Babies have delicate skin. From perfecting their post-bath skin care routine to trying to prevent cuts and bruises, looking after your little one’s skin is quite the task.
Even after all that work, babies often develop many skin issues in their first year. Eczema is one of the common conditions babies can develop.
About 1 in 8, or 13% of babies develop eczema. Eczema usually first shows up when a baby is between 3 and 6 months old, and almost all (85%) eczema will begin during the first year of life. Many children with eczema will outgrow it, with chances increasing 5, 10, and 20 years from onset.
What Causes Baby Eczema?
There are likely two major causes for eczema: an issue with the immune system or a defect in the skin.
Your baby’s eczema may be caused by one or the other, or both.
One potential cause of baby eczema is a malfunction in the immune system. Instead of ignoring harmless substances like pollen, food, and dust, the body releases histamines that cause itchiness when it comes into contact with these things. Your baby scratches and rubs at the itchy skin, causing redness, cuts, and maybe even skin thickening.
The other cause of eczema is a defect in the skin. Many people have a genetic mutation where their body doesn’t produce a key protein called filaggrin. This protein is in the keratin layer of the skin and makes the skin soft and springy. Filaggrin also helps prevent excessive water loss through the skin.
Without filaggrin, your baby has a skin barrier dysfunction. Skin barrier dysfunction is when the outermost layer of your baby’s skin allows too much moisture to escape, and allows external particles and chemicals into the skin. This leads to irritation.
Eczema-prone skin letting particles into the skin.
There is a genetic component to eczema, as children with a parent or sibling with eczema have a high risk of developing it themselves.
Eczema is the “itch that rashes.” Your baby’s skin becomes itchy and then your baby scratches, causing the body to create even more itchy histamine. This loop causes the skin to get worse (scaling) and worse (thickened skin) until something stops the cycle.
What are the Symptoms of Baby Eczema?
Eczema always begins with an itchy, reddish rash. The hallmark of eczema is thickened skin, scaling, and lichenification (lines through the affected areas). All of these three markers are not from the eczema itself, but from scratching the itchy skin. And these markers don’t happen immediately.
But here’s the rub — babies don’t have the strength or hand control to scratch at the same spot over and over. And they definitely don’t have the language to explain how itchy they are, so it’s sometimes difficult for parents to know if their baby has eczema or just dry skin.
Eczema is a chronic condition, so the skin gets thickened or scaly over time as a person scratches and scratches.
Despite all the talk of scaly skin, baby eczema typically is persistent red, dry skin:
- Most commonly on the face (especially the cheeks and forehead, but sometimes on the scalp)
- In the arms near the elbows and wrists, and behind the knees as baby begins to crawl
Eczema most-commonly appears on a baby's face and in the creases of the elbows.
Interestingly, redness in the diaper area is generally not eczema. It’s usually diaper rash.
Dry skin, on the other hand, is not isolated to certain areas on your baby’s body, and never results in skin thickening like in eczema, because there is no underlying itchiness.
However, both eczema and dry skin can be exacerbated by cold or dry temperatures.
If you believe the redness on your baby is persistent, and especially if your baby is frequently scratching or has difficulty sleeping, you should seek help from your pediatrician.
This simple tool can help you better communicate your baby’s symptoms to your doctor. The most important things to pay attention to are:
- How widespread the itchy redness is
- The severity of the thickening / scaling / lines - which is a marker of how itchy the rash is
- Any signs of pus or water “weeping” from the rash, which is a marker of infection