Eczema, also known as atopic dermatitis, is a common, chronic skin problem that causes intense itching and inflammation, and is characterized by flare-ups. Eczema affects about 17 percent of children, with 60 percent of cases beginning in the first year of life and 85 percent beginning by age 5.
In infants and young children, eczema is often an early sign of allergy problems, and 75 percent of affected children will go on to develop another form of allergy, such as asthma or hay fever. Often, eczema outbreaks are waning or have completely disappeared by the time respiratory allergy symptoms surface. In 25 percent of cases in young children, eczema is triggered by food allergies, such as milk or egg white. It has also been linked with the early introduction of solids to a baby's diet (before the standard 4 to 6 months of age).
Certain airborne allergens, such as dust mites and animal dander, can make eczema worse. Other triggers include: excessively dry skin (from low humidity, frequent washing, or harsh soaps); restrictive or wool clothing; fabric softeners; overheating and sweating; or saliva from drooling. While eczema occurs more often in babies with a family history, about 20 percent of children with eczema don't have a related food allergy or a family history.
Eczema has been called "an itch thatrashes" because itching is such a prominent symptom and the inevitable scratching further damages and inflames the skin. In babies, eczema typically begins as a dry, crusty rash on the cheeks and spreads behind the ears and to the scalp and body, usually sparing the diaper area. Infants may try to relieve the itching by rubbing their face against the crib sheet, irritating the skin. When a baby's skin is broken by scratching, bacteria and other germs on the skin surface can cause an infection. Fortunately, symptoms tend to improve as a child gets older, and in many infants, eczema has cleared completely by the time they're 3 to 5 years old.
Children with eczema often have high blood levels of the antibody involved in allergic reactions. Sometimes skin or blood tests are performed to identify food allergens that can aggravate the condition.
The toughest part of treating eczema is to break the destructive "itch-scratch" cycle that just makes it worse. Applying moisturizing creams frequently is your best bet here. When giving your baby a bath, use only mild soaps or non-soap cleansers. To prevent the skin from drying out, apply a thick moisturizer to the whole body immediately after patting your child dry.
Loose-fitting, 100 percent cotton clothing is recommended, including long-sleeved pajamas to prevent nighttime scratching. Use laundry products free of dyes and perfumes, and wash new clothes before your child wears them. Double-rinse clothing, towels, and bedding. While daily maintenance takes extra time, it's easier than treating a flare-up.
Your baby's doctor may also suggest that you eliminate a suspected food, such as milk or eggs, or try a low-allergenic diet for seven to ten days to see if symptoms improve.
If itching is severe enough to disturb sleep, applying cool, wet washcloths at bedtime can help. If necessary, a sedating antihistamine can be prescribed to help your baby sleep. When skin is inflamed, topical steroids may be given to reduce swelling. (These medications are given only for flare-ups because they can cause side effects when used too frequently.) Two new non-steroid, topical anti-inflammatory medications, Elidel and Protopic, have recently been approved by the Food and Drug Administration for use on children aged 2 and up, and studies suggest that these are safe for babies as young as 3 months.
If your child's skin becomes infected, oral or topical antibiotics can clear the infection and improve the skin condition. Keep your child's fingernails clean and short to prevent scratching and introducing bacteria.
Mothers of eczema-prone infants can reduce their baby's risk by breastfeeding and avoiding allergenic foods in their own diet. If you supplement breastfeeding, use a hypoallergenic formula. The risk of eczema is also reduced by delaying the introduction of allergenic foods in a baby's diet. To learn more, contact the National Eczema Association for Science and Education (800-818-7546).