Cradle cap

Cradle cap is the common name for infantile seborrhoeic dermatitis on the scalp. It causes thick, greasy or flaky patches that may look white, yellow or brown. The skin underneath can be mildly red.

Cradle cap is harmless in most babies. It is not contagious, and it is not caused by poor hygiene. It also does not mean that your baby has an allergy.

The condition often begins during the first weeks or months of life. It usually improves over time, although the scales may return for a while after they have been removed.

Similar patches can sometimes appear around the eyebrows, behind the ears, beside the nose, in the neck folds or in the diaper area. When more than the scalp is involved, it may be described more broadly as infantile seborrhoeic dermatitis.

Cradle cap usually develops gradually. The appearance can differ depending on skin tone, the amount of scale and whether other areas are affected.

Common features include:

• Thick, greasy or waxy scales on the scalp
• White, yellow or brown crusts
• Dry-looking flakes similar to dandruff
• Mild redness or skin discoloration underneath
• Scales that stick to the hair
• Little or no itching

The patches may cover one small area or much of the scalp. Cradle cap itself does not usually cause pain or make a baby feel ill.

Some hair may come away with loosened scales, especially if the crusts have been picked or rubbed firmly. This hair usually grows back once the scalp settles.

A very itchy, dry or weeping rash may be another condition, such as eczema. A circular scaly patch with broken hairs or obvious hair loss could have another cause, including a fungal infection. These appearances should be assessed rather than treated as cradle cap without advice.

The exact cause of cradle cap is not known.

Oil-producing glands in a baby's skin are particularly active during early infancy. Hormones passed from the parent before birth may help stimulate these glands for a time. Extra skin oil can cause dead skin cells to stick together instead of shedding normally.

A yeast called Malassezia may also play a part. This yeast normally lives on human skin and uses skin oils. Its presence does not mean that your baby caught an infection from another person.

Cradle cap is not caused by:

• Washing the scalp too little or too often
• Poor parenting or poor hygiene
• A food allergy
• An allergic reaction to breast milk or formula
• Contact with another child who has cradle cap

The condition is more closely related to normal changes in infant skin than to anything you have done.

Cradle cap is usually diagnosed by looking at the scalp and, when needed, the rest of the skin. Its location, greasy scales and lack of significant discomfort are often enough to identify it.

Tests are not normally needed. A clinician may consider another diagnosis if the rash is unusually sore, very itchy, spreading quickly, causing marked hair loss or not improving as expected.

Rarely, a small skin scraping may be examined if a fungal infection is suspected. Other tests are guided by the baby's symptoms rather than being routine for cradle cap.

Conditions that can sometimes look similar include eczema, psoriasis, contact irritation and scalp ringworm. A clinician can check for these if the appearance is unclear.

Mild cradle cap does not always need treatment. If it is not bothering your baby, it is reasonable to leave it alone and allow it to clear with time.

If you want to loosen visible scales, gentle scalp care is usually the first step. Wash the scalp with a mild, fragrance-free baby shampoo and rinse it well. While the scales are soft, gently massage the scalp with your fingertips or use a soft baby brush. Do not scrub.

A small amount of plain petroleum jelly, mineral oil or another infant-safe emollient may help soften thick crusts before washing. An emollient is a product that softens and moisturises skin. Leaving oily products on for long periods may allow scales to build up, so wash the product out as directed.

Avoid picking or peeling firmly attached scales. This can damage the skin, cause bleeding and increase the chance of infection. Do not use essential oils, undiluted plant oils or adult dandruff products on a baby unless a healthcare professional has said they are suitable. Some products can irritate infant skin or affect the eyes.

If gentle care does not help, a clinician may recommend a medicated treatment. Depending on the appearance and areas involved, this may include:

• An antifungal cream or shampoo to reduce yeast
• A short course of a mild anti-inflammatory cream
• A suitable emollient for affected skin folds

These products need to be chosen carefully for a baby's age and the area being treated. Treatments intended for adults may be too strong. Keep all shampoos and creams away from the eyes and mouth.

Cradle cap can return after treatment. This does not necessarily mean that treatment failed. The skin's oil production may remain active until the condition naturally settles.

Complications are uncommon.

Scratching, forceful brushing or picking can break the skin. Broken skin can then become infected with bacteria. Possible signs include increasing redness, warmth, swelling, tenderness, pus or a bad smell.

Temporary hair loss can occur when scales are pulled away with attached hairs. Hair usually grows back, but marked or patchy hair loss should be checked because it may have another cause.

A widespread rash can become uncomfortable, especially in warm, moist skin folds. This may need treatment even if the scalp patches are mild.

Cradle cap does not normally scar or interfere with a baby's growth and development.

Cradle cap cannot always be prevented. It is linked to normal infant skin oils and other factors that you cannot control.

Gentle scalp care may reduce the buildup of scales. Washing with a mild baby shampoo and brushing lightly with a soft brush can help keep flakes from becoming thick. More frequent or forceful washing does not prevent the condition and may irritate the scalp.

There is no need to change your baby's feeding because of uncomplicated cradle cap. Dietary restriction has no established role unless a separate allergy or medical condition has been diagnosed.

Cradle cap usually changes slowly rather than disappearing overnight. Scales may soften and lift after washing, then build up again over the next several days. This cycle can continue for weeks or months.

Most cases improve during infancy and clear by around the first birthday. Some clear much sooner, while a smaller number last longer. Persistent scaling after infancy may represent ongoing seborrhoeic dermatitis or another skin condition.

Your baby can usually bathe, sleep, feed and play as normal. Cradle cap is not spread by sharing towels, bedding or contact with other children. You do not need to keep your baby away from childcare or family members.

Visible scales can be concerning, but treatment does not need to remove every flake. The main goals are to keep the scalp comfortable, avoid skin damage and watch for signs that the diagnosis may be different.

Routine follow-up is appropriate if the rash continues despite gentle care, returns often or spreads beyond the scalp. A clinician can review whether medicated treatment is needed.

Arrange a routine appointment if:

• You are unsure whether the rash is cradle cap
• The scales do not improve after several weeks of gentle care
• The rash is very itchy, sore, weeping or bleeding
• It spreads widely across the face, body or skin folds
• There is marked or patchy hair loss
• The condition continues beyond the usual infant period
• A recommended treatment causes irritation

Seek urgent medical advice if the skin becomes rapidly more red, swollen, warm or painful, or if there is pus or a bad smell. Your baby should also be assessed promptly if they develop a fever, feed poorly or seem generally unwell alongside worsening skin changes. These signs may point to an infection rather than uncomplicated cradle cap.

Call emergency services if your baby is difficult to wake, has trouble breathing or appears severely unwell. These are not expected features of cradle cap and need immediate assessment.

Is cradle cap contagious?

No. It cannot be passed to another baby or adult through touching, towels, bedding or brushes. The yeast that may contribute normally lives on the skin.

Does cradle cap hurt or itch?

It usually causes little discomfort. Mild irritation is possible, but significant itching, pain or disturbed sleep suggests that another condition, such as eczema, may also be present.

Should I pick the scales off?

No. Firmly picking or scraping can cause bleeding, infection and temporary hair loss. Soften the scales and remove only those that lift easily with gentle washing or brushing.

Can cradle cap make my baby's hair fall out?

A few hairs may come away when loose scales are removed. This is usually temporary. Ask for medical advice if hair loss is marked, forms clear patches or continues after the scales improve.

Can I use oil on cradle cap?

A small amount of an infant-safe emollient, plain petroleum jelly or mineral oil may soften thick scales before washing. Avoid essential oils and food-based oils unless a healthcare professional recommends them. Wash oily products out rather than leaving them on indefinitely.

Is cradle cap caused by an allergy?

Cradle cap alone is not usually an allergy and does not require changes to breast milk, formula or solid foods. Seek advice if your baby has other symptoms that could suggest an allergy, such as hives, repeated vomiting, breathing problems or swelling.