Infant and Childhood Atopic Dermatitis

Atopic dermatitis, also known as eczema, is a common skin condition that can affect children of all ages. It causes the skin to be dry, itchy, and inflamed. The first signs of eczema usually occur between 6 and 12 months of age. About 60 percent of children with eczema will develop it in their first year of life. And 85 percent of eczema cases develop by age 5.^1,2

Sometimes, eczema goes away as a child gets older. For other people, flare-ups may occur later in life.³

What causes eczema in babies and children?

Eczema has several causes. In most cases, it is related to a combination of genetic and environmental factors. Children with a family history of eczema, allergies, or asthma are more likely to develop eczema.^2,3

Environmental triggers that can play a role in eczema flare-ups include:^2-4

• Dry air, especially in colder months
• Certain soaps, fabrics, fragrances, or laundry detergents that can irritate the skin
• Allergens like dust, pet dander, pollen, or certain foods
• Sweat
• Excess saliva or drooling
• Stress or illness

Symptoms of eczema in babies and children

Eczema symptoms can vary by age group. Here is what parents should know:^2-4

• In babies (0 to 2 years) – Eczema in infants who are 6 months or younger usually appears on the scalp, face, cheeks, and neck. As they get older, babies may have red, dry, and scaly patches on their elbows and knees. When babies feel itchy, they may be more fussy and have trouble sleeping.
• In toddlers (2 to 5 years) – Eczema in toddlers can appear in areas where the skin folds, such as the elbows, backs of the knees, and wrists. Patches may look dry or thickened, and they may include small bumps. Children might scratch more, which can worsen symptoms and lead to infections.
• In children (5 years and older) and teens – Eczema in older kids tends to show up in similar areas as it does in younger kids. However, the skin may become even more dry and thick over time from scratching. Older kids might have patches around their eyes, neck, hands, and feet as well.

Possible eczema complications for babies and children

Childhood eczema can sometimes lead to complications, especially if it is not managed well. Some common eczema complications among babies and children are:^2,5,6

• Skin infections – Frequent scratching can break the skin, allowing bacteria to enter and cause an infection.
• Sleep problems – Many children with eczema repeatedly wake up during the night because of itchiness. Waking up throughout the night has a distressing effect on children living with eczema, not to mention their parents.
• Eye complications – These may include itching around the eyes, eye-watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).
• Allergies and asthma – Children with eczema are at risk for developing allergies, asthma, and hay fever. This can happen before or after eczema first appears.

Eczema treatment options for babies and children

There are many treatment options for eczema in babies, toddlers, and children. Here is what experts recommend:^2,3,5,6

• Bathing – Short, lukewarm baths are best. Use a gentle, fragrance-free soap or cleanser to prevent irritation. Avoid scrubbing or vigorously rubbing the skin. After the bath, gently pat the skin dry and apply moisturizer.
• Moisturizing – Keeping the skin moisturized is one of the best ways to manage eczema. Apply moisturizer at least twice a day, or as often as needed. Parents should apply a thick, fragrance-free moisturizer right after bathing their child to lock in moisture. Look for moisturizers that contain ceramides – fats that help the skin barrier.
• Topical creams and ointments – Topical corticosteroids or non-steroidal creams are common treatment remedies for eczema. These medicines help reduce inflammation and itching. Some of these can be bought over the counter, while a dermatologist, allergist, or pediatrician prescribes stronger concentrated ones. Babies’ skin is more sensitive, so be sure to follow the doctor’s directions.
• Biologic medicines – For children ages 6 months and older with moderate to severe eczema, Dupixent® (dupilumab) may be prescribed. Dupixent is a biologic medicine. Biologics target specific parts of the immune system and can help reduce severe eczema symptoms. These are usually given as injections and are often used when other treatments have not worked.
• Avoiding triggers – Identifying and avoiding triggers can help reduce your child’s flare-ups. For example, use fragrance-free laundry detergents, avoid wool clothing, and try to keep your home free of dust.

Tips for parents

Managing childhood eczema can be challenging. But there are ways parents and caregivers can help make it easier. Here are a few:^5,6

• Create a routine for your child’s skin care, and stick to it daily.
• Keep your nails short to reduce the damage caused by scratching.
• Dress your child in soft fabrics like cotton to avoid irritation.
• Keep a symptom diary to track any possible triggers.