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This page gives information on toddler and baby eczema. Eczema in children is relatively common, particularly in families with an atopic (or allergic) tendency.

You will find information about what causes eczema, what it looks like (with more photos) and treatment including detailed information on how to keep eczema under control.

To go to a particular question you may have, click the link below or just keep reading for an overview of this common childhood skin rash.

Eczema-armInfantile eczema on arm
Eczema-baby-legInfantile eczema leg

To read country dresses for juniors about the use of Wet wraps in pediatric eczema, click here.

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What is baby eczema?

Eczema (or atopic dermatitis) is a dry skin condition that becomes itchy and flaky. The skin can become inflamed (looks red), and may even get infected (gets weepy) particularly with scratching. It usually begins early in childhood. In babies, the eczema rash often involves the face.

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How is eczema different in toddlers compared to babies?

In babies, the eczema rash is often on the face and body while in older children, the skin in the creases around the knees, elbows and ankles is affected. Some children have the skin over the entire body affected.

At times your child's skin will look good and at other times it gets worse. This is part of the disease and not caused by bad care.

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What does eczema look like?

Eczema face of babyInfantile facial eczema
Baby eczema trunkEczema on trunk

These photos show a baby with eczema - the face and trunk are affected.

Note the redness and the dryness of the skin. This is an itchy rash and children will tend to scratch. This can break the skin making infection more likely. It is important to break the itch-scratch cycle and this is the basis for the treatment of toddler and baby eczema.

The baby in the top photos has red inflamed areas on his arm and leg as well as characteristic thickened skin.

Infected facial eczemaInfected eczema
Eczema lichenificationThickened eczematous skin

The photo on the left above shows baby eczema that is crusted and weeping - this is infected eczema and this child will require a course of antibiotics. I usually treat with an antibiotic by mouth for at least 2 weeks.

The photo on the right below shows an older child with typical eczema in the elbow crease. It has the characteristic thickened skin we see in eczema which is called lichenification. Lots of moisturizers are needed to soften this skin and get it back to a more normal appearance.

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Who gets eczema?

Toddler and baby eczema occurs in about 15-20% of children and occurs in children with an allergic tendency. It runs in families and often goes hand in hand with asthma and hayfever.

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Is there a cure for toddler and baby eczema?

No, but there is a good chance that your baby's eczema will disappear as she gets older - most children grow out of eczema by six years of age. There is plenty you can do in the meantime to make the eczema better.

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How do I treat my toddler or baby's eczema?

The aim for toddler and baby eczema is to keep the skin soft and moist. When the skin is dry it is more likely to be itchy. The aim of moisturizing the skin is to break the itch-scratch cycle.

  • Daily bathing is good practice, but you need to use a soap substitute to stop the skin drying out (see below for information and soap substitutes). A bath oil can be used as well but is not necessary if you use a soap substitute- see below for examples of bath oils. An antiseptic should be added to the bath twice a week to reduce the skin becoming colonized with bacteria (Staph) - my preference is bleach but you can read more about this below in 'Examples of antiseptics'.
  • The bath water should be warm, not hot, as heat makes the skin itch. The bath can become slippery so use a bath mat to avoid accidents. Cover your child in the soap substitute (eg. Emulsifying Ointment) before getting in the bath and then limit the bath time to the time it takes to wash off the substitute. Pat the skin dry with a soft towel as rubbing may irritate the skin.
  • Use emollients or moisturizers to keep your toddler or baby eczema skin soft and moist. Moisturisers should be applied at least once a day, usually after bathing, but I often suggest to also apply the moisturizers at least four times a day. If the skin is very dry, you can apply every hour. If you are using a steroid cream as well, wait at least 10 - 20 minutes after applying the steroid cream before applying the emollient / moisturizer. You can keep the emollient / moisturizer in the fridge to keep it cool - this is especially useful for the creams you apply before bedtime.

    Examples of bath oils are Oilatum, AlphaKeri, Oilatum, QV, Aveeno or dissolve a teaspoon of Emulsifying Ointment under the hot tap. Oilatum Plus, QV Flare Up have antiseptic as well so only use daily if there is infection or otherwise use twice a week as an antiseptic - they are too strong for everyday use.

    Examples of soap substitutes are Emulsifying Ointment, White soft Paraffin or Soap-free washes that contain no fragrance/perfume (eg. Cetaphil, Dermasoft, Johnsons pH 5.5). Cover your child in the soap substitute before getting in the bath and then limit the bath time to the time it takes to wash off the soap substitute. Emulsifying ointment can leave a residue so put a muslin or similar sieve over the outlet to catch the residue when you empty the bath.

    Examples of antiseptics are Oilatum Plus or QV Flare Up but these are expensive. An inexpensive option is to add bleach (Janola) - add 2 capfuls of bleach to the bath or ½ a cup of bleach for larger baths. Just do this twice a week. The aim is to reduce the number of bugs on the skin that can exacerbate the itch-scratch cycle.

    Examples of emollients or moisturizers are Health E Fatty Cream, Alpha Keri Lotion, BK Lotion, E45 Cream, Cetamacrogol, Emulsifying Ointment, and 50/50 Liquid Paraffin/White Soft Paraffin. It is sometimes helpful to change emollients after a few months and use another one for a while.

    If you want, you could use one treatment, such as Emulsifying Ointment, as bath oil, soap substitute and moisturizer. Hold some in a teaspoon under the hot tap while running the bath to make the bath water oily, lather your child with the emulsifying ointment before the bath to act as a soap substitute and then apply to the skin after the bath as an emollient.

    Many mothers have found that using Lucas Pawpaw Ointment as an emollient has helped their child's eczema - to read more on this product, click here.

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What is the difference between lotions, creams and ointments?

Lotions, creams and ointments are all moisturizers (also called emollients). However, they have different water content. Lotions have the most water so absorb easily into the skin; however, lotions don't provide enough moisture to the skin to be used in toddler or baby eczema. Ointments have the most moisturizing quality but can be greasy on the skin and can clog up washing machines - if clothing has lots of ointment on it, soak in hot water before washing.

  • Creams: Sorbolene, Cetamacrogel, E45
  • Oily Creams : Health E Fatty Cream, Lipobase
  • Ointments: Emulsifying Ointment, Duoleum, White soft paraffin

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How do you apply moisturizers?

It is vitally important that you keep your child's skin moist if you are to control toddler and baby eczema.Follow these steps:

  • Take a good dollop of moisturizer out of the tub using a spoon - put on a paper towel or small tray. It's important that you don't put your hands into the tub of moisturizer to keep it free from bugs
  • Apply the moisturizer in a downward motion (in the same direction as the hair growth)
  • Don't rub the moisturizer in but leave it in a thick layer on the skin - it should naturally absorb into the skin within 10 minutes or so
  • Apply as often as necessary to keep the skin moist - hourly if necessary

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Should I use Aqueous Cream as a moisturizer or soap substitute?

No. Aqueous cream contains sodium lauryl sulphate and it has been found that it causes thinning of the top layer of the skin which makes the skin more prone to irritation. In eczema, this makes things worse, so aqueous cream should not be used in toddler or baby eczema.

In the past, aqueous cream was routinely used for eczema both as a soap substitute and as a moisturizer. If your child is on aqueous cream, stop using it. The skin layer will return to normal after you stop using the aqueous cream.

Alternatives to aqueous cream include Emulsifying Ointment and White Soft Paraffin.

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What should I do if my child complains of stinging when I apply the moisturizer?

Stinging in toddler and baby eczema usually occurs because the skin is dry and so you need to apply more moisturizer, not less. Try changing the moisturizer brand and apply a thick layer to the skin - don't rub in, let the moisturizer/emollient absorb into the skin.

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What shampoo can be used in toddler and baby eczema?

  • Aqueous cream can be used as a shampoo
  • 2% ketaconazole shampoo (Nizoral, Dandrozol)
  • 20% cetrimide shampoo
  • Normal shampoo can be used if you wash hair in sink (so the shampoo doesn't touch the body)

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Will I need to use steroid cream on my toddler or baby's eczema?

Most toddler and baby eczema will need a steroid cream to calm the inflammation in the skin, where it looks red and angry, some of the time. Children get flare-ups of their eczema (when the skin looks worse) and steroids will help calm these flare-ups.

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Are steroid creams safe in toddler and baby eczema?

There are different strengths of steroids, and if used as directed, they are safe. Datasheets on strong (potent) steroids say these should not be used continuously without any breaks - however, it is generally accepted that sometimes you need to use potent (strong) steroids for long periods initially to get a response and you will need to restart as soon as the skin flares again (read more on "When should I use steroid cream?").

The strength of steroid used will depend on your child's age, the severity of the eczema, previous use of steroids and whether the eczema is acute or chronic.

Only 1% hydrocortisone (mild steroid) should be used on the face at any age unless prescribed by a specialist.

Potency of Steroid Preparations:

Class

Potency

Example

1

Very Potent

Dermol

2

Potent

Elocon, Beta, Locoid, Advantan

3

Moderate

Eumovate, Synalar, Aristocort

4

Miild

1% Hydrocortisone

Steroid creams only need to be used once a day for toddler and baby eczema.

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When should I use the steroid cream on my toddler or baby eczema?

Keep the steroid cream in reserve for when the skin is inflamed - looking red and angry. Don't apply to broken skin.

If you have a baby, a mild moisturizer like 1% Hydrocortisone cream will usually be tried first. For older children, a potent (strong) steroid may be started first

The steroid should be applied to red, inflamed areas usually after the daily bath. Start using the steroid cream on your the toddler or baby eczema as soon as the red inflamed areas appear and continue using until the skin is clear. Once the skin is clear of red inflamed areas, you can stop using the steroid but start using it again as soon as the skin flares up again. Initially, you will need to restart the steroid fairly soon after stopping but, over time, you will find that you are using the steroid for less days in a row and that there are longer periods between steroid use. Strong (potent) steroids can be used in this way as well as 1% hydrocortisone.

If your child has very problematic eczema, some dermatologists advise that you use the steroid on weekends even when the skin is looking clear - the aim is to keep the skin as free of redness and inflammation for as long as possible.

For best results leave at least 20 minutes between applying the moisturizer and the steroid cream (steroid cream first).

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What is a Finger Tip Unit (FTU)?

A Finger Tip Unit (FTU) is a way of measuring steroid cream. One finger tip unit is the amount of cream that can be gently squeezed in a thin line onto the last joint of an adult index finger.

As a guide, for baby eczema, one FTU is enough for the face and neck, or the hands and feet, or one arm. Double this amount for one leg, and four times the amount for back and front of the body. A toddler will need slightly more cream. See below for specific amounts.

There should be enough steroid on the skin to make it look shiny.

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How much steroid cream should I use on my toddler's or baby eczema?

The table below gives the number of Finger Tip Units (FTU) for different parts of the body at different ages. Otherwise just apply enough to make the skin shiny.

Age

Face & Neck

1 Arm & 1 Hand

1 Leg & 1 Foot

Trunk (front)

Trunk (back) incl buttocks

3 - 6 mths

 

1

1

1/2

1

1/2

1 - 2 yrs

 

1/2

1/2

2

2

3

3 - 5 yrs

 

1/2

2

3

3

1/2

6 -10 yrs

 

2

1/2

1/2

1/2

5

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Are there other treatments for toddler or baby eczema?

  • Probiotics given orally, like lactobacillus, have been tried with some success in some toddler and baby eczema
  • Oils, such as Evening Primrose Oil and Flaxseed Oil, have not been shown conclusively to improve eczema but they are relatively safe
  • There is a cream called Pimecrolimus (ProTopic, Elidel) which is not a steroid. Elidel 1% can be used in children for short-term treatment of mild to moderate eczema and for intermittent long-term treatment (up to 12 months). It can also be used in conjunction with steroids. It is not as powerful as strong steroids like Betamethasone valerate (Betnovate) and has similar strength to 1% hydrocortisone. It still needs to be used with emollients/moisturizers. Elidel can cause burning and redness when it is applied. This is generally mild and improves over the first 5 days. Pimecrolimus is good for facial and flexural eczema. The Food and Drug Administration (FDA) has issued a warning that pimecrolimus use may lead to cancer and so should be used with caution for toddler or baby eczema.
  • Tacrolimus is similar to Pimecrolimus but slightly stronger. It has not been shown to be superior to strong steroids but is equivalent in potency. It is not available in New Zealand. The Food and Drug Administration (FDA) has issued a warning that tacrolimus use may lead to cancer and so should be used with caution for toddler or baby eczema. It is often used in conjunction with steroids for problematic toddler and baby eczema
  • Very occasionally, strong medications taken by mouth (such as Prednisone, Cyclosporin A) or UV light therapy are necessary to control toddler or baby eczema but your child will need to be under a specialist for this.

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Will changing the diet help my toddler or baby's eczema?

Most children with eczema do not have a food allergy that is causing the skin rash and so changing the diet will not help. However, if you have a young baby with severe eczema, there may be an associated food allergy (the younger the child and the more severe the eczema, the more likely a food allergy).

In those children with allergy causing the eczema, they will usually get rashes or more extensive eczema soon after eating a particular food or drinking milk (in the case of babies). If you notice this, remove that food from your child's diet (if you have a baby, this will need to be done under supervision with an appropriate other formula). If there is a marked improvement on removal of the suspected food, then the food may have been the cause - cautious reintroduction of the food after 3-4 weeks will enable you to be sure. If on reintroduction of the food, the skin remains clear, the food can continue in the diet. If the skin flares up again, that food needs to be removed from the diet. In those toddlers who do have an allergy to a food causing eczema, a trial of reintroduction can be made in 6 - 12 months time as many children will grow out of these allergies.

Extensively hydrolysed cow's milk formula or an amino acid based formula have been shown to improve baby eczema (infants less than 6 months of age). However, only change your baby's milk permanently if there is a clear improvement. If there is no improvement after 4 weeks, go back to your normal feed as food allergy will not be a factor.

In infants over 6 months with milk allergy, a soya based milk could be tried first. If the reaction continues, then a trial of an extensively hydrolysed formula or even an amino acid formula could be tried. No improvement over 4 weeks on an amino acid formula means the food is not causative in the eczema and your baby or child can go back on a normal diet for their age.

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Can my child have all the usual immunizations?

Virtually all children with eczema can have their normal immunizations (including measles). This includes children who have not eaten egg and those with an egg allergy.

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Can my child go swimming?

Yes. Your child should shower after swimming if the chlorine or the swimming seems to worsen the eczema. Apply moisturizer after swimming and if necessary, before swimming as well.

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Why is my child's skin paler when the eczema heals?

In children with darker skins, the skin can look pale once the eczema heals and this can make the skin look patchy. Don't worry, the normal skin tone will return. This is not a permanent change.

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What else can I do for toddler and baby eczema?

  • Try and control scratching as this makes the eczema worse. Wet wraps may help
  • Keep you child's nails short and clean
  • Encourage rubbing rather than scratching
  • Consider cotton mittens at night to stop scratching
  • Use a moisturizing cream which is kept cool in the fridge before going to bed
  • Try and distract your child when she is scratching
  • Loose cotton clothing will keep your child cool and comfortable
  • Avoid excessive exposure to sun - wear a sunblock (at least SPF 20)
  • Avoid skin products that have perfume in them - buy unscented products
  • Some children benefit when house dust mites are reduced - for example, using a dust-mite proof mattress
  • Some children benefit from an antihistamine (anti-itch medicine) at night
  • Some people find non-biological washing powder better for the skin than normal washing powder
  • Some children benefit from "wet wraps" - this is a technique where wet bandages are applied to moisturized skin and then covered in bandages. They are very good at softening hard eczema skin and they stop scratching.
  • If your child's eczema becomes weepy, it may be infected and you need to see your doctor in case antibiotics are needed.

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What can I do to help prevent allergic conditions like eczema?

Breast feed your baby for at least 3 months (6 months is even better). In the past, we recommended a partially hydrolysed formula (eg. NAN HA, Karicare HA) for high risk infants, so those with a family history of eczema, who were not breast fed. However, this is no longer a recommendation and if you can't breast feed your high risk infant then just use a normal formula. If your baby has a confirmed cow's milk allergy, then your baby will need an extensively hydrolyzed or an amino acid formula - see the milk allergy page.

Delay the introduction of solids until 4 - 6 months of age. A recent study suggests there is no benefit delaying introduction of solids, (including eggs, dairy and wheat), until after 12 months of age but they should not be introduced before 4 months of age. So eggs, wheat and dairy can be introduced after 6 months. There is no need to avoid any foods unless there is documented allergy.

Taking probiotics for 2-4 weeks before delivery has shown a reduced incidence in eczema in infants, so you could take probiotics (like Lactobacillus acidophilus) during the last weeks of pregnancy.

Preliminary studies looking at giving probiotics (Lactobacillus acidophilus) to infants at high risk (those with an allergic mother) during the first six months of life have not shown conclusively any benefit in reducing eczema (atopic dermatitis) in those babies so there is no evidence to support giving probiotics to your baby at this time. However, they are unlikely to do any harm.

It is recommended that babies and toddlers are protected from tobacco exposure to help prevent allergic conditions.

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References

  • Bath-Hextall F. Atopic Eczema. Clinical Evidence. BMJ Publishing Group. June 2006
  • Angie L. Taylor, Janet A. Dunstan and Susan L. Prescott. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: A randomized controlled trial. Journal of Allergy and Clinical Immunology, Volume 119, Issue 1, January 2007, Pages 184-191
  • British Journal of Dermatology, 138, 293-296
  • Filipiak B et al. Solid Food Introduction in Relation to Eczema: Results from a Four-YearProspective Birth Cohort Study. J Pediatr 2007, 10.1016/j.jpeds.2007.05.018
  • M Tsang, RH Guy. Effect of Aqueous Cream BP on Human Stratum corneum in vivo. Br J Derm. Nov 2010. 163(5); 954-958
  • Management of atopic eczema in primary care. A national clinical guideline - Scottish Intercollegiate Guidelines Network (SIGN); 2011.

To go to the top of the Toddler and Baby Eczema page, click here

To read more about Wet Wraps, click here - wet wraps are particularly useful if your child scratches a lot, particularly at night or if she has thickened skin from scratching

To go to the Skin Rash page, click here

To return to the Home page, click here

Last reviewed 9 August 2012



Источник: http://www.baby-medical-questions-and-answers.com/baby-eczema.html

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