Understanding eczema in children
Eczema is a common skin condition that usually begins to affect your baby before they are a year old. The affected skin will become dry, itchy and red. These areas can become cracked, red and weepy before scabbing over.
Eczema can be controlled and there are ways to help your child feel more comfortable. Appropriate skin care and cortisone treatment will need to be used for several years. Eczema is not contagious.
Signs and symptoms of eczema
Eczema can present itself in babies as a red, dry rash on their face or body. The rash can appear behind their ears, on their scalp, and on their legs, body and arms, and is very itchy.
Eczema can present itself in toddlers and older children as a rash in the skin creases around the wrists, elbows, ankles and knees. It can involve any area of the skin and the rash can sometimes cover the entire body.
At times, your child’s skin will appear well controlled, while at other times it may get worse. It is common for eczema to fluctuate in severity, and it is important to manage it effectively and control it during fluctuations.
The cause of eczema
There is no known cause of eczema. Your child is more likely to have eczema, hay fever or asthma if a member of your family has it. Some children who have eczema may also develop asthma or hay fever. This is called the atopic march or the atopic trio.
Eczema can be triggered or brought on by many different things including:
- Dryness of the skin
- Food intolerances or allergies
- Allergies to plant pollens, animal fur or dust mites
- Irritation from detergents, fabrics, soaps or other chemicals
- Being too hot or overheating
- Viruses or other infection
Managing eczema at home
Eczema can be managed at home in most children by:
- Identifying and avoiding triggers
- Keeping the skin well moisturised – avoid dryness
- Medical treatments
Identifying and avoiding triggers
Each child will react to different thing and it will require trial and error to work out what is causing the irritation to your child’s skin. Some common things that can cause irritation include:
- Dummies, dribbling or food around the mouth – applying ointment prior to eating can help soothe this
- Soaps, antiseptics, detergents, bubble baths
- Contact with animal furs
- Bedding and car seat covers made of prickly materials such as wool or acrylic cloth
Keeping skin moisturised
You can use a good quality moisturiser as often as necessary to avoid dryness. Different children will require different application schedules, some will only need one application a day while others may need several. Apply immediately after bathing to trap in the moisture that is already in the pores. This simple trick works wonders, so remember – bathe, towel dry, then immediately moisturise. Always.
Instead of using soaps that may cause irritation, bath oils, moisturisers and soap free body washes can be used. These products are just as effective as soap at cleaning the body. You may also wish to reduce the amount of bathing for your child, since many children actually don’t need daily baths or showers. Drying out the skin with too many baths can reduce the natural oils on the skin, and allow dryness, and thus itching and scratching.
The itching and redness may still remain even if you avoid trigger that irritate the skin.Your doctor may prescribe a cortisone-based ointment or cream. Cortisone is a naturally occurring hormone produced by the body and is very effective at controlling eczema when used as directed.
A weaker cortisone is used for the face and the stronger cortisone is used on the body. Even if the skin is open, it is important to apply the right cortisone to all areas that are affected by eczema. Don’t overuse cortisone, as over time with repeated use, cortisone cream is known to weaken and thin skin.
Scratching eczema can make it worse and possibly cause infection by opportunistic skin bacteria like staph. Some ways to help your child to stop scratching include:
- Distracting them with a toy or game
- Using moisturiser to keep their skin hydrated
- Apply a cool wet towel to the irritated area for immediate relief before reapplying moisturiser
- Keep their fingernails clean and short
- Keep your child cool, especially when in bed or on car trips
- A wet shirt or singlet can help reduce itching on the body
- A wet dressing can be applied to the limbs to reduce irritation and itching
Heat is a common trigger so it is important to keep you child cool. You can do this by:
- Bathing your child in a cool bath twice a day (but remember to reapply moisturiser and don’t wash with soap)
- Keep your house cool
- Dress your child in thin layers of cotton clothes
- Use a cotton blanket or sheet instead of a doona or woollen blanket
- Educate the teachers at your child creche, kinder or school about the importance of keeping your child dressed appropriately, and educate your child on the signs they may need a change of clothes
How diet affects eczema
Most children with eczema are not triggered by an allergic reaction to food, however it is possible for food to cause a reaction. A food allergy or intolerance should be considered if a baby has very widespread eczema. Older children can have an intolerance to preservatives or acidic foods that can cause breakouts of eczema around the mouth. It should not be assumed that certain foods will cause a reaction, and diets that restrict foods should only be undertaken when recommended by a doctor or dietitian. Elimination diets can be used to find trigger foods, with the instruction of your local paediatric hospital or clinic.
Is there a cure for eczema?
There is no cure for eczema, but it can be controlled and managed by looking after the skin as directed by a doctor. For most children, skin care such as cortisone treatments will need to be continued for several years.
Can my child go swimming?
If your child’s eczema is not flaring up, they are able to go swimming, but remember that chlorine is very drying to the skin, and precautions should be taken prior to swimming. Before swimming, is it best to apply a layer of water resistant moisturiser all over the body. After finishing swimming, you should wash the skin thoroughly in cool water with some bath oils before reapplying moisturiser. If the eczema flares up, it is best to apply a wet dressing before your child goes to bed.
Is eczema contagious?
Eczema is not contagious, but it is often passed through genes or inherited. Children born in families who have a history of allergies or allergic diseases such as hay fever or asthma have an increased chance of developing eczema.
Can my child be vaccinated?
Almost all children who have eczema are able to have their vaccinations normally. This includes those who have not eaten egg and who have a family member with an allergy to eggs. Eczema may occasionally flare up after immunisation.
Some of the key points to remember about eczema are:
- Keep your child as cool as possible at all times
- The severity of the rash will vary between days and this is normal
- Eczema cannot be cured, but it can be managed
- You should remove scabs as soon as they are ready, because scabs cause itching
- Eczema irritates the skin and makes it dry
- Using moisturisers can help ease irritation and dryness, especially applied immediately after bathing
- Children with eczema still need to be immunised
- Keep your child away from things that trigger their eczema
- If your child’s eczema worsens and doesn’t improve after a few days, you should consult your doctor
- Ask your doctor to make an eczema treatment plan for your child