What is baby eczema? What does it look like? How can you manage baby eczema, and reduce flare-ups? How is eczema related to food allergies?
This complete guide to baby eczema will cover all you need to know about baby eczema symptoms, care, and management.
What is Baby Eczema?
Eczema (or dermatitis) is a general name for several skin conditions that cause the skin to become inflamed. Types of eczema include atopic dermatitis, seborrheic dermatitis (cradle cap), and contact dermatitis.
The most common type of eczema is atopic dermatitis, which causes red, dry, and itchy skin. Atopic dermatitis affects between 10% and 20% of children, according to a 2014 study. It largely affects babies and children under five years of age. (We’ll refer to atopic dermatitis when we talk about eczema throughout this article.)
What exactly causes atopic dermatitis to develop is still unknown, but we do know that it involves both genetic and environmental factors. We also know that it involves the immune system. (Some theories suggest that a malfunction in the immune system causes skin barrier breakdown, and leads to eczema).
Learn more about baby eczema from Mustela and Board Certified Dermatologist Dr. Latanya Benjamin:
Eczema causes a baby’s skin barrier to become compromised, making it easier for irritants to enter through the skin barrier.
Samantha Casselman, Certified Pediatric Nurse Practitioner, program director for the Severe Eczema Clinic and Eczema school at Phoenix Children’s Hospital, and recognized “Ecz-pert” for the National Eczema Association, explains eczema like this: At a skin level, skin without eczema has an intact skin barrier, similar to a strong brick wall. But the skin of a person with eczema has a compromised skin barrier, like a brick wall with “missing mortar.”
An eczema baby’s skin barrier is not as strong, so bacteria and allergens can easily get through. This causes inflammation, or a flare-up, beneath the skin when the skin is exposed to certain irritants.
Eczema could appear anywhere on the body, including the face, scalp elbows, knees, joints, arms, legs, and torso.
What Do Eczema Symptoms Look Like?
Eczema (atopic dermatitis) causes inflamed, dry, red, and itchy skin. It can cause patches of dry or red skin, itchy and rough skin, or crusty bumps and scales that sometimes leak fluid, to develop on the body. If eczema areas get infected, they could become yellow.
In children with darker skin, eczema will still cause inflamed, dry, and itchy skin, and sometimes cause bumpy scales to develop. But eczema areas won’t be red. Instead, eczema will cause patches of dry skin that are dark brown, purple, or gray. These patches are often harder to see than eczema patches on lighter skin.
Source: Eczema Foundation
When the symptoms of eczema suddenly appear or get worse, this is called an eczema flare-up.
Eczema flare-ups will usually appear on the cheeks, forehead, scalp, knees, elbows, arm joints or leg joints, but they could appear anywhere on the skin.
Eczema can be mild, moderate, or severe. Here is a guide to how mild, moderate and severe eczema may look on a baby’s face, and how itching usually affects daily life.
Eczema may also look different depending on a child’s age, as we’ll cover below.
Where Does Eczema Most Often Appear?
Eczema tends to appear in different places on the body in younger babies, older babies, and toddlers. It also tends to look different depending on a child’s age. Here are the eczema symptoms to look for in babies and toddlers of each age group, as outlined by the National Eczema Association.
Remember, though, that eczema could appear in any area of the body, regardless of your little one’s age. The table below just outlines where eczema appears most often.
Young infants (under 6 months of age)
In young infants, baby eczema usually appears on the face at this stage, including the chin, cheeks, scalp, and forehead. But it could appear on any area of the body, including the arms, legs, or torso. It usually won’t appear in the diaper area, because that area usually remains protected by moisture.
At this stage, skin affected by eczema often looks red and “weepy” (with blisters that leak fluid).
Older babies (6 months-12 months of age)
In older babies, eczema usually appears on creases of the skin, especially on the elbows, knees, and elbow and knee joints. It may also appear on the face, like with younger infants. Again, though, it could appear on any area of the body, but not usually the diaper area.
Sometimes, baby eczema rash may become infected and form a yellow crust on the skin.
Younger toddlers (12-24 months years of age)
In toddlers, eczema often appears on the face in patches. It may show up around the eyelids or around the mouth. It also often appears in the skin creases (mainly behind the elbows and knees).
Older toddlers (24-35 months of age)
When your little one reaches the age of 2, eczema is very likely to appear in the knee and elbow creases, on their hands, or on their ankles and wrists. Their skin may become scalier, thicker and drier, especially if they’ve had eczema since their first year. This is known as “lichenification.”
Managing Eczema: Knowing and Avoiding Possible Triggers
Although we don’t know what causes eczema to develop in the first place, we do know many triggers that can cause baby eczema to suddenly get worse.
If your child has eczema, it may flare up when their skin is exposed to any number of triggers.
Some triggers that may cause eczema flare-ups include:
- Dry skin
- Dry air
- Skin infections
- Fragrances (found in lotions, shampoo, soaps, and laundry detergents)
- Dyes (also in shampoo, soaps, and laundry detergents)
- Fabrics (such as wool, polyester, or nylon)
- Environmental allergens, especially if your child already has an environmental allergy
- Common allergy-causing foods, especially if your child already has an allergy to that food
One key to baby eczema management is identifying possible triggers that seem to cause eczema to flare up, then keeping baby’s skin from coming in contact with them.
Some possible triggers should be avoided outright when your baby has eczema.
For example, stay away from shampoos, soaps, lotions, and laundry detergents that contain fragrances and dyes. Opt for unscented, dye-free bath and laundry products instead. Mild, unscented liquid body wash is always a good choice.
Also, don’t dress your baby in synthetic fabrics like polyester, wool, and nylon. Don’t use blankets and covers made from these fabrics, either. And avoid any other itchy, tight clothing. Opt for natural, loose-fitting cotton clothing instead, and use cotton bedding for their crib.
Be sure to wash new clothing and bedding before their first use as well, since unwashed fabric can contain irritating chemicals.
Managing Baby’s Eczema: Bathing
Daily bathing and moisturizing is essential to managing baby eczema. Never skip a bath!
Baby’s compromised skin barrier makes it easy for moisture to escape from the skin, which can lead to dryness and flare-ups. But giving baby a daily bath, and moisturizing them regularly, helps keep that moisture from escaping.
National Jewish Health shares more on why a daily bath is so essential for baby eczema care:
The best way to bathe eczema babies, and stop dryness and flares, is with the "soak and seal" method. In the "soak and seal" method, you bathe your baby daily, then apply moisturizer right after the bath.
Follow these steps for the best way to give a “soak and seal” eczema bath:
Use The Right Temperature Water
Use warm water, not hot water. Keep the water temperature between 97℉ and 98.6℉ for the most comfortable bath.
- Water that’s too hot for baby’s skin may make flare-ups worse.
- Also, repeated hot baths can make babies' skin dry out more, compared to adult skin. Your baby's skin hasn't fully developed, so it’s more sensitive.
- Buying and using a bath thermometer is helpful for checking the water temperature.
Use Unscented Body Wash, Not Soap
Mild liquid body wash is the best way to cleanse your baby's skin.
- This type of cleanser doesn’t dry out the skin, because it doesn’t affect the skin's PH.
- Make sure the wash is unscented, mild, fragrance-free and dye-free
Stay away from soaps.
- Soaps affect skin PH, so they’ll dry out your baby's skin even further.
- Also, stay away from any cleanser with a scent, fragrance, or dye. Fragrances and dyes are common irritants that can make baby eczema worse.
Scrub With Care
Wash your baby's eczema areas very gently. Don't scrub too hard, because this may make the affected areas worse.
Have Baby Soak For The Right Time
Let your baby soak for 10-15 minutes, or for the amount of time your dermatologist recommends.
Gently, Partially Dry Baby
Once you're finished with the bath, only partially dry baby. Pat baby gently with a towel, and let some of the water stay on the skin.
- Keep the skin somewhat damp. Leaving some moisture on the skin will help moisturizers sink in.
Apply A Steroid If Prescribed
If your dermatologist has prescribed a topical steroid for baby’s flare areas, apply the steroid right after the bath (and before moisturizing).
Consider Special Types Of Eczema Baths
If a regular daily bath isn’t enough to stop regular flare-ups, your dermatologist may recommend a bleach bath, an oatmeal bath, or a breastmilk bath. Follow the links for details on how to give these types of special baths, but always ask your baby’s dermatologist first before you start.
Managing Baby’s Eczema: Moisturizing
Regular moisturizing is just as crucial for managing baby eczema as the daily bath. In fact, it’s the “seal” part of the “soak and seal” method.
After your baby's bath, moisturize their skin right away to "seal" the remaining moisture from the bath into their skin, and help prevent it from escaping.
- Follow the 3-minute rule! Moisturize baby’s skin within 3 minutes after the bath. The moisture from the bath will escape through baby’s skin barrier if you wait too long to moisturize.
Choose a moisturizer that mimics and supplements the skin's natural barrier, which is made up of cholesterol, fats, and fatty acids.
This barrier usually lets the skin hold in enough moisture. But babies with eczema have a compromised skin barrier, so they need support from moisturizer to build up their barrier.
- Look for moisturizers that contain ceramides. Ceramides are the fats that the skin naturally makes to form the skin barrier.
- You could also use coconut oil, because it moisturizes, eases inflammation, and helps fight against skin bacteria with lauric acid.
- Ointments that are free from alcohol are also recommended. Avoid creams that contain alcohol, as alcohol can sting and burn the skin.
Please read this article to learn more about the best baby eczema moisturizer ingredients, as well as moisturizer ingredients to avoid.
Liberally moisturize all areas of baby’s body, especially the areas where the eczema is worst. There’s no such thing as too much moisturizer!
- If you plan to use wet wrap therapy or dress baby’s skin, let the moisturizer soak into your baby's skin for 3-5 minutes first, before covering.
Don’t just moisturize after the bath! For the best baby eczema care, you’ll need to intentionally moisturize baby at other times, throughout the day.
- Spritz your baby's skin with water at least twice a day, then apply moisturizer immediately after the spritz. The spritzing/moisturizing routine helps baby’s skin more effectively retain the moisture from their daily bath.
Managing Baby’s Eczema: Other Lifestyle Tips
Bathing and moisturizing are the cornerstones of baby eczema management, but they aren’t the only ways to manage baby eczema. Follow these other tips to help soothe your baby’s skin:
- Spritz and moisturize your baby’s skin whenever it looks itchy or feels dry.
- Think about keeping moisturizer by your diaper changing area as a reminder to frequently moisturize.
- Keep baby cool, because heat can make the eczema rash worse.
- You could use cold packs if your baby starts to flare up. Cold packs can distract from the uncomfortable feeling of a flare, as well as relieve itching.
- Another way to cool and soothe baby is to store moisturizers in the fridge. (Do not store prescribed treatments in the fridge, though, unless your doctor says it’s safe.)
- Keep the temperature of baby’s sleeping environment comfortable, so baby doesn’t get too hot at night. If baby sweats, this will make eczema even more uncomfortable, on top of the heat that makes the rash worse.
- Keep baby in the shade when outside on hotter days.
- Never put your fingers in baby’s eczema care products.
- You could contaminate the products with bacteria or other flare triggers if you stick dirty fingers in. Don’t take that chance!
- Choose moisturizer in a pump or squeeze tube instead.
- Scratching can make eczema flares worse, especially if baby starts a repeated itch-scratch cycle.
- Have baby wear no-scratch mittens, especially while they sleep, to discourage scratching.
- You could also have baby wear socks on their hands and feet to stop scratching.
- Turn on a humidifier in the room baby sleeps in (1-2 nights per week).
- Use an air purifier system where baby sleeps, to help remove environmental allergens that could trigger eczema.
- If your doctor prescribes a treatment for your baby’s eczema (such as a prescription moisturizer or steroid cream), start using it on baby’s skin immediately!
- Delaying the treatment will only make your baby’s eczema worse.
- Always follow your doctor’s instructions for applying prescription moisturizer. This way, you’ll apply enough to treat your baby’s flares, but not too much.
- Consider wet wrap therapy if baby’s eczema is moderate to severe.
Moderate or severe eczema requires more in-depth care than mild eczema. The tips in the linked article may help you develop a detailed routine based on baby’s eczema severity.
Will My Baby Outgrow Eczema?
Many babies who develop eczema in their first year eventually outgrow eczema by the time they start elementary school. Other children outgrow it by their early teens. Still others don’t completely outgrow eczema by these ages, but notice that their eczema is less severe (more manageable) as they get older.
But eczema, especially chronic eczema, can also be lifelong. Some babies never outgrow eczema, and have the condition for the rest of their lives. Unfortunately, there’s no cure for eczema, and no way to tell whether your little one will outgrow it.
The Atopic March, Food Allergies, And Eczema
Eczema (atopic dermatitis) and food allergies are very closely related. They are both considered allergic conditions, and they are both part of a progression known as the atopic march.
What is the atopic march? According to the atopic march, children with one allergic condition are at increased risk for others, and allergic conditions often appear in a certain order. In other words, one condition usually “marches” in front of the other, in a fairly predictable lineup.
Eczema comes before food allergies in the atopic march. This means babies usually develop eczema before food allergies, and babies with eczema are at the highest risk for food allergies.
But even though food allergies and eczema are closely related, and even though some symptoms may look similar, eczema rash is not the same as a food allergy reaction.
Food allergy rashes (hives) appear as raised bumps, which look different from the red, scaly rash of eczema. Learn more about how to tell the difference between a food allergy reaction and an eczema flare-up.
Eczema and Food Allergy Risk
Babies with eczema are at sharply increased risk for developing a food allergy. In fact, babies who have eczema are at the highest risk for developing a food allergy in the future.
According to Dr. Jonathan Spergel, Board Certified Allergist and Member of the National Eczema Association Scientific Advisory Committee, “Up to 67% of infants with severe eczema, and 25% of infants with mild eczema, will develop a food allergy.”
Introducing Allergens to Babies with Eczema
Introducing common allergenic foods to eczema babies early and often may be especially beneficial.
New dietary guidelines from the U.S. Department of Agriculture (USDA) recommend the early, frequent introduction of peanut, particularly for babies who have eczema.
According to the USDA’s new Dietary Guidelines, “if an infant has severe eczema...age-appropriate, peanut containing foods should be introduced into the diet as early as age 4 to 6 months.” This introduction is especially important for babies with eczema, because of their increased food allergy risk.
Also, as other international medical guidelines state, early introduction of other common food allergens may be beneficial for eczema babies as well.
For instance, guidelines from the British Society for Allergy and Clinical Immunology (BSACI) recommend that babies with eczema be introduced to allergenic foods, such as egg and peanut, as early as 4 months of age.
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