Edited by Dr. Greenhill. Dr. Greenhill, MD is a practicing Pediatrician in Dover, NJ. Dr. Greenhill graduated from New York Medical College in 1971 and has been in practice for 48 years. Dr. Greenhill is board certified in Pediatrics.
Babies have delicate skin. From clipping their nails to slathering them with lotion, you put in a lot of effort to protect your baby’s skin. Even with all that work, babies can still get rashes and bruise easily.
One of the most common skin conditions babies can develop is baby eczema. Baby eczema is actually incredibly common — 1 in 8, or about 13% of babies — develop eczema. The good news is we’re here to help.
Understanding the difference between eczema and a more generic skin rash can be difficult. And knowing how to prevent and treat your infant’s eczema can seem like a daunting task.
In this guide, you’ll learn everything you need to know about baby eczema. You’ll learn its causes and symptoms, how to treat it, and its relationship to other allergic diseases.
Table of Contents
- What is Baby Eczema? Causes and Symptoms
- Prevention and Treatment: Minimizing Flare-Ups
- The Link Between Baby Eczema, Asthma, and Food Allergies
What is Baby Eczema?
Causes of Infant Eczema
Baby eczema is caused by two things: an issue with the immune system and a defect in the skin. Eczema can be caused by one or the other, or both.
An Issue with the Immune System
Your baby’s immune system is responsible for what kind of substances their body reacts to. Instead of ignoring things like pollen, food, and dust, with eczema your baby’s body releases histamines that cause itchiness when it comes into contact with these otherwise harmless substances.
Your baby scratches and rubs at their itchy skin, causing redness, cuts, and sometimes skin thickening.
A Defect in the Skin
Baby eczema can also be triggered when a genetic mutation causes your baby’s body not to produce a protein called filaggrin. Located in the keratin layer of the skin, filaggrin makes the skin soft and springy, and helps prevent excessive water loss.
Without it, your baby’s skin has a skin barrier dysfunction. This means the outermost layer of their skin is letting too much moisture escape, allowing external particles and chemicals into the skin. This causes irritation.
Symptoms of Baby Eczema
Baby eczema is the “itch that rashes.” Eczema always begins with an itchy, reddish rash. With continuous scratching, this can turn into thickened skin, scaling, and lichenification (lines through the affected areas).
But eczema in infants can be hard to identify. Babies don’t have the strength or hand control to scratch the same spot over and over. And they definitely don’t have the language to tell us how itchy their skin is.
You can use this tool to identify and 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 thickening, scaling, or lichenification, which is a sign of how itchy it is
- Any signs of pus or water “weeping” from the rash, which can be a sign of infection
Types of Eczema
While itchy, thickened skin is a symptom of eczema, not all baby eczema is the same. Did you know there are actually four common types of eczema? But only two types of eczema are common in babies.
The two types of eczema-like skin conditions common in babies are:
- Atopic dermatitis
- Seborrheic dermatitis, otherwise known as cradle cap
You can read more about the other types of eczema — dyshidrotic eczema and contact dermatitis — here.
When people think of baby eczema, they are thinking of atopic dermatitis. Atopic dermatitis usually presents itself before your baby turns 6 months old, and sticks around pretty much their whole life. But it comes and goes such that sometimes your baby’s skin is totally normal, and other times it’s not.
Atopic dermatitis includes all the hallmark symptoms of eczema, including red, itchy rashes that can cause skin thickening, scaling, and lichenification.
Seborrheic dermatitis is also known to parents as cradle cap, and it is actually not eczema! Cradle cap is usually not itchy, which is a key difference from atopic dermatitis.
Seborrheic dermatitis presents as a rash on the scalp or face between 2 weeks and 12 months old, but usually resolves on its own. Unlike baby eczema, cradle cap is caused by skin that is too oily.
Prevention and Treatment of Baby Eczema
How to Prevent Baby Eczema
While there is no confirmed way to 100% prevent eczema, starting a healthy skin care routine before any symptoms show up has been shown to reduce the odds your baby will develop eczema.
Skin Care to Prevent Eczema
To help prevent your baby from developing eczema:
- Avoid soap and bubble bath, especially those with sodium lauryl sulfate
- Use fragrance-free products
- Avoid bath oils and additives, which can be drying
- Avoid using chemical/soap-based baby wipes, if possible
This will help your baby maintain their natural oils and protective layers. Daily use of emollients like shea butter, cocoa butter, and petroleum jelly are effective at preventing a skin barrier dysfunction.
Managing Eczema Flare-Ups
Besides establishing a good skin care routine with your baby, there’s not much else parents can do to actually prevent eczema. There are a lot of things, however, that can help prevent eczema flare-ups, and manage the symptoms when your baby’s eczema does flare-up.
Common triggers include:
- Body soaps
- Laundry detergent
- Pollen and dust
- Weather extremes
Hand soap, shampoo, bubble bath, and body wash — even ones with “natural ingredients” — can irritate sensitive baby skin. Doctors recommend:
- Avoiding bubble bath and body wash with sodium lauryl sulfate
- Using fragrance-free products
- Avoiding bath oils
- Ditching chemical/soap-based baby wipes
Clothes can be a major source of irritation, either from the ingredients used to wash those clothes, or the materials they are made of themselves. Doctors recommend:
- Avoiding fabric softeners and dryer sheets
- Dressing your baby in lightweight cotton
- Giving your baby cotton sheets to sleep on
- Washing clothes regularly to remove oils and dirt
Pollen and dust
The air carries pollen and mold onto every surface in our house. These environmental substances can irritate your baby’s skin. Doctors recommend:
- Having an allergist test your baby for environmental allergies
- Using air filtration systems
- Cleaning regularly
- Washing sheets and pillowcases frequently to remove pollens
Some foods might cause your baby’s eczema to flare up. While this is incredibly rare, if this is the case, doctors recommend having your baby tested for possible food allergies, and trying an elimination diet to remove possible triggers.
Eczema causes babies to become itchy when they sweat or get too hot. Extreme cold and dry weather can also cause a flare up. Doctors recommend:
- Using moisturizers daily
- Only dressing your baby in one more layer than yourself (to keep them from overheating)
- Removing hats and gloves when indoors
Strengthening the Skin Barrier
The final way to avoid flare-ups is to strengthen your baby’s skin barrier. Using an emollient daily can help seal your baby’s skin and prevent excess water loss and dryness.
Here are the best eczema creams for babies to help strengthen their skin and treat eczema flares.
Treating Baby Eczema Flare-Ups
If a flare-up does occur, it’s important to know how to best soothe and treat your baby’s sensitive skin. The three important things to cover when treating baby eczema flares are to:
- Stop the itching
- Prevent infection
- Heal skin
Stop the Itching
To stop the itching, you need to remove the histamine in the skin. The best way to do this is with topical steroids like hydrocortisone cream.
Always talk to a doctor before using hydrocortisone creams on a baby to treat their eczema. Do not use it on the same spot for longer than a week — long-term use has been associated with thinning of the skin.
Only use a topical steroid until the flare is under control.
To safely give your baby a bleach bath:
- Use 6 percent bleach for the bath. Do not use concentrated bleach.
- Add one teaspoon of bleach per gallon of water. For reference, bathtubs can hold anywhere from 40 to 80 gallons of water.
- Never apply bleach directly to your child’s eczema.
- Soak for five- to 10-minutes.
- Pat your baby’s skin dry, apply any medications, and then moisturize the skin.
Heal the Skin
Finally, heal the skin after an eczema flare using the “soak and seal” method.
Baby Eczema, Asthma, and Food Allergies
Babies who develop eczema are at a higher risk for other atopic diseases. Eczema is usually the first disease to present itself during the atopic march, with asthma, food allergies, and seasonal allergies (allergic rhinitis) following suit.
The progression of allergic diseases, known as the Atopic March.
Baby Eczema and Asthma
The severity of a baby’s eczema also determines the risk of developing asthma. About 20% of babies with mild eczema develop asthma, but that number jumps to 60% when they have severe eczema.
Doctors believe eczema pre-disposes babies to asthma when:
- Asthma triggers get through breaks in the skin
- The body has a large number of roving Th2 cells, meaning they have an overactive immune system.
These two things lead the body to identify otherwise harmless triggers and attack them any time they are breathed into the lungs or enter the sinuses.
Eczema Increases a Baby’s Risk of Developing Food Allergies
In addition to putting babies at higher risk for developing asthma, baby eczema also puts babies at higher risk for developing food allergies.
How old a baby is when the eczema starts appearing and how bad the eczema is determines the risk of food allergy.
The study above highlights that babies who develop severe eczema early on are at the highest risk of developing food allergies.
Babies who develop eczema very young (age 0-3 months) that need prescription strength medicines (severe eczema), have a 50% rate of food allergy. Babies who develop eczema closer to a year old, and those with mild eczema, only have a 5% rate of food allergy.
Why Does Eczema Cause Allergies?
Doctors think baby eczema creates the conditions for food allergies to develop.
Eczema lesions — the dry, itchy patches of skin — create breaks in a baby’s skin. Food particles can get through these cracks and sensitize your baby to those foods.
While sensitization doesn’t confirm an allergy, your baby’s body has already decided something is a threat, and is ready to attack that thing every time they come into contact with it.
New research has also proven that the unaffected skin from children with both atopic dermatitis and food allergy was more prone to water loss, had more Staphylococcus aureus bacteria, and had different gene expression. It was the combination of both eczema and a weakened skin barrier that set off food allergies.
Preventing Food Allergies
Controlling and treating your baby’s eczema can help lower their risk of developing food allergies. If you protect their skin with regular use of emollients and you’re able to prevent them from scratching, their eczema may not lead to food allergies.
Check out our list of the best eczema creams for babies.
Eating 2 grams of peanuts, eggs, tree nuts, dairy, and wheat protein 2-3 times a week each, from when babies start solids, has been shown to reduce the chances of those food allergies by 75%.
The current guidelines from the American Academy of Pediatrics decide how & when a baby should start eating foods based on the severity of their eczema.
4- 6 month old babies that have:
- No eczema or food allergies should start eating commonly allergenic foods 3 times a week at home as soon as they can eat solid foods.
- Mild eczema that responds to emollients or over-the-counter medicines should start eating commonly allergenic foods 3 times a week at home starting by 6 months old.
- Severe eczema that requires prescription drugs, egg allergy, or both should see a doctor to get tested for existing sensitization to foods.
- Babies who are not sensitized should begin eating commonly allergenic foods 3 times a week starting between 4-6 months old.
- Babies who are sensitized, but pass a food challenge, should begin eating those foods 3 times a week starting between 4-6 months old.
How to Introduce Allergenic Foods
Parents shouldn’t be afraid of following the American Academy of Pediatrics recommendations about early allergen introduction. It is easier to prevent an allergy than manage one for life, and introducing allergens early also reduces your baby’s chance of having a serious reaction.
In order to effectively reduce your child’s risk of developing allergies, your baby should eat 2 grams of the allergenic protein 2-3 times a week through their first year.
Lil Mixins is the easiest way to introduce peanuts, eggs, and tree nuts to your baby. Nut butters and eggs can be a choking hazard for babies, and they often include added sugars and salts that aren’t good for your baby.
Lil Mixins powders are just whole ground food and nothing else. They’re easy to mix in to what you’re already feeding your baby, so you don’t have to spend extra time thinning peanut butter or baking eggs so they’re safe for your baby.
Eczema Flare or Allergic Reaction?
If you’re beginning to feed your baby allergenic foods and they already have eczema, it’s important to know the difference between what an eczema flare-up and an allergic reaction to food look like.
Allergic reactions to food present as:
- Redness around the mouth
- Stomach distress such as vomiting or diarrhea
- Runny or stuffy nose, sometimes with clear discharge
- Redness or itchiness of the nose
- Swelling of the face, including puffiness around the eyes
- Difficulty breathing
- Swelling of the mouth, including the lips and possibly tongue
- Temperature < 97 degrees or a Fever of 101 degrees or higher
- Swelling of the throat and difficulty swallowing
- Weak pulse
- Losing consciousness
If your baby has a reaction, call your doctor. Mild reactions can be treated with an age and weight-appropriate amount of Benadryl. If your baby has a severe reaction such as coughing or wheezing, or both skin symptoms AND stomach symptoms, bring them to an emergency room immediately for observation and help.
Hives versus Eczema
The common confusing symptom of an allergic reaction is hives. Hives are not eczema.
Hives appear quickly and have raised bumps, turn the skin reddish or pale, and often look like mosquito bites. Hives also usually cover a large area of skin.
An eczema flare, on the other hand, develops slowly. Eczema patches are very dry and don’t have the same raised characteristic of hives. Eczema also tends to form in distinct patches.
Final Thoughts About Babies and Eczema
Baby eczema is common and easily manageable for parents. With this guide, you now know the risks associated with eczema, as well as how to manage it to minimize the effect it has on your baby’s life.
With a consistent skin care routine, and following the American Academy of Pediatrics’ recommendations when it comes to preventing other atopic diseases, your baby with eczema will grow up just like any kid without it.