Eczema in Babies

When to get help

Contact a GP urgently or call NHS 111 if your baby's eczema looks infected. The signs are weeping, oozing or a golden or yellow crust, small blisters or pus-filled spots, skin that is hot, swollen and increasingly painful, a rash that is spreading quickly, or a fever alongside the skin changes.

Get help the same day if the eczema suddenly develops clusters of small blisters or punched-out sores, particularly if anyone in the household has a cold sore. Eczema herpeticum, a herpes simplex infection of eczematous skin, spreads rapidly and needs urgent treatment.

NICE guideline NG143 on fever in under 5s states that children younger than 3 months with a temperature of 38C or higher are in a high-risk group for serious illness, and that children aged 3 to 6 months with a temperature of 39C or higher are in at least an intermediate-risk group. A baby under three months with infected-looking skin and a temperature of 38C or more needs urgent assessment.

Make a routine GP appointment if the eczema is not controlled by what you have been given, if it is disturbing your baby's sleep, if it is getting worse rather than better, or if you are unsure whether what you are seeing is eczema at all.

What eczema looks like in a baby

NHS guidance describes atopic eczema as causing skin to become itchy, dry, cracked and sore, with some people having small patches and others having widespread inflamed skin all over the body. It notes that inflamed skin can become red on lighter skin and darker brown, purple or grey on darker skin, which can make it harder to see.

The distribution changes with age. In babies it commonly starts on the face, cheeks and scalp, then moves to the outer surfaces of the arms and legs as they begin to crawl. Later in the first year and into toddlerhood it typically settles into the creases: the elbows, behind the knees, the wrists and the neck.

Itch is the defining symptom. A baby who is rubbing their face on the sheet, scratching in their sleep or generally unsettled at night may be itching even where the skin does not look dramatic.

The treatment that does most of the work

NICE guideline CG57 on atopic eczema in under 12s sets out a stepped approach in which emollients are the foundation. The key point, and the one most commonly missed, is that emollients should be used continuously and generously, including when the skin looks clear, not only during flares. Stopping when the skin improves is the single commonest reason eczema keeps coming back.

NHS guidance describes emollients as moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. Apply in the direction of hair growth rather than rubbing in, use them after bathing while the skin is still damp, and use them several times a day. Quantities are generous by comparison with ordinary moisturiser; ask your GP, pharmacist or health visitor how much your baby should be getting and how often to reorder.

The second treatment is a topical corticosteroid for flares. NHS and NICE guidance both describe steroids as used in short courses to bring inflammation down, with the potency matched to the site and severity. Parental caution about steroids is common and usually results in under-treatment, which prolongs the flare. Use what has been prescribed, for as long as prescribed, and ask if you are unsure. This page gives no amounts; follow the instructions you were given or ask a pharmacist.

Bathing

Daily bathing is fine and often helpful, using lukewarm water and an emollient wash rather than soap, bubble bath or detergent-based products. Pat dry rather than rubbing, and apply emollient immediately afterwards.

Triggers worth identifying

NHS guidance lists common triggers including soaps and detergents, certain foods such as cows' milk or eggs, some fabrics such as wool and synthetics, hormonal changes, skin infections, and environmental factors including cold, dry weather, damp and house dust mites.

Heat and overheating are particularly relevant in babies, because a baby wrapped for a cold room will itch more than one dressed lightly. Saliva around the mouth during teething and weaning is another frequent cause of a stubborn patch on the chin and cheeks, and a barrier layer of emollient before meals usually helps.

Food and eczema

NICE CG57 addresses this directly and cautions against uncontrolled elimination diets. Food allergy is more common in babies with moderate to severe eczema, but removing foods without assessment risks nutritional harm and rarely fixes the eczema on its own. If you suspect a food trigger, particularly if eczema is severe or there are gut symptoms or reactions within minutes of eating, raise it with your GP for proper allergy assessment rather than removing foods yourself. The American Academy of Pediatrics takes the same position.

Managing the itch and the scratching

Keep fingernails short and filed. Cotton scratch mitts or long-sleeved bodysuits at night reduce damage while a flare settles. Cool rooms and lightweight bedding help more than any topical product for night-time itching. Some families find keeping emollient in the fridge makes application soothing rather than something to be resisted.

The National Eczema Society provides practical support materials for families, including advice on applying treatments to a baby who objects, which is a common and underestimated problem.

What to expect over time

NHS guidance notes that atopic eczema commonly develops before the first birthday, that it can significantly improve or clear completely for some children as they get older, and that it is a long-term condition for others. Australia's healthdirect service describes the same pattern of improvement through childhood in many cases.

Ask for a review if you are using strong steroids repeatedly, if flares are becoming more frequent, or if the current plan is not holding. Referral to a dermatology service is appropriate for eczema that is severe, not responding, or repeatedly infected.