Dr. Greene

Baby Acne, Constipation in Babies, and Preemie Weight Gain

Is this much baby acne normal? It’s all down her chest and clustered around her nipples.
Newborn acne is pretty common, affecting about 1 in 5 babies. On average it shows up when kids are about 3 weeks old, but classically it’s limited mostly or entirely to the face and scalp. If it’s all down the chest and clustered around the nipples, it’s important to consider other causes.
  • Infantile acne starts later than newborn acne, when kids are 3 or 4 months old. This is often more dramatic than newborn acne, spreads beyond the head, and may need real acne treatment.
  • Erythema toxicum is a normal newborn rash that usually shows up in the first day or two. The bumps are often concentrated on the chest and usually disappear on their own within about a week.
  • Milaria can also look like acne. It usually shows up in the first week of life, and is often caused by being too warm.
But early rashes can also be infections or other problems. Many newborn skin findings are completely normal, but unless it’s clear what’s going on I favor having a doctor take a look to be sure.

For newborn acne, gentle daily washing with water and a mild cleanser is usually all that is needed. It’s best to avoid unnecessary oils or lotions. Newborn acne usually goes away on its own, with no scarring, by the time the baby is about 4 months old.

If you want to speed this up, you might want to talk with a doctor about using 2% ketoconazole cream twice a day or 1% hydrocortisone cream once a day, but this is usually completely unnecessary.

My daughter is on soy formula and has suffered with constipation on and off. She has started with food and the constipation seems worse. What is the best way to eliminate the constipation?
All other things being equal, it’s not unusual for soy formula to result in firmer stools than other options. If there’s a soy allergy (and soy is one of the more common allergens), then the stools may be even firmer. People often think of food allergies resulting in loose stools, but they can also cause constipation.

When the formula is the issue, switching to a hypoallergenic formula may solve the problem.

Sometimes making adjustments with the other feedings will also do the trick (decreasing white rice cereal and bananas; increasing foods like peas, pears, peaches, and prunes; giving 4 ounces of water daily; and considering adding apple or prune juice as a stool softener). Probiotics may also help.

If measures like these don’t eliminate constipation in babies, it’s important to consider other causes of constipation, including rare structural problems.

My daughter was born at 34 weeks weighing in at 5lbs 30z. She is now 11 months and she weighs 15 lbs 3 oz. Is that a good weight for a preemie?

We don’t want preemies – or other babies – to gain weight too quickly.

An 11-month old girl born at 34 weeks is about the same gestational age as a 9½-month-old girl born at term – and usually acts like a girl somewhere between 9½ months and 11 months old.

All other things being equal, healthy well-fed 9½-month-old girls average weighing between 18 and 19 pounds. On the WHO growth charts (the best for kids her age) she would be at about the 5th percentile for this age, which may be a very healthy weight or may be underweight depending on her height and overall health.

In general, 5% of healthy, well-fed kids weigh at or below the 5th percentile for their age – but that is also the percentile where it’s a great idea to take a thoughtful look at kids to be sure they are healthy and gaining at the best rate for them.

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Dr. Greene

Dr. Greene is a practicing pediatrician, author, speaker, children’s health advocate, and father of four.

Dr. Levine

Dr. Alanna Levine is a New York based pediatrician and a mom of two children.