Baby Skin Frequently Asked Questions

Eczema refers to a group of conditions that cause inflamed skin.  There are many types of eczema including atopic dermatitis, contact dermatitis, nummular eczema and dyshidrotic eczema.  People often say “eczema” when referring to any of these conditions.  

Atopic dermatitis (AD) is the most common type of eczema, affecting more than 9.6 million children in the United States. AD is a chronic condition that usually develops in infancy (usually in the first 6 months) or childhood, but can develop at any time in a person’s life. AD is characterized by itchy red patches on the hands, feet, backs of elbows and around knees, ankles, and wrists.  It may also affect a baby’s cheeks, chin, chest, forehead, or scalp.

References:

1. Eczema - National Eczema Association:  Eczema Causes, Triggers & Symptoms | National Eczema Association  Accessed 9.28.22

2. Eczema - American Academy of Dermatology Eczema types: Atopic dermatitis overview (aad.org) Accessed 9.28.22

3. Atopic Dermatitis - National Eczema Association Atopic dermatitis– Symptoms and causes | National Eczema Association Accessed 9.28.22

It is important to remember that eczema and its symptoms are different for everyone. Eczema almost always includes itchy skin. At times, the itch can get so bad that it causes people to scratch - also known as the “itch-scratch cycle”.

What to look for:

• Itch

• Dryness, sensitive skin

• Inflamed, discolored skin

• Rough, leathery, or scaly patches of skin

• Oozing or crusting

Your baby may have all or just a few of these symptoms.  There may be times when symptoms go away, and other times when your baby has flare-ups.  The best way to find out if your baby has eczema is to consult a healthcare professional.

References:

1. Atopic Dermatitis - National Eczema Association Atopic dermatitis– Symptoms and causes | National Eczema Association Accessed 9.28.22

2. Eczema - National Eczema Association Eczema Causes, Triggers & Symptoms | National Eczema Association Accessed 9.28.22

3. Eczema - American Academy of Dermatology Eczema types: Atopic dermatitis overview (aad.org) Accessed 9.28.22

Eczema generally appears as a red, dry, and itchy rash in lighter skin tones, but may be a challenge to see on darker skin tones, making diagnosis more difficult. On darker skin, patches may appear darker than the rest of the skin, looking purple, ashen grey, or dark brown.

Eczema also looks and acts differently in infants and toddlers than it does in older children. Here is a guide by age⁴:

Infants (first 6 months)
Eczema usually appears more red and “weepy” (oozing blisters), generally on the face, cheeks, chin, forehead, and scalp. It can spread to other areas of the body, but the diaper area is usually spared, where moisture protects the skin. 

Babies (6-12 months)
Eczema often appears on baby’s elbows and knees - places that are easy to scratch or rub when crawling. It may form a yellow crust, or small “pus bumps” on the skin.   

Toddlers (2-5 years)
Eczema tends to affect the face and is more likely to appear in the creases of the elbows and knees, or on the wrists, ankles, and hands. It may also appear on the skin around your toddler’s mouth and eyelids.

Children (5+ years)
Eczema usually appears in the folds of the elbows and knees and even on hands and behind the ears.

The best way to find out if your baby has eczema is to consult a healthcare professional.

References:

1. Atopic Dermatitis - National Eczema Association Atopic dermatitis– Symptoms and causes | National Eczema Association Accessed 9.28.22

2. Eczema - National Eczema Association Eczema Causes, Triggers & Symptoms | National Eczema Association Accessed 9.28.22

3. Eczema - American Academy of Dermatology Eczema types: Atopic dermatitis overview (aad.org) Accessed 9.28.22

4. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/symptoms

Genetics, environment, and skin barrier function can all play a big role in the development of atopic dermatitis (AD). It often runs in families and tends to lead into other allergic conditions such as asthma and allergic rhinitis (hay fever and seasonal allergies).  Having family members with these conditions can also increase your baby’s risk.

Researchers have found that certain genes affect the outermost layer of the skin called the epidermal barrier.  This barrier protects your baby’s skin from losing too much water and prevents germs from getting in through the skin. Alteration of this gene results in impaired barrier function. This can be inherited, although having genes that increase your risk does not guarantee development of eczema. A damaged skin barrier renders the skin more permeable to irritants, allergens and microorganisms which can trigger eczema symptoms.

Eczema is also believed to be caused in part by the immune system.  Researchers have learned that the immune system overreacts in people with AD, causing it to react to everyday things like pollen and pollution, which can lead to flare-ups.

Studies on atopic dermatitis development show that boys more frequently develop AD than girls during infancy, but there is a switch to predominance in girls in adolescence. African American and Asian American children tend to develop atopic dermatitis more often than white children.

Where you live can also have an impact.  While climate cannot cause AD, it can be a tipping point for those who are genetically predisposed.  Children who have a higher risk of developing AD tend to get it more often if they live in a city, a place that is cold and damp at least part of the year, or a mountainous area with low temperatures for at least part of the year. Children who live in a rural, or warm, humid area seem to have a lower risk.

There are also a wide variety of environmental factors that can trigger eczema symptoms. Common triggers can include - Irritants: such as soaps, detergents, and shampoos; Allergens: such as dry or wet weather, dust, mites, pollen, and molds.

References:

1. Eczema in Babies and Children - American Academy of Pediatrics Eczema in Babies and Children - HealthyChildren.org Accessed 9.28.22

2. Atopic dermatitis - Mayo Clinic Atopic dermatitis (eczema) - Symptoms and causes - Mayo Clinic Accessed 9.28.22

3. Pyun BY. Natural history and risk factors of atopic dermatitis in children. Allergy Asthma Immunol Res. 2015 Mar;7(2):101-5. doi: 10.4168/aair.2015.7.2.101. Epub 2014 Nov 25. PMID: 25729616; PMCID: PMC4341330. Natural History and Risk Factors of Atopic Dermatitis in Children - PMC (nih.gov) Accessed 9.28.22

4. Baby Eczema - National Eczema Association Baby eczema: causes, symptoms, treatment and more (nationaleczema.org) Accessed 9.28.22

5. Atopic Dermatitis Causes - American Academy of Dermatology. Eczema types: Atopic dermatitis causes (aad.org) Accessed 9.28.22

The exact cause of eczema in babies is unknown.  What researchers do know is that eczema in general is linked to a combination of impaired skin barrier function, environmental allergens and/or genetics.  Up to 25% of babies and toddlers experience eczema, and an estimated 60% of people with eczema develop it during their first year of life. 

References:

1. Nemeth V, Evans J. Eczema. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/

2. Baby Eczema - National Eczema Association Baby eczema: causes, symptoms, treatment and more (nationaleczema.org) Accessed 9.28.22

3. Atopic Dermatitis Causes - American Academy of Dermatology. Eczema types: Atopic dermatitis causes (aad.org) Accessed 9.28.22

To diagnose eczema, your healthcare provider will examine your child and talk with you about your child’s symptoms and medical history to identify potential allergies and rule out other skin concerns.

Your child’s doctor may ask you:

• When, how often, and where does your child develop dry, itchy patches of skin?

• Do you, or anyone in our family, have eczema, asthma, allergies like hay fever, or allergies to pet hair or dander?

• Does your child’s rash seem to happen after contact with something irritating, like certain fabrics, cleansing or other skincare products?

• Do you notice flares happen when your child’s skin is dry, or when the weather is very dry, hot, or cold?

It is important to remember that eczema may look and act very differently as your child gets older.  Your healthcare provider will evaluate your child’s symptoms and help you identify triggers so that you can better treat symptoms and manage it as they grow and change. 

Reference:

1. Understanding Eczema in Children Baby eczema: causes, symptoms, treatment and more (nationaleczema.org)

Goals of eczema treatment include relieving itch and moisturizing to help restore the skin’s moisture barrier.  Gentle skin care and generous use of moisturizers are considered first-line therapy for management of eczema symptoms. 

Cleansers and Moisturizers

Moisturizers help replace lost moisture, help restore the skin moisture barrier, and help relieve flare-ups. It is important to continue a regular moisturizing routine even when your child is not experiencing a flare.

Bathing Tips

• Use lukewarm water to wash your child.

• Use a mild, non-drying, gentle cleanser,

• Gently pat skin dry — don't rub.

• Avoid body sponges and washcloths.

Moisturizing Tips

• Apply an emollient- rich moisturizer, to damp skin (within 3 minutes after the bath).

• If needed, apply prescribed medications first and then liberally apply moisturizer. Talk to your healthcare provider about the use of prescribed medications.

Over-the-counter Medications

Topical anti-itch creams containing hydrocortisone may help to ease symptoms for children over 2 years of age. Follow the directions on the label carefully. Do not use more often or longer than recommended on the label or by your healthcare provider.

References:

1. Eczema in Babies and Children - American Academy of Pediatrics Eczema in Babies and Children - HealthyChildren.org Accessed 9.28.22

2. Baby Eczema - National Eczema Association Baby eczema: causes, symptoms, treatment and more (nationaleczema.org) Accessed 9.28.22

3. Atopic Dermatitis Causes - American Academy of Dermatology. Eczema types: Atopic dermatitis causes (aad.org) Accessed 9.28.22

While foods do not directly cause eczema, research shows certain foods may trigger eczema symptoms in 20-30% of cases of moderate to severe eczema. Additionally, foods are more likely to worsen eczema symptoms in children and infants under age 5.

Food allergies are common in children who have atopic dermatitis (AD). About 40% of babies and young children with moderate or severe AD have food allergies. A 2019 review reported that infants with eczema were six times more likely to have an allergy to cow’s milk, eggs, or peanuts at 12 months of age compared with infants without eczema.

Many parents believe that avoiding the foods that cause an allergic reaction will prevent allergic reactions and AD flare-ups. This list of foods includes anything that contains milk, eggs, wheat, soy, and nuts. While making dietary changes (eliminating trigger foods) may help reduce symptoms, it depends on the child’s particular allergies or sensitivities, so always speak with a healthcare professional to determine which foods might be best to eliminate if any. Just know that when a child truly has food allergies, removing the foods that cause an allergic reaction from a child’s diet rarely stops symptoms of AD.

If your child still has AD flare-ups, and you think a food allergy could be causing your child’s eczema, talk to your child’s healthcare provider.  Experts recommend allergy testing for foods only when a child has:

• Moderate to severe AD that skin care, trigger management, and medication cannot control

• An immediate allergic reaction after eating a specific food

The bottom line - eliminating foods can do more harm than good.  Always consult with your child’s healthcare provider before making dietary changes.

References:

1. Chang A, Robison R, Cai M, Singh AM. Natural History of Food-Triggered Atopic Dermatitis and Development of Immediate Reactions in Children. J Allergy Clin Immunol Pract. 2016 Mar-Apr;4(2):229-36.e1. doi: 10.1016/j.jaip.2015.08.006. Epub 2015 Nov 17. PMID: 26597013; PMCID: PMC4789144.

2. Nosrati A, Afifi L, Danesh MJ, Lee K, Yan D, Beroukhim K, Ahn R, Liao W. Dietary modifications in atopic dermatitis: patient-reported outcomes. J Dermatolog Treat. 2017 Sep;28(6):523-538. doi: 10.1080/09546634.2016.1278071. Epub 2017 Jan 24. PMID: 28043181; PMCID: PMC5736303.

3. Katta R, Schlichte M. Diet and dermatitis: food triggers. J Clin Aesthet Dermatol. 2014 Mar;7(3):30-6. PMID: 24688624; PMCID: PMC3970830.

4. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol. 1999 Sep;104(3 Pt 2):S114-22. doi: 10.1016/s0091-6749(99)70053-9. PMID: 10482862.

5. Eigenmann PA, Beyer K, Lack G, Muraro A, Ong PY, Sicherer SH, Sampson HA. Are avoidance diets still warranted in children with atopic dermatitis? Pediatr Allergy Immunol. 2020 Jan;31(1):19-26. doi: 10.1111/pai.13104. Epub 2019 Aug 1. PMID: 31273833.

6. Can food fix eczema? - The American Academy of Dermatology Can food fix eczema? (aad.org) Accessed 9.30.22

7. Robison RG, Singh AM. Controversies in Allergy: Food Testing and Dietary Avoidance in Atopic Dermatitis. J Allergy Clin Immunol Pract. 2019 Jan;7(1):35-39. doi: 10.1016/j.jaip.2018.11.006. Epub 2018 Nov 27. PMID: 30501976; PMCID: PMC6312729.

Studies on atopic dermatitis development (AD) show that boys more frequently develop AD than girls during infancy, but there is a switch to predominance in girls in adolescence.

In a recently published study, eczema on the cheeks was more common in boys at both 3 and 6 months of age, and with a trend also at 12 months of age, whereas eczema on the flexor surfaces (elbows and knees) was more common in girls than in boys at 3 months of age. These findings were consistent with studies in older children showing a slightly higher prevalence in boys than in girls with a reversal after puberty.

Reference:

1. Endre KMA, Landrø L, LeBlanc M, Gjersvik P, Carlsen KL, Haugen G, Hedlin G, Jonassen CM, Nordlund B, Rudi K, Skjerven HO, Staff AC, Söderhäll C, Vettukattil R, Rehbinder EM. Eczema distribution in girls and boys during infancy: A cohort study on atopic dermatitis. J Allergy Clin Immunol Pract. 2021 Sep;9(9):3513-3516.e2. doi: 10.1016/j.jaip.2021.04.053. Epub 2021 May 5. PMID: 33964509.

Eczema is a very common skin condition, affecting up to 20% of children and 3% of adults worldwide¹. While eczema can appear anywhere on the body, the most common areas of involvement for children are the flexural areas (parts of the body able to flex) of the arms and legs, whereas adults have more involvement on the head, neck and hands. Adults also tend to have more coin-shaped lesions² and a more lichenified (thickened and leathery), drier appearance³.

Children with eczema tend to have more oozing and crusty lesions, flaking skin, scaly patches, and higher prevalence of dermatitis of the eyelid⁴. Children also tend to be more prone to skin infection³.

Treatment of eczema signs and symptoms is essentially the same for adults and children³, but adults are more likely to have signs of chronic disease, hand eczema, and a stronger relationship of disease activity with emotional factors⁵ such as anxiety and depression³.

References:

1. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16. doi: 10.1159/000370220. Epub 2015 Apr 24. PMID: 25925336.

2. Adult vs child atopic dermatitis. Adult vs child atopic dermatitis (dermatologytimes.com)

3. Ellis CN, Mancini AJ, Paller AS, Simpson EL, Eichenfield LF. Understanding and managing atopic dermatitis in adult patients. Semin Cutan Med Surg. 2012 Sep;31(3 Suppl):S18-22. doi: 10.1016/j.sder.2012.07.006. PMID: 23021781. Understanding and managing atopic dermatitis in adult patients - PubMed (nih.gov)

4. Yik Weng Yew, Jacob P. Thyssen, Jonathan I. Silverberg. (2019). A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. Journal of the American Academy of Dermatology 80(2), 390-401. https://doi.org/10.1016/j.jaad.2018.09.035.

5. Ramírez-Marín HA, Silverberg JI. Differences between pediatric and adult atopic dermatitis. Pediatr Dermatol. 2022 May;39(3):345-353. doi: 10.1111/pde.14971. Epub 2022 Mar 16. PMID: 35297082.

Identifying and avoiding triggers is vitally important to managing eczema. But remember, eczema affects everyone differently, so your child’s triggers may not be the same as another’s. Also keep in mind that the effects of a trigger may not be immediately following exposure and the lag time to a reaction may make identifying the trigger more difficult¹. Some of the most common eczema triggers include:

Dry skin**²****:** When skin loses moisture, it can become dry, scaly and rough, which can lead to an eczema flare-up¹. Moisturizers help replace lost moisture, help restore the skin’s moisture barrier, and help relieve flare-ups. It is recommended to continue a regular moisturizing routine even when your child is not experiencing a flare.

Irritants**²** : Many soaps, disinfectants and fragrances can make eczema worse for baby’s skin. Common products that may cause a flare-up include: detergents and dryer sheets, bubble bath, shampoos, disinfectants, dyes, and coarse fabrics like wool¹. Always wash new clothes before they are worn, use dye-free and fragrance-free detergents, and choose sunscreen made for sensitive skin.

Allergens: Typical allergens like dust mites, pet dander, and pollen can cause itchy, inflamed skin^1,2. Minimize allergens in your home by vacuuming and wet-dusting frequently, keeping soft toys (which trap dust) to a minimum and wash them often. Groom pets regularly.

Environment: Extremes in temperature and humidity may trigger an eczema flare-up. Environmental triggers include very hot or very cold temperatures, high or low humidity, cigarette smoke and pollution¹. Keep the baby’s bedroom between 68 and 72°F and maintain even humidity in your home³.

Metals: Certain metals like chromium cobalt, chloride, copper, gold and nickel can cause an allergic response known as contact dermatitis¹.

Food: As many as one-third of children with eczema also have food allergies⁴. Though food allergies don’t cause eczema, they can be a trigger for worsening of existing symptoms. The most common food allergies are milk, eggs, soy, nuts, seeds, seafood, shellfish, and wheat. Food allergies among children tend to diminish with age, with the exception of nuts. Most children with food allergies eventually tolerate milk, egg, soy, and wheat, while allergy to peanuts and tree nuts is likely to persist⁵.

Stress: While stress doesn’t cause eczema, mental health conditions can make eczema symptoms worse¹. If your child is having problems at daycare, you may notice more eczema flare-ups than usual. Stress can also cause habit scratching, which perpetuates the itch-scratch cycle. In that case, keep your child’s fingernails short and consider cotton gloves or mittens if your child tends to scratch while sleeping.

References:

1. Eczema Causes & Triggers - National Eczema Association: Eczema Causes & Triggers | National Eczema Association

2. Baby eczema: causes, symptoms, treatment and more - National Eczema Association:

   Baby eczema: causes, symptoms, treatment and more (nationaleczema.org)

3. What Triggers Eczema in Babies- MedicineNet: What Triggers Eczema in Babies

4. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract. 2013 Jan;1(1):22-8. doi: 10.1016/j.jaip.2012.11.005. Epub 2012 Dec 27. PMID: 24229818.

5. Katta R, Schlichte M. Diet and dermatitis: food triggers. J Clin Aesthet Dermatol. 2014 Mar;7(3):30-6. PMID: 24688624; PMCID: PMC3970830.

Eczema in babies and children most often occurs where the skin flexes — inside the elbows and behind the knees¹. Where skin creases, skin is more susceptible to rubbing and irritation. Increased sweating in these areas can also dry out the skin².

In babies, eczema mainly appears on the cheeks and the outer surfaces of the arms and legs and – less commonly on the back, stomach and chest. Children, teenagers and adults who have eczema are most commonly affected on the backs of their knees, the insides of their elbows and the back of the neck³.

References;

1. Adult vs child atopic dermatitis. Adult vs child atopic dermatitis (dermatologytimes.com)

2. Eczema Causes & Triggers - National Eczema Association: Eczema Causes & Triggers | National Eczema Association

3. Eczema overview - NIH: InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Eczema: Overview. 2013 Sep 26 [Updated 2017 Feb 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279399/

There is lack of evidence to suggest maternal dietary restrictions during pregnancy or lactation reduce the risk of atopic disease¹. However, a diet rich in fruits, vegetables, fish, vitamin D, and probiotics is encouraged^1,2. Studies show that breastfeeding during the first four months of life modestly reduces the incidence of AD in infants at high risk, while exclusive breastfeeding for four to six months with weaning initiated at 4 to 5 months may provide the lowest risk for developing AD in all children².

References:

1. Dietary interventions to prevent atopic disease: Updated recommendations AAP https://publications.aap.org/aapnews/news/8699?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000

2. Little C, Blattner CM, Young J 3rd. Update: Can breastfeeding and maternal diet prevent atopic dermatitis? Dermatol Pract Concept. 2017 Jul 31;7(3):63-65. doi: 10.5826/dpc.0703a14. PMID: 29034131; PMCID: PMC5630244.

Eczema is a chronic condition, which means that it cannot be cured¹. Treatments, however, are very effective in reducing the symptoms of itchy, dry skin. Goals of treatment include relieving itch, and moisturizing to help restore the skin moisture barrier.

Some children outgrow their eczema. Others continue to have eczema flares and remissions for life. If your child’s eczema becomes more severe, your child’s doctor will consider other treatment options to manage symptoms and help prevent flares. The treatment plan will be tailored to your child’s individual eczema symptoms¹. Tips for managing flares include²:

• Knowing triggers so that you can avoid exposure.

• Sticking with a daily bathing and moisturizing routine

• Using OTC creams, balms, and prescription medications when needed, consistently and as prescribed.

References:

1. Can eczema be cured? American Academy of Dermatology: Can eczema be cured? (aad.org)

2. What is eczema? National Eczema Association: https://nationaleczema.org/eczema/

Eczema is not contagious. You can’t catch it, or give it to someone. The infections that children with eczema get are often from germs that usually live harmlessly on everyone’s skin. These germs cause problems for children with eczema because their skin doesn’t have a strong enough barrier to keep them out¹.

Consult your doctor if your child has yellow or honey-colored crusting and scabbing, weepy or oozy skin, blisters or pus bumps, or a rash that is not getting better despite treatment¹.

Reference:

1. Eczema in Babies and Children - American Academy of Pediatrics: Eczema in Babies and Children - HealthyChildren.org

Unfortunately, it’s impossible to predict how long your child will have eczema. For some children, eczema starts to go away by age 4. However, some children may continue to have dry, sensitive skin as they grow up and even into adulthood¹.

Reference:

1. Eczema in Babies and Children - American Academy of Pediatrics: Eczema in Babies and Children - HealthyChildren.org

An estimated 80% of children will “outgrow” their eczema by adolescence or adulthood, but some people have eczema all of their lives. Children diagnosed at a younger age, with more severe disease, and who live in an urban environment have a higher risk for prolonged disease, although atopic dermatitis may persist regardless of severity¹.

References:

1. Eczema Stats - National Eczema Association: Eczema Prevalence, Quality of Life and Economic Impact (nationaleczema.org)

Caring for a child with eczema can be stressful for you, your child and the rest of your family. There’s also the stress that comes with being asked questions by family and friends, like “what is wrong with your baby’s skin?” or “why is your child scratching all the time?”

The most important thing to remember is that you are not to blame for your child’s eczema. Be open with your partner, family and friends, and if you have access to people who are willing to help you, ask them. Here are a few tips to help ease your frustration and navigate your child’s eczema journey.

The 4 E’s of coping with eczema:

Educate

Family, caregivers and teachers need to know that eczema is a combination of genetics and environmental triggers and that it is not contagious. Know what triggers your child’s eczema is important for all who participate in their care to know¹. School can also be stressful for children with eczema requiring more emotional support and understanding.

Explore

There is no one trigger or treatment¹. Ask your child’s doctor about available treatments, including over-the-counter products that can help manage symptoms and prevent flares. Find a support network or online forum where you can share your concerns and fears with other parents who have similar experiences.

Engage

Living with eczema does not mean your child has to miss out. Children with eczema can do most of the things other children do. Think positively - with the right treatment regimen and trigger avoidance, you can help manage your child’s eczema, making life better for you and your family.

Empower

Let your child participate in their daily care by applying their own treatment as they get older – it will make them feel more independent and help boost their self-esteem.

Additional Resources:

American Academy of Dermatology (AAD) The AAD website provides a search tool that you can use to find a board-certified dermatologist in your area.

Skin of Color Society (SOCS) – The SOCS aims to raise awareness and champion excellence in the treatment of dermatologic conditions in skin of color. The SOCS website provides an extensive searchable list of providers on their website.

National Eczema Association. The National Eczema Association website also has a search tool that you can use to find a doctor or other healthcare professional in your area who specializes in treating eczema.

Reference:

1. Helping your child cope with eczema - National Eczema Association: Helping Your Child Cope With Eczema | Atopic Dermatitis and Kids (nationaleczema.org)

When we think of a baby, we often think of soft, supple, flawless skin.  Infant skin is different from adult skin in structure, function and composition and continues to develop over the first few years of life.^1,2 While the skin of infants and young children is softer and smoother than adult skin, the stratum corneum (outermost layer) is actually up to 30% thinner, making it more susceptible to infections and the penetration of allergens and irritants.^1,3 Because the skin is not yet fully developed, it is also more vulnerable to damage.¹ 

The functions of human skin remain essentially the same through every stage of life, including barrier protection, absorbing and shedding water, protecting against UV damage, regulating body temperature, and providing sensory perception.¹

Here are the key differences between your baby’s skin and yours:

• Thinner and more permeable: Baby skin has fewer elastic fibers, smaller cells and is up to 30% thinner than adult skin.³ This allows more substances to pass through, increasing the absorption of water and other substances. The surface area of a baby's skin is also three to five times greater than an adult relative to body weight, so irritants, allergens, and bacteria from the environment can more easily penetrate and be more concentrated in a baby’s body.⁴

• Less able to retain moisture. Baby skin can lose water up to 5 times as fast as adult skin. Adult skin cells have more molecules called Natural Moisturizing Factors (NMF), which help keep cells hydrated by attracting and absorbing water.⁴

• More susceptible to irritation. The skin microbiome is the ecosystem of bacteria that live on the skin’s surface. The microbiome of healthy skin is co-inhabited by billions of beneficial and harmful bacteria. An imbalance of these bacteria can cause dryness and irritation. An acidic pH not only limits growth of “bad bugs”, but it also fosters the growth of normal bacterial flora, which leads to a healthy balance of skin microorganisms. Baby skin pH tends to be more alkaline or neutral at birth. After the first month, it gradually becomes more acidic, allowing good bacteria to grow and protect the overall health of the skin.⁵   

• More vulnerable to sun damage. Infant and toddler skin has less of the darkening pigment melanin, that helps protect the skin from ultraviolet light. Therefore, baby skin can be damaged more quickly from sun exposure.⁶

• Less able to regulate temperature. Unlike adults, whose blood vessels in the skin widen or narrow to regulate body temperature, babies are not as adept at body temperature maintenance. Babies also have fewer sweat glands, so they can’t sweat to cool down like adults.⁷

It’s important that the products you choose to cleanse, moisturize and protect, support your baby’s developing skin and are gentle, mild and specially formulated for baby skin.
 

References:

1. Fluhr JW, Darlenski R, Taieb A, et al. Functional skin adaptation in infancy—almost complete but not fully competent. Exp Dermatol. 2010;19(6):483-492.

2. Telofski LS, Morello AP 3rd, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract. 2012;2012:198789. doi: 10.1155/2012/198789. Epub 2012 Sep 4. PMID: 22988452; PMCID: PMC3439947.

3. Stamatas GN, Nikolovski J, Luedtke MA, Kollias N, Wiegand BC. Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatr Dermatol. 2010;27(2):125-131.

4. Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol. 2008 Jul;128(7):1728-36. doi: 10.1038/sj.jid.5701239. Epub 2008 Jan 17. PMID: 18200056.

5. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011 Apr;9(4):244-53. doi: 10.1038/nrmicro2537. Erratum in: Nat Rev Microbiol. 2011 Aug;9(8):626. PMID: 21407241; PMCID: PMC3535073.

6. Sun-Safe Babies - The Skin Cancer Foundation - Accessed 9.12.22 https://www.skincancer.org/blog/sun-safe-babies/

7. Oranges T, Dini V, Romanelli M. Skin Physiology of the Neonate and Infant: Clinical Implications. Adv Wound Care (New Rochelle). 2015 Oct 1;4(10):587-595. doi: 10.1089/wound.2015.0642. PMID: 26487977; PMCID: PMC4593874.

Rashes can be very common. Most of them are innocent and transient, causing redness, itchiness and dry skin.¹ Here’s more on the most common baby skin rashes:

Diaper rash: Diaper rash is the most common skin condition seen in babies.² Diaper rash occurs when moisture in your baby’s diaper area causes irritation or growth of fungi or bacteria that normally live in small amounts on the skin. The best way to treat or prevent diaper rash is to keep your baby’s diaper area clean and dry and change diapers frequently. You can also apply an ointment or cream that contains zinc oxide or petrolatum skin protectant to protect your baby’s skin in the diaper, by forming a barrier and blocking out wetness.

Cradle cap: Cradle cap is also called infant seborrheic dermatitis. It looks like yellow scaly patches often surrounded by a red rash on your baby’s scalp. Overproduction of the oil-producing sebaceous glands on your baby’s scalp may cause cradle cap. Shampooing and brushing baby’s hair gently should help loosen the flakes.³

Eczema: Up to 25% of babies and toddlers experience eczema, a skin condition that usually appears as itchy, red patches on the hands, feet, backs of elbows and around knees, ankles and wrists.  It also may affect a baby’s cheeks, chin, chest, forehead or scalp.⁴ Dry skin, sweating, pet dander, pollution, or even dust can cause a flare-up. Scratching can make eczema worse, causing irritation, swelling and more itching.

While there is no cure, eczema symptoms can be managed by identifying and avoiding things that cause flareups and establishing a daily skin care routine. Goals of topical treatment include relieving itch and hydrating to help restore the skin moisture barrier.

Contact dermatitis: Contact dermatitis occurs as a reaction to an allergen or an irritant. Common irritants can include soaps, detergents, perfumes, and even grass.  Contact dermatitis causes an itchy skin rash that can also be painful. If the rash is making your child uncomfortable, check with your healthcare provider. Treatment includes moisturizers, anti-itch creams and topical steroids.³

Baby Acne: Baby acne causes little white bumps and pink pimples on the face, neck, upper chest and back of some newborns.³ The pimples are generally most noticeable within the first few weeks after birth and usually go away within baby’s first three months of life.² To care for baby acne, gently wash once a day with a gentle cleanser formulated for baby’s sensitive skin.

References:

1. Kutlubay Z, Tanakol A, Engýn B, Onel C, Sýmsek E, Serdaroglu S, Tuzun Y, Yilmaz E, Eren B. Newborn Skin: Common Skin Problems. Maedica (Bucur). 2017 Jan;12(1):42-47. PMID: 28878836; PMCID: PMC5574071.

2. Benitez Ojeda AB, Mendez MD. Diaper Dermatitis. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559067/

3. Common Skin Conditions & Rashes in Children: Causes & Treatment (clevelandclinic.org)

4. How to treat eczema in babies - American Academy of Dermatology How to treat eczema in babies (aad.org) Accessed 9.16.22

Until your baby is mobile, a daily bath really isn’t necessary.  The American Academy of Dermatology recommends bathing baby two or three times a week, as long as the diaper area is thoroughly cleaned during each diaper change, increasing the frequency as your baby gets older.¹

Bathing is a wonderful time to bond with your baby making a ritual about so much more than just cleansing. In fact, 84% of parents say bath time is some of the best quality time they get with their child. Research suggests that during this time, multi-sensorial stimulation can also be critical to baby’s happy, healthy development.

To give your baby a traditional bath, dermatologists recommend these tips: ¹

1. Gather everything you’ll need before you get started. You’ll need a wash cloth or sponge, a mild, baby body wash, and a baby shampoo if your baby has hair. Never leave baby alone in the bath.

2. Place your baby in the water. Use lukewarm water, testing the temperature of the water on the inside of your wrist to ensure that it’s not too hot. Gently guide your baby into the water, feet first. Most of your baby’s body should be well above the water, so occasionally pour warm water over your baby’s body for warmth.

3. Start with your baby’s head. Use the washcloth to gently wash your baby’s face and scalp. Use baby shampoo once or twice a week to clean your baby’s hair.

4. Clean the rest of the body. Use the washcloth or sponge and baby body wash to gently clean the rest of your baby’s body. Make sure to rinse after cleaning each area.

After bathing, immediately wrap your baby in a towel for warmth. Apply a moisturizer while skin is still damp to seal in moisture. Massaging baby while applying moisturizer is another opportunity for bonding and can help calm and sooth baby, while helping to preserve, protect and enhance their protective skin moisture barrier.

References:

1. How to bathe your newborn - American Academy of Dermatology https://www.aad.org/public/everyday-care/skin-care-basics/care/newborn-bathing#:~:text=Fortunately%2C%20with%20a%20little%20practice,stump%20falls%20off%20and%20heals. Accessed 9.12.22

2. Telofski LS, Morello AP 3rd, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract. 2012;2012:198789. doi: 10.1155/2012/198789. Epub 2012 Sep 4. PMID: 22988452; PMCID: PMC3439947.

It's normal for infants to develop small patches of dry skin in the first few weeks after birth.  In general, babies have thinner, more delicate skin than adults do. Because of this, their skin may lose moisture more easily, especially if they have atopic dermatitis.¹ Here are a few tips to help manage baby’s dry skin:²

• Limit bath time. The American Academy of Pediatrics suggests limiting bath time to less than 10 minutes in lukewarm water. 

• Use soap-free cleansers.  Non-soap cleansers are less drying and highly recommended for baby’s delicate skin.

• Choose the right moisturizer.  Moisturizers come in lotions, which tend to be thinner and lighter, and creams and balms, which are thicker, making them ideal for dry skin. Appropriately formulated moisturizers can preserve protect and enhance the skin barrier by supplying hydration and lipids and by helping to prevent water loss.¹

• Apply moisturizer immediately after bathing.  Gently pat dry and smooth on lotion while your baby’s skin is still damp to seal in needed moisture. Use a moisturizer at least once daily, even when skin is not irritated. Consistent daily use can help prevent dry skin, and provide lasting benefits to skin barrier function and overall skin condition.¹

References:

1. Avoiding Dry Winter Skin in Babies and Toddlers - American Academy of Pediatrics Avoiding Dry Winter Skin in Babies and Toddlers - HealthyChildren.org Accessed 9.12.22

2. Ilnytska O, Kaur S, Chon S, Reynertson KA, Nebus J, Garay M, Mahmood K, Southall MD. Colloidal Oatmeal (Avena Sativa) Improves Skin Barrier Through Multi-Therapy Activity. J Drugs Dermatol. 2016 Jun 1;15(6):684-90. PMID: 27272074.

Protecting babies from harmful ultraviolet (UV) radiation is important not only for avoiding the immediate consequences of painful sunburns, but also for minimizing skin cancer risk later in life.

The American Academy of Pediatrics (AAP) suggests that sunscreen be applied on children older than 6 months. Instead, keep your baby out of direct and indirect sunlight as much as possible—especially between 10 a.m. and 2 p.m. Stay indoors or place baby in shaded areas like under a thick canopy, beach umbrella or stroller canopy. Dress your baby in lightweight clothing that covers their arms and legs with a wide-brimmed hat that covers the baby’s face, neck and ears.  When traveling in the car, use a removable mesh window shield to block sunlight.

After 6 months of age, use a broad-spectrum sunscreen, to protect against UVA and UVB rays, with an SPF of 15 or higher. When choosing a sunscreen, look for zinc oxide or titanium dioxide as the active ingredient. These non-toxic, mineral-based formulas physically block rays off of your baby's skin. Apply sunscreen 15 minutes before sun exposure, and reapply every two hours after that. 

References:

1. Bringing up a Sun Safe Baby - Skin Cancer Foundation. https://www.skincancer.org/blog/bringing-up-a-sun-safe-baby/#:~:text=Tiny%20Babies%2C%20Big%20Risk&text=You%20may%20be%20tempted%20to,are%20with%20shade%20and%20clothing. Accessed 9.13.22

2. Should You Put Sunscreen On Infants? - FDA. https://www.fda.gov/consumers/consumer-updates/should-you-put-sunscreen-infants-not-usually  Accessed 9.13.22

A simple routine of cleansing and moisturizing are two great ways to keep baby’s skin looking and feeling healthy. Cleansing helps keep baby free of unwanted irritants (saliva, nasal secretions, urine, feces) dirt and germs, while moisturizing helps restore hydration and improve skin barrier function.¹

The skin microbiome, sometimes called the skin flora, is the term for the trillions of bacteria, fungi and viruses that live on your skin. The skin and its microbiome continue to mature and develop long after birth, playing an important role as a first line of defense.² Skin care routines can help maintain the integrity of the protective skin barrier and support the skin microbiome.  In a clinical study, adding an application of lotion after bath using a moisturizer specifically formulated for baby’s skin, was shown to increase skin microbial richness (think of it as the good bacteria outnumbering the bad).³

Here are a few more tips to keep baby’s skin healthy:^1,4

1. Protect your baby from the sun.  Keep your baby out of the sun as much as possible—especially between 10 a.m. and 2 p.m when the sun’s rays are strongest. Stay indoors or place baby in shaded areas like under a thick canopy, beach umbrella or stroller canopy. Dress your baby in sun-protective clothing, including a lightweight, long-sleeved shirt, pants and wide-brimmed hat.

2. Keep your baby clean. Gently bathe your baby two to three times a week. When bathing your baby, use lukewarm water and mild, fragrance-free baby body wash and shampoo.

3. Nourish baby’s skin. It's normal for infants to develop small patches of dry skin in the first few weeks after birth. Appropriately formulated moisturizers can preserve protect, and enhance the skin barrier by supplying hydration and lipids (such as ceramides) and by helping to prevent water loss.⁴

4. Prevent diaper rash. Change dirty diapers as soon as possible — even if they are just wet. Clean area and apply a petrolatum skin protectant ointment to prevent diaper rash. If a diaper rash develops, be gentle when cleaning the diaper area and apply a zinc oxide diaper cream.

5. Trim baby’s nails. Trim your baby’s nails to prevent scratches. Use a nail file to create a rounded shape.

6. Wash baby blankets, sheets, and clothing using a gentle baby detergent.

References:

1. Telofski LS, Morello AP 3rd, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract. 2012;2012:198789. doi: 10.1155/2012/198789. Epub 2012 Sep 4. PMID: 22988452; PMCID: PMC3439947.

2. Grice, E., Segre, J. The skin microbiome. Nat Rev Microbiol 9, 244–253 (2011). https://doi.org/10.1038/nrmicro2537

3. KA Capone, D Friscia, L Telofski, J Nikolovski, Presented at _AAD_2019

4. How to care for your baby’s skin, hair and nails - American Academy of Dermatology. https://www.aad.org/public/everyday-care/skin-care-basics/care/baby-care-skin-hair-nails Accessed 9.13.22

5. Ilnytska O, Kaur S, Chon S, Reynertson KA, Nebus J, Garay M, Mahmood K, Southall MD. Colloidal Oatmeal (Avena Sativa) Improves Skin Barrier Through Multi-Therapy Activity. J Drugs Dermatol. 2016 Jun 1;15(6):684-90. PMID: 27272074.