Eczema in Babies and Children: Calming Dry, Itchy Skin

When to See a Doctor

Most eczema is managed at home with a plan from your child's doctor. These signs mean it needs more help, or that the skin has become infected.

If your child needs emergency care, come to Limi Children's Hospital now, day or night. If you cannot get here quickly, go to the nearest emergency department. Have someone else drive if you can, so you can watch your child, and call 0813 408 5400 on the way so the team can prepare.

What Eczema Is

Atopic eczema (also called atopic dermatitis) is the most common type in children. The skin's outer layer works like a wall that keeps water in and irritants out. In eczema, that wall is leaky. Water escapes, so the skin becomes dry, and soaps, sweat, germs and dust get in more easily, so the skin becomes inflamed and itchy. Scratching damages the wall further, and the itch gets worse: the itch-scratch cycle.

Eczema often starts in the first year of life. It runs in families together with asthma, hay fever and food allergy. It is not infectious, and it is not caused by poor hygiene. Many children's eczema improves a lot as they grow, though the skin may stay sensitive and dry.

How Eczema Looks, Including on Darker Skin

Eczema is itchy. Without itch, it is probably something else. Where it appears changes with age:

• Babies: cheeks, forehead and scalp first, then the outer arms and legs and the body. The nappy area is often spared, because it stays moist.
• Toddlers and children: the skin folds — inside the elbows, behind the knees, wrists, ankles, neck, and around the eyes and mouth.
• Long-standing eczema: skin becomes thick, rough and leathery with deeper lines where it has been scratched for a long time.

The Daily Routine

Moisturisers (emollients) are the most important treatment, even on days when the skin looks good. They repair the leaky wall.

Moisturise Generously and Often

• At least twice a day, and more often when the skin is dry or in the harmattan. Many children need it three or four times a day.
• Use a lot. The skin should look shiny afterwards. A large tub may last only a week or two for a young child, and that is normal.
• Smooth it in gently, in the direction the hair grows, rather than rubbing up and down. Rubbing the wrong way can block the hair roots and cause small spots.
• Choose plain and unperfumed. Thicker, greasier products (ointments, plain petroleum jelly) protect more and are inexpensive; lighter creams are easier in the heat. The right one is the one your child will let you use.
• Scoop from tubs with a clean spoon, not fingers, to keep germs out.
• Avoid olive oil and similar cooking oils on eczema; some studies show they can weaken the skin barrier.

Bath Time

1. Short and lukewarm. Five to ten minutes in water that feels comfortable on your wrist, not hot.
2. No soap, bubble bath or perfumed baby wash. Wash with an emollient or a soap substitute instead.
3. Pat dry gently with a soft towel. Do not rub.
4. Moisturise within a few minutes, while the skin is still slightly damp, to seal the water in. Apply any prescribed cream to the flared areas as your doctor has shown you.

Bath emollients and wet floors are slippery. Hold your child firmly, and never leave a baby or toddler alone in the bath, even for a moment.

Flare Triggers

Eczema comes and goes. A flare is a spell when it gets worse. Common triggers:

Steroid Creams, Used Correctly

When eczema flares, moisturiser alone is not enough. The usual treatment is a steroid cream or ointment prescribed by a doctor. These are not the same as the steroids athletes misuse. They calm the inflammation quickly, stop the itch, and let the skin heal.

• Steroid creams come in different strengths. A mild one is used on the face and in skin folds; a stronger one may be used for a short time on thicker skin of the body and limbs. Use only the one prescribed, only where it is prescribed.
• Use it for the time your doctor says, usually until the flare has settled and a few days beyond, and then go back to moisturiser alone. Some children are advised to use it on a couple of days each week on problem areas to stop flares returning.
• Apply the moisturiser and the steroid at different times, leaving a gap between them as your doctor advises, so one does not dilute the other.
• Other non-steroid creams may be prescribed for the face or for long-term use.

How Much: The Fingertip Unit

Doctors measure steroid creams in fingertip units. One fingertip unit is a line of cream squeezed from the tube along an adult's index finger, from the tip to the first crease. It covers an area of skin about the size of two flat adult hands. Your doctor will tell you how many fingertip units to use for each part of your child's body, and for how long.

The Fear of Steroids

Many parents worry that steroid creams will thin or darken the skin. When the right strength is used on the right place for the right time, as prescribed, this is very unlikely. Using too little, stopping too early, or avoiding the cream altogether leaves the skin inflamed, itchy, infected and more likely to be left with dark or pale marks. If you are worried, say so — the doctor explains the plan and shows you how much to use.

Never Use Bleaching, "Toning" or Mixed Creams

Buy creams from a registered pharmacy, check the label and NAFDAC number, and bring every cream you use to the appointment.

Sleep and Scratching

• Keep nails short and smooth. Cotton mittens or socks on the hands can help babies at night.
• Keep the bedroom cool, with light cotton bedding, and do not overdress for sleep.
• Moisturise before bed, and keep a small pot by the bed for night-time itch.
• Distract rather than scold. Older children can learn to press or pinch the skin instead of scratching.
• Antihistamine medicines do not treat eczema itself. A doctor may occasionally suggest one for a short time during a bad flare. Do not give sleepy antihistamines to babies without medical advice.

Severe eczema that needs treatments such as wet wraps, light therapy or tablets is managed by a skin specialist. Our paediatric dermatology service at Limi treats children whose eczema is hard to control.

Eczema and Food Allergy

Babies whose eczema started early and is severe are more likely to have a food allergy, especially to egg, milk or groundnut. But food is not the cause of most eczema, and cutting foods out without testing can harm a child's growth. If eczema does not improve with a good skin routine, or a food seems to make it worse, or your child reacts quickly to a food (hives, swelling, vomiting), talk to the doctor before removing it. Introducing common allergy foods early and regularly may lower the chance of food allergy — see our guide to allergies and starting solids.

School and Play

• Send a small, labelled pot of moisturiser for use after washing hands, sport and swimming.
• Ask for a cotton uniform or a cotton layer under a synthetic one.
• Let the teacher know that eczema is not infectious, so other children do not avoid your child.
• Sport and swimming are fine. Rinse off sweat and chlorine and moisturise afterwards.

Myths About Eczema

Questions Parents Ask