A 3-month-old infant with erythematous, scaling crusts on the scalp is suspected to have cradle cap. What is the most appropriate initial intervention?

• A. Selenium sulfide shampoo
• B. Permethrin 1% cream rinse
• C. Warm olive oil compresses
• D. Scrubbing of scalp with hexachlorophene

Answer: (C)

Cradle cap is a common, self-limited seborrheic dermatitis of infancy. The first-step approach focuses on gentle cleaning and softening of the greasy scales rather than aggressive treatments. Applying warm olive oil to the scalp helps to soften the crusts, making them easier to remove with a gentle wash. This minimizes irritation and skin trauma, which is important in a delicate infant skin setting. After softening, wash with a mild baby shampoo and rinse well, avoiding harsh scrubs.

Stronger or topical medications—like selenium sulfide, or antifungal creams—can irritate or harm an infant's scalp, and scrubbing with potent agents is not appropriate as an initial move. Hexachlorophene has safety concerns and is not used in infants. If cradle cap persists or worsens despite gentle cleansing and softening, follow-up with a pediatrician is the next step.