When Mara De Maio saw the red, crusty skin on her 2-month-old's ear, she wasn't sure what to make of it. But when Estella developed spots all over her body a few weeks later, the Longmeadow, Massachusetts, mom rushed her to the pediatrician. "I was worried she was having an allergic reaction," remembers De Maio. Instead, she was told that Estella has a form of eczema called atopic dermatitis, an often chronic dry-skin condition that affects about one in five children and commonly debuts in infancy--symptoms show up by age 1 in 60 percent of cases. If your child is diagnosed, it's important to monitor and treat symptoms daily to keep them in check. We asked experts for their tips to help you prevent flare-ups and soothe sore skin.
There are several types of eczema, but atopic dermatitis is the most common. It's a noncontagious, very itchy red rash that can look dry, scaly, or bumpy. It may appear all over the skin or be confined to specific areas--especially those that get a lot of friction, such as the bends of the elbows and knees, between skin folds, and under the elastic band on a diaper. Food, spit-up, and drool can also irritate sensitive skin around the mouth, says Dawn Davis, M.D., section head of pediatric dermatology at the Mayo Clinic in Rochester, Minnesota. If you notice your baby rubbing the affected area with her hand or wriggling on her crib sheet, she's probably trying to scratch it, which can make the rash worse.
Babies with eczema may have inherited a defect in the protective outer layer of their skin, which allows irritants and allergens to get in, says Amy Paller, M.D., chair of dermatology at Northwestern University Feinberg School of Medicine, in Chicago. This may also help explain why children with eczema often develop allergies and asthma, especially when there's a family history of the conditions. Although there isn't much you can do about your genes, you may be able to help your child sidestep eczema with a few lifestyle changes. It's best to breastfeed exclusively for six months, and consider cutting out highly allergenic foods, such as eggs, milk, peanuts, soy, seafood, and wheat while you're nursing. "The research is mixed, but some studies suggest these steps could help reduce your baby's risk of developing eczema and allergies," says David Rosenstreich, M.D., director of the division of allergy and immunology in the department of medicine at Montefiore Medical Center, in New York City.
Easing the Itch
If your baby does develop the skin condition, there's a lot you can do to manage symptoms. First, avoid triggers such as fragrances in lotion, cleansers, and detergents, as well as extreme temperatures--dress your baby in layers to make sure he doesn't get too hot or cold. Keep the indoor temperature between 68 and 72 degrees Fahrenheit and choose cotton pajamas without elastic bands. There's no need to limit baths; just wash him in lukewarm water with a gentle cleanser and apply either lotion, cream, or ointment--depending on the severity of your child's symptoms--afterward to seal in moisture. Running a cool-mist humidifier in your baby's room can also help keep the skin hydrated.
For severe flare-ups, your doctor may prescribe a corticosteroid cream to use in addition to your moisturizing routine. If your baby's skin starts to ooze or crust or gets worse despite treatment, he may have an infection. "That requires topical or oral antibiotics," says Nanette Silverberg, M.D., director of pediatric and adolescent dermatology at St. Luke's-Roosevelt Hospital Center, in New York City. Many doctors also recommend mixing a small amount of bleach into your baby's bath at least twice a week, to help prevent flare-ups and infections. Be sure to talk to your pediatrician about whether it would be helpful for you to do this. According to Dr. Paller's research, it is safe--as long as you stir the bleach in the water first and make sure your baby doesn't get it in his mouth--and five times more effective at treating eczema than soaking in a bath without bleach.
The ultimate key to managing symptoms is partnering with your pediatrician or pediatric dermatologist to find a plan that works for your baby. Fortunately, eczema typically lessens as kids get older, and many outgrow it by the time they start school.
For tips on keeping your baby's skin smooth in dry winter weather, go to parents.com/winter-skincare.
Originally published in the October 2013 issue of Parents magazine.
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