Managing Your Child's Eczema Day To Day

Reader asks Dr Lee about keeping her child eczema free

Eczema is managed, not cured, and most of the difference between a controlled child and a miserable one comes down to two things done properly: enough emollient, and not being frightened of the steroid.

The biggest problem in eczema care is under-treatment, not over-treatment.

Parents are widely and understandably wary of topical steroids, so they apply a thin smear of a weak one for a day or two, the flare doesn’t settle, and the child stays inflamed for weeks.

Using the prescribed strength properly for the prescribed number of days settles a flare and then stops. That’s a smaller total steroid exposure than months of inadequate treatment, and a far more comfortable child.

If you’ve got concerns about the steroid, raise them with your doctor instead of halving the dose on your own.

The routine

Soak and seal, every day, whether or not the skin looks bad:

Short, lukewarm bath or shower. Not hot. Heat worsens itch.
No soap, bubble bath or foaming wash. A soap substitute or emollient wash instead.
Pat dry, don’t rub. Leave the skin slightly damp.
Emollient within about three minutes, while the skin still holds water. That timing is what makes the whole thing work.
Apply downwards in the direction of hair growth, not rubbing in circles, which can block follicles.

How much to use

Almost every family uses too little. Emollient should be applied generously, several times a day, not only after bathing. A young child with widespread eczema can reasonably get through a large tub in a couple of weeks. If a tube is lasting months, that’s the problem.

Ointments work better than creams, and creams better than lotions: greasier is more effective, and less pleasant. A common compromise is ointment overnight and a cream during the day.

Order of application

Steroid first on the affected patches, then emollient over the top, or leave twenty to thirty minutes between them. Emollient goes everywhere; steroid only where there’s active eczema.

Common triggers

Heat and sweat. The dominant trigger in Singapore, and the one most within your control. Air-conditioning at night, light cotton clothing, fewer layers than instinct suggests, and a rinse plus re-application of emollient after any sweating.
Dust mites. Weekly bedding washes at 60°C, because cooler water doesn’t kill them. Mite-proof mattress and pillow encasements, and humidity kept around 50 to 60%.
Soap, bubble bath, detergent and fabric softener. Fragrance-free everything, and skip softener entirely.
Wool and synthetic fabrics. Cotton or bamboo, loose, with labels cut out.
Saliva and food on the face in babies: barrier ointment around the mouth before meals.
Chlorinated pools: rinse immediately afterwards and re-apply emollient. Swimming is otherwise fine.
Stress and illness, which reliably produce flares.

Food and eczema

A common and costly misunderstanding: food allergy is usually not the cause of eczema. The relationship generally runs the other way. Inflamed skin allows sensitisation to food proteins, so severe eczema raises the risk of developing food allergy instead of resulting from it.

Don’t put a child on an elimination diet without medical advice. Unsupervised exclusions rarely improve the skin, frequently cause nutritional problems, and can make a real allergy worse by removing a food the child was tolerating.

If you suspect a food connection, whether that’s consistent flaring within hours of a specific food or immediate symptoms, that’s a conversation with a doctor, not a change to make at home.

Scratching and sleep

Nails short and filed smooth, checked weekly.
Cotton mitts or long sleeves at night for young children.
Cool the itch: emollient kept in the fridge, or a cool damp cloth. Something to do instead of scratching helps more than “stop scratching”.
Wet wrapping for severe flares, if your doctor or nurse has shown you how.
Antihistamines do little for eczema itch itself, though a sedating one occasionally helps sleep short-term. Ask, don’t assume.

When to see a doctor

Signs of infection: weeping, yellow or golden crusting, pustules, increasing pain, or the child becoming unwell or feverish
Not settling despite proper treatment for a week or two
Sleep is being lost, the child’s or yours. This is a legitimate reason to ask for more help and is often not raised
Repeated infections, where a doctor may suggest additional measures

Seek urgent care for a rapidly spreading rash of small painful blisters or punched-out sores, particularly with fever and an unwell child. This can be a herpes infection of eczematous skin, which spreads fast and needs immediate treatment.

The outlook

Most children improve substantially by school age, and many outgrow it. In the meantime it’s exhausting for the whole household. The sleep loss is real and cumulative, so say so to your doctor rather than treating it as something to absorb.

Frequently asked questions

Are topical steroids safe for children’s eczema?

Used as prescribed, yes, and under-treatment is the more common problem. Applying a thin smear of a weak steroid for a day or two leaves a child inflamed for weeks, which is a larger total exposure than using the prescribed strength properly for the prescribed days. Raise any concerns with your doctor instead of reducing the dose on your own.

How much moisturiser should I use?

Far more than most families do: generously, several times a day, not only after bathing. A young child with widespread eczema can reasonably get through a large tub in a fortnight. Ointments work better than creams, and creams better than lotions.

What’s the right bathing routine?

Short and lukewarm, no soap or bubble bath, pat dry leaving the skin slightly damp, then emollient within about three minutes while the skin still holds water. Apply downwards in the direction of hair growth, not in circles.

Does food cause eczema?

Usually not. The relationship generally runs the other way, with inflamed skin allowing sensitisation to food proteins. Don’t start an elimination diet without medical advice: unsupervised exclusions rarely help the skin, often cause nutritional problems, and can worsen a real allergy by removing a food the child was tolerating.

What triggers eczema in Singapore specifically?

Heat and sweat above all, which is also the most controllable: air-conditioning at night, light cotton clothing, fewer layers, and rinsing and re-applying emollient after sweating. Then dust mites, which thrive in the humidity: weekly bedding washes at 60°C and mite-proof encasements.

When is eczema an emergency?

A rapidly spreading rash of small painful blisters or punched-out sores, especially with fever and an unwell child, needs urgent care. This can be a herpes infection of eczematous skin, which spreads quickly. Weeping, golden crusting or pustules suggest bacterial infection and need same-day attention.

What to remember

Emollient, generously, several times a day, and within three minutes of patting dry. Most families use a fraction of what’s needed.

Use the steroid properly when it flares. Under-treating is the common mistake and it keeps the child inflamed for longer.

Heat and sweat are the local trigger: aircon, cotton, fewer layers. And don’t start an elimination diet on your own.