What is the recommended treatment for an infant with prickly heat (miliaria)?

Treatment for Prickly Heat (Miliaria) in Infants

For infants with prickly heat (miliaria), the recommended treatment is to keep the baby cool, dress them in lightweight, loose-fitting clothing, and avoid overheating by ensuring they wear no more than one layer more than an adult would wear in the same environment.

Understanding Prickly Heat in Infants

Prickly heat, or miliaria, is a common skin condition in infants characterized by small, raised bumps that typically appear in areas where sweat accumulates, such as:

• Neck folds
• Armpits
• Diaper area
• Chest and back

This condition occurs when sweat ducts become blocked, trapping perspiration beneath the skin and causing inflammation.

First-Line Treatment Approach

Cooling Measures

• Maintain appropriate environmental temperature: Keep room temperature comfortable, not too warm
• Dress appropriately: Infants should be dressed with no more than one layer more than an adult would wear to be comfortable in the same environment 1
• Avoid overbundling: Excessive layers and covering of the face and head should be avoided 1
• Monitor for overheating: Check for signs such as sweating or the infant's chest feeling hot to the touch 1

Clothing Recommendations

• Use lightweight, loose-fitting, natural fiber clothing
• Dress clothing inside out when possible to reduce irritation from seams 1
• Select natural fibers that allow better air circulation 1

Bathing and Skin Care

• Give cool baths without soap or with mild, non-irritating soap
• Allow the skin to air dry completely
• Avoid using oils, lotions, or ointments on affected areas as these can further block pores

Prevention Strategies

1. Environmental Control:

   • Maintain a cool environment
   • Use air conditioning or fans in hot weather (though there is insufficient evidence to recommend fans specifically for SIDS risk reduction) 1

2. Appropriate Clothing:

   • Use infant sleep clothing designed to keep the infant warm without the hazard of head covering or entrapment 1
   • Avoid excessive layers

3. Regular Skin Monitoring:

   • Check skin folds regularly for signs of irritation
   • Keep skin folds clean and dry

When to Seek Medical Attention

Consult a healthcare provider if:

• The rash worsens or doesn't improve within a few days
• The infant develops a fever
• The rash appears infected (increasing redness, warmth, swelling, or pus)
• The infant seems uncomfortable or has trouble sleeping due to the rash

Common Pitfalls to Avoid

1. Overheating the infant: This is a significant risk factor that can worsen miliaria and potentially increase other risks 1

2. Using petroleum-based products: These can further occlude sweat ducts and worsen the condition

3. Overdressing: Parents often overdress infants, particularly during sleep, which can exacerbate heat rash 2

4. Ignoring environmental factors: Room temperature plays a crucial role in preventing and treating miliaria

Remember that while prickly heat is uncomfortable, it is generally harmless and typically resolves quickly with proper cooling measures and by avoiding overheating. The key principle in treatment is to keep the affected areas cool and dry to allow the blocked sweat ducts to clear.