Yellow skin and sore bottoms: two common worries in the early weeks

Two of the most common things parents notice in the early weeks show up on a baby's skin: a yellowish tinge in the first days after birth, and a red, sore nappy area a little later. Both are usually mild and easy to manage. Both also have a few signs that mean you should call someone quickly. Here is how to tell the difference.

Part one: newborn jaundice

What it is

Jaundice makes a baby's skin and the whites of their eyes look yellow. It happens because newborns have a build-up of a substance called bilirubin, which their young liver is still learning to clear. It is very common, often appears around the second or third day after birth, and in most babies fades on its own within about two weeks. In some breastfed babies it lasts a little longer and is still harmless, but that should always be checked.

How to look for it

• Check your baby in good daylight if you can.
• Look at the whites of the eyes, the gums and inside the mouth.
• Gently press on the tip of the nose or the forehead: if the skin looks yellow as you release, mention it.
• On brown or black skin, yellowing may be easier to see in the eyes, gums, palms and soles of the feet than on the face.
• Check nappies. A newborn's wee should be pale or colourless, and poo should be yellow, green or mustard-coloured, not pale.

What helps

Feed often, as advised by your midwife, because feeding helps your baby pass bilirubin out in their poo. Some babies with jaundice are sleepy and may need waking for feeds; ask your midwife about this. Do not put your baby in direct sunlight to treat jaundice. If treatment is needed, it is usually phototherapy, a special light given in hospital, and it works well.

Call your midwife, health visitor or doctor promptly if

• You think your baby looks yellow at any point, so they can check.
• Jaundice appears in the first 24 hours after birth; this needs urgent assessment.
• The yellow colour is spreading or getting deeper.
• Your baby still looks yellow after about two weeks, or three weeks if they were premature.
• Your baby's poo is pale, chalky or white, or their wee is dark yellow or orange.

Get urgent help if your baby with jaundice

• Is very sleepy, hard to wake or will not feed.
• Is floppy, or arches their back with a high-pitched cry.
• Has a fever, or seems unwell in any other way.

Part two: nappy rash

What it is

Nappy rash is red, sore or spotty skin in the nappy area. It is usually caused by skin being in contact with wee and poo for a while, along with rubbing. It is common at every stage of the first year, and it often clears in a few days with simple care.

What helps

• Change nappies often, as soon as they are wet or dirty.
• Clean gently with water and cotton wool or fragrance-free, alcohol-free wipes.
• Pat dry, do not rub, and let the skin dry fully before a new nappy goes on.
• Give nappy-free time on a towel or changing mat each day.
• Use a thin barrier cream if your pharmacist or health visitor recommends one.
• Avoid soap, bubble bath, talcum powder and scented lotions on the area.
• Check the fit. Nappies that are too tight can rub.

Ask your health visitor, pharmacist or doctor if

• The rash has not improved after a few days of good care.
• It is bright red with spots spreading into the skin folds, which can be a sign of thrush.
• There are blisters, open sores, pus or swelling.
• The rash spreads beyond the nappy area.
• Your baby has a fever or seems unwell.

The care in the small things

There is something quietly holy about these tasks: checking eyes in the morning light, changing yet another nappy, gently patting sore skin dry. They are unseen by most of the world, but not by God. The psalmist says, “Like as a father pitieth his children, so the LORD pitieth them that fear him” (Psalm 103:13). The tenderness you feel as you care for your baby is a small picture of the tenderness God feels for you.

A prayer at the changing mat

Lord, thank You for Your tender care over me. Heal my baby's skin and help their little body grow strong. Give me gentle hands, sharp eyes and the confidence to call for help when I need it. Amen.