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An exploration of skin care routines for babies of different social and ethnic backgrounds

O'Brien, Ediri

[Thesis]. Manchester, UK: The University of Manchester; 2014.

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Abstract

There is a dearth of empirical evidence on infant skin care but literature suggests that product use is common place. UK guidelines for postnatal care advise parents to avoid all skin care products, despite there being little reliable evidence to inform practice. Emerging evidence has compared water-only and product routines providing valuable data but there remains a paucity of data on how ethnicity and other factors impact on infant skin and the motivating factors behind parental choices of infant skin care. The overall aim of the study was to identify differences in infant skin and skin care due to ethnicity and other demographic factors. The objectives were to examine the changes in the biophysical measurements of infant skin at birth and 4 weeks and determine whether these were related to ethnicity or other factors, and to explore parental reports of skin care routines and product use and their views on infant skin. This mixed methods secondary analysis study was set within a pragmatic paradigm and utilises a concurrent triangulation design. A rich source of quantitative and qualitative data was previously collected in two large randomised controlled trials to assess the effectiveness of different methods of bathing newborns and cleansing the nappy area. Quantitative biophysical measures of infant skin and product use were analysed statistically in SPSS. Qualitative diary data of skin care practices, product use and maternal observations of infant skin were analysed using content analysis.Infant skin changed significantly in the first 4 weeks of life as hydration and melanin increased and pH and erythema decreased. Parents were unfamiliar with the process of natural skin maturation but were aware of all minor changes and were often anxious about the condition of skin, which prompted product use. Oils (33.9%, n=188) and cream/lotions (13.8%, n=88) were the most frequently reported products used (excluding trial allocated bath wash and wipes). The skin integrity and skin care practices of infants from Black & Minority Ethnic (BME) groups differed significantly from White British infants. BME infants had less hydrated skin at birth but the most hydrated by 4 weeks and had increased levels of erythema. BME groups used more skin care products than other ethnic backgrounds, particularly oils (used on 62.4% of BME infants, n=83). This study contributes to the evidence base of infant skin care by increasing understanding of how ethnicity and other factors influence newborn skin, product use and skin care practices. Acknowledgement of such data into midwifery education and the development of infant skin care guidelines will facilitate health professionals in providing advice that is culturally sensitive and relevant to the real-world context of infant care.