Cradle Cap: What Causes It and How to Loosen the Flakes Gently

Cradle cap is the oily, yellow scaling or crusting you sometimes see on a baby's scalp. HealthLink BC says it's a normal build-up of skin oils, scales and cells. It isn't harmful, it isn't an illness, and it isn't a sign that you're not washing your baby enough. It usually clears up by the first birthday, and the Canadian Paediatric Society (CPS) says it doesn't need treatment. If the flakes bother you, softening them with oil and brushing them out gently is all most babies need. Prices are in CAD.

What cradle cap looks like

• Patches of greasy, yellowish scale or crust on the scalp, sometimes thick, sometimes just flaky.
• Sometimes redness that spreads beyond the scalp. CPS says it can show up in the neck folds, armpits, behind the ears, on the face and in the diaper area.

Eczema can look similar, but CPS describes it as dry, rough or scaly skin that's often itchy, and often on the cheeks and forehead as well as the scalp. If you can't tell which one your baby has, ask your doctor or public health nurse.

How to loosen the scales, step by step

This is HealthLink BC's method. You can do it at bath time.

1. Oil first. About an hour before you shampoo, rub a little baby oil, mineral oil or petroleum jelly into the patches. This softens the scale.
2. Wet the scalp. At bath time, wet your baby's head with warm water.
3. Brush gently. Scrub the scalp for a few minutes with a soft-bristle brush. A soft baby hairbrush or a soft toothbrush works.
4. Comb. A fine-tooth comb can lift the loosened scales out of the hair.
5. Shampoo and rinse. Wash with a mild baby shampoo, rinse well and towel dry, so the oil doesn't sit on the scalp.

Go gently. The aim is to lift scales that are ready to come off, not to scrape the skin clear in one go. CPS also notes that shampooing too often can dry out the scalp, so you don't need to do this every day.

Products for the routine

• A mild shampoo. Attitude Baby Shampoo and Body Wash ($12.95) comes in a fragrance-free version and works as a shampoo and body wash in one.
• A cradle cap cream. Mustela Cradle Cap Treatment ($17.95) goes on the scalp and is rinsed off. Mustela says it helps clear cradle cap and keep it from coming back. It's optional: the oil-and-brush method above doesn't need it.

Whatever you use, keep it out of your baby's eyes and rinse well. Our baby care toolkit guide covers the rest of the grooming kit for noses, nails and bath time.

When the rash spreads past the scalp

When cradle cap spreads onto the face, behind the ears or into skin folds, it's often called seborrheic dermatitis. CPS says an unscented moisturizer, 2 to 3 times a day, helps, and that a mild 0.5% hydrocortisone cream is safe and usually effective for this rash. Ask your doctor or pharmacist before you use a medicated cream on your baby, and see your doctor if the rash isn't improving.

When to see your doctor

See your doctor or public health nurse if:

• the rash spreads, or isn't getting better with the steps above;
• the skin looks raw, cracked, weepy or crusted in a way that's different from the usual greasy scale;
• your baby seems itchy or uncomfortable, or you're not sure it's cradle cap.

In BC you can call 8-1-1 any time. In Ontario, call Health811 at 811 for free advice from a registered nurse, 24 hours a day.

Prices were current when we wrote this. Baby shampoos and skin care are also at our Richmond, Burnaby and Ottawa stores. If you're looking for a particular product, call the store ahead of your visit to check.