Ask the Expert: How to Manage Your Child’s Eczema

If your child has eczema, you probably already know that caring for their skin can feel like a struggle sometimes. Whether it's the constant itching, poor sleep, regular flare-ups or the frustration of trying out different treatments, parents often find themselves questioning how to best help their children.

Our Consultant Dermatologist Dr Veronique Bataille has answered some questions you might have about eczema, along with some helpful tips that will hopefully help you and your child.

Q: Why does my child’s eczema flare up unexpectedly?

A: Eczema flare-ups can happen without warning, even when your child’s skin seems to be without symptoms for weeks or months. The causes of flare-ups can vary and include common triggers like allergens (dust mites, pollen, pet fur), harsh soaps or laundry detergents, or even stress. A true food allergy is rare in children but if you see a direct relationship between flare-ups and food intake try to keep a food diary. More often than not you might find irritant dermatitis from food smeared around your child’s mouth, which does not indicateva food allergy. 

Changes in the weather, especially in winter when there is less humidity from central heating, and less UV exposure, can make eczema worse. However, for some, excess humidity which causes sweating can make eczema worse. 

Safe limited UV exposure is usually good but not recommended for babies under 12 months. Understanding your child’s triggers is important as it can help you to avoid certain flare-ups. If you seek advice from a dermatologist, you can start using more effective treatments earlier. 

Q: How can I stop my child from scratching their eczema?

A: This is a tricky one, as we all understand the strong temptation to scratch an itch. On top of that, young children may not understand that scratching can lead to further irritation, infections, and thickened skin.

To help stop your child from scratching their eczema you could try the following:  

Keep skin well moisturised: This can help to reduce the urge to scratch by soothing dry, itchy skin

• Use distraction techniques: When appropriate, engage your child in activities like drawing and playing together, to keep their hands busy
• Choose comfortable clothing: Soft, breathable fabrics and even cotton gloves at night can help to keep scratching at bay during sleep
• Make sure you have the right strength of steroid for your child’s eczema as it is often under-treated. You can discuss this with your dermatologist but if the eczema flares straight after stopping the treatment or responds poorly, then you may need to upgrade the creams. Topical steroids have a bad press but if used as prescribed they are entirely safe and can be important for improved quality of life for parent and child

Q: Should I be worried about using steroid creams for my child’s eczema?

A: Many parents are concerned about using topical steroids, but as discussed above when used as prescribed, they are safe. You may want to scale up and see which one finally controls the eczema and then scale down to wean the skin off the steroids slowly. 

You should create gaps between treatments but avoid using the creams for only a day or two at a time as you need a length of treatment to maximise longer term response. Usually we’ll recommend that you use the steroid creams for up to 2 weeks but some severe eczema may need a little longer during the weaning off phase. 

If you're still worried about long-term use, ask your dermatologist about non-steroidal alternatives or additional treatments that can complement steroid use.

Q: How do I identify what’s causing my child’s eczema flare-ups?

A: Looking for triggers can be one of the hardest parts of managing your child’s eczema. More often than not, it’s a combination of factors rather than just one thing. A good first step is to start a diary that tracks diets, skincare products, and lifestyle and environmental factors that might coincide with flare-ups.

Common triggers might include:

• Environmental factors: Dry air, synthetic fabrics, and even certain household cleaners can sometimes cause irritation. A dusty environment with lots of house dust mites can also be an issue for some children. Avoid disinfecting all surfaces and being overly-hygienic as children need to be exposed to normal microbes which will protect them against flares. This is why children in large families, especially with pets, tend to experience less eczema
• Skin care products: Fragranced lotions, bubble baths, soaps, and detergents can irritate your child’s sensitive skin. However, lack of moisturising is often the most common cause of dry skin. Avoid bathing your child daily if their skin is particularly dry, as water can strip the oils from the skin and make eczema worse
• Foods: Dairy, eggs, nuts, and gluten might cause a flare-up, but food allergies are in fact rare and most flare-ups have nothing to do with food. Testing for food allergies is not commonly recommended in children with eczema unless the history is very clear about a potential food. Clinics for food allergy are not easily available in the NHS, o reven privately. 

Q: How can I help my child to sleep better with eczema?

A: Eczema flare-ups often get worse at night when the child may be hot so avoid covering them too much, causing your child (and you) to have a more broken night’s sleep.

Here are a few things you can try:

• Massage and moisturise: After a bath and before bed, massage emollient or eczema-friendly moisturiser into your child’s skin, as this can feel soothing and relaxing
• Choose comfy bedding: Use cotton sheets and pyjamas that will keep irritation to a minimum. Avoid synthetic fabrics. For severe eczema there are some silk tops and leggings especially designed for helping eczema at night. 
• Keep the bedroom cool: When the room is a comfortable, cool temperature this may prevent your child from getting too warm, which can irritate eczema. Humidifiers can also help in the winter when central heating is needed. You should avoid leaving the thermostat too high in the bedrooms, and windows can be opened at night when the temperatures allow. 

Q: Can eczema be triggered by stress in young children?

A: Yes. While stress is often thought of as a trigger in older children or adults, it can also affect younger ones, especially if they’re going through big changes (like starting school, or dealing with a house move). While these are parts of life, identifying how emotional stress can increase inflammation and cause flare-ups can help you to prepare your child for the changes, and manage their symptoms more effectively.

Try these things:

• Create a relaxing bedtime routine: Consistent routines can help to reduce stress, and create special time for you and your child
• Gentle activities: Plan some easy activities like reading, drawing, and playing outside with your child, which can help to reduce anxiety

Q: What should my child eat if they have eczema?

A: Diet can play a role in eczema flare-ups but it is not in fact the allergies which are likely to be an issue as these are actually rare.  The most important thing about food is to make sure that, when your child is old enough to switch to food, you use fresh food and avoid ready made baby food. 

It is important to introduce a healthy, varied diet to make sure you child’s palate is used to new food as this will create a good diverse gut microbiome which will help to control eczema. Ready-made baby foods often have too much sugar, salt and also contain preservatives which should be avoided. 

Avoid restrictive diets in babies and young children unless absolutely necessary for well documented allergies. Restricting foods may cause deficiencies and is likely reduce the diversity of the gut microbiome early in life. 

Q: How can I help my child feel better about their eczema if they’re self-conscious?

A: As children get older, they may become more aware of how their eczema affects their appearance, which can lead to feelings of embarrassment or frustration. To help your child cope. However, the good news is that the eczema usually clears in childhood. 

Here are some tips for helping your child with eczema flare-ups:

• Talk: Let them know it’s okay to talk about their feelings and reassure them that eczema is a common condition that many children have, and it’s nothing to be ashamed of
• Focus on the positives: Help your child to feel good about their strengths and the things they enjoy, rather than focussing on the appearance of their skin
• Find support groups: Connecting with other parents and children who have eczema can be very valuable, as you’ll gain the support and experience of people who are in similar situations to you

Q: When should I seek help from a dermatologist for my child’s eczema?

A: If you’ve tried over-the-counter treatments, but your child’s eczema doesn’t seem to improve or gets worse, it may be time to see a dermatologist.

They can help develop a personalised treatment plan for your child that addresses any underlying possible triggers. Early intervention can help prevent the condition from worsening, improve your child’s quality of life and empower you to make the right choices for your child. 

Visit our London clinic

If you’re at all worried about your child’s eczema, we’re here to offer our expertise and help. Our Consultant Dermatologists can offer weekend and after-school appointments to suit you. Please email admin@themedicalchambers.com, call 020 7244 4200, or make an appointment online.