby to feel secure.

Oil Massage-Oil acts as a source of warmth and nutrition and helps in weight gain of the babies. Coconut oil, sunflower oil,synthetic oil and mineral oil are being used for massage.Babies massaged with oil showed less stress behavior and lower cortisol levels than those who were given massage without oil . Thus, oil massage has multiple benefits and hence is recommended

Evidence Based Recommendations for Skin Care in Neonates and Infants

1.Skin-to-skin care (SSC) for all mothers and newborns without complications at least

for one hour.

2.Vernix caseosa should not be removed.

3.First bath should be delayed until 24 hours after birth but not before 6 hours.

4. Duration of bath should not exceed 5-10 minutes.

5.Liquid cleanser with acidic or neutral pH preferred as it will not affect the skin barrier function or the acid mantle.

Prevention of diaper dermatitis - 6.Frequent change of diapers

In babies with diaper dermatitis, frequent change of diapers, use of super absorbent diapers and protection of perineal skin with a product containing petrolatum and or zinc oxide.

7.Use of soft clothes and water for cleansing the diaper area is encouraged.

8.Only fragrance free baby wipes can be used.

9.Nothing should be applied on the cord stump.

10.Kangaroo mother care is recommended for the routine care of preterm and low birthweight,

newborns weighing 2000 g or less at birth, as soon as the neonates are clinically stable.

11.Swaddle immersion bathing could be adopted, with the training of nursing staff.

12.Gentle application of appropriately selected emollients will help to maintain the barrier

13.Application of emollient in babies born in families with high risk of atopy tends to reduce the risk of developing atopic dermatitis.

14.Oil massage has multiple benefits and hence is recommended.

15.Vegetable oils such as olive oil and mustard oil should not be used.

For further reference log on to:

Madhu R, Vijayabhaskar C, Anandan V, Nedunchelian K, Thangavelu S, Soans ST, Shastri DD, Parekh BJ, Kumar RR, Basavaraja GV. Indian Academy of Pediatrics Guidelines for Pediatric Skin Care. Indian Pediatr. 2021 Feb 15;58(2):153-161. PMID: 33632947.