A Parent’s Guide for a Child with Eczema
Eczema is hallmarked by dry and sensitive skin that becomes red and exceedingly itchy.
Frequently small patches start on the forehead, cheeks and scalp and then spread to the upper body and lastly to the folds of the elbows, wrists and knees. It is very important to control the itching that is associated with eczema as scratching the rash can cause it to become raw, crusty and even ooze. This scratching can injure the skin even more and start a brutal sequence where scratching leads to a rash and itching, which leads to more scratching, which leads to a worse rash or possibly even infection. The first symptoms of eczema usually start between two and six months of age and the cause is unknown. Often eczema runs in families that have a history of asthma and allergies, but that is not always the case. It is important to remember that this is a chronic disease that requires constant care, but only about one third of children will persist with the symptoms of eczema into adulthood. While there is no cure for eczema there are several successful treatments that are designed to control and prevent the inflammation and itching that is at the heart of this disease.
Perhaps the simplest and most effective of these would be moisture. Skin that is plagued by eczema requires a great deal of moisture, even between eczema flairs. When possible you should coat your child’s skin in a moisturizing ointment or even a cream, but try to avoid regular lotion because it is far less superior at providing moisture. Bathing has often been a source of controversy when it comes to eczema, but most doctors now recommend one 20 minute bath every day with a MILD soap or soap substitute followed immediately by a moisturizing ointment or cream. Sometimes a child will react poorly to a daily bath and their eczema will actually get worse. If this is the case try to give baths every other day.
Sometimes it will be necessary to use a topical steroid to provide relief to your child. It is very important to follow your doctor’s exact instructions about the application of this medication. In general you will want to apply a steroid right after a bath (before you apply the moisturizer) and again one or two other times during the day. Steroids should not be applied to a child’s diaper area or face unless specified by the doctor. If either of these areas are very bothersome you can ask your child’s doctor about using an over the counter 1% hydrocortisone cream. Often these are safe and effective on these sensitive areas. Because eczema is extremely itchy and scratching makes it even worse it is very important to provide adequate itch relief. You might find that your child has problems sleeping at night because in some children the itching peaks during the night. To ease your child’s discomfort and help them sleep you may want to give an antihistamine, such as Benadryl before bed. If you find your child still wakes up itching you may want to ask your child’s doctor about getting a prescription antihistamine. In general they last longer then Benadryl and will provide an entire nights relief.
Finally, last but certainly not least it is particularly important that you keep your child’s nails cut short. Itching is inevitable no matter how under control your child’s eczema is. By keeping fingernails cut short you will lessen the amount of damage done by your child’s scratching as well as lessen the likelihood of bacteria trapped under the nails getting into the affected area and causing an infection. Remember that eczema is a chronic condition and requires daily treatment. You should never be afraid to call your child’s doctor if you have any questions for concerns about your child’s condition or treatment. You should always call if you do not see improvement after a few weeks of treatment, if it becomes worse (pus, scabs or bleeds) or is keeping your child awake at night. It is not unusual to require several trips to the doctor to find the treatment combination that is right for your child, but once it is found it will provide your child with much needed relief.
