Eczema in babies and young children: causes, symptoms and treatments

What causes eczema in children?

Eczema is a chronic inflammation of the skin (it is sometimes called dermatitis). The skin is very dry and then becomes red and inflamed and itchy.

This leads to what is known as the 'itch-scratch cycle' – your skin itches so you scratch, which makes the skin more itchy, which makes you scratch more, and round and round it goes.

Over time the affected skin can become thickened. It can crack or blister and may become weepy and infected.

On darker skin, the redness may not be as apparent and the patches of eczema may look darker brown, purplish or grayish in colour. There may also be small bumps under the skin.

Doctors don’t know precisely what causes eczema. Atopic eczema is the commonest form of eczema. Atopy is the medical word for having a genetic predisposition to develop eczema, asthma, hayfever and allergies, and it tends to run in families.

There are many different types of eczema, and these include:

Discoid eczema – eczema that occurs in circular or oval patches
Contact dermatitis – eczema that occurs when the body comes into contact with a particular substance

Where do patches of eczema usually appear?

Eczema tends to occur on what are called the 'flexural surfaces' of the body, though it can occur anywhere. Flexural surfaces are areas where the skin and joint flexes – so the inside of elbows and wrists, the back of knees and front of the neck. It is also very common on the face, especially around the eyes.

How can I try to stop my child’s eczema flaring up?
Avoid anything which could be irritating their skin. Sometimes flare-ups happen for no reason, but they can be related to an irritant, for example soap or bubble bath, which dries out the skin. Use soap substitutes to clean your child
Avoid fabrics that irritate the skin, such as scratchy wool, and stick to light clothes made of natural fibres
Keep a diary of what is happening when your child’s eczema flares, for example, what they've eaten, is it cold or hot weather, or have they been around a cat or dog,
Hard as it can be, you need to try to stop your child scratching their eczema, as this sets off the itch-scratch cycle
Your child may scratch in their sleep so keep their fingernails short and use anti-scratch mittens on babies

How is children's eczema treated?

The main treatment for eczema is to moisturise, moisturise and then moisturise some more. Putting moisture back into the skin not only treats the existing eczema but also helps to prevent flare-ups.

I often see patients – both children and adults – whose skin improves, from using moisturisers or steroid ointments/creams so that they stop using the emollients but then their eczema flares up again.
Dr Philippa Kaye

Your GP can advise you on the types of emollients (moisturisers) to use on your child’s skin to prevent and treat flare-ups. These tend to be unfragranced and free of any skin irritants. They may need to be applied many times a day.

Creams are thinner than emollients and so need to be applied more frequently. Ointments are greasier and often better for eczema, even though they can be messier.

If your child cries or gets distressed when you apply a cream, it may be that it stings on their sore skin. In this case, try an emollient to see if that is less painful.

You can’t use too much emollient – every time your child’s skin looks dry it has sucked up all the moisture and needs more. You may well need a tub for nursery, one for home and one for journeys.

You may also find that you use different emollients for different purposes, for example a soap-substitute emollient and then an emollient cream/ointment after your child’s bath and throughout the day. Or you may use a cream in the day but a greasier, thicker emollient at night.

You may notice that emollients have a fire warning on their label. Don't worry, emollients are not flammable, and they are not flammable on your child's skin. But dried emollient residue on clothing and bedding can be flammable if it comes into contact with a naked flame. Please don't abandon your child's emollient routine – the risk of an emollient-related fire is extremely low. Just be vigilant if your child is around anyone lighting a candle or a cigarette (as you would be anyway). And wash your child's bedding and clothes frequently to reduce the build-up of emollient residue.

Why are steroids used to treat childhood eczema?

Your GP will often prescribe steroid creams/ointments to control flare-ups and to reduce inflammation. They will usually start your child on a low-dose steroid, but if there is no improvement after a few days, they may increase the strength. The steroids are used for approximately a week at a time.

In general, you apply emollients every day but only use topical steroids when there are flare-ups.

There are different regimes, but mostly you apply the emollient and then wait 30 minutes to allow it to soak in before applying the steroid cream/ointment.

Topical steroids – those applied to the skin – are usually used once a day, sometimes twice.

Short courses of topical steroids tend not to have side-effects, but if they are used for long periods or in high doses they can affect children’s growth. If your child is on high doses of steroids their growth will be monitored.

When does my child need to see a GP?

The answer depends on your child’s skin, and how they and you are managing their eczema.

If you are using emollients regularly and their eczema is under control, then there is no need to see a doctor, but if they are getting flare-ups and what you are using is not working then please do see them.

Eczema can become infected, so if the skin becomes very red and angry, perhaps with yellow crusting or oozing, or if your child becomes unwell, then you need medical advice.

It can be very upsetting to see your child scratching and becoming distressed due to their itching and scratching, but there are multiple treatments for eczema. If the creams and ointments don’t work, then your GP is likely to refer you to the local paediatrician or skin specialist to explore other options.

You may feel like you are drowning in emollients, but they really do help and in most cases children’s eczema improves as they get older.

What about food allergies and eczema?

In some children a food allergy may be making their eczema worse. But please do not eliminate foods from your child’s diet without seeing your GP first.

You are likely to be asked to make a food-symptom diary for your child over a period of weeks to try to identify any likely triggers in your child’s diet. Your child may be tested for food allergy, and this could include cow’s milk, eggs, peanuts or wheat.

Depending on the results, and the other treatments your child is getting for their eczema, you may then be advised to remove these foods from your child’s diet.

About our expert Dr Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.