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In this National Eczema Society webinar we look at the management of eczema in babies and toddlers, including what eczema is, why the child has eczema, how to treat it. The webinar is presented by Julie Van Onselen, Dermatology Nurse Advisor to the National Eczema Society. This is the first in a series of seven topics that will be discussed within our Exploring Eczema webinar series to help people better understand how to manage their eczema. This information is intended for people living in the UK and reflects UK medical guidelines.
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If you have any questions, or suggestions for future webinar topics, please contact emartin@eczema.org.
Questions
Can my four month old swim in the pool with eczema or will this make it worse?
All babies should learn to swim from the earliest age. Cover them in a layer of emollient to protect their skin before they get in the pool. When it’s time to get out, if possible, take them home for their post swim bath. Often the water in the showers at a swimming facility have the same chemicals in as the pool, so instead of washing off the pool irritants, it can add to it. Once home, ensure you wash them in a tepid bath and apply a generous layer of emollient after. Teach your baby to enjoy the water and never restrict a child from learning how to swim, it’s a vital life skill and there are always ways of managing your child’s skin. Please see our factsheet about Swimming and Eczema for more guidance on managing your child’s eczema at the pool.
Are Milton baths a good form of treatment for babies and toddlers?
Milton baths are bleach that’s heavily diluted with water. These can be very hard to get right as if you have too much bleach then you can burn the child’s skin, and if you’re not adding enough then the bath is too weak to treat any infections on the skin. I would advise against these, especially if your child has more severe eczema. I would suggest using your emollient for bathing and washing, you can also get bath oils to add to the water, see our guidance on emollients for more information. If this is something you would like to explore, please ask your healthcare professional as they will be able to provide more guidance as to whether a bleach bath would be appropriate for your child, as if your child has a recurrent infection, this may be a good form of treatment, but in a lot of cases it can often irritate the eczema and make it worse.
How many times should I be applying emollient to my child throughout the day?
Every nappy change or several times a day is usually a good start. It’s good to get in the habit of regularly applying emollient to your child’s skin, so you’re familiar with the process and so they become used to it quickly. This doesn’t mean you need to be applying a lot at once, just enough that it’s a thin film covering the surface of the skin. It does depend on your child’s skin though, if they only have very mild eczema then twice a day should suffice. Continue to monitor the child’s skin and discuss with your healthcare professional if you notice any change.
My child has eczema around their mouth and on their neck whilst teething, any suggestions for this area as dribbling makes it quite difficult to apply emollient?
Teething can mean that eczema is worse on the face as saliva is an irritant. During this time it would be helpful to opt for a heavier, greasier emollient. This will help to form a stronger barrier between the skin and the saliva. Stay away from using baby wipes on the face as the chemicals in these can cause further irritation, instead opt for a cotton cloth that’s been rinsed in tepid water, gently wipe across the effected areas, removing any food or saliva, then immediately after apply a thick layer of emollient, before the child has had the chance to dribble on their face again. You may need to do this each hour and certainly each time the child eats to keep the area clean, avoid infection and to reapply the barrier cream if it’s been wiped off.
My three year old has eczema behind their knees, and it sometimes appears in the crease of their elbows and the back of their neck. Can eczema spread?
All the areas you have labelled are typical areas for eczema to occur. Eczema isn’t something that can spread, it can just appear in different locations across the body. For example, if you have eczema on your arms and touch your legs, it won’t spread to your legs that way. Eczema is caused by dry skin and if left untreated, the skin will continue to dry and eczema will appear in more places on the body. The only thing that does spread is if one patch of eczema becomes infected, then the infection can transfer to other areas of eczema on the body. If you suspect your child’s eczema is infected, take them to see their healthcare professional for the appropriate treatment.
What’s the best way to stop a baby scratching at night? My child is waking up 2-3 times per night.
First things first, speak to your healthcare professional to revise your treatment plan as the current one is not working. You may need to try a different emollient that is more effective at treating the dry skin, as if your child is scratching, the skin will be dry and eczema is not being adequately treated. In some cases you may need to use a short course of steroid creams to get the flare under control. If you and your child are not getting enough sleep, this can delay the child’s skin from calming down quicker and place more strain on yourself as a parent/guardian, make sure to raise the impact on sleep with your healthcare professional.
Can we apply steroid cream to the nappy area of a baby?
Please follow the guidance from your healthcare professional. But yes, you can apply steroid to the genital area of a child, although it should be a mild strength. Sometimes skin irritation there can be caused by a fungal infection and not eczema, in those cases you will need to apply an anti-fungal cream instead of a steroid cream. This should be discussed with your healthcare professional before anything is applied to the child’s skin.
How do you know when you’re using the correct emollient for your child?
The answer is simple, if their eczema is under control, they’re not itching and they’re sleeping well at night, then it’s working! If your child is scratching, not sleeping well and their overall mood seems irritable, then it may be worth speaking to your healthcare professional about trying another emollient. There are lots of different formulations, sometimes you may require a greasier one for overnight application to really help lock in the moisture in the skin, then opt for another lighter emollient for daytime use. It’s important to note that sometimes an emollient can sting when first applied, this is a sign that it’s treating the broken skin from eczema, the more you apply the less the sting will happen as it repairs the skin barrier, so don’t take sting as a sign the emollient isn’t the correct one for your child, as difficult as it is to watch your child in discomfort you’re doing them a kindness, persevere and it will cease quickly. Sometimes it takes a few different types to discover the emollient that works best for your child, don’t lose heart, continue to apply emollients regularly and maintain discussion with your healthcare professional about how you and your child are getting on.
Does my child need an eczema diagnosis to be prescribed emollient?
Yes, it is always important to raise any concerns about your child with your healthcare professional. They will be able to assess your child and put them on the correct treatment plan for their eczema. Whether you’re well versed in dealing with eczema as it runs in the family, you should always raise it with your child’s healthcare professional so they can maintain knowledge of it on their medical records. You’ll also be able to get your child’s emollients prescription for free from your GP.
Is there a link between baby acne and eczema?
Baby acne is the transfer of hormones from the mother in the early stages of life. There isn’t any link between baby acne and eczema. It will go away on it’s own.
Is there a benefit to combining creams and lotions at bedtime?
No, just choose one formulation that suits the dryness of your skin. A lot of people opt for a thicker, greasier emollient at night that provides a more intense overnight treatment, that means the child can wear a much more lightweight cream during the day that doesn’t cover their clothes, their toys and your house in a greasy layer of emollients. There is no advantage to using two different types at once.