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Eczema in Babies and Young Children

Eczema in babies is common. Atopic eczema (which occurs mainly where there's a family history of eczema, asthma or hayfever) is thought to affect one in eight children.  Your baby will usually grow out of the condition. For this reason, many doctors don't use the term eczema at this early age.

Baby eczema often starts between the ages of two and four months. The symptoms are usually patches of red, dry, rough and itchy skin, but sometimes it might be made up of tiny red bumps that ooze.  They appear on the face or behind the ears and in the creases of the neck, knees and elbows, although it may appear just about anywhere on a baby’s body. It may be very itchy, which can lead to your baby scratching and the eczema becoming infected.  Eczema isn't contagious, however.

Infant eczema can be easily confused with cradle cap, another red, scaly rash of infancy. Cradle cap generally clears up by 8 months, and usually appears on the scalp, sides of the nose, eyelids and eyebrows, and behind the ears.

Why Do Babies Get Eczema?
No one really knows what causes eczema. It's an immune system reaction that can be triggered by certain soaps, creams, allergies, and detergents, and may worsen with stress, heat, and sweat.

Heredity is a big factor in whether or not an infant gets eczema. If a close family member has eczema, asthma or allergies, a baby is a lot more likely to develop eczema.

Defects in the skin barrier, allowing moisture out and germs in, could also be a factor.

Does Eczema in Infants Go Away by Itself?
Fortunately most children outgrow the itchy irritation of eczema before school age.

A small number of kids will have eczema into adulthood. Remissions do happen and can last for years, though the tendency to have dry skin often lingers.

What Triggers Eczema in Children?
What triggers one infant's eczema won't trigger another's. Still, there are some common eczema triggers to avoid, including:

  • Dry skin. This is often caused by low humidity, especially during winter when the air is dry. Dry skin can make a baby's eczema more itchy.
  • Irritants. Think scratchy wool and nylon clothes, perfumes, body soaps, baby bath, bubble bath, laundry soaps, animals, chemical sprays and cigarette smoke. These can all trigger a baby's eczema flares.
  • Stress. Children with baby eczema may react to stress by flushing, which leads to itchy, irritated skin -- and an increase in eczema symptoms.
  • Heat and sweat. Both heat and sweat can make the itch of infant eczema worse.
  • Dirty soft toys. The faeces of the house dust mite can sometimes cause an allergic reaction and make eczema worse. Dust mites collect on soft toys

Could a Certain Food be Causing my Child's Eczema?

  • Researchers continue to study the links between food and eczema. Some experts believe that removing cow's milk, peanuts, eggs, or certain fruits from a child's diet may help control eczema symptoms.  In a study published in 2007, for example, German researchers found a correlation between a maternal diet high in margarine, vegetable oils, and citrus fruit during the last four weeks of pregnancy and eczema in children by 2 years of age.
  • In addition, while the jury is still out, some recent studies suggest that prenatal and infant supplementation with probiotics (microorganisms that promote the development of healthy bacteria in the gut) may help prevent the development of eczema in infants who are at high risk of developing allergies or eczema (those in families with older children who have eczema, for example). Some studies have also shown that probiotics can reduce the severity of eczema once it has developed.
  • It is important to discuss any dietary changes with a health professional.

How Can I Treat My Baby’s Eczema?
Taking care of your baby's skin is the first step to managing infant eczema, especially when the condition is mild. Try:

  • Moisturizers. A good moisturizer, fragrance-free cream (aqueous cream for example), or ointment such as petroleum jelly, when used daily, will help your baby's skin retain its natural moisture. Apply immediately after a bath, with downward strokes (don’t rub it up and down.)
  • A lukewarm bath. This helps hydrate and cool the skin, and may lessen itching. Speak with your doctor about using an antihistamine to relieve your baby's itchy skin.
  • Topical steroids. Over-the-counter steroids like hydrocortisone creams and ointments can help lessen the redness and inflammation of a baby's eczema, when used as directed. Though these creams are safe, they can lead to thinned skin and other issues if applied for too many days to the same part of the body.
  • Other topical treatments are available by prescription to ease inflammation. Speak with your pediatrician.

In severe cases of eczema in children, skin care can be complemented with:

  • Ultraviolet light therapy
  • Antibiotics for rashes that become infected

How Can I Help My Baby’s Eczema at Home?
One of the keys to treating infant eczema is to prevent your baby from scratching. Scratching can make the rash worse, lead to infection, and cause the irritated skin to get thicker and more leathery.

Be sure your baby's nails are trimmed often, and then take the edge off of them with a file if you can. Some parents also slip "scratch mittens" onto their little one's hands. Others try long socks, tucked in under a long-sleeved shirt, so they're harder for a baby to remove.

Other things you can do to treat your baby's eczema at home include:

  • Bathe your baby for no more than 10 minutes in warm water. Hot water can strip skin of its natural, protective oils.
  • Use soap only where your baby may be dirty, such as the genitals, and hands and feet. Simply rinse off the rest of your baby's body. Alternatively, aqueous cream can be used for washing.
  • Pat your baby's skin dry with a soft towel; don't rub.
  • Apply a moisturizer while your baby's skin is wet.
  • Oatmeal soaking products added to your baby's tub may make your little one's skin less itchy. Talk to your doctor.
  • To minimize the irritation of clothing rubbing on the skin, dress your baby in loose clothes made of cotton. Always wash new clothes before putting them on your baby.
  • Use a mild, fragrance-free detergent to wash your baby's clothes.
  • During a flare-up, you can try applying cool compresses to the area several times a day, followed by a moisturizer.
  • Avoid putting too many blankets on your baby or overdressing your little one.
  • Limit soft toys to one or two favourites. Each week, wash them at 60˚C or put them in a plastic bag in the freezer for 24 hours to kill any dust mites. Wash bed linen at 60˚C as well.
  • Rapid changes in temperature can make eczema worse, so try not to let your child get too hot and then cool quickly, or vice versa.
  • If eczema seems to be triggered by environmental allergens, such as seasonal allergies, you might want to consult an allergist for tips on how to deal with these allergies.

When Should I See a Doctor About Baby Eczema?
Don't just assume your baby has eczema -- get a medical diagnosis first. This not only eases your mind; it can help you treat your baby's eczema more effectively.  Your doctor can diagnose eczema by examining your child's skin. He may send you to a dermatologist for confirmation and treatment.

Once you know infant eczema is what you're dealing with, keep an eye on your baby's condition and call your doctor if:

  • Your baby doesn't respond to treatment within a week of starting over-the-counter hydrocortisone creams. Prescription treatment may be necessary.
  • A yellow or light brown crust or pus-filled blisters appear on top of the eczema. This could be the sign of a bacterial infection that needs antibiotics. Contact your doctor.
  • Your baby is exposed to anyone with cold sores or genital herpes, both of

Using Bleach to Treat Eczema
A study published in the May 2009 issue of Paediatrics tested treatments on children with severe eczema. The kids ranged in age from 6 months to 17 years.

Researchers found that soaking for five to ten minutes twice a week in a diluted bleach bath was five times more effective at treating eczema than plain water (used by the placebo group). The improvement was so dramatic that the researchers stopped the study early to allow children in the placebo group to benefit from the method.

Amy Paller, senior author of the study and the Walter J. Hamlin professor and chair of the department of dermatology and professor of paediatrics at Northwestern University Feinberg School of Medicine, says that – with their doctor's approval – parents of children with moderate to severe eczema might want to try this method, especially if their child gets skin infections.

Paller recommends a scant two teaspoons of bleach per gallon of bathwater (or 1/2 cup per full tub) at least twice a week, taking these precautions: 1) Make sure your child doesn't drink the water. 2) Disperse the bleach in the water before putting your child in the tub (you don't want undiluted bleach to get on her skin).

Nashville paediatrician Smith agrees with Paller's approach. "It's safe and easy to do," he says. "It's basically like a freshly chlorinated swimming pool, which serves to kill germs in the pool. It is very useful for kids with recurrent skin infections related to eczema, but it has also been shown effective just to eliminate bacteria, making the eczema easier to treat."

Smith tells parents to use 1/3 to 1/2 cup for a full tub or 1 teaspoon per gallon. He also suggests rinsing off briefly afterward, to get rid of the bleach smell.

To avoid getting the bleach water in your child's eyes or mouth, Smith cautions not to use bleach on the face. Instead, he recommends a good barrier ointment such as petrolatum to protect the skin on the face from irritants such as saliva, food, and beverages.

For open, oozing areas on the face, he suggests over-the-counter antibiotic ointments such as bacitracin or a polymyxin/bacitracin combination. If these remedies don't work, it's time to get in touch with your child's doctor.

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