Eczema, also known as dermatitis, is a genetic skin condition that can be exacerbated by allergies, a depleted or fragile skin barrier, and certain triggers in the sufferer's environment. In babies, it can appear from about three months after birth. It typically shows on the cheeks first. It can be an incredibly distressing condition to observe in a child who is not yet verbal. Managing eczema in babyhood is also challenging, as their skin is especially delicate, and medications that may be offered to adults and children, such as oral corticosteroids, are inappropriate for babies under twelve months. It is relatively common in babies, with the American Academy of Dermatology Association estimating that around one in five worldwide are affected. As it tends to run in families, learning about it with your first baby can prepare you for future cases as you have more children, though triggers and severity can vary. It is important to seek treatment for baby eczema and create a management plan with your doctor as soon as you notice it.

What does eczema look like?

Eczema is a red and itchy rash that appears in patches that can become inflamed (flare up) as a result of environmental triggers. Scratching it can also cause inflammation and bleeding. It can appear anywhere (or everywhere) on the body but is particularly common in creases (the backs of the knees, for example), and in babies it often starts on the face.

So, how can parents manage baby eczema?

Before giving you our tips, Unii would like to recommend keeping a skin diary for your baby if you can. The skin can change quite quickly in response to different substances and behaviours and every eczema case is different. You will save a lot of time going through things with your doctor if you can give them up-to-date information about your child’s physical responses and comfort level.

Get your baby’s hygiene routine right.

Keep your baby’s baths short (between five and ten minutes) and lukewarm. Wash (never scrub) them gently with soap-free, fragrance-free cleanser.
Emollients, or medicated moisturisers, need to be applied regularly (twice daily or as often is needed to provide relief). A baby with eczema will have a depleted natural moisture barrier that needs support from these creams, which tend to contain rich, fragrance-free ingredients like white paraffin, petrolatum, mineral oil, and dimethicone. These are frequently inexpensive and do not require a prescription. You may wish to buy large tubs or bottles to keep at home.
Keep your baby’s nails short and clean.
Keep your baby's sheets and clothing clean with non-biological detergent and change them regularly. Clothes and bedding coated in emollients are a fire hazard.

Look for triggers.

There is a long list of potential eczema triggers that may result in short-term flare-ups or a general worsening of the problem. These can, but do not always include:

Drying and irritating skin care products with soaps, fragrance (including natural fragrance), non-fatty alcohol (sometimes listed as alcohol denat. or SD alcohol on product ingredient lists), exfoliants, colours, aromatherapy oils and their derivatives (e.g., lavandula is a fragrant derivative of lavender oil), and sometimes lanolin. Lanolin is a tricky ingredient for eczema sufferers, as some react well to it and others do not. As there are so many other 100% safe emollients available, you may find it easier just to use alternative creams or balms on your baby.
Pet dander
Dust
Eggs, nuts, soy, gluten, or milk
Biological clothing detergents
Extreme temperature changes
Synthetic, picky, or abrasive fabrics
Stress
Cuts or infections in the skin
Cigarette smoke
Saltwater or chlorinated water

Should I change my baby’s diet to improve their eczema?

Your baby will typically be on breastmilk or formula for the first six months. Formula is not thought to cause eczema flare-ups, though parents of babies with severe eczema may be advised to switch to a product with hydrolysed (or pre-broken down milk) proteins, which can be less inflammatory.

While some studies show breast milk protects against allergies and eczema flare-ups, others suggest it has no impact. Speak to your doctor before trying something like an elimination diet to remove traces of any food you are worried about from your breastmilk.

While weaning your baby, you will likely be carefully checking their reactions to new foods to ensure they do not have a food allergy. As mentioned above, foods can trigger eczema flare-ups in some sufferers, while others do not react to them at all. There’s really no need to narrow your child’s food selection unless you’re certain a food is a problem.

How can I stop my baby’s skin from itching?

Bathing in raw, unflavoured oats, avoiding irritating skin products and clothing, avoiding temperature extremes, and keeping your baby’s skin well moisturised as described above can all help with itching. Hydrocortisone cream may be recommended for babies under one for a short time under a doctor’s supervision to regain control of severe eczema. Do not apply ice to itchy areas of your baby’s skin.

Can my baby take antihistamines for eczema?

Eczema itching is not caused by the release of histamine, so antihistamines will not help. In addition, babies under one should not take antihistamines of any kind unless it is prescribed by a doctor.

What if my baby’s eczema is weeping?

Weeping means your baby’s skin is oozing clear or yellow fluid. It can be a sign of infection and should be seen by a doctor in the first instance. Wet bandages may be recommended for treatment and relief, but it’s most important the area be checked to keep any potential infection from getting worse. A baby with bleeding eczema needs medical attention. If an eczema flare-up is not bleeding or weeping but has lasted for two to three days, you should also seek medical help.

My baby has eczema and is weaning. Is a child with eczema more vulnerable to food allergies?

Yes, a baby with eczema is more likely to develop a food allergy, though many do not. It’s also worth noting that eliminating allergens alone will not improve your baby’s eczema if they have an allergy of any kind, not just food-related, though it may prevent flare-ups. The skin condition will always need conventional management through moisturisers and other anti-inflammatory efforts.

Do I need to get rid of the family pet to improve my baby’s eczema?

Pet dander is a known eczema trigger and isn’t just on your pet’s body—if you have a pet that wanders around the house, they could be shedding anywhere. Not all pets have dander; it’s really just the cuddly ones—dogs, cats, rabbits, etc. Getting rid of a family pet can be heartbreaking, but a reptilian or aquatic alternative may be healing in more ways than one.

Do I need to get rid of the carpeting in my home to improve my baby’s eczema?

The UK’s National Eczema Society suggests removing carpets from your home if your child has severe eczema. Carpet can harbour dust mites and other allergens in a manner that’s hard to clean thoroughly on a regular basis. Vinyl, hardwood, and resin flooring can be mopped and steam-cleaned every day.

How should I choose clothing that won’t irritate my baby’s eczema?

Extremes of temperature in either direction can cause eczema flare-ups, as can certain fabrics, so it’s very important to dress your baby appropriately. Cotton or any other natural fiber, apart from most kinds of wool, is best right next to the skin. Fine merino wool clothing is safe on skin with eczema.

Will my baby outgrow eczema?

Many children will outgrow eczema by the time they start school, but this is not guaranteed. More than fifty percent of people with eczema have an additional genetic problem that makes them deficient in filaggrin, a protein that forms part of the natural moisture barrier that seals and protects the skin. Those people will have eczema their whole life; even if it appears to be gone, it can return as a result of environmental and other triggers. Your family history can be instructive, and it’s always worth speaking to relatives who’ve suffered from eczema about what’s worked for them. The longer a child has eczema or any chronic condition, the more important it is to seek support for their mental and emotional wellbeing, as well as your own if necessary. Many parents describe watching a baby struggle with eczema as traumatising. According to the American Academy of Dermatology Association, if your child still has eczema by the time they begin school, you should seek to make a plan to help them avoid triggers and speak to their teacher about it before term begins.

For more advice on keeping your child healthy in their first year of life, check out Unii’s Baby Health Journey with Dr. Su Laurent.

How can I manage my baby's eczema?

Unii looks at managing this common and very distressing chronic condition in babies.