Eczema is an itchy dermatitis that is usually allergic in origin and occurs in families. It usually starts with patches of dry, itchy skin which in babies and young children (the commonest sufferers of the condition) are behind the ears and knees, in the body creases at the elbows and the neck, on the face and on the trunk or scalp. When the eczema is bad the skin is red, raw, weeping and crusted and may become infected.
Eczema is not infectious and most babies grow out of their infantile eczema. For a few, though, allergic eczema can persist throughout life. About three children in a hundred suffer from it and many of these have a family history of eczema, asthma, hay fever or other allergies.
What causes it?
• There is no doubt that there is a familial susceptibility.
• As eczema is much more common in bottle-fed as opposed to breastfed babies there is little doubt that an allergy to cows’ milk plays a part in many children. Some children are allergic to other foods too.
• Scratching makes it worse, so it is best to avoid wool and nylon next to the skin because these make the skin hot and sweaty.
• Feathers, down and wool bedding make it worse.
• The single greatest preventive measure is undoubtedly to breastfeed a baby right from the very start and not to give him or her even one bottle of cows’ milk. This will need very careful supervision because it is still the practice in many maternity hospitals to take babies away from their mothers at night and to feed them the odd bottle of cows’ milk formula.
• The way round this is to talk to your family doctor and midwife before the baby is due to ensure that everyone knows that you have a baby that is ‘at risk’ and is to be totally breast-fed from birth. If eventually you find breastfeeding impossible (which is rare with good advice) then you will have to use a soy-based milk. There are several on the market.
Aim to feed your baby breast milk exclusively for at least four months and preferably longer. The protective effect is greater the longer you continue but after about six months you should add in other (non milk-containing) foods.
Unfortunately, even this way of feeding a baby may not prevent all eczema. This comes about for two reasons. First, the child may be allergic to some other allergen, such as the house-dust mite; and second, antigens in the mother’s diet may be transmitted to the baby via her milk. Recent research suggests that eating large quantities of certain allergens during pregnancy can sensitize a susceptible child in utero. The answer here is to take all foods in moderation during pregnancy, especially foods that are likely to induce allergies in children. These include cows’ milk and all its products, eggs, wheat, nuts, fish, tomatoes and colourings and preservatives. If you have a family history of allergy, and especially of eczema, it makes sense to avoid these foods as much as possible during pregnancy and breastfeeding, or at least certainly never to binge on them. Don’t worry about the calcium you will be missing-it can be eaten in other forms, and you can take zinc and calcium supplements (Sandocal effervescent tablets are good) which more than compensate for the calcium loss in dairy products. Start weaning your solely breast-fed baby at about 5-6 months and be sure to breastfeed after each meal until the end of the first year of life. Introduce vegetables and fruit first of all and then add milk-free margarine. Over a few weeks add in foods that are ‘safe’ (not on the above list of common culprits) and see how it goes. If ever a food seems to precipitate eczema stop giving it and don’t try it again until the child is 2. If a child is allergic to eggs he or she might also be allergic to chicken, so beware.
• Having done your best to prevent eczema at source dress your child with soft cotton next to the skin-never wool or nylon. These latter will make him or her hot and sweaty, which makes any early eczema likely to progress further than it otherwise would. Choose loose clothing styles that keep the child neither too hot nor too cold.
• Disposable nappies may irritate -use soft terry nappies. Change nappies frequently and clean the child’s bottom well. Avoid plastic pants if there is any sign of nappy rash. Never wash nappies in biological detergents because very allergic babies are allergic to the enzymes in them. Drying clothes out of doors helps destroy house-dust mites and bacteria. Avoid feather, down and wool bedding because these can irritate eczema. Use duvets filled with synthetic filler and cotton cellular blankets and cotton sheets. Change bedding twice a week at least, and damp-dust and vacuum the child’s room daily.
• Join a self-help group to help you cope with the day-to-day problems and prevent family discord. Having a baby or child with severe eczema can be exhausting for all the family and you will be grateful for tips on how to cope.
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