Eczema in babies and children

Eczema, or atopic dermatitis, is a common skin condition in babies and children.

It usually begins before 1 year of age. Typically, eczema causes dry, red, itchy skin. When eczema gets worse it's called an eczema flare. Usually there is no single cause for an eczema flare.

About 1 in 5 children under 2 years of age have eczema. Some children grow out of eczema, but others will have it for life. Eczema is not contagious.

The cause of eczema is not known. It's likely that eczema may have a genetic basis, as it tends to run in families.

Eczema can be triggered by many things. Examples of common triggers in babies and children are:

• heat — avoid overheating with clothing and blankets
• irritants — soaps, shampoos, fragrances and scratchy clothes
• environmental allergens — dust mites, grasses, plant pollens and animal fur
• food allergies
• playing in sand pits
• sitting on carpets or grass

It's important not to put your child on a special diet without advice from your doctor or a dietitian.

Every child with eczema will have their own set of triggers. But sometimes the condition can flare for no apparent reason.

It's important to see your doctor if you are concerned about your child's health or their skin.

Your doctor can diagnose your child's rash. It's important to get a diagnosis as there are other skin conditions that look similar to eczema.

Your doctor will examine the rash and ask you about when it began. They may also ask whether other family members have eczema or other allergies.

Your doctor may refer your child to a dermatologist (skin specialist) to do a skin biopsy. A skin biopsy is when the specialist takes a small sample of skin for testing.

Unfortunately, there is no cure for eczema. But there are many treatments you can try.

Treatment involves:

• protecting the skin every day
• reducing irritants and triggers where possible
• treating eczema flares with creams prescribed by your child's doctor
• controlling itch
• preventing and treating infections

Your child's eczema will improve more quickly if you treat it soon after you first notice the rash. Prompt treatment will also reduce the chance of complications.

Corticosteroid treatment

Your child's doctor may prescribe a corticosteroid cream or ointment for an eczema flare. This should only be put on skin affected by eczema. This treats the inflammation (redness and itching).

Different creams are used depending on:

• the part of the body affected
• the severity of the eczema
• the age of your child

Apply moisturiser after using the corticosteroid cream.

You may be given milder creams to use in sensitive areas like the face and nappy area.

Ask your doctor or pharmacist if you have any questions about using corticosteroid cream.

For many children, eczema is a condition that comes and goes. It can change over time, so you may need to see your doctor many times.

How do I prevent my child with eczema having flares?

The goal of treating eczema is to minimise flares and keep the skin healthy between flares.

It's important to moisturise after showering or bathing once the skin is dry. Use moisturisers to:

• keep the skin in good condition
• reduce the itch caused by dry skin
• reduce the chance of infections

Use a thick moisturiser with no fragrance on your child. Apply this as often as needed, even when their skin is clear of eczema.

You can use bath oils for eczema to prevent their skin from drying out.

People with eczema have sensitive skin, so try to avoid things that irritate the skin. This includes many soaps, moisturisers and toothpastes. Your pharmacist can help you choose products suitable for eczema.

Controlling itch

The following things may reduce itch:

• For immediate relief, apply a cool, soft, wet towel to the area. Leave for around 5 to 10 minutes, then apply a thick layer of moisturiser.
• Mineral salt sprays can also help with immediate relief.
• Wearing a wet singlet or t-shirt under a thin layer of clothing can help relieve itchiness. You might need to repeat several times throughout the day.
• At bedtime, apply a wet dressing until the eczema has cleared up.

Learn more about wet dressings from the Royal Children's Hospital.

What do I do when my child has a flare-up?

You can prevent skin damage by applying creams prescribed by your doctor as soon as eczema appears.

During an eczema flare, you may need to:

• moisturise your child's skin more
• dress your child in smooth, cotton clothing to stop irritation and sweating

See your doctor if:

• your child's eczema does not improve after 2 days of normal treatment
• there are weepy, crusted or broken areas, or signs of infection

Your doctor can prescribe a cortisone cream or ointment for an eczema flare.

Keep your child's fingernails short to avoid them scratching as much as possible.

Children who have eczema are more likely to have:

• allergic rhinitis or hay fever
• asthma
• food allergies

Affected skin can be very itchy. The itchiness can cause sleep problems for your baby or child. Itching can also lead to scarring.

Infections

Children with poorly managed eczema are more likely to have skin infections. Bacterial infections may need to be treated with antibiotics.

Severe cases of eczema can cause cracks in the skin that weep fluid. This can also lead to infection.

Herpes simplex virus

The herpes simplex virus, which causes cold sores, can cause severe infections in children with eczema. Family and friends should not kiss your child when they have cold sores.

Difficult to treat eczema

If your child's eczema is difficult to treat, your doctor will prepare an eczema treatment plan. The plan is a medical document, that is completed by your doctor or nurse practitioner.

Your child may need wet dressing treatment at home or in hospital.

The Eczema Association of Australasia is a national non-profit charity that can provide information and support. Call 1300 300 182.

Eczema Support Australia provides advice and support on managing eczema. You can call them on 1300 329 362.