Around 1 in 5 babies have eczema at some point, so there’s a good chance that many of you are scratching your heads over how to manage this right now.  A quick Google on baby eczema brings up literally 1000s of websites with different advice, leaving parents muddling through their questions such as is it ok to use steroid creams, do we need allergy testing, and would a humidifier help?

Add in the usual cocktail of advice from other people and it’s no wonder you might be feeling confused.

Everyone’s skin is slightly different when it comes to eczema. Although the principles of management are the same, another parent’s go-to cream will not necessarily be yours. Getting your baby’s skin back to the smooth, glowing look you desire for photos can be a journey. Happily, most families will get there, as long as you’re ready with time and patience.

Let’s look at a few things to help you arrive at your destination.

Is it eczema?

Eczema tends to start on the face and spread to other areas of the body, sparing the diaper area. Eczema is itchy, red, inflamed, dry patches of skin in caucasians. Eczema on black skin looks more like dark/greyish patches.

Once inflammation subsides, skin pigment can become darker or lighter. Known as post-inflammatory hypopigmentation, this will eventually subside once eczema is under control, but may take several months.

Is it teething rash or eczema?

Essentially they are the same process, as drooling of saliva causes dermatitis or inflammation from skin contact.

Seborrheic dermatitis is also incredibly common in babies. Sometimes difficult to differentiate from eczema, it causes red patches on the body. The rash is not itchy and usually accompanied by cradle cap.

What causes eczema in babies?

The “why” over eczema often overrides the “what to do” when it comes to parents’ questions. Unfortunately there isn’t usually one single reason.

The exact cause of eczema is unknown. Researchers think it is a combination of genes and environmental triggers.  Something external seems to “switch on” the immune system causing skin cells to flare up. Problems with the skin barrier lead to dryness and inflammation. Babies have a naturally fragile skin barrier, so dryness and eczema are common.

If there is a family history of asthma, eczema, or hay fever then it’s more likely (but not certain) your baby can develop eczema.

What triggers eczema?

Common triggers are pollens, animals, wool fibers (or anything scratchy), heat, or dry skin. Many parents want to know if a humidifier can help eczema. There’s no evidence that it will, but some people do find them helpful.

What about food and eczema?

Your instinct might be telling you it must be something your baby is eating, or something mom is eating and going into breast milk.

It’s just not that simple. There are two issues when it comes to infants: food and eczema.

Babies with severe eczema unresponsive to treatment may have cows milk protein allergy. Babies will often also have digestive symptoms. Treatment is via changing formula to extensively hydrolyzed formula milk or breastfeeding mothers going lactose (dairy) free. This should only be done under supervision of a physician.

Once weaning takes place, some foods can cause a flare in eczema. This can be tricky to detect as the flare is often a day or two later. Common foods to do this include milk, eggs, soya, wheat, tomato, and citrus fruits.

Worsening eczema following food is a separate issue from food allergies that cause more immediate reactions such as hives, lip and facial swelling, or breathing difficulty. These usually occur within 30 minutes of eating the trigger food. Reactions such as this must be discussed with your physician.

Should I change what I am eating if breastfeeding?

The American Academy of Paediatrics state that if there is a history of severe food allergies in your family then you might wish to avoid fish, eggs, peanuts, and other nuts. Evidence in this area is somewhat conflicting. Overall, it’s important to follow a balanced and healthy diet.

How should I manage my baby’s eczema?

Dermatological moisturizers (often called “emollients” by your physician) are absolutely key to management. Most people underestimate how often they should be using them. At least 4 times a day is good. After every diaper change is even better if your baby’s skin is particularly dry.

There are tons of different moisturizers out there, in gel, cream, or ointment forms. None of them are the “best;” the right one is the one that you use and which works.

Smooth on moisturizer gently in the direction of hair growth. Vigorous rubbing will disturb the skin.

Regular emollient may be enough to get on top of mild eczema.

If not, then your physician may recommend a short course of steroid cream or ointment. You may be alarmed at the word “steroid.” Myths abound about these: that they thin the skin, change skin pigmentation, or can get into the bloodstream.

While all of these side effects can occur with prolonged use of high dose steroids, the smaller dose of steroids commonly used for eczema are safe under supervision of a physician. In reality, many parents try to put off using steroids when they are actually needed, ending up with sleepless nights with itchy babies and prolonging the overall misery.

Physicians usually start with hydrocortisone 1%, the mildest steroid, unless the eczema is more severe. Steroids are applied in a pea-sized amount to the affected areas for the duration recommended by your physician. Leave at least 30 minutes before applying any emollient.

What about bathing?

Bathing should be no more than once a day, for 15 minutes in water that is lukewarm.

Bath oils have been traditionally recommended for eczema but recent evidence shows they probably don’t make a difference.

Wash skin simply with water or use one of the many emollients that are also soap substitutes.

Using baby shampoo for eczema is not recommended.

Pat skin dry after bath (don’t rub) and then apply emollient.

My baby is so itchy, what can I do?

Eczema is itchy by definition and scratching makes the skin more inflamed. Breaking the itch-scratch cycle can go a long way towards improvement. While it’s wishful thinking that we can just tell babies (or anyone) to just stop scratching, there are a few things you can do to minimise the damage.

• Keep your baby’s nails cut short.
• Apply emollient straight out of the fridge for a cooling effect or ask your physician for one of the anti-itch formulas.
• Many parents try mittens. These may work but you may find your child can pull them off!  Some recommend products such as ScratchSleeves that they claim are impossible for children to remove.

What are the natural remedies for eczema?

Most natural remedies have not been subject to scientific studies, however some parents report that coconut oil, sunflower oil, or calendula cream have helped. Colloidal (ground) oatmeal in a sock held under water running into the bath is reported to help some children with itch.

Don‘t despair

Parents often struggle with eczema due to the appearance itself, due to the time taken up applying creams and because a visible skin problem often means people give well-meaning advice which can often be very confusing.

Eczema is also often a condition that comes and goes, with flare ups that need managing more intensively, leaving parents disappointed that there is no cure. However, the long term outlook is good, with most children outgrowing their eczema with time.