Eczema in children is kept calm with three things: moisturiser every day, even when the skin looks fine, short lukewarm baths with moisturiser straight afterwards, and steroid cream as directed on the packaging or by your healthcare provider when it flares up. What makes it worse is dry indoor air, hot baths, soap, wool against the skin and sweat. Most children grow out of eczema, but in the meantime it is the tedious daily moisturising that makes the difference.
November, the radiators are on in the flat, and the two-year-old wakes at three and scratches the backs of her knees until they bleed. Eczema is one of the most common causes of broken nights in families with small children, and it is a condition that comes in waves: calm in July, dreadful in February. There is no cure, but there is a way of managing it that keeps most children comfortable most of the time. Here it is, and here is what usually goes wrong.
What eczema looks like at different ages
| Age | Where it sits | What it looks like |
|---|---|---|
| Babies, from a couple of months | Cheeks, scalp, the outside of arms and legs | Red, dry, flaky patches, sometimes weeping, cradle cap on the scalp |
| Toddlers, one to four years | Inside of the elbows, backs of the knees, wrists, ankles, around the mouth | Dry, red, itchy patches that become rough from scratching |
| Preschool and school-age children | Inside of the elbows, backs of the knees, neck, hands, eyelids | Dry, thickened skin, itching especially in the evening |
Moisturising: the most important part, and the one most often skimped on
- Every day, even when the skin looks fine. Moisturiser is prevention, not just treatment. If you stop once it has cleared up, it comes back.
- A lot of it. A thin layer does no good. The skin should shine for a while afterwards. A family with a child with eczema gets through big tubs.
- Straight after the bath, within a few minutes, on slightly damp skin. That is when the moisture gets locked in.
- Fragrance free, and a cream your child will accept. The pharmacy has many, and the best one is the one that actually gets applied. Some children only tolerate one particular kind, and that is fine.
- Lotion in summer, a richer cream or ointment in winter, when the indoor air in Stockholm is at its driest.
- Make it a routine: after the bath, before pyjamas, with a song or a book. Two minutes that save whole nights.
Bathing without drying out the skin
- Lukewarm water, not hot. Hot water dissolves the skin's own oils.
- Short: five to ten minutes.
- Bath oil in the water, or shower oil, instead of soap. Soap only where it is needed, fragrance free.
- Pat dry, do not rub.
- Moisturise within a few minutes, the whole body.
Every day or every other day is fine with this routine. It is not the bath that dries the skin out, it is hot water, soap and not moisturising afterwards. Chlorine at the swimming pool can irritate: rinse thoroughly and moisturise well afterwards, and it usually goes fine.
When it flares up: steroid cream
When the skin is red and itchy and your child is scratching, moisturiser is not enough. Then you need a cream that dampens the inflammation, and that is steroid cream (cortisone cream). Mild steroid cream for children is available over the counter at the pharmacy, with instructions on age and how long it may be used. Stronger strengths are prescribed by your vårdcentral (local health centre) when needed. The principle is to treat firmly enough until the skin is calm and then taper off, rather than applying a little, rarely, over a long period. Many parents are afraid of cortisone, and that fear often means a child walks around with itchy, broken skin for weeks. Used correctly, in the amount and for the time the packaging or doctor specifies, steroid cream is safe and effective. Ask the pharmacy, BVC (the child health clinic every family is enrolled in) or 1177 (the national healthcare helpline) if you are unsure, and never use an adult's cream.
What makes it worse, and what calms it
| Makes it worse | Calms it |
|---|---|
| Dry indoor air in winter | Lower heating in the bedroom, air the room, a damp towel on the radiator |
| Hot, long baths and soap | Short lukewarm baths with bath oil |
| Wool and synthetics directly against the skin | Cotton next to the skin, wool as a mid layer on top |
| Sweat, clothes that are too warm, fleece pyjamas | Light clothing, a cool bedroom, cool cotton pyjamas |
| Scratching, long nails | Short nails, cotton mittens at night for small children |
| Scented detergents, fabric softener, scented wipes at nappy changes | Unscented detergent, no fabric softener, water and oil at nappy changes |
| Stress, infections, teething | Pass on their own, moisturise more in the meantime |
When to seek care
| Seek care | Manage at home |
|---|---|
| Yellow crusts, weeping, hot and swollen: infected eczema | Dry, red patches that itch |
| Lots of small blisters in the eczema, especially after contact with cold sores | Flaky skin |
| Your child is not sleeping because of the itching despite treatment | Your child scratches sometimes but sleeps |
| Over-the-counter steroid cream does not help within one to two weeks | Gets better within a few days with cream |
| Large areas on a baby | Cradle cap on the scalp and slightly dry cheeks |
| Suspected food allergy that coincides with flare-ups | Flare-ups that follow the weather and colds |
How we do it with our families
In families where a child has eczema, moisturising is part of the nanny's evening routine, and it is on the note from you: which cream, where, how much, and whether it is a steroid period. Esther, who is with a family in Järfälla two evenings a week, keeps the bath short and lukewarm, moisturises while the child stands on the bathroom mat and sings the same song every time, and cuts nails on Wednesdays because that is the day she is there. She writes on the note if she has seen new patches or if the child has been scratching more than usual. The same nanny every time sees the difference between a good week and a bad one.
This text is general information and does not replace advice from BVC, your vårdcentral or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows what is normal for them and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Food allergies in children · Pollen allergy in children · Bedtime routine for children · FAQ
Frequently asked questions
What is atopic eczema?
A dry, itchy, recurring skin inflammation that is common in babies and children, often in families with allergies or asthma. In babies it sits on the cheeks and the outside of the arms and legs, in older children on the inside of the elbows, the backs of the knees and the hands. It comes and goes, and most children grow out of it.
How often should we moisturise?
Moisturiser at least once a day when the skin is calm, and several times a day when it is dry or itchy. It is most effective straight after a bath, on damp skin. Use plenty and often, and choose a fragrance-free cream your child tolerates. It is the daily moisturising that keeps the eczema away.
Can we use steroid cream on children?
Yes, mild steroid cream is available over the counter and is used in periods when the eczema flares up, as directed on the packaging. The pharmacy or BVC can guide you on strength and duration, and the vårdcentral prescribes stronger creams when needed. Fear of cortisone often does more harm than the cream, because untreated eczema itches, gets infected and disturbs sleep.
How often should children with eczema bathe?
Short baths or showers in lukewarm water, ideally every day or every other day with bath oil in the water, and then moisturiser within a few minutes. Hot water, a long soak and lots of soap dry the skin out. Pat dry rather than rubbing, and moisturise the whole body, not just the patches.
Is eczema caused by food?
Rarely. In some babies with severe eczema there may be a link to milk or eggs, but that should be investigated through BVC or the vårdcentral before you remove any food. Cutting out foods on your own rarely helps the eczema and can leave your child with deficiencies or new allergies.