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Dr SEARS L.E.A.N. Series: Raising Healthy Kids

This original 9-part series published every fortnight has been condensed to one longer informative post. This series examine the DrSearsLEAN (Lifestyle-Exercise-Attitude-Nutrition) tips and privileged to have DrSears’ team to help with the tips for parents with eczema children.

Healthy Kid’s Diet

Tip #1: Pick Your Salad

It is a fun way to learn about fruits and vegetables in a farm, by picking them and making your own salad. Most of the farms listed on pickyourown.org are in the US, but you can also find vegetable farms in Singapore! Parents of eczema children may think that their child is allergic or hypersensitive to certain foods, particularly when there’s an eczema flare after consumption of a new food. But is the food really a trigger?

How do Parents know if it’s the Food that’s Triggering an Itch?

There are certain foods that are more common in triggering an allergic reaction, but food in itself is not a common eczema trigger. The nature of eczema is that it comes and goes and it’s best to have the suspected food be confirmed in a skin prick test or if need to, an oral food challenge before excluding it. Should food be a trigger, usually it’s a few food rather than many foods. Even food that shows up positive in a skin prick test may not trigger itch and thus need not be excluded from your child’s diet.

You may start suspecting a food allergy when:

1.             Your child shows immediate rashes or swelling around the mouth (oral allergy syndrome). This is less common in young children but some foods such as banana, kiwi, avocado, and potato have triggered such reactions. Other reactions could be itchy bumps or abdominal pain, vomiting, itchy eyes, sneezing or wheezing.

2.             Your child shows delayed reactions, more than 24 hours, after consuming the food. However, such foods are harder to detect through skin prick test or by observation as abdominal pain, itchiness or diarrhea could also be due to other reasons.

For a start, you can keep a food diary for your child, logging everything he/she eats for 4 to 6 weeks. I actually recorded from my baby’s first bite all the way to 9 month old but there’s no discernible pattern because my baby turned out to be not allergic to anything! I was a paranoid mom for so long until the negative results from the skin prick test, which is why I recommend it to every parent to save themselves the agony of second-guessing.

DrSearsLEAN’s recommendation

Eczema is a condition caused by two factors: first, a genetic tendency toward dry, irritated skin; and second, skin allergies to a variety of irritants and foods. The cause is mainly genetic – an inborn tendency toward dry skin and allergies. There is no way to change this genetics. The important issue is not what causes eczema in the first place, but what allergies and skin irritants is your child exposed to that is triggering the flare-ups.

If your child has any food allergies, then they will play a major role in causing eczema. The problem is, you may not know if your child has any food allergies, and if he does, which foods is he allergic to? Thankfully, there are six common foods that make up nearly 90% of possible allergic foods. These are milk, egg, soy, peanuts, fish and wheat.

What Foods for Eczema Child?

Before we discuss the common food allergens that may trigger your child’s eczema, let’s have some fun looking at DrSearsLEAN  – Traffic Light Eating for healthy diet:

GREEN Light foods are “Go” foods. They are all high in nutrients and are all fruits & vegetables.

Yellow Light foods are “Slowdown” foods. These are foods that are ok to eat every day, but you need to use portion control. Examples of yellow light foods include whole grain bread, pasta, eggs, lean meat, fish, and olive oil.

Red Light foods are “Stop and Think!” about making a better choice. These are foods that are highly processed and contain high amounts of sugar and trans-fat. Red Light foods are foods such as cookies, candies, fast food, doughnuts, etc.

What are the Common Food Allergens?

Food is not a common eczema trigger, but certain foods that children are more commonly allergic to include cow’s milk, eggs, soya, wheat, fish, nuts and gluten (this is different from celiac disease). Cow’s milk should not be excluded unless it’s proven intolerant or to trigger a reaction. Salicylates, usually present in concentrated juice/sauce, unripe fruits and areas around the skin, can also trigger itchiness and redness. Salicylates increase the release of histamine but cooking the food can reduce the chance of allergy.

Should Elimination Diets be carried out?

Food should not be excluded until proven allergic to. A dietian should always be consulted and advice followed. Parents need to be educated in nutrition and be able to read food labels. A restricted diet, usually consisting of meat, vegetables, fruits, water and rice milk, should not be continued if there is no improvement after 6 weeks. There are cases when food removed from a diet added back later in childhood causes a more severe allergic reaction than before.

AskDrSears also has an article on eczema, which shares allergic triggers such as milk, egg, soy, peanuts, fish and wheat. The advice was to eliminate all six foods for 2 to 3 weeks, then re-introduce each food one at a time to determine which is causing the allergy.

DrSearsLEAN’s recommendation

As mentioned last week, there are six common foods (milk, egg, soy, peanuts, fish and wheat) that make up nearly 90% of possible allergic foods. Eliminate all 6 foods for 2 to 3 weeks. If you see dramatic improvement, then re-introduce each food one at a time to determine which is causing the allergy. It is important to note that fruits and vegetables are not common allergens and are very important in boosting your child’s immune system and the phytonutrients and antioxidants they contain are powerful anti-inflammatories. Try incorporating fruits and vegetables into every meal – even breakfast!

Healthy Kid’s Lifestyle

Tip #2: Make a Rule – Less TV, More Exercise!

Make a rule’ – which is no TV or video games on weekdays or before 30 minutes of play outside. Ideally, instead of watching TV, children can spend time exercising and do a range of activities from inviting their friends over to play to playing sports as a family. TV (and IPad) is becoming a ‘baby-sitter’, offering some relief for parents to finish up the chores or tidy the house (my own favorite phrase is ‘Order Has Been Restored!’). I have to confess that I let my baby watch TV since 3 month old, but only baby sign language dvd which has distracted her from scratching. As parents of eczema child would appreciate, it’s immensely stressful and difficult to keep the child from scratching and if TV can help, is that ok?

TV and Eczema and ADHD

The American Academy of Pediatrics recommends no TV for children below two years old. A study by Dr. Dimitri Christakis, Director of Child Health Institute at Children’s Hospital and Regional Medical Center (Seattle, Washington) showed that for every hour of TV watched, the toddler has a 10% higher chance of developing attention problems by age 7. The study is not without its limitations, which include data collected based on parents’ recollection, no data on content of TV programs and attention problems do not necessarily equal ADHD (‘Attention Deficit Hyperactivity Disorder’). Another study done by Carl Landhuis of University of Otago in Dunedin similarly concluded that children aged 5 to 7 who watched more than two hours of TV are more likely to develop symptoms of ADHD. Common reasons why TV is not good for children are that the fast-paced screens are not natural and replaces other activities like reading that require attention development. The noise of the TV also interferes with the brain’s ‘inner speech’, especially if TV is left on all the time when no one’s watching.

The bad news for parents with eczema children is that study has suggested an association between eczema and ADHD in children. 5.2% of 1,436 children with eczema also have ADHD versus 3.4% of children without eczema. Also the younger the child has eczema, the increased likelihood of ADHD. Thus, it would appear that even though TV may help distract a child from scratching, it is even more critical not to let eczema children watch TV given the higher correlation with ADHD.

DrSearsLEAN’s recommendation

Television plays a big role in childhood obesity because watching TV is a non-active activity that often leads to boredom (believe it or not!) and a tendency to over consume junky foods. Be a role model for your children and don’t eat while watching TV. Encourage them to participate in another activity such as reading or imaginative play. Your children will imitate your actions so always remember that how much time you spend watching TV and what other behaviors you practice while watching TV is a choice. Taking the time to invest in your child by playing with them is always a worthwhile investment for both your and their health!

Tip #3: ‘Set an Example’ – It’s easier to Exercise as a family

Exercise as a family such as ‘develop a routine’, ‘play sports together as a family’ and ‘have each person pick a different family exercise or activity to learn together’. It’s even more important to encourage each family member to keep fit because obesity is contagious! As written in the ‘The New England Journal of Medicine recently published a study that showed that if one spouse is obese, the other is 37 percent more likely to become obese, too’. For families with children with eczema, it is even more important because there appears to be a link between obesity and eczema.

Obesity is Contagious

Obesity and Eczema

In a study conducted by Dr. Jonathan Silverberg, dermatologist at St Luke’s Roosevelt Hospital (New York), there’s increased risk of developing severe eczema for children who are obese. Particularly, for children who became obese between age 2 to 5, the risk is three times higher than non-obese children. A later study focusing on adults gave similar results but the good thing is in both studies, eczema symptoms improved when weight is reduced.

Another study in Sweden also showed that hand eczema co-relates with individuals who are obese, have higher stress and smokes. The reason for obesity affecting eczema could be due to obesity resulting in inflammation in fat tissue, which overtime, can affect the skin.

DrSearsLEAN’s recommendation

Moving around and being active is one habit kids can learn easily, especially if their parents set a good example. Rather than thinking of movement as “exercise”, think of it as “play”! Running, hopping, skipping, jumping, riding a bike, etc, – These are all things kids (and parent) naturally enjoy. Movement does far more than just help control obesity. Moving more improves mood, helps you to feel better, improves sleep, helps digestion, encourages self-confidence, and more! Take some time to play with your child everyday. It will benefit both of you immensely!

Tip #4: ‘Reduce Stress in Your Life’ – Laugh More and Be Grateful

Leading a healthier and happier life comes from having the right attitude to life, and that includes taking steps to reduce stress, increase laughter and be grateful. There are many practical tips to follow but as parents of eczema children, it may be hard to do so; for instance, it’s hard to think positively when the eczema flares yet again for no reason. Or it can be difficult to enjoy a dvd when your child keeps scratching during the movie. Worse, repeated failed attempts to keep the eczema under control could demoralize the parent so much that it’s hard to appreciate the good even in our spouse, not to mention someone we don’t like.  The stress that families with eczema faces is considerable and a study has shown that stress levels in mothers caring for young children with eczema are equivalent to those mothers of children with severe disabilities.

Stress Triggers Eczema

While it may be more difficult to keep the stress level low in families with eczema children, it is important to do so should stress be one of the triggers of the eczema. As stated in Adnan Nasir’s book Eczema Free for Life, stress is the number three trigger and can worsen eczema by:

(i)         Stimulating hormones to be released which result in an increase in inflammatory substances the skin is allergic to

(ii)        Suppressing the immune system which results in a decrease in defense proteins to protect the skin

(iii)       Weakening the lipid skin barrier which results in dry skin that is vulnerable to irritants

Museums, Factory Tours, Animal Farms but Swimming?

Swimming is a fun activity such as having fun with balls and slides in water parks or leisure pools.  But many parents are worried about bringing their child with eczema to the pool, fearing that the chlorine in the swimming pool water may worsen the eczema. On the contrary, my baby’s doctor actually advised swimming three times a week but not more than 10 minutes each time. Be sure to shower them immediately and apply generous amount of moisturizer.

According to a factsheet from the National Eczema Society, chlorine is generally the least likely to cause skin irritation. In another of their fact sheet, it is suggested that re-creating chlorinated swimming pool with a bleach bath can have positive anti-septic effects on the skin. In particular, eczema skin is susceptible to colonization of staphylococcus aureus bacteria that can cause infection if it penetrates the skin. More than 90% of the people with eczema have staph versus less than 10% of people without eczema. Swimming is therefore a fun way to reduce this bacteria and applying steroid will then be more effective.

DrSearsLEAN’s recommendation

Chlorine and other chemicals in water can sometimes be the cause of skin irritation and contribute to eczema in a small percentage of kids. Always bathe your child in clean fresh water after swimming and avoid using regular soap. Most regular soap, whether liquid or bar soap can cause dryness. A natural soap mixed with moisturizing lotion and free of perfumes will enhance skin moisture. These can be found in any drugstore or supermarket. Also avoid scented lotions and use PABA-free suntan lotion to protect their skin. Be sure to use a generous amount of moisturizer after bathing your child.The lotion helps seal in all the moisture gained from the bath to help control your child’s eczema.

Overall, swimming is a fun way to get your kids moving more! Plus, they are learning a life-long tool. It’s much easier to learn to swim when your child is young. Getting them used to the water helps them overcome fears and could be a life-saving tool  someday!

Indoors Fun versus Sweating it Outdoors

There are many fun activities to do indoors and some are ‘put together a PLAY basket’ and ‘get a pedometer’. One of the tips is ‘plan your family vacation around an outdoor activity’, such as camping which is an opportunity to get away from technology and instead, do some biking and hiking. However, outdoor exercise inadvertently comes with sun and sweat. Heat and perspiration is the number one trigger for eczema and is also the only trigger I’ve identified for my baby. The combination of heat and perspiration may set off a ‘heat rash’ as an eczema child’s skin is more vulnerable to chemicals in sweat which may irritate the skin.

Sunlight – To Block or Not?

According to a factsheet from the National Eczema Society, sun exposure is drying to the skin and may aggravate eczema for some people. Ron Sweren, M.D., a dermatologist and director of the photo-medicine unit at Johns Hopkins also said that sunlight can serve as a trigger that worsens eczema. To prevent sunburn, sunscreen lotion is a must but again, you can read here that some of the ingredients may also irritate your child’s skin. Moreover, according to Sewon Kang, M.D., director of department of dermatology at John Hopkins, increased sweating will lead to more showers taken, which again could worsen the eczema. In less common cases, there may be sunlight allergy or photosensitive eczema which further restricts exposure to sun.


However, there are also cases of eczema that improve with sunlight exposure and there’s a treatment known as phototherapy that exposes the skin to UVA1 rays that can soothe the skin without causing sunburn. Moreover, vitamin D that comes from sunlight has been shown to increase the production of skin proteins (cathelicidin) which protects against skin infection.

Dr Sears L.E.A.N.’s recommendation

Eczema results from the combination of a genetic tendency toward dry, sensitive skin and a susceptibility to allergies. Although most children aren’t bothered by the day-to-day wear and tear of soaps, dirt, sweat, heat, clothing, and everything else we come into contact with, the skin of a child with eczema is hypersensitive to everyday life. It is important for you to monitor your child and identify the main trigger for developing eczema flare-ups. For some it could be heat and sweat, others are triggered by what they eat (or what mom eats if they are breastfeeding), grass, dirt, or chemicals in the environment around them. Although there is nothing you can do to change your child’s genetic susceptibility to dry, sensitive skin, there are many steps you can take to improve skin health, reduce exposure to irritants, track own allergic triggers, and minimize the impact the eczema has on your child’s day-to-day life

Healthy Kid’s Nutrition

Boosting our immune system is important, particularly for both parents and children with eczema because the lack of sleep can lower our immunity. As recommended on DrSearsLean.com, we should choose healthy food that contain the following eight immune system boosters, namely vitamin C, vitamin E, carotenoids, bioflavonoids, zinc, garlic, selenium and omega-3 fatty acids. Out of these eight immunity boosters, parents may find that zinc and essential fatty acids are often recommended for children with eczema.

Tip #5: Get Healthy Eating Food, not Supplement

There’s some research that points to zinc and omega-3 fatty acids can help to reduce skin rashes in adults and also that eczema children appear to be deficient in essential fatty acids which results in a lower production of anti-inflammatory prostaglandins that can help fight skin infection. However, research is not conclusive as clinical trials have also been conducted with no significant impact on eczema. Parents should incorporate the immune system booster food into the child’s diet rather than in supplement as excessive intake of say, zinc can inhibit immune function. The RNI (reference nutrient intake) for zinc is 4mg per day for a six month-old and 5mg for a toddler. Zinc-rich foods include beans, chickpeas, beef, turkey and spinach while omega-3 rich foods are salmon, tuna and sardines.


DrSearsLEAN’s recommendation

To improve your child’s skin from the inside out, add these nutrients to his or her diet:

  • Fruits and vegetables can help improve allergic and inflammatory diseases like eczema. If you have a picky eater who avoids fruits and veggies, you may consider giving them a whole food supplement to help boost their immune system.
  • An omega-3 supplement provides beneficial fats to help the skin stay healthy. Good sources of Omega-3s are avocados, salmon, tuna, flax seeds, pumpkin seeds.
  • Probiotics taken in liquid, powder, or pill form can help decrease food allergies.

Choosing A Healthy Drink for Kids

Parents beware that not all drinks packaged for children and have ‘vitamins’ listed on the packaging are healthy. As stated on DrSearsLean.com, drinks with the main ingredient ‘high fructose corn syrup’ may result in overeating because it does not trigger a hormone, leptin, that creates fullness. Moreover, children who drink more than 12 ounces per day of concentrated juice are more likely to be overweight. For eczema children, it’s also best to avoid sugary drinks which contain caffeine (may trigger eczema), increase tooth decay while artificially flavored drinks have been linked to ADHD. For a healthy choice, plain water with lots of fruits and vegetables is best

Does Softening Water Help?

Water makes up 60% of our body and is useful for flushing out waste and toxins. There are some observations that eczema is more prevalent in areas where water is hard as the higher calcium and magnesium content may be a skin irritant. However, from a clinical trial conducted by Professor Hywel Williams and Dr Kim Thomas of the Centre of Evidence Based Dermatology at University of Nottingham, there is no impact of using softened water on eczema. However for parents who have found water softeners to improve their children’s eczema, they certainly can continue to do so. Skincare routine like moisturizing, showering without using harsh soap and appropriate treatment is still required.

DrSearsLEAN’s recommendation

Water is an essential nutrient. Water is to our body what oil is to a car; we can’t function without it. Like growing plants, growing kids need lots of water. Our bodies are 50 to 70 percent water, and much of that water has to be replaced every day. Water helps prevent constipation, eliminate toxins from the body, hydrate the brain, and keeps breathing passages moist and clear of mucus. As a general rule, children need around one ounce of fluid per pound of body weight per day. The majority of your fluids should be from plain water, but a small amount of fluids can also be from milk or 100% fruit juice. Drinking soda should be discouraged. Many juice drinks and all sodas are high in calories, provide no nutrients, and are usually sweetened with high fructose corn syrup (HFCS), which you should always avoid.

MarcieMom: Thank you Dr. Sears for being with us throughout the whole series. I’ve been so glad and delighted to hear your advice which definitely gives me the confidence to raise a healthy child, despite her eczema.

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