Eczema in babies and children

What it is

Childhood eczema causes dry, itchy, inflamed skin. In babies it often starts on the cheeks and scalp; in older children it appears in the elbow and knee creases, wrists and ankles. Most children improve as they grow.

How it works

Children's skin barrier is thinner and loses water faster; in eczema it is weaker still, so dryness and itch begin early, often in the first year.

Why it matters on darker skin

On darker skin eczema may look brown, purple or grey, with small bumps, and can leave temporary light or dark patches. Heat, sweat and harmattan dryness are common triggers.

Causes and triggers

Soap, bathing in hot water, heat and sweat, wool, fragrance, saliva on the face, infections and sometimes food allergy in babies with severe eczema.

What helps — and why it works

Use a fragrance-free moisturiser generously several times a day, especially after a short lukewarm bath. Use a soap substitute. Dress your child in soft cotton and keep nails short. A doctor can prescribe creams for flares; used as directed, they are safe and help sleep. Emollient at least twice daily and after baths: rebuilds the barrier. Expected timeline: days. Prescribed creams for flares: settle inflammation. Expected timeline: 1–2 weeks. Cotton clothing, short nails: less friction and scratching damage. Expected timeline: immediate.

What to avoid and why

Avoid fragranced soaps and lotions, antiseptic baths, herbal pastes, shea butter mixed with fragrance, and adult or "toning" creams.

Common mistakes

• Stopping emollient between flares.
• Excluding many foods without medical advice.
• Herbal or adult creams.

Caring for children's skin

Children's skin is thinner, loses water faster and absorbs more of what is applied to it relative to body size, so simpler is safer. For most children a short lukewarm bath, a fragrance-free soap substitute and a plain emollient are all that is needed, plus shade, clothing and sunscreen from six months of age. Avoid adult products, essential oils, antiseptics in bath water, bleaching or 'toning' creams, and cosmetic treatments such as relaxers and gel nails. Medicines and medicated creams should be used only as a doctor, nurse or pharmacist advises, and in children Melanin & Me does not offer photo checks: a clinician should see the child. Trust your instincts as a parent: a child who is unusually sleepy, floppy, not feeding, breathing fast or has a rash that does not fade when pressed with a glass needs urgent care. Keep a simple record — photos and dates — of rashes that come and go, as this helps the doctor.

Products, medicines and when to worry

When choosing products for children, look for fragrance-free formulas with short ingredient lists, and avoid adult acne, anti-ageing or lightening products, essential oils and talc. Medicated creams — including steroid creams, antifungals and antibiotics — are safe and helpful when prescribed for the right condition and used for the right length of time, but mixed creams sold over the counter can contain strong steroids that are unsafe for children. Sunscreen is suitable from six months of age; younger babies should be kept in the shade and covered. Do not give medicines intended for adults, and ask a pharmacist about the right medicine for a child's age and weight. Seek urgent care for any rash with fever and a very unwell child, a rash that does not fade under a glass, swelling of the face or lips, or blistering of the mouth or eyes.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.