If your child has patches of dry, rough, itchy skin that seem to come and go, they may have eczema. Eczema is one of the most common skin conditions in childhood, affecting roughly 1 in 10 children in the United States. It often starts in the first year of life. While there is no cure, the right daily skin care routine and treatment plan can keep most children comfortable and sleeping well.
What Is Eczema?
The most common type of eczema in children is atopic dermatitis. In children with eczema, the skin barrier, the outer layer that holds in moisture and keeps out irritants, doesn't work as well as it should. The skin loses water easily, becomes dry and is more sensitive to irritants and allergens. The immune system also overreacts, leading to inflammation, redness and intense itching.
Eczema tends to run in families, especially families with a history of eczema, asthma, hay fever or food allergies. It is not contagious, so your child cannot catch it from or give it to anyone else.
What Eczema Looks Like at Different Ages
- Babies: red, dry, sometimes oozing or crusty patches on the cheeks, forehead and scalp, and on the outer arms and legs. The diaper area is usually spared.
- Toddlers and young children: dry, scaly patches in the creases of the elbows and knees, on the wrists, ankles and around the mouth.
- Older children and teens: thickened, darker or leathery skin in the body folds, hands and neck from repeated scratching.
On darker skin tones, eczema may look brown, purple or gray rather than red, and it can leave temporary lighter or darker spots after it heals.
The hallmark of eczema is itch. Scratching damages the skin further, which leads to more itching, a frustrating cycle known as the itch-scratch cycle.
Common Eczema Triggers
Eczema usually goes through periods of flares and calmer times. Common triggers include:
- Dry air, especially in winter with indoor heating
- Heat and sweating
- Long, hot baths and harsh soaps or bubble baths
- Fragrances in soaps, lotions, detergents and fabric softeners
- Rough or scratchy fabrics like wool and some synthetics
- Saliva and drool, especially in teething babies
- Infections of the skin, or colds
- Stress or lack of sleep
- In some children, allergens such as dust mites, pet dander or pollen
Keeping a simple diary of flares can help you spot your child's personal triggers.
Daily Skin Care: Soak and Seal
A consistent routine is the foundation of eczema care, even when the skin looks clear.
- Bathe daily or every other day in lukewarm (not hot) water for 5 to 10 minutes.
- Use a gentle, fragrance-free cleanser only where needed, and skip bubble baths.
- Pat the skin gently with a soft towel, leaving it slightly damp.
- Apply any prescribed medicine to flared areas first.
- Within 3 minutes, moisturize generously all over with a thick, fragrance-free cream or ointment. Ointments and thick creams in a jar or tube usually work better than thin lotions.
- Moisturize again at least once more during the day, and anytime the skin feels dry.
More Tips for Everyday Comfort
- Dress your child in soft, breathable cotton clothing, and remove tags if they irritate.
- Wash clothes and bedding in a fragrance-free, dye-free detergent; consider an extra rinse cycle.
- Keep fingernails short and smooth. Cotton mittens at night can help young babies who scratch in their sleep.
- Keep the bedroom cool, and use a humidifier during dry winter months.
- Rinse and moisturize after swimming in chlorinated pools.
- Gently wipe drool from the face and apply a barrier ointment.
Medical Treatments
When moisturizing alone isn't enough, your pediatrician may recommend:
- Topical corticosteroids: anti-inflammatory creams or ointments in different strengths, used for short periods on flared skin. When used as directed, they are safe and effective. Ask us how much to use and for how long.
- Non-steroid prescription creams and ointments that calm inflammation, often used on the face or for longer-term control.
- Treatment of skin infections, which can trigger flares.
- Referral to a dermatologist or allergist for severe or hard-to-control eczema. Newer treatments are available for children with moderate to severe eczema.
Antihistamines don't treat eczema itself, but a doctor may suggest one in some cases to help with sleep. Don't start any new medicine, including "natural" remedies or essential oils, without checking with us first.
Eczema, Food Allergies and Asthma
Children with eczema, especially when it starts early and is severe, are more likely to develop food allergies, asthma and hay fever. However, foods are not the cause of most eczema, and removing foods from a child's diet without medical guidance can lead to poor nutrition and may even increase the risk of food allergy. Babies with severe eczema may benefit from early introduction of foods such as peanut, but this should be planned with your pediatrician, who may suggest allergy testing first. Read more in our article on treating your child's allergies.
Eczema Questions Parents Often Ask
Can my child with eczema go swimming?
Yes. Many children with eczema swim without problems. Apply a moisturizer before swimming to protect the skin, then rinse off with fresh water and moisturize again right after getting out of the pool.
Which sunscreen is best for eczema-prone skin?
Mineral sunscreens with zinc oxide or titanium dioxide and no added fragrance are usually the gentlest. Test a small area first, and use shade, hats and clothing for babies younger than 6 months.
Will my child outgrow eczema?
Many children see their eczema improve a lot by school age, though the skin may stay sensitive and dry. Others continue to have flares into adolescence or adulthood, which is why a good long-term skin care routine matters.
When to Call the Pediatrician
- The rash is not improving with good skin care
- Itching is keeping your child (or you) from sleeping
- Skin is oozing, crusted with yellow scabs, painful or has pus, which may signal a bacterial infection
- Your child has a fever with a worsening rash
Seek care the same day if your child with eczema develops clusters of painful, punched-out blisters or open sores, especially with fever. This can be a sign of a herpes virus infection of the skin (eczema herpeticum), which needs urgent treatment.
Living Well With Eczema
Many children's eczema improves as they get older, and some outgrow it entirely. In the meantime, a simple routine of gentle bathing, generous moisturizing and prompt treatment of flares makes a big difference. Eczema can also affect a child's sleep, mood and self-esteem, so be sure to share these concerns with us. Ask us about creating a written eczema action plan that fits your family's routine. For other skin topics, see our articles on diaper rash and treating warts.
This article is general health information for parents and is not a substitute for medical advice. If you are worried about your child, contact your pediatrician; in an emergency, call 911.
Questions about your child's health?
Our Chestertown pediatric team cares for newborns, children and teens. Request an appointment, read our new patient information or browse more articles on the pediatric health blog.