The bothersome itch: Impact of child feeding practices on eczema

What causes eczema? 

Research shows that the prevalence of eczema has been increasing over the last 20 years. The causes of eczema are actually not fully known, and could be different for each child.

In certain severe cases, food allergy may be a trigger and the two most common foods culprits are eggs and cow’s milk. This is more typical among younger children and those who are more seriously affected by eczema.

According to Professor Lee Bee Wah, “The presence of food allergy in infants and young children with severe eczema has been found to be as high as 33 to 66% in some studies done by specialized allergy centres

“Children with a family history of eczema or a personal or family history of other atopic conditions (e.g. asthma, allergic rhinitis or allergic conjunctivitis) have a higher risk of developing atopic eczema,” added Dr Mark Koh.

The consequences of eczema

Symptoms may appear by the time the child is 3 months of age. Areas of the face, hands, elbows, inner creases and almost any body part can dry, flake, swell and even blister and turn to lesions. These lesions may start before the baby reaches the age of one – this happens in 80% of children

“Poorly controlled eczema can have profound effects on a person’s quality of life, possibly leading to psychosocial problems. Itching is a major problem in patients with eczema. This can lead to poor sleep, difficulty in concentration in school, and poor academic results,” said Dr Koh.

He further emphasied, “Patients with recurrent flares or moderate-to-severe disease may have problems attending school and participating in sports and other physical activities. They may need recurrent admissions in hospital. In addition, parents of severely affected patients can face severe psychological stress, leading to poor quality of life.”

Link between eczema and asthma

The presence of eczema in infancy is a marker of higher risk of asthma in childhood.  “This is called the ‘atopic march’ where children who are prone to allergic problems may start off with eczema and food allergies in early infancy and then progress to wheezing, asthma and nose allergy (allergic rhinitis) in later childhood. However, not all allergic children follow this progression.” explained Professor Lee.

She added, “Children with eczema may be at higher risk of cow’s milk allergy. Cow’s milk allergy may present as an immediate allergy with constellation of signs such as skin swelling, hives, vomiting, running nose and wheeze.”

Keeping eczema at bay

There is  currently no known cure for eczema. According to Dr. Koh, “Most children with eczema will improve by the time they reach school-going age, some patients may have persistent or recurrent disease till adulthood. Eczema can recur again even after a period of  recovery.”

In terms of feeding, breast milk, , besides providing numerous other health benefits,  is likely the best bet to help lower the risk of eczema in a child with a family history of allergies, “Breast feeding for 4 to 6 months is advocated. At the moment the scientific evidence is unclear for other forms of intervention. There are some studies that advocate the use of partially hydrolysed formula (hypoallergenic) and others the use of prebiotics. However more studies are required to recommend these with certainty,” said Professor Lee.

Partially-hydrolysed formulas refer to milk formulations for young children which have their protein source partly broken down into smaller molecules. Recent guidelines on the management of food allergy released by the Singapore Ministry of Health state that a hydrolysed formula can be recommended for babies with a family history of allergy who cannot be completely breastfed. Indeed, several studies have shown that the use of partially-hydrolysed formulas in high-risk babies were associated with a lower incidence of eczema, with the preventive effect lasting up to 6 years of age.

The formula for comfort

Parents may wish to take the family history of allergy into consideration when selecting a suitable source of nourishment for their young children. This decision is best made in consultation with a doctor. While more research still needs to be carried out, partially-hydrolysed formula milk could be an option for the prevention of eczema in high-risk children, if breastfeeding is not possible. Such products however should not be fed to children who are allergic to milk or have existing milk allergy symptoms. The choice of formula milk should also adequately support the nutritional needs of a rapidly growing child, especially that of the brain, eye and immune system.

Article brought to you by the makers of Total Comfort^TM  

Special thanks to Professor Lee Bee Wah, Paediatrician, and Dr Mark Koh, Consultant Dermatologist, for sharing their expert opinions.

Prof Lee Bee Wah,
Paediatrician
The Child and Allergy Clinic
3 Mount Elizabeth #11-11
Mount Elizabeth Medical Centre Singapore 228510

Dr. Mark Koh Jean Aan
Consultant Dermatologist
Changi General Hospital, Dept of Dermatology
Visiting Consultant Paediatric Dermatologist
KK Women’s & Children’s Hospital, Paediatric Dermatology Service