Babies A to Z


The scalded skin syndrome is a severe superficial bacterial skin infection known as Ritter disease or dermatitis exfoliativa neonatorum in newborn infants, and toxic epidermal necrolysis in older children. Milder forms are known as pemphigus neonatorum or bullous impetigo. Scalded skin syndrome and Lyell syndrome are terms that cover all forms.

It is caused by the bacterium Staphylococcus aureus (golden Staph) that spreads from nose, eyes, mouth or umbilicus to areas of skin damaged by eczema or injury. It may be a complication of the Stevens-Johnson syndrome.

The infant or child has severe peeling of skin that commences on the face and genitals and spreads across body. The skin appears similar to very severe sunburn. Death from fluid loss through damaged skin or internal spread of infection is possible.

A culture of swabs from the nose, eyes, throat and umbilicus will confirm responsible bacteria and the appropriate antibiotic (eg. penicillin or erythromycin). The infection responds slowly to antibiotics, but most children recover.



A dry scalp may be caused by excessive washing of the hair, particularly with medicated or perfumed shampoos and soaps. All soaps and shampoos tend to remove oil from the skin, and the first step in treatment is to recommend washing the hair no more than twice a week, and using a very mild baby shampoo. As you age, this problem often becomes more acute as the hair thins with age, and more of the soap or shampoo can penetrate to the unprotected scalp.

After washing, the gentle massaging of a small amount of baby oil into the scalp will help replace any lost oil, and thus reduce dryness and itching. It will take several weeks for the scalp to recover, but if used consistently, most will return to normal.

In severe cases, gels or lotions containing a steroid can be prescribed to settle the scalp inflammation. These should only be used short term until the discomfort and skin flaking have settled, and then the sensible shampooing methods outlined above should be followed.


Scarlet fever (second disease) is a bacterial infection of children caused by bacteria from the Streptococcal family.

These infections are now very uncommon because of the widespread use of antibiotics for minor infections.

The patient is unwell with a fever and sore throat for a few hours to two days before the typical “scarlet red” rash develops, which consists of bright red, pinhead size dots on the face, neck, armpits, groin and other areas. The skin immediately around the mouth often remains a normal colour.

The tonsils are usually enlarged, red and painful, and the tongue may be red and swollen. The skin of the palms and soles may flake away in severe cases.

The diagnosis is confirmed by taking a swab from the throat, and by specific blood tests. It can be very effectively treated and prevented by antibiotics such as penicillin and erythromycin.



Seborrhoeic eczema or dermatitis is a widespread, common form of eczema that can occur at any age.

It is caused by inflammation of the oil producing sebaceous glands in the skin, but the cause of the inflammation is unknown.

In infants, seborrhoeic eczema frequently affects the scalp to cause cradle cap or the buttocks to cause nappy eczema. Other frequently affected areas are the cheeks, neck, armpits, groin and folds behind the knees and elbows and under the breasts. In adults, it is responsible for some forms of dandruff. On the scalp, it appears as a red, scaly, greasy rash. In skin folds, the skin is red, moist and breaks down into tiny ulcers. On exposed areas such as the face, the rash is red, scaling and may contain tiny blisters.

The scalp is treated with a lotion or cream to remove the oil and scale, and regular shampooing. Tar solutions are applied in resistant cases. In other areas, mild steroid lotions or creams are used. Soap should be avoided and substitutes used.

A complication may be the development of a secondary fungal infection.

Seborrhoeic eczema tends to be chronic and recurrent. Children often grow out of it in the early teens, but in adults it may persist intermittently for years.



Babies have larger heads proportional to their bodies than adults, and have weaker muscles to control the movement of the head.

If a baby is picked up and shaken vigorously, the baby cannot adequately control the movement of its head which will flop back and forward and side to side with considerable force, resulting in injuries that can vary from whiplash and muscle tearing to eye haemorrhages, brain haemorrhages, coma, convulsions and death. Bruising may also be seen on the arms and trunk where the baby has been held tightly.


A delay in the onset of speech in a child (language delay) may have many reasons. Parents should always remember that there is an enormous variation between children when learning to speak, and a delayed start to speech is not necessarily a sign of some serious condition.

Never the less, if parents are concerned about a significant delay in their child’s language development, they should seek professional assistance.

Delayed speech may be due to deafness, a lack of stimulation (people not talking near them), an intellectual disability, autism and abnormalities of the mouth and throat (eg. cleft palate). Some children just decide that they do not want to speak, and then suddenly start speaking quite fluently at a later age.



The spinal cord runs from the base of the brain, through the vertebrae of the back, and carries nerve messages from the brain to the body. Spina bifida is a failure of the vertebra to close over the spinal cord during development as a foetus. There are several degrees of severity:- Spina bifida occulta is the mildest form in which only the vertebral arch is affected, and the spinal cord works normally.

- Meningocele is more serious as there is a protuberant sac at the level of the failed fusion, which contains cerebrospinal fluid only, but the spinal cord has some damage.

- Meningomyelocele is the most serious form in which a raw, uncovered sac containing nerve tissue and cerebrospinal fluid protrudes onto the surface of the back. There is a significant risk of infection in the spine and brain and it may be associated with other birth deformities such as hydrocephalus and anencephaly (failure of the brain to develop).

The cause is unknown, but the incidence of spina bifida is higher in subsequent pregnancies after one child has been born with the condition, and in those of Irish and Welsh ancestry. The foetus develops its spinal cord and vertebrae in the first three months of pregnancy from a flat strip of nerve tissue that folds in upon itself lengthwise and fuses into a rod. It is then surrounded by the bony arch of the vertebrae. Spina bifida is the failure of the vertebral arch to form, usually in the lower back, allowing the spinal cord to be easily damaged. The unfused vertebral arch has a double pointed (bifid) appearance on x-ray examination.

Spina bifida occulta has no symptoms, but with a meningocele only some of the necessary nerve messages are transmitted to the legs and bladder causing some muscle weakness, abnormal sensations and poor bladder control. Patients with a meningomyelocele have paralysis and loss of all sensation below the level of damage and no control of the bladder or legs (paraplegia).

Mothers who are at high risk can have a test performed on the amniotic fluid that surrounds the baby in the womb between the 14th and 16th week of pregnancy to detect the defect. It may also be detected by an ultrasound scan during pregnancy. After birth, x-rays, and MRI and CT scans of the back show every detail of the defect. Folic acid supplements taken during pregnancy appear to prevent the condition.

Spina bifida occulta requires no treatment, but with a meningocele an operation to close the defect in the back is performed in childhood, while with a meningomyelocele a major operation to close the defect in the back is performed early in life, but this does not cure the paraplegia.


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