Author: Gauri Kshirsagar

Keeping babies clean and good skin hygiene are essential to “overall health”. Cleansing helps keep skin free of unwanted substances, dirt, and transient germs. Keeping hands clean, particularly in the case of babies with their hand-to-mouth behaviors, can help reduce or prevent oral transmission of microbial contaminant.

In this article, I have summarized important factors in bathing, oil massage and post bath care of the baby. Before going through the following article, also do read the various myths followed in India in my post “Myths & Facts of Baby care in India”

In case of twins, synchronizing their bathing time is very important. Either you can try to bath them together (which is difficult in the early months) or bath them one after the other without too much time gap in between. By doing so you can atleast be sure of atleast one common nap time after bath. Later it becomes quite easy to bath them together.

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OIL MASSAGE 

Traditional Oil massage in India and its Disadvantages

In India, oiling (massage) or bathing is often performed by the ‘maalishwali‘ ( local baby masseuse). Usually the process starts off with a rather forceful body massage and scrub, followed by a warm-to-sometimes-hot bath. It is concluded by ‘smoking’ the towel-dried infant with incensed fumes. Several babies respond to the ritual either with steadily escalating cries, or a stupor-like sleep from being too tired to rebel. Being a first time mother I too was coaxed into giving my twins this rigorous schedule everyday until I discontinued it and begun bathing & oiling them myself, minus the vigorous massaging and smoking. Even if you decide to hire the masseuse, do keep in mind to bring out some changes in the traditional method to a more healthy and scientific one. Most common side effects of this traditional oil massage are:

1. Too much rigorous rubbing has led to “green stick fractures” in the baby. A green stick fracture is a fracture in a young, soft bone in which the bone bends and breaks. Despite the name “fracture”, during the majority of cases the bone is broken and hard to find in x-rays.
2. Rough hands of the masseuse may lead to abrasions, scratches or injury over the delicate skin of the baby. Always check the surface of the palms of the masseuse.
3. After oiling the baby becomes too slippery to handle, so care should be given in handling of the baby and avoid accidents

Does Oil massage has any scientific advantage?

YES, It does have a lot of advantages:

1. The act of touch fulfils the basic need to feel safe, comfortable and loved. Touch is also an intrinsic factor in child development. Touch is proposed to play a role in growth, development and overall well-being. Massage is one of the most beautiful and gentle methods of touch. It is practiced in most countries and has recently been researched extensively in western countries.
2. Oil Massage make the skin of the baby supple and prevents dryness.
3. Oil massage keeps the baby warm in colder climates
4. Aids mother-child bonding in general.
5. Massaging doesn’t straighten bones but it does build muscle tone, and should be done gently.

Which oil to be used and how to massage a baby?

1. It is important to note that the oil used in such a situation ought to be smooth, of optimum viscosity and friction free or else it would lead to abrasions on the skin surface. The oil should be nonocclusive so that it does not block the skin pores and allows the skin to breathe. It ought to be safe and mild to suit the baby’s delicate skin and the ingredients should be thoroughly tested for their potential to cause contact sensitivity(done by applying a bit over the skin and checking for any redness, if there is immediately discontinue).Coconut oil is one of the oldest and safest form of moisturizers we know and is very beneficial.
2. Oil massage should be preferably done by the mother. Massage given by the mother increases the bond between the mother and her baby. It helps in the physiological and psychological development of the babies.
3. Babies should be massaged from the tenth day of life and the ritual can easily be continued. Appropriate knowledge of correct massage techniques is imperative in order to attain maximum therapeutic benefits from it. Complete head to toe massage should be a daily routine.
4. Massage should be gentle and judicious and done 1-2 hours before bathing.
5. A traditional baby massage starts at the feet and works its way up the body with the head and even face the last to be massaged. The legs and arms are usually rubbed with firm downward strokes, hip to ankle and shoulder to palms. Circular clockwise movements are used for the stomach and chest and anticlockwise movements for the back.
6. Use respectful touch and stop the massage if your baby isn’t enjoying herself/himselg or seems uncomfortable. It’s also best to avoid a massage if you’re very tense, or if your baby is upset.
7. Be careful in applying oil over the scalp. It may lead to seborrhiec dermatitis (dandruff). Avoid application over the scalp if there is any scaling.
8. Too much oiling should be avoided in summers, since it may occlude the skin pores and lead to miliaria formation.
9. Other aspects such as gram flour scrubs and smoke therapy have no medical basis and should be avoided.

Here is a guide on how to massage a baby, which I got off the internet, showing various steps of baby massage. Click on the following link: Baby Massage step by step guide

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BATHING

Traditional Bathing method in India

Most newborn babies get a bath every morning right from birth. The traditional way is for the mum, grandmother or dai to sit on the bath floor or on a very short stool with their legs outstretched in front and crossed at the ankles. The baby either lies along the legs with his head towards the feet and head towards the body or is placed across the legs facing downwards. Usually, the baby is placed facing downwards when the mother wants to wash his hair.The mum will not sit in this manner as long as she has lochia or her stitches are healing. So often, it is the grandmother or a dai who bathes the newborn.

Traditional Method or the Bathtub? which one to opt for?

Both have its advantages & disadvantages. I personally always  preferred the traditional method because, it was easier to handle (by the dai), could bath the baby in flowing water as opposed to collection of water in a tub, prevents excess soaking of the skin, I could adjust the technique of bath as the baby grew up (for e.g. the baby adjusted well from a sleeping to sitting than to standing position very well). The disadvantage of the traditional method was that the dai was always needed (atleast in the initial 3- 4 months), had to always instruct the dai on the proper method of bathing and I had to be always present while bathing the babies, whereas in case of using a bath tub, you can manage alone and not be dependent on the dai. There are many varieties of baby bath gear available online, but before trying them out, always check their safety features.

Correct method of bathing a baby

1. Whoever bathes your baby, make sure he/she is placed comfortably and is held firmly. He/she will probably already be slippery from his/her oil massage and will become even more so when he gets wet and soapy. To reduce the chances of your baby slipping, a towel or cotton cloth can be placed on the legs for your baby to lie on.
2. Always be present for the baby bath ‘in person’.
3. The bath of the newborn should not last more than 5 minutes, prolonged bath increases the hydration of the skin and reduces the threshold for friction
4. For the initial baths (1- 2 months), sterile or potable clean water is sufficient. (you can collect only the hot water in a bucket about 2-3 hours prior to the bath and allow it to cool, then add hot water to get the right temperature)
5. Soaps and cleansers are best avoided in the first few weeks of life and later very less amount should be used. Too much soap leads to dryness of the skin. Always prefer a liquid soap over a bar of soap (I recommend “Cetaphil body wash” or “Jhonson’s Tip to Toe wash”)
6. The neonate should be bathed in a warm room, and should be dried quickly and thoroughly from head to toe, followed by wrapping in a warm dry towel and placing next to the mother.
7. Try to minimize the uncomfort and subsequent amount of crying by the baby, for example minimize the pull over the skin, handling too tightly, avoid hot water, too much rubbing. If baby enjoys the bath, its a smooth ride thereon.
8. Most baby shampoos in the market contain anionic surfactant which ensure adequate cleansing. The pH should be close to that of tears and, thereby, won’t cause irritation to the eyes. (I recommend “Johnson’s baby No tear Shampoo”)

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POST BATH SKIN CARE

1. The care of the baby skin after bath is very important to prevent dryness, specially in case of atopic dermatitis and in the winter season
2. Always dry the baby with a soft towel thoroughly and avoid water collection in body folds like the neck, arm pits, diaper area.
3. Apply a moisturizer “cream” (I recommend Cetaphil RESTORADERM moisturizer) after drying the baby with a soft towel. Apply evenly over the face, abdomen, back and limbs. Use thinner layer of moisturizer in the summers or use a baby lotion (For example Johnson’s Baby Lotion, which is a shorter acting moisturizer). In winters moisturizers have to be applied twice a day.
4. Talcum powder is useful to absorb moisture during hot and humid weather. They can prevent maceration over the skin folds in infants. However, too much of their use can lead to blockade of sweat-duct pores resulting in miliaria formation. Applying talcum powder all over the body is not necessary, powder only the diaper area, to avoid moisture collection.
5. Do not wrap the baby tightly after bath.
6. In case of Identical twins apply a “kajal” mark over the forehead to avoid confusion.
7. Do not apply “kajal” or “surma” in the eyes.
8. Avoid using accessories like bangles, necklaces, threads, etc.

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