Eczema
Eczema (also called atopic eczema or atopic dermatitis) is a very common dry skin condition. It affects about 1in 5 babies and children in the UK. Eczema often appears in the first few months of life. Eczema usually improves in most children as they get older, but some children with more severe eczema may continue to have eczema into adult life.
Eczema can cause the skin to become itchy, dry, cracked and sore. Sometimes, children with eczema make may have periods where the eczema becomes more severe (flare ups).
Many things, called “trigger factors” can make the eczema worse. These include:
- Irritants such as soap, clothing (wool, polyester), cigarette smoke, chlorine in swimming pools
- Changes in the climate such as drier air or temperature (too cold or too hot)
- Environmental allergens such as house dust mite and moulds
- Viral illnesses
- Hormone changes
- Stress and anxiety
- Rarely foods
- Immediate reactions (less than 1 hour) after eating.
- Delayed reactions (4 to 6 hours) after eating with a flare of eczema.
The National Eczema Society has more information about household triggers and how to manage them.
There is currently no cure for eczema, however avoiding trigger factors and using of moisturisers 3 to 4 times a day can help keep it under control. Your local community pharmacist or GP can advice you if other treatment for eczema is needed.
The exact cause of eczema is unknown. It is not down to one thing. Atopic eczema often occurs in people who get allergies. “Atopic” means sensitivity to allergens. This type of eczema can run in families, and often develops with other conditions like asthma and hay fever.
If you are worried that the eczema rash looks different to normal please see our page on rashes for advice on where to seek help
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How to tell it's Eczema?
Eczema in babies often appears at between 3-6 months of age. It can develop anytime after birth or in childhood.
The main features of eczema are:
- Intense itch
- Dry skin
- Rash
- Redness
- Inflammation
In infants and babies, eczema affects the face, scalp and body. It does not usually affect the nappy area. As your child grows older the pattern of eczema changes. It affects the skin behind the elbow and the knee. In some children it affects the whole body.
In children of Asian, black Caribbean or black African ethnic groups, eczema can affect different places including the front surface of the knee or wrist. It can also look different with the skin being bumpy and slightly darker instead of red
It is important to be aware of and look for signs of worsening eczema
Recognise a flare: A ‘flare’ is a worsening of the eczema. Skin may become red, sore, (more)itchy, crack or bleed
Recognise infected eczema: If skin suddenly worsens, weeps fluid or crusts it could be infected and your child may need antibiotics. Seek urgent advice if your child is unwell or the infection is widespread.
Blisters or cold sores need urgent antiviral treatment. See your GP or seek medical advice the same day.
Food allergy: this is rare. Consider food allergy if eczema started as a baby. It is not usually the cause of eczema in older children
Picture credit: Skin Deep is a project developed by two groups in the UK who aim to produce resources that educate professionals and the public about skin presentations in children with different skin colours.
How to treat Eczema
Treatment of eczema can help reduce symptoms. Most children’s eczema improves over time. Severe eczema can have significant impact on daily life. Eczema has an increased risk of skin infections.
Top Tips
- Moisturise every day, even when the skin is clear of eczema
- Apply moisturiser using downward strokes. Do not rub it in
- Do an extra rinse when washing clothes
- Wear soft, comfortable, loose clothing
- Keep fingernails short to prevent scratching
Emollients
- Emollients are moisturisers that soften the skin. It is okay to try different emollients. Talk to your GP or nurse if you do not like one you have been given
- Expect to use large amounts. A large tub (250 to 500 g) per week
- Use everyday, all over
- You may need to change emollient type if one does not work
- Emollients form a protective barrier on the skin
- Emollients are best used few minutes after a warm bath, while the skin is still slightly damp
- Emollients are safe so they can be used as many times a day as needed
- Use at least 2 times a day when skin clear but increase to 4 to 6 times a day during flare ups or when the skin looks dry
- Do not put hands in tubs of emollients as these can introduce “bugs” easily. This is a common reason for repeated skin infections in eczema. Use a clean spoon or spatula to get emollients out of the tub
- For school and for older children and young people emollients with pumps may be better
- Apply in direction of hair growth. This reduces the chance of infection
- Fire hazard. Most eczema treatments contain paraffin and are flammable
- Visit our Healthier Together page for more information on how to apply eczema treatments
Bathing & Showering
- Avoid Bubble baths and perfumed products (some of the eczema bath products can provide bubbles if put in running water)
- Use your moisturiser (emollient) or a soap free wash to cleanse skin. Soap or soap based products can dry the skin.
- Bath water should be tepid or lukewarm as heat is a common eczema trigger
- Skin should be patted dry after bath
Topical (On Skin) Steroids
- Steroid creams and ointments are treatments for flare ups of eczema and help heal the skin. Steroids come in different strength from mild to strong steroids.
- Steroids are safe when used in short courses as advised by your doctor. When applying it is important to apply sparingly to the skin so that skin glistens.
- Use topical steroids once a day to eczema that is red and itchy. Stop when no longer red and itchy and restart if eczema comes back
- Leave a gap of 20 mins between applying your emollient and steroid. This is so that the topical steroid is not made less effective by the emollient.
- Visit our Healthier Together page for more information on how to apply eczema treatments
See your doctor if:
Eczema is infected. It may be pustules, blisters, painful, weeping fluid. Antibiotics may be needed.
Eczema is not going away with regular daily use of topical steroids for 2 weeks.
Eczema is causing waking at night, missing school or mood problems.
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
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