Cradle cap: Gentle care and warning signs

What cradle cap looks like

Cradle cap is greasy scalp scaling from infant seborrheic dermatitis, often beginning in the first weeks of life.

Uncomplicated cradle cap usually causes neither pain nor itching.

What causes cradle cap?

Typical cradle cap is not contagious and does not mean a baby has been poorly washed.

Its precise cause remains uncertain; skin oils and normally present yeast may play a part.

Leave attached scales alone

Mild cradle cap can be left to settle without removing every scale.

Do not pick cradle cap.

Picking or scratching the crusts can increase the risk of infection. If the material does not move with a gentle wash or light brush, leave it attached.

Prepare for a gentle wash

Use fragrance-free baby shampoo.

Use warm, not hot, water; support the head and shoulders and never leave a baby alone while washing. If you need an item that is out of reach, stop the task and take the baby with you.

For a newborn whose cord stump has not fallen off and healed, AAD guidance favors sponge bathing before tub baths.

Wash and brush gently

Gently brush only loose flakes.

Rinse shampoo out thoroughly and gently towel-dry the scalp.

Clean the soft brush with soap and water to remove oil and flakes.

Washing frequency and recurrence

The AAP suggests washing every other day for many babies, but eczema or another skin condition calls for an individual washing plan.

Cradle cap often clears during the first year, but the timing varies and some cases last longer.

Choosing oils and softeners

An infant-appropriate emollient or non-food-based oil may soften attached scales; ask a clinician or pharmacist which product and timing fit your baby.

The NHS advises against olive oil and peanut oil for cradle cap.

RCH’s Australian handout mentions olive oil, whereas the NHS advises against it. RCH marks that handout as awaiting review; ask your clinician or pharmacist which product to use.

Medicines need a specific plan

Do not use adult shampoo or start medicated anti-dandruff shampoo on an infant without the baby’s clinician advising it.

A clinician may recommend an antifungal or mild steroid for selected cases; the product, body site and duration need a specific plan. Do not borrow a sibling’s tube or copy an adult dandruff routine.

If a product makes the rash worse, stop using it and seek medical advice. Do not add another new product simply to undo the first one before getting advice.

When to arrange a review

Contact your baby's clinician for bleeding, fluid, or swelling. If the baby also has fever or looks unwell, use the urgent section below. A routine follow-up appointment is not a reason to postpone an urgent assessment.

Pain, troublesome itching, an unusual smell, hair loss or a severe rash extending beyond the scalp needs clinical assessment.

Arrange a review if care has not helped after a few weeks; Australian guidance also advises review when scales persist beyond 3 months of age.

A clinician usually assesses cradle cap by examining the scalp and considering other skin conditions.

When to seek urgent help

A baby under 3 months with a temperature of 38°C or higher needs urgent medical assessment.

NHS guidance uses a digital thermometer in the armpit and advises urgent contact for suspected fever in babies under 3 months, even before a reliable reading is available. In the UK, NHS under-5 guidance directs families to 999 or A&E for a baby under 3 months with a temperature of 38°C or higher. Outside the UK, use the local urgent or emergency service; 999 is a UK number.

Difficulty breathing, being hard to wake or blue or grey lips calls for emergency help; in the UK call 999, and elsewhere use the local emergency number. Do not use this article, a care log or an online photograph comparison as a step that must be completed before seeking help.

For a baby under 1 month, a cluster of tiny blisters or pimples needs medical care now.