A Pediatric Dermatologist Shares What Parents Need To Know About Baby Eczema

As newborn babies adjust to the world, it’s normal to notice a few little blips on their skin. Some redness here, or a mild break out on their cheeks. However, usually, these pass within hours. If they don’t, it may be time to ask your pediatrician if it’s possible that you’re dealing with baby eczema. It can be stressful to notice anything out of the ordinary in those early weeks of new parenthood, but baby eczema is very common.

How do you know if your baby has true eczema, and when should you worry about allergies to food or their environment? We asked Dr. Teresa Wright, Chief of Pediatric Dermatology, Le Bonheur Children's Hospital, to help explain the surprisingly confusing condition, including what causes baby eczema, how parents can treat it, and when to call your pediatrician.

What is baby eczema?

“Eczema is a general, umbrella term that we use in dermatology that can actually include a number of skin conditions,” Wright explains. When a baby is experiencing a rash of some kind, it will often be called “baby eczema,” even though that term can mean a few different things. In terms of symptoms, though, Wright says baby eczema usually refers to rashes that are:

• Red
• Bumpy
• Often scaly
• Sometimes itchy, but not always

Generally, when parents are told that their baby has baby eczema, the term is referring to atopic dermatitis, Wright says. Atopic dermatitis is the kind of eczema that often runs in families, has a genetic component, and can sometimes go along with allergies or asthma.

It can be particularly tricky to clearly diagnose atopic dermatitis in babies, Wright explains, because often there is an overlap with seborrheic dermatitis, which most of us know as cradle cap. “What many people don't know is that cradle cap can also cause a rash on the body,” Wright explains. “Frequently, when we see babies with what we end up calling eczema, they have features of both seborrheic dermatitis and atopic dermatitis.”

What causes eczema in babies? Why do babies develop eczema?

Understandably, parents are often focused on identifying a single cause for their baby’s eczema, but that’s very hard to do. “It’s definitely multifactorial,” Wright says. There are definitely genetic factors, she says, and there is often a family history of eczema. Allergies may be at play, though Wright urges parents not to jump to conclusions about food allergies. “In years and years of seeing babies with eczema, and seeing babies who’ve had their formula changed, or mom is eliminating things from her diet if she's breastfeeding, it rarely makes a big difference,” Wright shares.

Because of this, and because sometimes drastic dietary changes can result in malnutrition — particularly in older infants — Wright discourages elimination diets in most patients. “I've seen very well-intentioned parents end up causing severe malnutrition in their child because they're searching for something that's going to help, and they're getting kind of all kinds of information from all kinds of places,” Wright explains. If a parent has concerns about potential food allergens in baby formula, breast milk, or actual, solid foods, she urges families to discuss that with their pediatrician, and ideally see a good pediatric allergist who can explore that with them and test for allergies, if need be.

Does eczema look different in babies and toddlers? Eczema symptoms by age

Infants 0-12 months

At this age, Wright says, an eczema rash is extremely diffuse. Babies with eczema may have red, scaly, patches on their face, trunk and extremities. In general, younger infants with eczema tend to have it on their:

• Cheeks
• Elbows
• Wrists
• Knees
• Ankles
• Tops of the feet

Toddlers & childhood eczema

As your baby ages into toddlerhood, Wright says that for many children, eczema on their face and cheeks will begin to clear up. “Some kids, especially if they have more severe atopic dermatitis, will still have facial involvement,” Wright adds, saying that at this age, it tends to be more on the eyelids than the cheeks, especially if your child has allergies to airborne allergens.

How do you treat eczema in babies?

Babies and children with eczema tend to have really dry and sensitive skin, Wright explains. A daily skin care regimen that focuses on keeping the skin clean and moisturized is key to keeping eczema under control. But what exactly does that look like? Is it safe to bathe your baby every day? And what soap is best? “There's this misconception that if you bathe every day, it makes eczema worse. However, there’s no clinical evidence to suggest that daily bathing worsens your eczema. So, I generally recommend a short bath or shower every night,” Wright says.

Especially in the summer, Wright recommends a short nightly bath or shower to clean off any sweat, dirt and germs that have built up during the day. And it’s not just to keep eczema from flaring up. “Kids with eczema, especially if it’s more severe, are very prone to secondary bacterial infections. So keeping the skin clean is really important.”

The daily eczema treatment routine she recommends for pediatric patients is:

1. A short bath (or shower for older children) that is quick and not overly hot. “If you're taking a long, hot shower with a harsh, perfumed soap, then you get out and don't put on any moisturizer, that's going to worsen your eczema.”
2. Use a mild cleanser that’s labeled clearly as fragrance-free. “‘Unscented’ does not mean fragrance-free.”
3. Use only a small amount of that mild cleanser, and just focus on the areas that get really dirty. “I always say like ‘pits and bits.’ So, armpits, feet, groin.”
4. Pat dry.
5. Apply any medicine that your baby has been prescribed.
6. Moisturize. Slather on a really good, thick, emollient. “For babies, we recommend plain Vaseline ointment, because it doesn't contain any allergens, it’s cheap, and it won’t cause burning or irritation if there are open areas of skin.”

Does baby eczema go away on its own?

Here comes the good news, especially for parents who are dealing with serve baby eczema. Baby eczema sure can go away on its own, Wright assures. “About a third of kids will outgrow it by the time they start school, maybe up to another third by the time they hit puberty.” Some kids will outgrow their eczema completely and many will improve dramatically during childhood, she assures. “Certainly I see a lot more kids that gradually get better and have milder, and more localized eczema,” Wright explains, reminding parents that as a pediatric dermatologist, her patient pool tends to be only the most extreme cases.

When to contact a the doctor

Baby eczema is quite common, and pediatricians see tons of eczema, Wright says. Even though they are not pediatric dermatologists, “they're very good at treating baby eczema, and advising parents,” Wright explains. However, if a parent is not satisfied with a pediatrician’s care for their baby’s eczema, that's the time Wright suggests asking for referral to a pediatric dermatologist, “although we're kind of few in numbers,” she adds. So, if there is not a pediatric dermatologist in your area, a good, board-certified dermatologist should be trained to see patients of all ages, and they certainly should be comfortable with atopic dermatitis in a baby or a child.

Baby eczema symptoms that Wright says warrant an immediate call to your health care provider include:

• If there is an open area of skin with oozing or crusting
• Puss or little blisters
• Little fluid-filled bumps on the skin
• If your child has a fever
• If the skin seems painful

Any of these more severe symptoms could indicate an infection, and Wright suggests seeing your pediatrician immediately or heading to an emergency room if the pediatrician is not available.

Expert:

Dr. Teresa Wright, M.D., Chief of Pediatric Dermatology, Le Bonheur Children's Hospital