Helping Kids Cope with the Anxiety of Eczema Treatment

Cherilyn Garcia, from Los Angeles, is a mother of three children with atopic dermatitis. Having been diagnosed with eczema as an infant herself, she deeply understands the itch, the flares and the way topical steroids prescribed to heal dry, cracked skin can sometimes make it feel worse. Naturally, she also understands why kids try so hard to avoid their treatment. 

“They’ve all had anxiety about [steroid creams],” Garcia said of her children. “And they’ve each had their own way of showing it.”

When Nolyn, 12, and Joaquin, 11, had frequent flares when they were younger, applying their medication was a daily struggle, Garcia said. Nolyn would outright refuse the cream for the patches on her face. And Joaquin would constantly wash the cream off his hands, making them drier and creating a painful cycle of hand washing and reapplication. 

Jonas, 6, has the severest eczema of the three, with flares all over his body. “Jonas has a sensory type of anxiety and is very particular about the clothing he wears and the way it feels on his skin,” Garcia said. He also has a “manic energy” when the cream triggers more itching, and often feels angry, sad or moody before and after his treatment.

To help the kids cope, Garcia and her husband, Jason, have successfully used strategies like: explaining the science behind eczema, steroid creams and skin barriers; layering coconut oil and Aquaphor under the steroids to ease irritation; and simple distraction to remove their focus from the pain and discomfort post-application.

These days, Nolyn and Joaquin’s eczema — and treatment anxiety — are under control with the rare flare triggered by changes in weather and food allergies. 

Why children feel anxiety about treatment

The Garcias aren’t alone. Whether it’s creams, pills, needles, injections or bleach baths, it’s common for children with eczema to feel anxiety about their treatment. 

“[The anxiety is] often about not knowing what to expect, doing things that are uncomfortable or painful and a fear of pain,” said Jennifer Moyer Darr, a licensed clinical social worker at National Jewish Health in Denver, Colorado.

To learn more about treatment-related anxiety in children with eczema and how their caregivers can help them cope, we spoke with Darr and Stephanie Mejia, a certified child life specialist at Sala Institute for Child and Family Centered Care at NYU Langone. Here’s what they had to say.

What are some ways treatment anxiety manifests in children with eczema? 

Jennifer Moyer Darr (JMD): Some children fixate on the treatment by talking about it, refusing, repeatedly asking the same questions and thinking or worrying about it even when doing other things. When very anxious, children may cry to the point of having difficulty catching their breath or vomiting. Some children try to hide or physically resist the treatment. And others may draw pictures about it or even have nightmares.

Are there specific types of eczema treatments that cause more anxiety than others?

JMD: Common treatment anxiety tends to stem from the soak-and-seal approach, wet wraps, and biologics or injectable medications. For soak and seal, many children report that the water or topical treatments hurt or sting. This is especially true when their eczema is in the moderate-to-severe range. Some children are anxious or embarrassed about others seeing them in the wraps. Wet wraps can also be anxiety producing for children with sensory issues. Many children have a fear of needles and therefore, injectable treatments can also cause significant anxiety.

How do parents unknowingly contribute to their child’s anxiety? 

JMD: Children are very perceptive and can pick up on parental tension and stress. This can exacerbate their own thoughts and worries and can also create anxiety where none previously existed. Parental word choices can also contribute to anxiety. If we talk about the treatments negatively, it sends the wrong message. Comments about treatment being “terrible” or “torture” or treatment costs making one “go broke” exacerbate children’s angst.

How can parents distinguish between typical treatment-related discomfort and more serious signs of distress in their child? 

JMD: Anticipatory anxiety is not uncommon when we do something new or know we have to do something we dislike. Typically, this decreases once we do something a couple of times. If the level of distress increases or doesn’t decrease with exposure, it may be a more serious issue. If attempting to provide treatment results in a panic attack, physical or emotional outbursts such as hitting or threats of self-harm or shutting down and withdrawal, please talk with your provider and a therapist.

What are some strategies or techniques parents can use to help ease their child’s anxiety during treatment? 

JMD: Being honest about what to expect and explaining it in age-appropriate language can be very helpful. Maintaining a consistent routine related to the care and treatment, and using both distraction techniques and positive reinforcement can all be helpful. Also, giving age-appropriate choices can be empowering. But be careful to only provide a couple of options that are equally acceptable.  

Stephanie Mejia (SM): Acknowledge the discomfort and explain the reason behind the treatment — children understand way more than we think. Share what you have been noticing when they scratch and what they can look forward to when they are on treatment. 

And make a plan surrounding the treatment. If it involves receiving an injection, creating a coping plan is usually helpful. That could be counting, watching something or squeezing a stress ball. Create “first and then” phrases for the plan. For example, “First we’ll put the ointment on, then we will have a dance party.”

A coping plan can be adjusted at any time. The best thing about it is that it’s yours. For example, if your child does well with treatment at night rather than the day, see if the plan can be adjusted. If your child does better with injections in your lap, then advocate for them to sit with you.

Are there any alternative or complementary therapies that can help? 

JMD: Parasympathetic-inducing techniques such as biofeedback, diaphragmatic breathing and mindfulness can be very helpful. I’ve also found that self-hypnosis and cognitive behavioral therapy can also be very helpful, especially using reframing techniques.

What role do healthcare providers play in treating this type of anxiety? And when should a parent seek a doctor’s help? 

JMD: Healthcare providers can explain the treatment to the child in a developmentally appropriate way. Knowing what to do, why they’re doing it, how it may feel and how they may react can be very helpful. I often tell children, “Some kids tell me it’s uncomfortable at first but quickly helps them feel better.” Or, “Some teens have told me that the injection burns for a couple of minutes but they prefer that to all the skincare and itching.” 

Some anxiety is normal as they start a new treatment intervention, but if it doesn’t decrease, parents should consult with their doctor. It’s also never too soon to talk to a therapist familiar with the treatment. Often, we can help address potential challenges before they occur.

SM: You should feel comfortable partnering with your healthcare provider and discussing any concerns. It’s probably best to seek a doctor’s help if the anxiety is interrupting your child’s daily activities.