Cradle Cap In Older Children

Dear Amalah,

I think this question should hit your sweet spot of baby/kid issue meets hair and skincare, so here goes. My son is 7, and about a year ago I noticed his scalp was super flaky and kind of scaly-looking. I figured we needed to change his shampoo (we were still using the easy baby combo shampoo and body wash) and got him some Head & Shoulders. When that didn’t help, I guessed it was maybe that we weren’t washing his hair enough (we live in a cold but dry climate so baths every day have never been nice to his skin). When THAT didn’t help, I changed his shampoo again to some hippie natural scalp care stuff I found at Whole Foods. 

Finally, when THAT didn’t help, I took him to our pediatrician. Who diagnosed him with…cradle cap. At 7 years old! I had no idea that older kids could even get cradle cap, and since he never had it as a baby I had NO idea what it even looked like. Or what to do about it! Which I’m still not sure about.

Our pediatrician just said to put olive or coconut oil on his head and use a fine-tooth comb to remove the flakes, but we’ve tried that and 1) he said that it hurt so much (both his scalp and the comb getting snagged in his hair) that he cried, 2) he’s still got a ton of gross yellowish brown spots all over his head, and 3) his hair looked horrrrrrible for days because it was so slicked up with oil but I was worried I irritated his scalp enough that I didn’t want to be super aggressive with shampooing. 

What do I dooo? Is there a better product or process than what our pediatrician recommended? Should he see a dermatologist? I feel so silly to not know how to deal with something from the baby/newborn days that’s randomly cropped up years later. He insists it’s not itchy, plus he’s got nice thick curly hair so it’s not visible to most people, but I still see it and want to fix it. Help!

Out of My Newborn Element

ME TOO MINE TOO!

None of my babies ever got cradle cap, so JUST LIKE YOU, I was completely flummoxed when my youngest son’s scalp suddenly developed a gross coating of brown-ish crusty skin in kindergarten. Was it an allergy? Something in our water? A fungal infection? Bad hygiene?

Nope. Cradle cap, aka infantile seborrheic dermatitis.

Cradle Cap vs “Dandruff”

In older kids and adults, seborrheic dermatitis often gets lumped under the “dandruff” category, but I think that’s a touch misleading. Most of us hear “dandruff” and think of a dry, itchy scalp and those annoying white flakes on a black sweater. But this flavor of cradle cap doesn’t actually itch at all, and the “flakes” are more like a yellowish/brown crust of stubborn scales on the skin that don’t shed on their own.

You’ll find the Internet is (AS PER THE USH) is a font of conflicting and contradictory advice on 1) what causes cradle cap, and 2) how best to treat it. Try a dandruff shampoo! No, dandruff shampoos don’t work! Wash the hair more! No, wash it less! Use mineral oil or petroleum jelly! No, those are terrible ingredients, go with organic coconut oil! Olive oil! Anything but olive oil! Get something medicated and anti-fungal! No, home remedies all the way!

ASFSDKDHFKDFLDJFPPJEFPFJEP.

Here is the perfect combo that worked for my son

We tried a variety of shampoos and home remedies before we found the perfect combo for my son: This combination brush and comb for cradle cap, and Cetaphil’s Baby Moisturizing Oil. 

I (personally and completely anecdotally) find the Cetaphil oil much more effective than regular household oils or dandruff shampoos. It’s less greasy, absorbs quickly, and keeps his scalp healthy for longer — we went from seeing the flakes return every other month or so to almost a full year! (Yes, it can absolutely re-occur and be a chronic sort of condition for some kids — my son is super prone to it returning during the colder months, likely due to oil over-production.)

How to Treat Cradle Cap in Older Children

I also think your pediatrician did you a disservice by not recommending the more specialized comb (which will be far, far less painful) AND for leaving out a couple clarifying instructions/steps.

Step 1: During bathtime, apply a very small amount of the oil to a wet scalp, before shampooing. You can always add more, but as you witnessed, it’s easy to go overboard and turn your child’s hair into a giant oil slick.

Step 2: Use the nubby part of a cradle cap brush to GENTLY massage the oil into his scalp. Make it nice and pleasant for him while the oil starts to break up/loosen the scales.

Step 3: Let the oil sit for a few minutes. Wash his body, let him play for a while, read him a book, etc.

Step 4: Using the comb part of the brush, GENTLY comb the scales away. They should flake off very easily at this point. Don’t try to comb them all the way out of his hair — you’ll get rid of them in the next step so there’s no need to pull the comb through the full length of his hair. Just use the teeth to gently nudge at and release the dead skin.

Step 5: Shampoo shampoo shampoo. Leaving the oil residue on the scalp can 100% make everything worse, so you really DO want to get a little aggressive with washing it out. But “aggressive” with the mildest shampoo you can find. Fragrance-free baby shampoo is ideal since you might need to do a couple of shampoos before all the oil (and the dead skin) is gone. Rinse thoroughly.

Step 6: Spot check his scalp while it’s still wet. See if you missed any spots and continue using the comb as needed. Since these flakes will need to be combed completely out of his hair (unless you want to stick him back under the shower head for another shampoo/rinse), spray the ends of his hair with a gentle de-tangling spray.

Using the soft nubby part of the brush and letting the oil sit and absorb for a while should make the actual flake removal a LOT less uncomfortable and irritating for your son. My son’s only issue with the process is usually boredom, but thankfully it’s been easier to spot treat and stay on top of the condition since switching to the Cetaphil oil. Good luck, and you’re definitely not the only post-newborn parent to get completely baffled by cradle cap appearing well past the cradle days!

Sources: 
1. Seborrheic Dermatitis in Children by National Eczema Association

More on children’s skincare at Alpha Mom

1. Gentle Care for Winter Scalps
2. 10 Ways to Stop Eczema Cold This Winter
3. The Seven-Month Itch

Photo source: Depositphotos/Dmyrto_Z