Toddlers (18 Months – 4 Years)
Caring for skin from 18 months – 4 years
The skin of toddlers is more resilient than newborn skin, but still a long way from structural and functional maturity. While generally more fragile than adult skin, toddlers’ skin is also able to rapidly grow and heal, but requires a different level of care.
Toddler skin structure
New skin cells are formed at the bottom of the epidermis (the top layer of skin) and travel up to the surface where they are shedded, or ‘sloughed off’; continually renewing the skin. In toddlers and babies this process happens quickly, providing a high turnover rate of skin cells. As a result, the skin cells of little children are smaller and more tightly packed than in adults. Up close, the surface of their skin is also very different to adults, with a tighter network of fine lines and ridges (called microrelief lines).
The epidermis is significantly thinner in small children, with the top layer, the stratum corneum, being only about two thirds the thickness of that in adults. We can liken the skin to a brick wall, with the individual cells overlapping to form a barrier. In toddlers, this wall is not as thick and the bricks which make it up are smaller, allowing for substances to pass through more easily.
The barrier function of the skin is still emerging at this age, meaning that the skin of toddlers is not as effective at holding water or keeping out harmful substances, as adult skin is. Thus, the skin of toddlers is more vulnerable than adult skin and appears smooth and fine. Collagen is one of the fibres which make up the contents of skin cells, providing them with structure and flexibility. It has been found that the network of collagen fibres in small children is not as dense as in adults.
Babies and children are more sensitive to a range of environmental conditions as they have a larger skin surface area to weight ratio. This means that chemicals absorbed through the skin tend to have a greater effect. It also means that their heat regulation differs, with infants losing heat through their skin more rapidly in cold temperatures, compared to adults.
Toddler skin care
Soaps and bathing
The American Academy of Dermatology (AAD) recommends the use of mild, fragrance-free cleansers and soaps on toddlers and young children. The AAD also suggest application of a topical moisturiser after bathing to prevent dry skin and rashes. These can be used up to three times daily on toddlers with particularly dry or sensitive skin to help rehydrate it.
Children with eczema or other dry skin conditions may be better off with a moisturiser in place of a traditional soap or cleanser. When bathing, it is crucial to keep safety in mind; water must be of a moderate temperature and NEVER leave toddlers unsupervised in the bath.
Dermatologists encourage parents to regularly assess their child’s skin for signs of allergy, infection or injury. These may include dryness, redness, itchiness, swelling and changes in colour or texture; concerns should be addressed by a medical professional.
Instituting sun protection measures is vital during childhood, as children are particularly susceptible to skin damage from solar UV radiation. Good methods of sun protection include: shielding exposed skin with the regular application of a high SPF, broad-spectrum sunscreen; covering the skin with lightweight, sun-protective clothing; wearing broad-rimmed hats and seeking the shade (for more information, refer to the article Sun safety).
Photosensitivities (“sun allergies”)
It is as a child begins to spend more time outdoors that they may first experience a photosensitive reaction (commonly referred to as a ‘sun allergy’). Photosensitivity causes skin to react, or be ultra-sensitive to, light. Children with sun allergies may be sensitive to a specific type of light or to several different wavelengths; this could be visible light or ultraviolet (UV) light, both are emitted by the sun.
If you notice a reaction on your child’s skin that you or your doctor cannot explain, it may be the result of sensitivity to a stimulant such as light. See our article on Photosensitivity and ‘sun allergies’ in children for more information.
Young children have poor temperature regulation compared to adults and need to be closely monitored in extreme temperatures. In hot weather it may help to dress them in cooler fabrics such as cotton and avoid heavy bed coverings. Woolen clothing worn in the cooler months should be placed over the top of a less irritating fabric such as cotton, particularly for children with itchy or sensitive skin.
American Academy of Dermatology, For Kids, Accessed 03 November 2016, https://www.aad.org/public/kids>.
‘NSW Government 2017, ‘Hand, Foot and Mouth disease’ Last accessed 21 March 2018 http://www.health.nsw.gov.au/Infectious/factsheets/Pages/handfootmouth.aspx>.
Hijazy, M 2000, Principles of Pediatric Dermatology, retrieved 26 July 2010, http://www.dermatologyinfo.net/english/ebook.htm>.
Stamatas, GN, et al. 2011, ‘Infant skin physiology and development during the first years of life: a review of recent findings based on in vivo studies’, International Journal of Cosmetic Science, 33(1):17-2