Baby milia: newborn white spots explained

Many newborns have tiny white spots on the nose and cheeks in their first days. Most of the time these are milia, and they are one of the most common and harmless things on a new baby's skin. This guide explains what baby milia are, how they differ from baby acne and other newborn rashes, how long they last, and the signs that mean a call to your child's doctor. For milia at any age, see the hub guide, what milia are.

Skinli gives general education and is not a doctor. Your child's doctor or health visitor is the right person to look at any spot you are unsure about.

What baby milia are

MedlinePlus, from the U.S. National Library of Medicine, says "Milia are tiny white bumps or small cysts on the skin. They are almost always seen in newborn babies." It explains that "Milia occur when dead skin becomes trapped in small pockets at the surface of the skin or mouth."

StatPearls, a medical reference hosted by the same library, calls the newborn type congenital milia. It says they "occur spontaneously and are present at birth," and that in babies born early "its onset in premature newborns could manifest weeks later." The NHS says milia "often appear on a baby's face when they're a few days old."

How common they are

• StatPearls says congenital milia occur "in up to 40% to 50% of healthy full-term neonates," so common that they "could be considered a typical variation."
• A 1990 survey in the Journal of the American Academy of Dermatology examined 420 newborns in their first week. It found milia in 36 percent and Epstein's pearls, small cysts in the mouth, in 56 percent. Skin findings of some kind were seen in "almost every baby (99.3%)."
• A 2012 study of 1,000 newborns in Spain, published in Pediatric Dermatology, found milia "predominantly located on the cheeks, chin, and forehead."

What they look like

MedlinePlus lists the signs in newborns:

• "Whitish, pearly bump in the skin of newborns"
• "Bumps that appear across the cheeks, nose, and chin"
• "Whitish, pearly bump on gums or roof of mouth (they may look like teeth coming through the gums)"

The NHS says the spots "usually appear on their nose but can also be on other parts of the face, inside their mouth, or on their scalp or chest," and that "The spots may appear white or yellow, depending on your child's skin colour." StatPearls describes them as smooth, dome-shaped bumps smaller than 3 mm that "in darker skin, they may show a subtle blue tint."

Can they look red? MedlinePlus says "Rough sheets or clothing may irritate the skin and mild reddening around the bump. The middle of the bump will stay white."

Milia in the mouth: Epstein pearls and Bohn nodules

MedlinePlus says "Similar cysts are seen in the mouths of newborn infants. They are called Epstein pearls. These cysts also go away on their own." StatPearls names the cysts on the gum border Bohn nodules and the ones on the palate, the roof of the mouth, Epstein pearls. MedlinePlus says they "may look like teeth coming through the gums." For white bumps on the lips of older children and adults, see milia on lips.

How long they last

• MedlinePlus: "Skin changes on the face or cysts in the mouth often go away after the first few weeks of life without treatment. There are no lasting effects."
• NHS: "In young babies, they usually go away within a few weeks and do not need treatment. In older children milia might last longer."
• StatPearls: newborn milia "tend to resolve spontaneously without scarring within a couple of weeks, though they may persist for several months, usually disappearing during the first month of life."

What to do, and what not to do

Do nothing to the spots themselves. MedlinePlus says "In children, no treatment is needed." StatPearls says congenital milia "do not require specific treatment, as they tend to resolve spontaneously."

Wash gently. The American Academy of Dermatology (AAD), in its advice on baby acne, tells parents to be gentle with a baby's skin, to avoid scrubbing, and to wash with "lukewarm (not hot) water."

Do not squeeze, pick or scrub. Milia are closed pockets of keratin that clear on their own, so squeezing has nothing to gain.

Skip adult skin products. The AAD says "Never put acne medicine or acne wash on your baby's skin, unless your child's dermatologist or pediatrician recommends it." The FDA advises: "Avoid using BHA-containing products on infants and children." BHA means beta hydroxy acid, such as salicylic acid. The AAD also says to "Stop using any oily or greasy skin care products" on a baby with acne.

There is no prevention. MedlinePlus says "There is no known prevention." StatPearls says newborn milia "occur spontaneously."

Milia or baby acne?

These two are often confused. MedlinePlus says irritated milia are sometimes called "baby acne," and that this "is incorrect" because milia are not a true form of acne.

The AAD estimates that 20 percent of newborns have a type of acne called neonatal acne, usually seen at 2 weeks of age, and says "it can develop any time before 6 weeks of age." The breakouts are usually "on your baby's cheeks and nose." MedlinePlus says mild newborn acne is "caused by some of the mother's hormones that stay in the baby's blood."

The difference in plain terms:

	Milia	Neonatal acne
When	At birth or in the first days	Around 2 weeks, before 6 weeks (AAD)
Look	Tiny pearly white or yellow bumps	Breakouts on the cheeks and nose (AAD)
Treatment	None needed (MedlinePlus)	Usually none; ask a doctor before any (AAD)

Acne after 6 weeks is different. The AAD says acne that develops after 6 weeks of age is called infantile acne, and "you'll want to see a board-certified dermatologist or pediatric dermatologist," partly to "Rule out something going on inside your child's body."

Milia in older babies and children

Milia do not only happen in the newborn weeks. The NHS says "Milia can also affect older babies and children, with spots on their eyelids, forehead or nappy area," and that in older children "milia might last longer."

StatPearls says milia that appear later, called acquired or secondary milia, "usually affects older children, and a previous history of trauma or bullous skin disease could be present." Bullous means blistering. It adds that in older children milia "could be associated with an underlying inherited skin disorder or be secondary to skin trauma," and that "when in doubt about the diagnosis, the patient should be referred to dermatology." So milia that appear after the first months, that are many, or that follow blisters or an injury are worth showing to your child's doctor. The guide what causes milia lists the triggers the sources name, and milia under the eyes covers eyelid milia at any age.

Other newborn spots

• Erythema toxicum. MedlinePlus says this is "a common, harmless rash that looks like little pustules on a red base," appearing 1 to 3 days after birth and gone "by 1 week." The NHS calls it "Raised red, yellow and white spots."
• Sebaceous hyperplasia. StatPearls says tiny yellow oil gland bumps are "not rare in newborns," found in 43.7 percent of 1,000 newborns in one Iranian study, and that they come from "exposure to maternal hormones."
• Heat rash. The NHS describes "small, raised spots" with "an itchy, prickly feeling," which "may be harder to see or look grey or white on brown or black skin."

When to call a doctor

Ask your child's doctor or health visitor about white spots that are still there after a few months, that spread, bleed or grow, or that you are not sure are milia. The AAD says to see a dermatologist for acne that starts after 6 weeks of age.

The NHS says to call 999 (in the US, 911) or go to an emergency department if a child "is unwell with a rash" and has signs such as "a stiff neck," is "bothered by light," seems "confused, agitated" or is "not responding like they usually do," has "difficulty breathing," or if "the rash looks like small bruises or bleeding under the skin and does not fade when you press a glass against it." It says to ask for an urgent appointment if a baby under 3 months "has a temperature of 38C," which is 100.4°F. StatPearls says milia are commonly asymptomatic, meaning they cause no other symptoms, so a baby with spots who also seems unwell needs a doctor's check.

For sun care as your baby grows, see when an infant can wear sunscreen.