Understanding your infant or toddler’s eczema
Eczema usually appears in the first six months to five years of a child’s life. In fact, as many as 10% of all infants in the US have some form of eczema. While there are a few different types of eczema that your infant or toddler can develop, the most common form is called atopic dermatitis (AD). AD is a chronic condition that starts with the immune system.
It’s important to understand which type of eczema your baby may have and also his or her symptoms and triggers. This will help you better treat and manage the condition as your infant or toddler grows, since some will continue to experience eczema as an older child and teenager. The only way to be sure your baby has eczema and what type, is to make an appointment with your doctor.
How did my infant or toddler develop eczema?
Like all many types of eczema, we don’t know the exact cause. What we do know is that infants and toddlers who develop eczema do so because a combination of their genes and environmental factors. When something outside the body triggers the immune system, cells go into overdrive and cause the skin to flare up in the form of rashes, redness and intense itching.
We also know that babies who come from families with a history of AD, asthma, or hay fever (known as the atopic triad), are more likely to have atopic dermatitis. Babies with atopic dermatitis are more likely to develop hay fever or asthma as they get older.
Eczema is not contagious. Your baby cannot “catch” it from another person, or give it to someone else.
Is eczema different for infants or toddlers, than it is for older children?
Eczema looks and acts differently in infants and toddlers than it does in older children. The location and appearance of eczema changes as they grow, so it’s important to know what to look for during every stage of your infant or toddler’s life.
- Babies (first six months) >
Eczema usually appears on the face, cheeks, chin, forehead and scalp. It can also spread to other areas of the body, but not usually in the diaper area, where moisture protects the skin. The skin at this stage also tends to look more red and “weepy.”
- Babies (six to 12 months) >
At this stage, eczema often appears on your baby’s elbows and knees — places that are easy to scratch or rub as they’re crawling. If the eczema becomes infected, it may form a yellow crust, or very small, “pus bumps” on the skin.
- Toddlers (two to five years) >
Around the age of two, your toddler’s eczema is more likely to appear in the creases of the elbows and knees, or on their wrists, ankles and hands. It may also appear on the skin around your toddler’s mouth and the eyelids. Your toddler's skin may start to look dry and scaly at this stage and become thick with deeper lines — this is called “lichenification.”
- Older children (five years +) >
Eczema usually appears in the folds of the elbows and/or knees. Sometimes, it’s only on a child’s hands — at least 70% of people have had hand eczema at some time in their life. Redness and itchy patches behind your child’s ears, on their feet or scalp, may also be a sign of AD. But these could also be symptoms of another condition, like seborrheic dermatitis, which can exist with eczema. See your doctor to identify what kind of condition your child has and determine the best course of treatment.
Are there things that can make my baby’s eczema worse?
The key to helping your infant or toddler stay healthy while living with eczema, is to keep the irritated skin under control. That’s why it’s good to know about the everyday “triggers” in your baby’s surroundings that might make their eczema flare up, or get worse.
Some of the most common eczema triggers:
- Dry skin
- Heat and sweating
- Allergens such as pet dander, pollen or dust
Your infant or toddler’s eczema may be worse in the winter when the air is dry. Saliva from drooling can also cause irritation on your baby’s cheeks, chin and neck.
Some baby’s triggers may also include allergens from pets and dust mites. Or they might be sensitive to some fabrics (like wool), cigarette smoke, or chemicals in the products we use on our body or in our homes (perfume, shampoo, laundry detergent, or air freshener).
Read more about the most common eczema triggers for children.
How can I help control my infant or toddler’s eczema?
It’s important to remember that every infant or toddler may be affected differently by eczema. The best way to manage his or her eczema is by getting to know their symptoms and triggers so that you can help keep it under control.
There are also some things you can do at home to help ease your baby’s eczema. But if the redness and rash becomes worse, or infected, your doctor might prescribe an antibiotic medication until it improves.
With all forms of skin products, you should look for the ones that are unscented and dye-free, so that you don’t further irritate your baby’s skin.
Some products to help manage your child’s eczema, and how to use them:
Moisturizers are classified based on the amount of oil and water they contain. The more oil in a moisturizer, the better it usually is at treating your baby’s eczema. All moisturizers — ointment, creams, and lotions — should be applied in a thick layer, at least twice a day. And, it is important to moisturize your baby’s skin within three minutes after bathing, so that the ointment or cream is most effective.
Ointments are usually the first choice for treatment. They have the highest oil content of all the products you can use to manage your baby’s eczema (followed by creams and then lotions), so they don’t generally burn when they’re applied to sensitive skin and are very good at sealing in moisture.
Saliva from drooling can cause irritation on your baby’s cheeks, chin, and neck. When this happens, you might try applying an ointment to help lock in moisture and protect these areas from further irritation. During the summer, you may want to treat your baby’s eczema with a cream instead of an ointment, in order to prevent what’s called miliaria, or “prickly heat.” This can sometimes develop after an ointment is applied when the weather is hot and humid.
Creams are second to ointment in the amount of oil they contain and are also very good at sealing in moisture. Lotions contain the least amount of oil and may have added preservatives that can burn when applied to skin that’s scratched or broken.
If you baby’s skin stings or burns after you apply moisturizer or while you are bathing them, switching from a cream to an ointment may help. Adding a cup of table salt to your child's bathwater, also may help reduce stinging or burning.
The Seal of Acceptance Product Directory can help you find the best and least irritating moisturizer for your child.
Very mild eczema can be controlled with a good bathing and moisturizing routine. Mild eczema may require some use of a low-potency topical steroid ointment. But most infants, toddlers, and children with moderate to severe atopic dermatitis will need to use a low or medium potency steroid ointment more regularly in order to control their symptoms. These are also called topical corticosteroids.
Steroid ointments are safe when they are used correctly. Your doctor or dermatologist can help you decide which one is the best for your baby’s eczema.
Some tips for safe steroid ointment application:
- Use the mildest steroid possible to control your baby’s eczema
- Only apply steroids to red, itchy, rough skin that is affected by eczema, and avoid contact with normal, unaffected skin
- Do not apply them to your baby’s skin folds (armpits, groin, thighs) if possible, especially for long periods of time
- Do not use them use on the eyelids
- Apply a milder steroid to treat the face
- Apply them no more than two times a day
- Enough steroid ointment should be used so that the skin feels “tacky” right after it is applied. It should absorb into the skin within a few minutes
- One of the two daily applications of steroid ointment should be immediately after bathing your baby
- Moisturizer should always be applied on top of the steroid ointment
The areas of your child’s skin that are affected by eczema may look lighter once redness clears. This is normal. The cells in your their skin that make color (pigment) don’t work the way they normally do when their skin is inflamed from eczema. The good news is these cells will recover, and the color in your child’s skin will improve over time.
Learn more about the topical corticosteroids used to treat your infant or toddler’s eczema.
Topical Calcineurin Inhibitor
If your toddler is two years or older, your doctor may suggest using a topical calcineurin inhibitor (TCI), such as Protopic ointment or Elidel cream. These medications help fight inflammation and approved for children in this age group. TCIs are sometimes used in rotation with steroids to treat infants.
Cleansers (like soap), additives (like bubble bath and epsom salts), and scrubbers (like loofahs and rough washcloths) can dry out your baby’s skin and further irritate it. For these reasons, you should avoid using soaps, additives and scrubbers when you bathe your child.
Cleansers should be unscented, dye-free and only used to wash your baby’s diaper area, or other areas of the body that are dirty. It is important to moisturize your baby’s skin within three minutes after bathing so that the ointment or cream you’re using is most effective.
The Seal of Acceptance Product Directory can help you find a cleanser for your baby.
Bathing and bleach baths
A bathing routine is the key to treating your child’s dry skin. Baths are usually preferred over showers and should be warm (not hot) and last fewer than 10 minutes.
If your infant or toddler has moderate to severe atopic dermatitis or a history of infection, your doctor might recommend bleach baths. Bleach baths are used to help prevent infection by controlling the amount of bacteria on the skin. For example, staphylococcus aureus “staph” is a common bacteria that lives on the skin of many children with eczema. A bleach bath can help control this bacteria so that it doesn’t cause an infection.
Bleach baths are safe — much like bathing in a swimming pool that contains chlorine. You can make one for your toddler or older child by pouring one-quarter cup of bleach into a bathtub filled half-way. For infants, you should use one to two teaspoons of bleach per gallon of water in a baby tub. Be sure to dilute the bleach before your baby’s skin comes into contact with it and avoid getting bleach water in their eyes.
Bleach baths are usually recommended a few times per week. And, it is always important to moisturize your baby’s skin within three minutes after any kind of bathing so that the ointment or cream you’re using is most effective.
Most gentle baby shampoos are safe and effective to use. Choose shampoos that are unscented and dye-free. The fewer the ingredients, the better.
The Seal of Acceptance Product Directory can help you find a shampoo for your child.
Gentle skin care, moisturizers and steroid ointments are effective treatments for eczema. If your child’s eczema does not respond to these, he or she may be a candidate for other kinds of treatment. It is important to talk with your doctor about the different options available and which one is the best for your infant or toddler.
Topical tar preparations can provide relief and oral antihistamines can be very helpful for some children with eczema. They can help reduce itching, but they also cause drowsiness.