Ask the Ecz-perts: Mental Health and Children With Eczema

In this edition of Ask the Ecz-perts, we discuss what parents should consider when trying to decide if their child with eczema might benefit from seeing a mental health professional. Studies show that children with eczema are much more likely to develop anxiety or depression and to experience lower self-esteem. 

Our experts include: Lisa Lombard, PhD, a licensed clinical psychologist who practices in Chicago; Jennifer Moyer Darr, LCSM, a licensed social worker with the National Jewish Health organization; and Morgan Maier, PA-C, a dermatology physician’s assistant at Seattle Children’s Hospital.

For a young person with moderate to severe eczema, what are the benefits of talking to a therapist?

Jennifer Moyer Darr, LCSM (JMD): Sometimes just having a safe place to share your feelings is enough. Normalizing a child’s emotions and experiences is immensely helpful. Learning to relax and calm your body can help kids with eczema decrease their itching. For older children, we often focus on issues related to relationships, individuation and taking on responsibility for their own healthcare needs. We also work on building their self-esteem.

Lisa Lombard, PhD (LL): Talking with a therapist can help a young person build coping skills for managing stress and anxiety. This can also really improve sleep. Some therapists may also use role-playing to practice social scenarios where the child may often receive blunt or hurtful comments from other children; this can help the child feel more comfortable in social situations like school, sports and parties.  

Morgan Maier, PA-C (MM): Having someone to talk to – who isn’t a parent or guardian, or even a friend – is helpful because it creates a safe space: there may be a social dynamic with the parent that prevents the child from being forthcoming about their own concerns and issues with atopic dermatitis (AD). In that safe space, the child can discuss with the therapist how AD is impacting their life.

What are some indications that a child with eczema might benefit from mental health counseling?

JMD: It’s not unusual to see increased anxiety and depression in children with eczema – especially when it is moderate to severe. Pay attention to whether your child is withdrawing from friends and activities, talking negatively about themselves or expressing anger at their illness. 

Passive suicidal ideation is scary and not uncommon, but this is a mental health symptom that needs intervention. Passive suicidal ideation is thinking about dying or a desire to be dead, without a plan or intent to act on it. Comments such as “my life would be easier if I were dead” can show how overwhelmed and sad some children become when managing their healthcare needs. If a child or loved one ever has active suicidal ideation, this requires immediate attention. Call 911 or your nearest emergency room.

LL: Parents need to consider whether their child’s behavior is interfering with their daily functioning. If your child is demonstrating any of the following, it’s a good indication that they need some degree of mental health support: 

• Isolating (and used to be more social);
• Irritable and negative (compared to neutral to positive mood);
• Unexpectedly crying and tearful;
• Having sleep problems;
• Quick to anger in ways that are excessive and even destructive;
• Unexplained decline in school work;
• Regression, i.e. behaving in ways more typical of when they were younger;
• Self-harming; or
• Expressing hopelessness.

What questions should parents be asking themselves to better understand their children’s mental health as they enter the “tween” or teenage years?

MM: As kids get older, it can be harder to connect and figure out how they’re doing for a wide variety of reasons, including the typical tween/teen desire for autonomy. For parents of tweens/teens who live with eczema, ask yourself the following questions:

• Are they participating in the activities they normally like, such as sports, art, hanging out with friends? 
• Do they mention or point out when they see someone with good skin?
• Do they keep their skin covered even in warmer weather? 
• Do teachers express concern about your child sleeping in class, itching in class, having outbursts or withdrawal from social interactions? 
• Are they searching the Internet for solutions for their skin? 
• Are they displaying signs of stress and anxiety like picking at the skin, pulling at their hair or other hygiene changes?

Having a safe place to have a sounding board, where there is no judgment, is essential and can also help young patients with motivation, stress reduction techniques, goal building and other tools to help young people be successful in treating their eczema.

Is family therapy a good option?

JMD: Family therapy helps everyone understand each other more effectively. Sometimes it’s easier when we have a neutral party to help parents figure out what drives certain behaviors. And don’t forget to involve siblings: they often have their own feelings about how one child’s eczema may impact the whole family’s dynamics.

LL: Family therapy helps parents express support, concern and share difficult feelings. I would emphasize a team mindset and talk about how parents are “coaches” to support and encourage children to make lifestyle changes that can reduce their flare ups. For younger children, it could be the sole method of treatment. For tweens and adolescents, family therapy is a good idea on an intermittent basis to complement individual therapy sessions.

What should a parent consider when looking for a therapist for their child?

JMD: Finding a therapist with eczema experience is ideal. Ask your eczema provider for recommendations, as they may know people in the healthcare community. Finding a provider who at least understands and works with chronic health conditions is your next best option; still, you may have to provide them with some education specific to your child’s healthcare issues. You’ll also want to consider providers who are in network with your insurance. Not all plans have mental health coverage, but depending on the plan, and the individual’s needs, therapy can sometimes be billed with what’s referred to as a “Health and Behavior Code.”

LL: Look for someone who is a licensed clinical practitioner. The younger the child, the more important it is for the parents to be involved, too. Some children, tweens and older, may appreciate a therapy group with their peers, as they would be able to see that other teenagers their age experience similar emotions. 

MM: Many practices now have screening questions to help ensure that a child and therapist are a good fit. Parents should consider what they can fit in their child’s schedule. Is video therapy easier or is it preferable to meet in person? Does the family prefer a provider with experience in the LGBTQ+ community? Does the age or ethnicity of the provider matter to the family? Having a therapist that fits with what the family feels most comfortable with is very important.

What if your child is reluctant to see a therapist?

MM: If your child is reluctant to see a therapist, encourage an honest conversation. Ask them questions about why they don’t want to go. What are their fears about therapy? Is there a stigma? Acknowledge with your child that it can feel weird or foreign to talk to a stranger about personal issues and that it’s normal to take it slow until they gain trust with the therapist. It’s okay that the child may not want to really open up right away, that it takes time. 

JMD: I sometimes tell parents: “you may be able to force them into the car, but you can’t force them to talk.” Many children don’t want to talk or scowl at us through their first session. Often children don’t understand the concept of therapy and view it as a consequence to something they did or something about them. Try talking through the benefits of therapy. Agree to a set number of sessions. Let the therapist know about your child’s reluctance in advance of the meeting and share some suggestions about what may help your child feel more relaxed in the meeting.

Do you have a question for our ecz-perts? Email them to editor@nationaleczema.org.