Why does my older kid still have cradle cap?

When Hilary Dupont’s* daughter Mia was a baby, she had cradle cap (which often looks like waxy, crusty whitish or yellowish patches on the scalp). Most babies grow out of cradle cap by the time they’re three months old, but Mia’s has been hanging around well into her school years, although her thick hair mostly covers it up.

Cradle cap in kids is relatively common

When she was eight, Dupont noticed the white, crusty patches around Mia’s hairline and eyebrows, and took her to get checked out by their doctor, who prescribed a medicated shampoo. At age 10, she still has some crusty patches on her scalp, and her mom has noticed dandruff flakes in her hair.

“Her dad deals with similar issues, so I wonder if this will be a lifelong thing?” says Dupont.

A. Yasmine Kirkorian, a pediatric dermatologist at Children’s National Hospital in Washington, DC says that in school-aged kids, thick waxy patches or “scales” that stick to the hair or scalp are usually called “pityriasis amiantacea” which refers to how it looks, rather than a specific diagnosis.

“It’s like super dandruff, or kids' dandruff on steroids,” she says of this problem that reaches well beyond 12 months of age.

What causes cradle cap in older kids?

There are several conditions that cause pityriasis aminatacea, so it’s important to have your family doctor, pediatrician or dermatologist have a look so it can be treated properly. If your kiddo’s scalp is itchy, for example, it could be eczema (also known as atopic dermatitis), which can be helped by over-the-counter or prescription creams.

Ringworm, a fungal infection that’s fairly common in school-aged kids, can also appear on the scalp (where it’s called “tinea capitis”). “Ringworm can really fool you because it can look many different ways,” she says. “It can look like powdery, flaking dandruff or it can look like bigger clumps of flakes, rather than being distributed throughout the scalp. It can be accompanied by hair loss or broken hairs.”

Tinea capitis is treated with oral anti-fungal medication or a medicated shampoo and, if needed, topical steroids to calm skin inflammation. It can be more common in people of African descent.

If your doctor thinks you’re dealing with the non-infant version of cradle cap, it’s called seborrheic dermatitis. “It’s typically due to an excess oil production from the follicles and it’s thought to be related to a specific type of yeast species that kids come into contact with at school or at home,” says Michael Hill, a pediatrician in Newmarket, Ontario.

Seborrheic dermatitis doesn’t have anything to do with hygiene, and it’s not contagious, he says. Rather, it’s a combination of being a bit more predisposed to producing extra oil, which is food for the yeast that is naturally found on the skin of many people.

It’s not all that common in school-aged kids but it does happen occasionally, says Kirkorian, adding that anecdotally, a close relative with the skin condition psoriasis can sometimes mean a kid is more predisposed to seborrheic dermatitis.

How to deal with it

While seborrheic dermatitis is not a cause for concern, it often doesn’t look all that great, which can bother kids or parents. It's not necessary, but you can first treat the scalp to soften and loosen the scales with oil, such as coconut, mineral, sunflower or safflower oil, says Kirkorian. Steer clear of petroleum jelly, which can irritate the scalp and actually increase yellow scales.

Massage a small amount of oil into the scalp and let it sit for 10 minutes or so while you and your kid read a book together. “Don’t use olive oil. It will actually feed the yeast that lives on the scalp and causes dandruff,” says Kirkorian. Lavender, mustard and tea tree oils, or shampoos that contain them, can be irritating to the skin, so skip those if they are causing irritation. This organic coconut oil is affordable and a favorite for scalp treatments.

After the oil (or just start with this step), wash the hair by gently massaging the scalp with an over-the-counter or prescription dandruff shampoo that contains active ingredients like salicylic acid, tar, zinc or selenium ingredients.

This bottle of Nizoral is a bestseller for treating dandruff and cradle cap in kids. It's an over-the-counter solution that can be used in place of regular shampoo, though it's certainly not tear-free. That means parents should be careful to assist children and make sure it stays out of their eyes.

“It’s often useful to rotate two or three dandruff shampoos with different ingredients: one night do zinc-based, one night do selenium sulfide-based, one night do another anti-fungal. The different ingredients work synergistically,” she says.

Your older kid may have been washing their hair on their own for a while, but it can’t hurt to show them how to massage the scalp while they're shampooing. The goal is to loosen the white flakes of dead skin, wash them away and treat the underlying areas.

Rinse the shampoo out as usual, and condition the hair if that’s what you normally do or if the dandruff shampoo is making the hair dry or brittle. You can then gently comb your child’s hair to see if you can remove any loosened flakes, but don’t comb if the hair is breaking or falling out with the plaques.

Wash the hair on the same schedule you usually would, whether that’s every few days or once a week. And if your child’s scalp is sore and red, stop the treatment (and don’t start one to begin with) and check in with your doctor.

Seborrheic dermatitis can continue to flare up off and on, especially during dry, cold winter months but with the right treatment, it should end up being no big deal.

* Names have been changed.