This guideline discusses the most frequently asked questions parents have about common skin rashes and birthmarks.

1. Acne - small red bumps on the face
2. Drooling rash
3. Erythema Toxicum - red blotches with small white lump in the center
4. Forceps or birth canal injury
5. Milia - tiny white bumps on the nose and cheeks
6. Mongolian spots - bluish-green birthmark, usually on buttock
7. Stork bites (pink birthmarks) - on back of neck or bridge of nose
8. Strawberry hemangiomas - raised red birthmarks.
9. Diaper rash

Call your doctor now (night or day) if:

• Baby is less than 1 month old and looks or acts sick
• Less than 12 weeks old with fever above 100.4°F rectally
• True blisters (little bumps containing clear fluid)
• True pimples (little bumps containing pus)
• Skin looks infected
• Rash is painful to the touch

Call your doctor within 24 hours (during regular office hours) if:

• You think your child needs to be seen.

Call your doctor during weekday office hours if:

• You have other questions or concerns.

Parent care at home if:

• Normal newborn rashes or birthmarks and you don't think your child needs to be seen.

Home care advice for newborn rashes and birthmarks:

1. Acne: More than 30 percent of newborns develop baby acne of the face -- mainly small red bumps. This baby acne begins at 3 to 5 weeks of age and lasts until 4 to 6 months of age. The cause appears to be the transfer of maternal hormones just prior to birth. Since it is temporary, no treatment is necessary. Baby oil or ointments make it worse.

2. Drooling rash: Many babies have a rash on the chin or cheeks that comes and goes. This is often due to contact with food and acid that has been spit up from the stomach (especially prolonged contact during sleep). Other temporary rashes on the face are heat rashes in areas held against the mother's skin during nursing (especially in the summertime.) Advice: Rinse the face with water after all feedings or spitting up. During hot weather, change the baby's position more frequently and put a cool washcloth on the area.

3. Erythema toxicum: More than 50 percent of babies get a rash called erythema toxicum on the second or third day of life. The rash is composed of ½ inch to 1 inch red blotches with a small white or yellow lump in the center. They look like insect bites, but are not. They can be numerous, keep occurring, be present anywhere on the body surface (except the palms and soles), and look terrible. Their cause is unknown, they are harmless, and they resolve by 2 weeks of age. No treatment is necessary; ointments or baby oil make it worse.

4. Forceps or birth canal injury: The pressure of a forceps on the skin can leave bruises, scrapes, or damaged fat tissue anywhere on the head or face. Skin overlying bony prominences (such as the sides of the skull bone) can become damaged even without a forceps delivery by pressure from the birth canal. Fetal monitors can also cause scrapes and scabs on the scalp. The bruises and scrapes will be noted on day 1 or day 2 and disappear by 1 to 2 weeks. A fat tissue injury won't be apparent until day 5 to day 10. A firm coin-shaped lump, under the skin and sometimes with an overlying scab, is the usual finding. This lump may take three or four weeks to resolve. For any breaks in the skin, apply an antibiotic ointment four times per day until healed. Call back if it becomes tender to the touch, soft in the center, or looks infected.

5. Milia: Milia are tiny white bumps that occur on the faces of 40 percent of newborn babies. The nose and cheeks are most often involved, but milia are also seen on the forehead and chin. Milia are many in number and occur equally on both sides of the face. Although they look like pimples, they are much smaller (pinhead size) and not infected.They are blocked-off skin pores and will open up and disappear by 1 to 2 months of age. They do not look like water blisters. No ointments or creams should be applied to them.

6. Mongolian spots: A Mongolian spot is a normal bluish-green or bluish-gray flat birthmark that is found in over 90 percent of Native American, Asian, Hispanic, and African American babies. They are also seen in 10 percent of Caucasians, especially those of Mediterranean descent. They occur most commonly over the back and buttocks, although they can be present on any part of the body. They vary greatly in size and shape. They have no relationship to any disease. Most fade away by 2 or 3 years of age, although a trace may persist into adult life.

7. Stork bites (pink birthmarks): Flat pink birthmarks (also called salmon patches) occur over the bridge of the nose, the eyelids, or the back of the neck ("stork bites") in more than 50 percent of newborns. The ones in front are often referred to as "an angel's kiss". All the birthmarks on the bridge of the nose and eyelids clear completely. Those on the eyelids clear by 1 year of age; those on the bridge of the nose may persist for a few additional years. Those on the forehead that run from the bridge of the nose up to the hairline usually persist into adult life. Laser treatment during infancy should be considered. Most birthmarks on the nape of the neck also clear, but 25 percent can persist into adult life.

8. Strawberry hemangiomas: Red birthmarks that are raised or increasing in size (strawberry hemangiomas). These usually start after 3 weeks of age. They become larger for 1 year, then fade away over 6 to 8 years without any treatment. They run a small risk of bleeding with trauma. Any bleeding should stop with 10 minutes of direct pressure. Discuss any skin conditions not covered here with your child's doctor on your next regular visit or (sooner if you have concerns.

Parent Care for Pediatric Symptoms. Copyright © 2005. Barton D. Schmitt, MD, FAAP