Is My Baby's Eczema Severe?
A Quick Guide to Eczema in Babies
Since 2016, the official recommendation from the American Academy of Pediatrics has been to introduce peanuts to all babies as early as 4-6 months of age.
However, the recommendation also includes the caveat that babies with “severe”, as opposed to “mild-to-moderate” eczema should approach peanut introduction differently.
Source: Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel.
So, the big question is: how do you know which category you baby falls into if they have signs of eczema?
Luckily, we're here to shed some light on what can sometimes be a very stress-inducing topic.
Always work with your Pediatrician
Chances are if you are noticing skin conditions on your child, you have spent some time researching to determine if it is eczema, or another issue. Babies, as a rule, tend to have extreme skin reactions because their skin is still getting used to being outside in the real world.
To make things even more complicated, eczema and its symptoms often come and go.
If you haven’t already, start keeping a log or journal of what skin issues you are noticing. Pictures can be very helpful for you and to show your pediatrician.
Also keep track of when those issues seem to show up (all the time, after using sunscreen, after a bath, etc).
Schedule a visit with your pediatrician, and show them all the information you have collected. An evaluation by a professional will be necessary to distinguish the differences between eczema and other skin reactions, such as allergic contact dermatitis which may present similar symptoms.
Once your pediatrician has established that it is indeed eczema and not a different skin condition, you can work with them to determine the severity of your child’s eczema.
Understanding What a Doctor May Be Looking For
Severe Eczema as it relates to food allergies is defined as “persistent or frequently recurring eczema, with typical morphology and distribution assessed as severe by a health care provider and requiring frequent need for prescription-strength topical corticosteroids, calcineurin inhibitors, or other anti-inflammatory agents despite appropriate use of emollients”
There are no formal eczema scoring systems that a doctor uses in the office. Those that exist are mostly developed for clinical trials. However, a scoring system such as SCORAD (SCORing Atopic Dermatitis), can be a good reference point for a confused parent who doesn’t know what to pay attention to and what information to relate to the pediatrician.
SCORAD takes into consideration the total surface area of the body that is affected, the severity of the visible symptoms, and the subjective symptoms (itchiness, inability to sleep).
The image below is one representation of the visible symptoms taken from a European patient education website, but it is the most useful one we have found in helping differentiate between mild, moderate, and severe.
If you have the stomach for it, there are more images on google. In general you will see that severe eczema is pretty unmistakable. Some minor redness is or scratching is not severe eczema.
But the line between mild and medium or medium and severe can be blurry, especially as symptoms come and go.
Tell your doctor about swelling, oozing or weeping cuts, a change from baby-soft skin to the thickened skin, and the scratching.
The connection between severe eczema and peanut introduction is an interesting one. Essentially, the official AAP and NIAID Guidelines call for first checking with your pediatrician if you think your child might have severe eczema, and then - pending their approval - ensuring that you introduce peanuts as early as possible to their diet (4-6 months of age).
The reasoning here is counter intuitive, but it's supported by large scientific studies: if your child has severe eczema, that can be an indicator for a higher likelihood to develop a peanut allergy later on, so it's actually MORE important to make sure they are introduced to peanuts early on, to lower their chance of developing the peanut allergy as they get older.
For more information, you can check out our Parent Resource Center, which is chock full of the latest scientific studies, simplified so they're easy to understand.
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