When babies are born, their skin is not fully mature, and it needs extra care. Experts do not generally recommend soap for babies, especially those with dry skin or eczema (atopic dermatitis).
This article looks at the reasons why parents and caregivers may wish to avoid using soap to wash a baby. It also suggests some alternatives.
Babies’ skin has three main functions, which are to prevent:
- the loss of water from the body
- irritants and allergens getting in
For the skin to be able to perform these functions, it needs to be at the right pH. It also needs to be intact so that it forms a barrier.
Babies’ skin is particularly prone to dryness, which can disrupt the barrier function and lead to various issues, such as infection and eczema. It is, therefore, important that any products that people use on a baby’s skin help preserve its pH and integrity. If the pH rises, the skin barrier can become weakened.
Babies’ skin has an acidic pH. At birth, the skin’s pH is 6.4, and it falls to about 4.9 over the next few days.
Soaps and soap-based cleansers are naturally alkaline, with a pH of about 10. As a result, they can disrupt the pH of the skin’s outer layer. They can also remove lipids from the skin’s surface, along with natural moisturizing factor (NMF), which can cause irritation and other problems.
Due to this, experts usually advise people against using soaps when bathing babies. Instead, synthetic cleansers may be more suitable. These are normally neutral or acidic, and manufacturers can formulate them to be especially mild. They may contain emollients and other ingredients that help protect the skin of babies.
In 2016, a European panel of skin care experts recommended cleaning babies’ skin with either plain water or liquid cleansers that:
- do not contain any known irritants
- are neutral or mildly acidic (pH 5.5–7)
- have minimal effect on the surface of the skin
The National Health Service (NHS) in the United Kingdom recommend using plain water alone for the first month.
In a 2019 trial in China, researchers compared three different ways of caring for the skin of babies who were in good health and aged up to 6 months at the start of the study:
- mild liquid baby wash (cleanser) and then moisturizing baby lotion
- water and then baby lotion
- water only
The parents or caregivers bathed the babies nearly every day for 12 weeks, and the researchers examined their skin at 6 and 12 weeks. The team concluded that the first method, with the baby wash and lotion, had advantages over the other two in terms of retaining the moisture content, pH, and barrier function of the skin, among other measures.
Emollients are a kind of moisturizer and a mainstay of treatment and care for people with dry skin or eczema. Research has shown that emollients can protect babies’ skin by restoring water and lipids to it and forming a protective layer.
Instead of soaps or other products, parents and caregivers can use unscented emollients on the skin of babies with eczema. It is best to smooth or dab the emollient onto the skin rather than rubbing it in.
These products are suitable both for cleansing, instead of a soap product, and for moisturizing after washing or bathing. For babies with eczema, it is important to use emollients every day, even when there is no flare-up.
In the U.K., guidance from the National Institute for Health and Care Excellence says that people should use emollients or emollient washing products for children with atopic eczema. However, as a recent review identified a lack of evidence around emollient bath products, this aspect of the advice may change.
The guidelines and advice about how to bathe babies with eczema vary, but the general recommendations include:
- lukewarm baths of 5–10 minutes
- only using cleanser where necessary
- using a mild, unscented cleanser
- avoiding scrubbing the baby’s skin
- patting the skin dry gently
- applying moisturizer immediately after bathing
Bathing and then moisturizing can be an effective way of replacing moisture in the skin and keeping it there.
People can apply moisturizer once or twice a day to babies with dry skin and eczema. It is a good idea to pat babies dry with a towel, rather than rubbing them.
For babies with eczema, there are other treatments and ways to prevent flare-ups. These include:
- Avoiding triggers: These can include sweat, saliva, tobacco smoke, dry air, laundry detergents, and baby products.
- Using emollients: Even when the eczema has cleared, people should continue using emollients.
- Applying corticosteroids: Doctors may sometimes prescribe corticosteroids that people can apply to the skin.
- Trying other treatments: If the eczema is more severe, and other methods are not effective enough, doctors may recommend alternative options, such as phototherapy, other medicines, or bandages.
Parents or caregivers who suspect that their child may have eczema should see a doctor, who will be able to confirm the diagnosis and advise about treatment.
It is also a good idea to seek medical advice if:
- the emollients seem to irritate the baby’s skin
- the eczema is severe, and other treatment options — such as topical corticosteroids — may be necessary
- for further advice during flare-ups
- if there are signs of infection
Signs of infection may include:
- the eczema getting worse
- sore, swollen skin
- the baby seeming unwell, hot, or shivery
- fluid oozing from the skin
- the skin having a yellow crust or small yellowish-white spots in the areas that eczema affects
Usually, experts will not recommend soap for babies’ skin, particularly if they have eczema or dry skin. Instead, it is better to use emollients for washing and moisturizing.
Moisturizing a baby’s skin after washing them with plain water or a mild baby wash is an effective way of restoring moisture to the skin and trapping it there.
Anyone who suspects that their baby may have eczema or notices diagnosed eczema worsening should seek medical advice.