Babies & eczema – what you need to know

Atopic Eczema (or dermatitis) can cause dry, inflamed, red and sometimes weeping or infected skin and intense itching.

It’s important to get a correct diagnosis from a Doctor and maybe necessary a specialist. Most babies develop eczema is between two and six months of age. If a parent has eczema, a baby is more likely to get it too.

Most babies are virtually clear of the condition by the time they reach 3 years old. However, some children will have eczema into adulthood and those that don’t still tend to have dry skin.

Your child’s ages and eczema

• 0-6 months. Eczema is most likely to affect a baby's facial area covering the cheeks and forehead. It can appear red and weep fluid. It also shows up as patches of red or dry skin. The skin is almost always itchy and rough, too.

• 6-12 months. As your baby begins crawling they might develop eczema on the patches of skin that rub on floor. It's important to be careful about letting those sore patches of skin become irritated when your baby is crawling as the skin could become infected if continuously broken.

Itchiness is a strong factor but babies tend to rub more than scratch. If the eczema is infected it will be weeping and oozing and there may be yellow/brown crusting.

Breast Feeding

• If you are able to breast-feed, do so for at least 3 months. Do not supplement feeds with cow’s milk or formula feeds if possible

• Delay introducing mixed feeding as long as possible

• When you begin weaning watch carefully for any reactions, in particular to cow’s milk, eggs and fish – the most common foods that can be problematic. Swelling or itching of the lips, or sickness, are signs that your child may be intolerant to these foods

• If an infant seems to react to a large number of foods then see your doctor

• Infants who seem to react to certain foods early can often tolerate them when they get older

• Don’t cut out certain foods, such as dairy products, from diet during pregnancy, or breast feeding. Moderation is the key instead of avoidance. Always a health professional for diet advice

Treatment Tips

• Don’t panic – most eczema flares can be managed quite effectively and getting upset will flow through to the baby – it is not your fault.

• Use sensitive washing powder for the whole family not just the baby’s clothes – you hold the baby against your clothes and often put them on your bed! Always wash baby’s clothes before they wear them.

• Try to keep your baby from scratching itchy skin. Keep baby’s nails short and take the edge off with a file to stop damage to the skin, or cover the baby’s hands with cotton mitts.

• Use cotton or bamboo sheets in cots as well as cotton or bamboo covered products for prams, carriers and car seats.

• Bathe babies daily in a bath of lukewarm to warm water at least once a day and always add a hypoallergenic oil or soap free wash.

• After bathing, pat the skin with a soft towel leaving it slightly damp. Apply any prescribed steroid creams or ointments, allow time for the medication to be absorbed (about 10-20 minutes) and then gently apply the moisturiser.

• Steroid creams and ointments prescribed for babies are usually of a very weak formulation (1% hydrocortisone) and can reduce itchiness and speed up healing - they are extremely useful in controlling a flare-up and safe to use.

• Moisturising the skin is very important, this keeps it supple and less likely to crack and also helps relieve itching. Try to moisturise every nappy change and wash your hands first.

• If baby is having a very hot itchy skin day, pop your moisturiser in the fridge to quickly cool and numb the itchiness when applied.

• Loose cotton or bamboo clothing helps to avoid skin irritation. Dress babies in layers so they do not overheat.

• Baby will sleep better in a well-ventilated bedroom with minimal heating – if you must have heating on, place 1-2 containers of water in the room to add some moisture.

• A baby who has been rubbing/scratching constantly may need some pain relief to help sleeping – scratched or rubbed skin can be really sore.

Introducing Solids

Try not to introduce any solids until 4 months. Then, hold off giving foods that commonly cause allergies, (ie cow’s milk, wheat, eggs, corn, chocolate, peanuts, fish, citrus, etc).

Introduce foods one at a time as a sort of “test”, watching out for an allergic reaction. Give each food for at least a week, before introducing others.

Introduce foods in this way: Give a teaspoon on the first day, two teaspoons on the second day, and go on adding another teaspoon each day until a complete serving is given. (If you suspect that your child may be sensitised to the food, go more slowly.) If your baby rejects any food, do not persist in offering it, or disguise its taste. While introducing a food, watch carefully for allergic symptoms which can include colic, unsettled behaviour, altered bowel habit, vomiting or regurgitation of feeds, worsening of eczema, excessive mucus etc.

If no symptoms show up during the introduction of the food, then it can be included in the diet. If symptoms appear, stop the food, wait a week, begin a new food. If in doubt, try the food again.

Remember

• There is no cure for eczema but it can be well controlled

• It is common for the severity of the eczema to change, and essential to control the eczema as soon as it flares up

• Don’t overdress a baby with eczema or use too many coverings - hot and sweaty skin can trigger an eczema flare

• Secondary bacterial or viral skin infections are common in children with eczema – they may be prescribed an antibiotic or need infection control such as bleach baths

• Relatives and friends offer well-meaning advice – follow the advice from your health professional

• Most babies with eczema can have all their vaccinations (including measles) in the normal way including those who have egg allergy. Sometimes, the eczema may flare up after immunisations.

Article supplied by Eczema Association of Australasia.