Though the answer is still uncertain, it’s leaning towards a Yes for pregnant woman to take probiotics Lactobacillus rhamnosus (LGG) in her third trimester. 1st things first, probiotics are live lactic acid bacteria that has been purported to help with food digestion, production of vitamins, prevention of infection and regulation of immune system. Probiotics is commonly used to treat digestive issues as they can withstand the stomach and bile acids, colonize the digestive tract and balance the good/bad bacteria. Some probiotics strain helps to reduce diarrhea and bloating in children treated with antibiotics. There are many different strains of probiotics and over 200 probiotics products, with different strain and dosage.
So what’s this LGG and is it proven?
LGG, is one of the most researched strain and used to strengthen the gut by defending against unwanted bacteria and virus. Increasingly, there’s research supporting the use of LGG for treatment of eczema and clinical studies have been conducted. You can refer to this article for a summary of the studies, but in a nutshell, not all the studies conclude eczema prevention and reduction in eczema severity but 2 out of the 3 studies on LGG showed reduced incidence of eczema in children by age 2. The mothers (in one study, only allergy-prone moms) started taking the probiotics in the last 5 weeks of pregnancy and during breast-feeding for 3-6 months after birth. Sometimes the child is also given the probiotics and generally, the incidence of eczema is reduced by half. There’s less support that probiotics can reduce asthma or allergy, and in one of the study, there’s actually higher incidence of wheezing after taking probiotics.
How to take these probiotics?
Your genealogist must be consulted as there’re so many types of probiotics and the dosage varies. Dosage is counted in CFU, which stands for colony forming units. I’ve read that to be effective, the CFU need to be in billions. You can also ask your genealogist of his/her knowledge of the research studies on the probiotics that you’re being prescribed. Also, some advised against giving the probotics supplement directly to infant, especially those below 1 month old (I’ve found a product online that gives probiotics to children above 4 years old in the form of chewable tablet, not available in Singapore). So do check with your doctor before taking these probiotics.
Would I take LGG in my next pregnancy?
If you read this post, you’d know I haven’t decided if I want to have a second child! So far, I’ve known of a friend who has eczema who took LGG prescribed by her genealogist in both pregnancies and so far, both her girls aged 3 and 5 have no eczema. So, I think I will give probiotics a shot if my genealogist is supportive of it. But, I’d still be keeping my fingers crossed because I’m not the one with eczema (my hubby is). Anyone has any experience on taking LGG? Do comment and let the rest of us know!
I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.
VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker.
Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil (picture from vmvhypoallergenics.com)
Marcie Mom: I note with interest that your product Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil can prevent diaper rash.
What is the ingredient that prevents this rash and how it is different from the off-the-shelf diaper rash cream?
Dr. Verallo-Rowell: The USDA- certified Organic Virgin Coconut Oil and Monolaurin
Both ingredients – no reported allergies, irritations from either one.
1. Virgin coconut oil prevents the diaper rash by its giving an additional barrier film of protection on top of the skin to help protect the skin from irritating chemicals: urine, feces, sweat, preservatives, possibly antiseptics that may be used by manufacturers of diapers. Paper / tissue products are often preserved, some even with formaldehyde or formaldehyde-like chemicals. In addition, virgin coconut oil under the influence of natural skin bacteria that contain lipases (the same lipase enzymes that break down the sebum/fats produced by our skin glands to produce fatty acids that give the skin is acidity or acid mantle – an innate antiseptic function from the skin) – produce monoglycerides of its lauric, capric and caprylic fatty acids. These are well studied to have broad-spectrum antiseptic properties.
2. The purified monolaurin produced in the laboratory of Dr. John Kabara wrote and worked on this ingredient since the 1960s… is added for additional protection of the skin.
Laura: Most diaper rash creams primarily contain just zinc oxide and petroleum jelly.
One dermatological (prescriptive) diaper rash ointment contains an antifungal drug (many diaper rashes are actually a fungal condition) and cannot be obtained without a prescription (it also costs around US$300).
We mimic both the effects of the above in Oil’s Well in that the Virgin Coconut Oil provides a bit of the barrier function of zinc oxide and petroleum jelly, and the monolaurin provides an antiseptic, antibiotic and antifungal action. Note that monolaurin is also present in breast milk as another innate or natural antibiotic provided by nature from breastfeeding infants.
Prevent Diaper Rash
Marcie Mom: For prevention of diaper rash, your recommendation is to apply where the skin comes into contact with wetness. However, for eczema rash, I read that it’s least likely to be where the skin is wet.
Dr. Verallo-Rowell: Need to know the context of this statement because wetting the skin in those with eczema does make the skin more moisturized (water is the best moisturizer) but that wetness must not be chronic to macerate it such as in the diaper and around the mouth areas from saliva, mucus, sweat, food, etc.
Diaper Rash vs Eczema
Marcie Mom: My baby often gets rashes and scratches around the diaper waist band and the upper thigh joint areas. How can a parent differentiate between diaper rash and eczema rash? And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse?
Dr. Verallo-Rowell: Yes. Can be from pressure (a form of dermographism) or actual irritation (rarely at that age, allergy), by the chemicals in the elastic material of the waist and thigh band or even the chemicals in laundry soap.
How can a parent differentiate between diaper rash and eczema rash? By the presence of the rash in other areas more commonly involved by atopic eczema rash in babies: outer areas of the upper and lower extremities, the face.
And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse? Yes if the moisturizer has ingredients that are irritating to the skin usually by virtue of its scent, preservatives, antibiotics, dyes, non-medical grade lanolin, etc. Note that vitamin E and tea tree oil, propolis, and some other natural ingredients are top allergens in the allergens list.
Marcie Mom: A BIG THANK YOU to Dr. Verallo-Rowell and Laura for helping us in this series on sensitive skin products. We’ve learnt SO much from you and SO much more confident on how to choose and manage the sensitive skin of our children.
I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.
VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker.
In our previous interviews, we have learnt what to look out for in the product packaging, including understanding the list of ingredients. In this interview, we wish to focus on the use of sensitive skin products on the parts of the child which are more delicate.
Marcie Mom: Thanks Laura for taking time to help us learn more about managing the delicate parts of our child’s skin. First, let’s all be on the same page relating to what defines delicate skin?
Is it where the skin is thinner, like eyelid, face, neck, underarm and groin area?
Dr. Verallo-Rowell:Yes, where the skin is thinner: eyelids, neck, groin because of the easier absorption of chemicals. Plus, often wet areas such as cheeks, around the mouth from milk and food, neck and maybe the chest, and of course the diaper areas where maceration and heat “thins” the skin. Also from trauma and sweating of physical activities in school and at play with the use of play devices or clothing and shoe wear — hence the need sometimes for milder laundry soaps.
PLUS the following conditions:
– Those diagnosed with an atopic problem: asthma, hay fever, and of course atopic dermatitis/ including a family history especially when (+) in both sides of the family. To treat and to prevent barrier loss because barrier dysfunction is a basic problem in those with atopic skin.
– Those with medical conditions that make them “sensitive” Example: being off and on antibiotics a lot which disturbs the balance of naturally opposing bacteria and fungi in skin and the natural, healthy dominance of one over the other; those on maintenance drugs which make them prone to drug allergies or even photosensitivity; those who are obese and prone to sweatiness (or who are otherwise prone to sweatiness).
Washed-off Product Use
Marcie Mom: I also read that rinsing the product immediately is stated in many of your products’ instruction. For eczema children, they may need to soak in bath oil (my baby soaks in colloidal oatmeal bath oil).
How long would you advise parents to let their child soak?
Dr. Verallo-Rowell: I generally like colloidal oatmeal bath oil but am careful to read the ingredients list for any additional ingredients as listed above and elsewhere. For the more sensitive I prefer the pure virgin coconut oil in water for 5 to 15-minute soaks.
Marcie Mom: And can they do so if they have a rash at the groin area?
Dr. Verallo-Rowell: Yes with the virgin coconut oil. I have seen extremely irritated skin, however, where even water makes them sting. In these cases, I prescribe the total removal of all products with just a bit of the VCO applied very lightly and gingerly, section by section — which I’ve found to be soothing until the oil can be applied all over. Once less sensitive, soaking in it can be done.
Laura: In case you’re reading instructions of “rinse immediately” for things like shampoo…this is important for ALL wash-off products. Wash-off products contain ingredients that are, as the name implies, meant to be washed off (such as surfactants or soaping/bubbling ingredients). Their action is cleansing, and they are not meant to stay on the skin for more than a few seconds at a time in the shower or bath. But oils and moisturizers? Or oils in a soak? These are usually fine to “marinate” in for a while 🙂 Again, with the caveats above of hypoallergenicity.
Shampoo & Shower Tips
Marcie Mom: When I’m showering my 2 year old, I apply shampoo on her hair and bath oil on her tummy, back and legs. For her face, neck, underarm and groin, I don’t apply any bath oil on them but just rinse with water (I assume some of the bath oil would inadvertently flow to these areas when I’m rinsing). Is this the correct technique and clean enough?
Dr. Verallo-Rowell: Wise and smart. Another technique I use is the pure VCO as the cleansing oil on any irritated/irritable/potentially irritable skin. It’s all in one: functions as a mild cleanser, barrier and for healing.
Marcie Mom: Lastly, the eyelid. Eyelid eczema is not uncommon for children and furthermore, children tend to scratch their eyes when sleepy or tired. I normally wipe my baby’s eyes with cotton pad soaked in slightly warm cooled boiled water followed by a thin layer of moisturizer.
What would be your advice on treating rash on the child’s eyelid? Is there any ingredient that is a no-no for the eyelid?
Dr. Verallo-Rowell: Wet with a little water the way you do it above, then apply the VCO alone or with pure plain petroleum jelly to lock in the water. The oils “melt” in a few minutes. Gently pat into the skin and if necessary (not usual) wipe off any excess to avoid their getting into the eye.
Laura: A nice alternative to the plain petroleum jelly can be our popular Big, Brave Boo-Boo Balm, which is petroleum jelly but with the coconut-derived monolaurin.
Marcie Mom: Thanks so much again, it sure gives me some peace on what I can do for the sensitive part of my baby’s skin.
I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.
VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker.
Marcie Mom: Given that a child with very sensitive skin/eczema can be allergic to many ingredients, it makes sense that the fewer ingredients, the less likelihood of triggering an allergic reaction.
Is there an average number of ingredients a moisturizer is likely to have?
Laura: There is no one average to give because different formulations necessitate different quantities of various things like emulsifiers, stabilizers and so on. For example, a shampoo might normally need to have a longer ingredients list than, say, a lipstick, because the shampoo contains so much water and needs more preservation, whereas a lipstick or concealer is mostly wax and therefore needs less preservation. A good bet is to compare similar products, e.g. two toothpastes. If toothpaste A has 10 ingredients and toothpaste B has 25, then A is probably the safer bet. Of course, toothpaste A could have allergens and toothpaste B could have no allergens…
In a nutshell: hypoallergenicity is a highly complex concept with many, many moving parts and it would be unreasonable to expect any mother or any consumer to master (or even familiarize herself with) all of these myriad issues. As we are mostly “lay” moms who want to care for children with very sensitive skin, it’s not a matter of mastering this complexity or of finding one magic bullet. It’s a matter of choosing products with as many of the good-practices as possible. If I were to summarize the safest best practices into a simple checklist, this would be it:
1) Look for zero or as few allergens as possible. Your best bets for this are a) a patch test when your child is old enough and b) a VH-Rating.
2) Avoid the most consistent top allergens: paraben, fragrance, masking fragrance, dyes, “coca”-surfactants
3) Choose shorter ingredient lists (but check them against #2 above).
4) Try to opt for brands with real clinical legitimacy. Published studies in well-known medical journals and presented studies in the large medical conventions are a good bet. At least you’ll know that their claims are backed by research that has objectively been considered scientifically valid enough for presentation and publication…so you might at least feel more comfortable trusting their claims.
Marcie Mom: Great checklist! I’m so happy that we’ve understood lots and understand so much better when we read the product label.
I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.
VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker.
Marcie Mom: For a parent on a tight budget (also considering long term and frequent use of moisturizers), should he/she start the child on the cheapest lotion/cream available? If not, is there certain baseline to start with, for instance, it must state ‘suitable for infant with eczema’ or not contain ‘perfume’?
Dr. Verallo-Rowell: The answer is no. Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients versus, for example, pharmaceutical-grade or higher-quality or purer ingredients, which are frequently more expensive. Some cheaper products are dyed with relatively cheap ingredients to add attractiveness in children’s eyes. Cheap or expensive, preservation is also problem, as are added antibiotics. All these are allergens and break down the skin’s natural barrier.
Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients
Make function be the basis for your choice. Remember that in different forms of eczemas you pay attention to the skin’s outermost barrier layer: genetic innate barrier dysfunction initiates atopic; allergic or irritant reaction breaks down the barrier in contact; food around the mouth area can physically act on the barrier, and secondarily, bacteria cross damaged barrier in all types of eczemas. Hence to keep the barrier as intact as possible:
Place the least irritating, partially occluding product you can find without any of the above: scents, preservatives, antibiotics, dyes.
Mineral oil and pertroleum jelly are long time favorites of us dermatologists. They are cheap and excellent barriers, but they are petrochemical derived. Consider non-preserved, non-adulterated oils. For this my favorite is virgin coconut oil because it needs no preservation and is broken down by lipases of friendly skin bacteria into monoglycerides with antiseptic properties. I have a published paper on VCO vs. Olive oil in Atopic Dermatitis that includes comparison on Staph. Aureus action by both oils.
Can you list for us some common irritants and list them on a scale of 1-10 (1 being the most likely to cause allergy)?
It’ll also be great if you can let us know if there are other common names for these irritants.
Perfume, Fragrance
Benzyl alcohol (Phenylmethanol / Phenylcarbinol), also named as Natural grape aromatic preserves & scents in “fragrance-free products”
Does the Sun help? And is more sun good for eczema child? or bad?
Wearing a Hat also blocks the Sun (and also my hubby)
That’s something that parents seem to be very worried about and have reason to be as sunscreen lotion does contain several ingredients that are potential irritants. My baby Marcie uses Cetaphil and so far, it has worked well. But I have to confess that apart from applying before swimming, I don’t use the sunblock lotion since her eczema is triggered by heat so we’re seldom in the sun. Still, I did some research online and summarized for those of you who are looking into sunscreen lotion.
What’s UVA, UVB and SPF?
UVA rays can penetrate the skin and causes skin damage and aging; UVB, on the other hand, can cause sunburn. The lower the SPF number, the less protection against the UVB rays. Children should use at least SPF30 (SPF 30-59 is considered high) due to their delicate skin. SPF 30 means about 97% of the UVB rays are blocked. For babies, SPF 40 and above is recommended, though babies below six months should not even be in direct sun.
How to Protect from the Sun?
Apart from applying sunblock, your child can also wear a hat, thin but tightly woven white cotton, sunglass and use his/her favourite umbrella! Avoid going out from 11am to 4pm, where the rays are strongest.
What Sunscreen Lotion to get?
Sunscreen lotion are generally divided into two types – those that are chemical absorbers and those that are physical reflectors. Chemical absorbers penetrate the skin more and are more likely to irritate than physical reflectors, which reflect the UV rays from the skin. Physical reflectors are usually titanium dioxide/zinc dioxide based and the drawback is that they leave a white sheen on the skin (nano particles technology can reduce this white sheen but reported to increase risk of cancer; in particular, avoid spray-on and stick to cream/lotion).
Also, stick to what you’d normally look out for in moisturizers – fragrance-free, preservative-free, lanolin-free, propylene glycol-free, PABA-free (para-aminobenzoic acid not only stains clothing but requires an alcohol vehicle to work), suitable for sensitive skin, hypo-allergenic, avoid ingredients like methyldibromoglutaronitrile, quaternium 15, benzophenones, oxybenzone, octinoxate, dibenzoylmethanes, mexoryl, retinylpalmitate, salicylates, octocrylene and cinnamates (I’m not sure if you can find one sunscreen lotion without any of these ingredients; the ones I listed first are what seem to be the more allergic ones).
How to apply Sunscreen Lotion?
First, test on a small part of the body, preferably inside of the arm. Wait for 24 hours to watch for any allergic reaction.
2013 update: Read my interview with Sonia Badreshia-Bansal MD (in collaboration with American Academy of Dermatology) on sunscreen.
2014 update: Watch (or listen) to my Youtube slideshow on sun protection for kids.
2015 update: Read my interview with Dr Thomas Rohrer (in collaboration with American Academy of Dermatology) on how to treat sunburn.
2015 update: Skin (fun) facts! What’s the difference between normal, eczema and baby skin with regard to sun protection, find out here.
If no issue with the lotion, apply moisturizer as per normal for your eczema child. 30 minutes later, apply sunscreen lotion. 20 minutes later, can go into the sun. Subsequently, apply every 2 hours particularly if contact with water or the child perspires a lot (even if the lotion says it’s water-proof). Apply even if in water as the cooling effect of water does not mean no sunburn. Lastly, make sure the sunscreen lotion hasn’t expired!
Tubifast Garment (pic taken from www.molnlycke.com)
MarcieMom learnt online that wet wrapping is a method used to keep moisturizer/emollient on the child’s skin, particularly for children who has severe eczema and requires their skin to be kept hydrated. MarcieMom started looking for easy to use wet wrapping in Singapore and found that Tubifast Garments, a product of Mölnlycke Health Care Limited, is available in Mount Elizabeth Hospital (Update 2019: The common Tubifast bandage sizes are also available at Guardian pharmacy). As some parents are new to Tubifast, MarcieMom contacted Mölnlycke Health Care to find out more about their products and how to use them.
Marcie Mom: I read from your website that Tubifast is a 2-way stretch technology, meaning it can stretch horizontally as well as vertically. It comes in ‘tube’, therefore removing the need to bandage and secure with tapes or pins. It is recommended on your site to be worn by children under their clothes, including pajamas. I haven’t seen the actual product, but I imagined it to be like wearing thermal wear which isn’t very appealing and brings to mind trapping heat and scratchy. From your experience, how did the children with eczema describe wearing Tubifast?
Mölnlycke Health Care: Tubifast is made of SoftSeam technology which helps to reduce irritation of sensitive skin. The material of Tubifast is very soft and comfortable, yet not very thick. It is totally different from thermal wear. For Eczema patient, Tubifast is worn after application of emollient (either wet wrapping or patch wrapping). Feedback from children are always very comfortable and it really eases their itchiness and prevents them from scratching.
Marcie Mom: It is written on your website to first apply Epaderm (an emollient brand under Mölnlycke), followed by wearing Tubifast Garment/bandage. Does a certain type of emollient go better with Tubifast? And is there a preference for lotion or cream when using with Tubifast?
Mölnlycke Health Care: No. Any type of emollient that is meant for ezema can be used with tubifast.
Marcie Mom: For wet wrapping, it is stated on your website to wear one damp layer of Tubifast, over the moisturizer, followed by another dry layer. This sounds really warm to me, yet I understand that the damp layer can cool and soothe the skin. How does this work? And how long can the child’s skin be kept cool?
Mölnlycke Health Care: Wet wrapping helps to keep skin hydrated and moist, hence reduces inflammation. It also helps to ease the itch and scratch cycle for ezema patients by giving a cooling sensation to the skin that prevents children from further scratching and causing potential injury. You can constantly keep the damp layer moist by spraying water every few hours (depending on the environment / temperature especially in the air-condition room).
Marcie Mom: I’m thinking through some practical questions parents may have, such as (i) how many hours should my child wear Tubifast for it to be effective? (ii) how often should I wash Tubifast? (iii) how do I wash Tubifast, can it be steamed? (iv) will my child get crinkled skin from osmosis? (v) will my child catch a cold like wearing wet clothes? (vi) can my child continue to sleep in air-conditioned room?
Mölnlycke Health Care: (i) Usually Tubifast wet-wrapping is worn during night time. However, please consult a dermatologist who specializes in treating atopic ezema. (ii) No fixed frequency for washing. As and when deem required. (iii) Hand wash tubifast and air-dry it. (iv) So far we have not received such feedback but please consult your dermatologist for further information (v) Tubifast wet-wrapping is to be worn under supervision of a healthcare professional (vi) Please consult your healthcare professional.
Marcie Mom: Thanks, I think we’ve covered many questions that will come to parents’ mind. Should there be more questions, I’ll let you know and update in the comments. p.s. to readers of eczemablues.com, I asked for this interview as I’m curious why wet wrapping is seldom seen in Singapore. I did not receive any money from Mölnlycke Health Care for this interview.
Special Guest – Massage Therapist – Paola Bassanese
Massage is frequently cited as beneficial and recommended in many baby guidebooks. As one of the benefits of massage is reducing stress of the child, and stress is a common eczema trigger, this post explores the benefits of massage and how it can be applied to a child with eczema.
Special Guest: Paola Bassanese is the founder, director and lead therapist at Energya Ltd, a massage therapy clinic based in Central London. Paola received ITEC Qualifications in Swedish massage and has won several awards, including the prestigious special award from Italian Chambers of Commerce for representing Trieste, Italy abroad. Paola is also a regular contributor to the Huffington Post and Kingsroad.co.uk. Paola will advise further on massage techniques for eczema children and teenagers.
Benefits of Massage
Massage has many benefits, but pertaining to eczema children, there is a research study that shows decreased eczema symptoms in children whose moisturizers are massaged onto the body versus normal application. As stress is a common trigger of eczema, reducing stress through massage may help to relieve an eczema flare. Massage has also been cited to increase bonding with parents, reduce colic and constipation and improve sleep.
How to Massage
Personally, I think babies enjoy touch and just stroking them (and making funny, happy faces) is great. Paola will suggest some techniques for massaging children. Also, teenagers generally feel awkward being massaged by their parents and thus enlisting the help of a massage therapist will be useful. Below are some quick guidelines for massaging children with eczema:
– Oil is often recommended but given the sensitive nature of eczema skin, it’s best to stick with the moisturizers that you’re already using on your child.
– Choose a nice, quiet time and set a cosy atmosphere. Best not to massage after food. Massage after bathing is usually the best time for babies.
– Keep the session short, be gentle and cut your nails, remove rings and scratchy material.
– For eczema child who is prone to dry skin, avoid rubbing the skin too hard but instead stroke gently downward.
– Finally, gauge your baby’s response! If baby is already squirming and upset, don’t add to the stress by forcing a massage.
Paola’s Advice
– First of all, go on a massage class you make sure you apply the technique correctly. A mother and baby massage course would be a perfect starting point.
– Some oils can be irritating so only use a lotion prescribed by your doctor. Sometimes coconut oil can be used but check for allergies.
– The best technique to use for eczema is manual lymphatic drainage. Ideally you need to pass a massage course and a specialised lymphatic drainage course or workshop to be able to perform this technique. However, you can follow these tips:
– Always apply the lighted of pressures working in small semi-circles on the face. Work upwards from the neck, to the jaw, chin, cheeks, eyebrows. The idea is to “pump” the skin slowly and delicately, almost patting the skin cells onto the face.
– On the arms and legs, work from the extremities towards the heart: from fingertips to armpits and from toes up to the hips. Here the movements are different and the small circles are only used on the inside of the upper arms and the inside of the inner legs. Forearms and lower legs need a gentle brushing motion, where you “scoop” the skin lightly towards the heart.
– Abdominal massage: follow the large intestine doing small circles starting from the bottom right of the abdominal wall going up on a straight line, then going across under the rib cage on a horizontal line, and finally moving downwards on a vertical line. Continue with small circles around the belly button. The pressure must be light to avoid discomfort.
– Lymphatic drainage can be particularly beneficial for teenagers as it can rebalance the production of sebum on the face and soothe acne breakouts. You can concentrate on the face and arms only if the young person is feeling self-conscious. Another alternative is to use pressure points so no skin is exposed. Using your thumbs, follow the length of the spine on either side pressing for a few seconds then releasing.
During an inflammatory flare-up any type of touch may feel uncomfortable especially if the skin is dry and cracked. In that case avoid broken skin and only light massage the areas that are looking healthier or massage the scalp to provide some relaxation.
Frequent scratching or rubbing of eyes can be due to itchiness caused by eye allergy or infection; but for a child with eczema, it is possible that he or she has eczema on the eyelid. Though eyelid eczema is more common in adults wearing cosmetics, children can also suffer from dry, sensitive and itchy eyelid. The skin around the eye is thin and sensitive, and also vulnerable to irritants and allergens just as other parts of the body of an eczema child. My baby Marcie sometimes scratches her eyes, and the eyelids look red, dry and sometimes a little swollen.
Here’s a little bit more of how you can identify eyelid eczema in your child:
– Eyelid is itchy, looks inflamed or scaly.
– Eyelid is red or swollen.
– If scratching is vigorous and prolonged, it may cause a change in the appearance of the eyelid, e.g. extra fold of skin under the eye or darker eyelid.
– Extreme rubbing can even lead to deformed cornea (keratoconus)
I haven’t asked for any medical advice regarding eyelid eczema, but I usually wipe Marcie’s eyelid with cooled boiled water on cotton pad. If her eyelid looks oily (at the place where mascara is applied, not that I apply eye makeup on her), I will use slightly warm cooled boiled water that can remove the oil better. I will then sparingly apply Physiogel AI cream on her eyelids, and usually, she stopped scratching after a few days since her eyelid eczema is not severe. Do do see a specialist and seek appropriate treatment as you can read below, it’s a little trickier to treat the eyelid eczema.
– Certain irritant/allergen in moisturizers may worsen the eyelid eczema, see this post and the comment section for some of these irritants.
– Eyelid can be moisturized, but avoid doing it too generously that it flows into the eye and irritate the eye.
– Check with the doctor if the steroid lotion/cream that you have can be applied on the eyelid. There’s some research that shows increased risk of cataract and glaucoma with steroid use. (Also read that the risk of cataract is higher for people with severe eczema for more than ten years…but let’s not scare ourselves too much now and just focus on managing our children’s eczema for now)
– As the eyelid is already thinner than other skin, and extensive steroid use causes skin thinning, do consult your baby’s doctor on the frequency you can apply the steroid. (note: don’t get put off steroid use, as there’s research that there’s no long term adverse effect if used as doctor prescribed)
– For cleaning the eyelid (if need to), ask your baby’s doctor first if you want to use eye lid cleanser as most of these are for adults only.
Update: Since this post, I have interviewed several dermatologists on eyelid eczema and how to clean and treat it, here are the posts:
Are you running out of ideas to distract your child with eczema from scratching? Marcie (in photo) knows about 200 signs from Amercian Sign Language (ASL) and sometimes when she wants to scratch, I’d quickly distract her by asking her how to sign certain animals, like “Mouse”, “Monkey” or “Bird”. Most of the time, it works as Marcie would respond by doing the sign and soon forgot about scratching.
Here’s Marcie’s Signing Story:
At about 3 month old, when we decided she could watch TV and hence, should watch programs suited for her, we went to the library and borrowed a few children DVDs. She’s really taken to Signing Time and watching the DVD already distracted her from scratching.
By about 6 month old, she already started signing back. Her first signs were “More”, “Milk” and she loved signing “Cat”, “Dog” and “Bird”.
By about 15 month old, she actually knew more signs than my husband and I! We left her to watch the DVD on her own, while we quickly did household chores and given her good memory, she actually learnt more than us.
Now, at almost 2 year old, Marcie knows almost 200 signs (she could know more, cos I only counted those I learnt with her). Marcie is scratching less and likes dancing now, so although she’s signing less, signing has helped us for almost a year with distracting her from scratching.
So, are there other benefits to Signing? Marcie’s “True/False/Not Sure” response.
Yes, you won’t find helping eczema children as a benefit listed but there are many other listed benefits:
1. Able to communicate with caregiver, thus reducing frustration/tantrums (from your baby, not you!) – True. Marcie, despite her eczema, did not show sign of frustration of not being able to communicate with us.
2. Improve motor skills – Not sure. Being an eczema baby from 2 weeks old, Marcie has better finger dexterity than other babies her age. Before others discover their fingers, Marcie was already scratching! Baby’s finger muscles develop earlier than speech muscles, so they can sign before they can talk.
3. Understand English earlier and Increase Vocabulary – True. Marcie knows 200 words already, and she knows her A to Z at about 14 month old. By knowing, I meant she can sign and she can pinpoint the alphabet if I ask her which is “M”. Also, I read that alphabet like C and Z may confuse a child, and knowing that they have different sign allow the baby to know they are different alphabet. Also alphabet like W may mislead the child to thinking it’s three alphabets. Also, teaching a child using a multi-sensory approach can help him/her remember better. Read interview with MySmartHands founder on benefits of baby sign language.
4. Deeper bonding with parents, higher trust level- Unsure. I co-sleep with Marcie and was stay at home mom for 11 months, without hiring a maid/au pair. So, I can’t tell if she’s bonded with me because of the signing or not.
5. Helps talking, does not delay speech – Unsure. Marcie, at almost 2 year old, hasn’t talked much though she sings to herself, dances and tries to say certain words.
6. Stimulates intellectual development – Unsure. Research conducted showed higher IQ of signing babies (114) compared to non-signing babies (102). I think Marcie is already smart, so I can’t tell this one (lol, I know I’m one of those moms who think her baby is smarter than others).
7. Boost self-esteem and confidence – Unsure. Marcie is quite shy around strangers, say in sunday school.
8. Learn a recognized 2nd language, rather than make-up signs – Yes. I’m intending when Marcie is older to sign up to volunteer with the deaf association. You need to go through their sign language course but I’m sure we’ll pick up quickly given the head start.
All in all, I love signing with Marcie and I love seeing her stop her scratching and sign in response to my request for “What’s the Sign for Eat?”
Many moms have asked who to recommend for their baby’s doctor – whoever we decide on, I feel that the doctor must be specialist in children and have the best interest of the child. It is also very important that we, as parents, be confident and partner with our child’s doctor. This is particularly the case if you’re prescribed oral steroid, you have to trust your doctor and follow through, giving up halfway makes it more difficult to decide on the next treatment step.
So, here’s the list of doctors who see eczema children, take the poll at the end or add in your own in the comments.
1. Prof Hugo Van Bever – My baby’s doctor, Head and Senior Consultant, Division of Paediatric Allergy, Immunology & Rheumatology, at NUH. (Please see below, Dr Lynette Shek is the current Head and Senior Consultant of the department.) He’s from Belgium 🙂 During his consultation, I find that he takes time to understand and form a proper diagnosis; I never told him this, but I was really afraid of bringing my baby to a hospital to get a skin prick test. Borrowed his book ‘Allergic Diseases in Children‘ from the Singapore’s library and felt more assured when I read that he cares deeply for his chronically ill patients.
2. Dr Lee Bee Wah – Consultant Paediatrician and Clinical Paediatric Immunologist/Allergist, The Child and Allergy Clinic, Mount Elizabeth Medical Centre. She’s recommended by my general practitioner whose children have allergies and see Dr Lee. I’m not sure about charges though, my GP told me charges depends on duration of consultation.
3. Dr Liew Woei Kang – Paediatrician, Special Interest in Allergy & Immunology, SBCC Baby & Child Clinic. We’ve met and he’s active in driving initiatives related to allergy children. He also consults in several of Singapore’s hospital with children clinics. Dr Liew is the past president of Asthma Allergy Association in Singapore.
You can read the notes that I took from an eczema forum with A/P Mark Koh as one of the speakers here.
5. National Skin Centre – They have a Paediatric Dermatology Clinic, and some of the doctors listed here also do visit consultation there.
I facilitate quarterly eczema support group sessions at the NSC, please contact me if you’d like to be on the mailing list.
6. Raffles Children Centre, Raffles Hospital – They have a paediatric medicine specialty, with atopy (allergic conditions) and dermatology sub-specialties.
7. Mt Alvernia Hospital – They have different children clinics within the same hospital, do check first the doctor’s specialty before making appointment. Kinder Clinic is one of the clinics with a branch in Mt Alvernia; they have an paediatric allergy, immunology and rheumatology specialty. Here’s a list of their doctors, with doctors listed for specialties in pediatric allergy, immunology and dermatology should you want to make an appointment.
9. Polyclinics in Singapore – I think they have doctors who treat eczema, though not specializing in children. For those who don’t mind a longer waiting time, you can go to polyclinic first and get a referral to NUH. As far as I know, the difference between going to NUH straight, or getting a referral, is the latter may be a longer waiting time. The last time I attended an eczema support group session at NUH, I was told that subsidized patients will also have the same doctor to follow-up on their condition. The other doctor, A/Prof Lynette Shek, same dept as Prof Hugo, also has many positive feedback from moms in forums (and she is the current Head and Senior Consultant, Division of Paediatric Allergy, Immunology & Rheumatology, NUH)
A final reminder
Generally, I recommend parents with severe eczema child to see specialists and not just pediatricians or general practitioners. This is particularly so as skin prick/blood test is administered in hospitals. Do note that Changi Hospital, Tan Tock Seng and Singapore General Hospital do not have a children clinics. If your favorite doctor has been left out, do leave their names in the comments!
2017 update: Apart from eczema, Marcie has had various conditions over the years that affect the skin such as shingles, chickenpox, HFMD, impetigo and the latest in 2017 was ringworm (and allergy to ringworm that resulted in rashes all over her body). I realized from the recent experience that a dedicated general practitioner (who is experienced, and actively studies information such as Dermnetnz, can accurately diagnose and formulate the right treatment as well.
Marcie Mom at eczemablues.com catches up with Laura Berg, the founder of My Smart Hands, an international company of about 200 instructors that educates young minds using sign language. Marcie Mom interviews Laura because signing has occupied Marcie’s fingers and distracted her from scratching her eczema rash. To let readers of eczemablues.com learn more about signing, Laura will share about the benefits of signing and addresses some of the common misperceptions of teaching sign language to your child.
Marcie Mom: Hi Laura, from 2005 when you started designing My Smart Hands’ curriculum to now, what are the top three positive changes you’ve noticed in the children who learnt sign language? Laura: The top three positive changes would be:
1. Signing reduces frustration. Many children want to desperately communicate with us and they can’t do so easily because their language skills aren’t quite there yet. Signing can bridge the gap until language develops which hugely reduces the child’s frustration level.
2. We are finding that signing enhances language. It doesn’t make children talk sooner but it does build their language skills. There is a difference between speech and language. Children can use language (signing) without speech and therefore exercise that portion of their brain. If a child is a late talker, his/her vocabulary will be much larger if they’ve used sign language before they are able to talk.
3. It builds confidence. A child who is easily understood by the adults around them experiences less frustration and displays more confidence. These children don’t have to worry about not being understood. It boosts their self-esteem as they are able to engage more with the adults in their lives.
Marcie Mom: Many parents are worried that learning sign language will delay the development of speech. Have you seen that happening or is there any negative impact on the child’s behaviour? Laura: This is a common concern that parents have. Mind you, I am hearing this concern less and less. The longer the idea of signing with babies have been around, the longer there is proof that this is a complete myth. Some people think children will be lazy and just want to sign. I, personally, have never seen a lazy child when it comes to talking. They want to talk, they babble all the time! As soon as they are able to do so they will.
To elaborate on my point above, there is a difference between speech and language. A child can still have language without the ability to speak or form words. I often use the example of two children and both of them don’t talk until they are two years old. You’ve signed with child A but not with child B. Child A is able to communicate and engage with his parents. His parents know that this child understands them so they give him more complicated language to use (through the use of sign). Child B on the other hand is left with choices, does she want an apple or an orange for a snack? Whereas child A might be asked, “what would you like for a snack”. This question alone allows for more though process to take place and more consideration of what the child wants. By the time these children turn two, child A will have a much larger vocabulary than child B because he was able to use language all that time.
So no, signing definitely does not delay speech. It definitely helps language skills 🙂
Marcie Mom: It’s probably not common for parents to come up to you and say that signing has helped to distract their child from scratching the eczema rash. Has there been any other instance you’ve come across that signing has helped to distract the child in a positive way, say from throwing tantrums? Laura: Yes definitely! It’s a great way to easily communicate with the child in a discrete and even distracting way. When my daughter was younger she would throw a fit every time I told her ‘no’ but she’d be completely fine if I signed ‘no’ to her. I’m not sure why that is but I know it worked for her and definitely reduced the number of fits she threw. A mom who took one of my classes reported that when her daughter would throw a temper tantrum she would start to sing and sign the Itsy Bitsy Spider song. She would try to just sing it and the child would completely ignore her. When she put the actions to the song the movement would catch her daughter’s eye and snap her out of the temper tantrum she was throwing.
Marcie Mom: What advice will you give parents who are keen to explore learning sign language with their child? And how best can parents approach it? Laura: The main thing I would tell parents is to not be intimidated! You can easily learn the signs that you teach your child as you go. Simply look up one sign and start with that. I recommend starting with the sign ‘milk’. Once you become comfortable with that sign then look up another one and teach your child. It’s very simple, don’t be intimidated!
I recommend parents start with 1-5 signs in the beginning. This way you won’t feel too overwhelmed. The most important thing is to be consistent with your signing. It is more important to sign the word every time you say it than to introduce tons of signs throughout the day. Even if you sign one thing until your child signs back you will find that very useful. Once your child realizes that a sign means something then you will find that he or she will pick more signs up faster.
And most importantly, don’t give up. If you are consistent your child will pick signing up. Each child picks it up at different stages. The benefits will definitely come. Enjoy and have fun!!
Marcie Mom: Thanks Laura!
p.s. To readers of eczemablues.com, I asked Laura for the interview because signing has helped Marcie with her eczema. I did not receive any money from Laura or My Smart Hands for this interview.
When you are a first-time mom, you get lots of advice; if you are a first-time mom of an eczema child, you get even more advice on everything from everyone, and sometimes they get contentious. Detergent is one of the issues where opinions differ – some say no detergent, some say little detergent, some say organic detergent and most of the time, it brings about frustration. So what is right?
Unfortunately, yet again, there is no clear cut answer. Detergents are everywhere, from laundry, to residue on our clothes (supposedly up to 2% of the fabric weight), towels, dishes, food containers, bedding, bathroom, floor, furniture, hair, skin (ours that come into contact with our children) and lint. There are parents who believe in cutting out all sources of detergent but given the prevalence of detergent even in dust, it is difficult to cut everything.
Below are some of what I’ve found out, from various research papers and online.
1. Increase in eczema is linked to increased usage of soap and detergent personal wash products in children (taken from review article Features of childhood atopic dermatitus by Hugo Van Bever and Genevieve Illanora, who in turn quoted Dr Michael Cork’s 2002 article)
Dr Michael Cork’s article in Dermatology in Practice published that eczema in british children increased from 3% in 1950s to more than 20%; during this time, the sales of detergent increased from 76m pounds in 1981 to 453m pounds in 2001. There is also an increase in central heating, carpeting, double glazing/wall insulation that promotes the environment for dust mite to thrive.
2. Is detergent bad?
Apparently, yes. Detergent strips the protective fats of our skin barrier, making it easier for irritant and allergen to penetrate. Eczema skin is dry, and thus more suspectible to cracks in the skin, making it even more vulnerable. The ingredients which are bad in detergent include sodium lauryl sulfate, triclosan, formaldehyde, sodium hydroxide, linalool and sodium flouride. These chemicals are not only used in detergent (including some hypoallergenic detergent), but also fabric softener, bubble bath, insect repellent, air freshener, toothpaste, bleach, liquid soap and baby wipes!
(A Sweden study showed that 5–7% of 3,000 eczema patients patch tested positive to linalool, which is found in 60-80% of perfumed hygiene products and detergent liquid. Linalool is a fragrance ingredient found naturally in lavender and mint, and when oxidised, can cause contact allergy).
3. So what to use and how to use?
Mild, fragrance-free, dye-free, lubricant-free, phosphate-free, brightener-free products suited for sensitive skin. (many webpages recommend puraderm). Recommended to use liquid detergent, instead of solid and to use 1/8 to 1/2 of the recommended dosage (supposedly washing machines are more water-efficient now while detergents have gone more concentrated). Using more detergent than necessary does not make your clothes cleaner but instead creates a build-up of residue which you can tell if your clothes get stiff when dried.
4. So how far should you go in cutting down detergent?
Personally, I used as little detergent as I can pour out and I invested in a washing machine with allergy care function which supposedly washes away chemicals, which I think it does as each cycle is 2 hours! I clean my floor with water only and that’s about all the measures I take. I find cutting all traces of detergent to be too exhausting and so far it hasn’t seem necessary from observing my baby’s skin reaction. What’s your take on this? Do drop me a comment!
One thing that my husband and I can’t quite agree on is how much to moisturize – I like to slather huge amounts (think pressing the bottle pump vigorously, and just applying VERY liberally) while my husband prefers to pump with measured control as he feels that too much moisturizer get wasted on the clothing and when my baby hides under the blanket to escape from us). So how much is enough? And when to moisturize?
Let’s first establish that moisturizing is a must; it’s the one advice that I had from Marcie’s doctor Prof Hugo Van Bever, and in his words “You Can’t Moisturize Enough”. In a later follow-up consultation even after Marcie’s eczema is under control, his advice is still to continue moisturizing.Moisturizing helps to restore the skin barrier which is typically broken/thin in eczema skin, and that allows irritants and allergens to penetrate the skin. Moisturizer helps to trap water (after a bath) and also retain moisture in the skin. As you can see in the chart, people who moisturize more had to pay less visits to the doctor. I also read that the more moisturizer one uses, the less severe the eczema is.
So, how much to Moisturize? From what I’ve read is 400-500 grams per week, that’s one bottle of QV 500ml lotion or 2 bottles of Physiogel lotion, which is also the amount that I’ve been applying for Marcie. If you read my budgeting post, you will know how much it cost.
Steroid first or Moisturizer first? That’s another item that my hubby and I can’t agree on, but I think he’s right. Steroid first, then moisturizer.
When to Moisturize? Immediately after shower, and roughly at every diaper change/ 2-3 times per day. Moisturize even when the eczema is under control and for whole body, not just the rash area.
What Moisturizer to choose? I’ve tried to decipher the ingredients with not much success, but have posted here on what to generally look out for.I’ve later read that silicone is to protect the skin, butylene to re-hydrate and prolipids to restore. I know that propylene glycol and sodium lauryl sulfate may irritate the skin. You can also refer to this link for more on the ingredients (I didn’t summarize them ‘cos I’d tried for 2 days to compare ingredients across brands and they just don’t label them the same way…)Whatever it is, don’t give up on moisturizing! Anyone has any brands that worked for your child? Do post in the comments, thanks!
Update on:
How Much to Moisturize – read this Q&A with dermatologist Dr Jeff Benabio here
On Steroid or Moisturizer first – read this Q&A with Dr Bridgett here
On which ingredients to avoid in skincare production – read this Q&A with Dr Verallo-Rowell here
One of the most contentious parenting issues between my parents and I are over giving my baby cold water. From about six months old, when my baby Marcie was started on water and solids, I realised that she preferred cold water, refrigerated baby juice and fruit puree. My parents had always disagreed over the temperature of her food, even to go as far as suggesting it caused her eczema and low weight gain; both of which, I countered with (a) my baby whose eczema is triggered by heat really prefers cold stuff, and eating cold food is better than no food and (b) the low weight gain is due to abnormally high birth weight (heavy newborn at 4kg plus) and possibly, lack of good sleep.
So, is giving cold drinks to baby really that bad? My answer, if you do not believe in TCM, is no – drinking cold drink will mean that your baby needs to use energy to warm the liquid up, thus less energy for body functions. If you believe in TCM, the theory is that cold drink weakens your lungs, lowers your immune system and as my parents believe, causes asthma (which again is a myth). However, certain cold drinks (not due to the temperature) are indeed bad for your baby:
2. Sugary drinks that increase chance of tooth decay.
3. Artificially flavoured drinks which have been linked to ADHD.
As you can see in my baby bag, I always pack ice or cold drink (or both if going to the zoo). To me, if cold water can stop my baby from scratching, offer her (and me) some relief when dining out or when outdoors in a park/zoo, why not?
Marcie had her half-yearly check-up last Saturday at NUH’s children clinic and we are happy that her skin is considered good enough not to use steroid. Instead, we ought to follow the 3 tips from her doctor, Prof Hugo (in picture):
1. Moisturize, especially after Marcie has got in touch with water (after a bath or swimming)
2. Use chlorhexidine before applying steroid cream to clean away the bacteria so that the steroid cream will be more effective
Update 2018: Instead of chlorhexidine gluconate wash, Octenisan is recommended instead as it is less drying. Do not use an antiseptic body wash daily as both the good and bad skin bacteria are washed off. Also, the antiseptic body wash lotion has to be left on the skin for at least a minute before rinsing off to give sufficient time for the antiseptic to work.
More likely than not, children with eczema tend to have poorer sleep due to eczema flares or scratching. My baby Marcie at 18 months is still co-sleeping with us, and it has helped her to sleep better (though it hasn’t helped me to sleep better, but as you can appreciate, it is joy to see our children without bloody scratches in the morning).
Apart from co-sleeping, below are my top 5 tips to help our children with eczema sleep better.
1. Keep the room cool
Heat is often a trigger but do get your child tested to know what the triggers are for him or her. Marcie’s trigger is heat and we have the room cool (air conditioner at 22 deg C, fan at low speed 1 and humidifier).
2. Apply plenty of moisturizer
There is really no running away from applying moisturizer. Moisturizing keeps the skin from drying, which in turn reduces the chance your child will scratch. If you need help with the choice of moisturizer, you can read this post.
3. Keep baby fresh
As sweat can be an irritant to broken skin, I shower my baby later in the evening, after her dinner; or if she has already showered twice for the day, I will wipe her with cool boiled water using soft cotton pad. Of course, plenty of moisturizer after bathing or wiping. You can read about showering your child here.
4. Have her wear light cotton clothing
A few times, I put her in one piece long suit that really helps to keep her from getting to her itchy skin BUT it also makes her warm. You can trial and error to see if it is better to have her wear short sleeve or long sleeve. I’m sure you know by now that your child has a knack for finding ways to scratch, even when you thought he or she is ‘well protected’ with the pyjamas.
5. Treat the eczema rash
Do treat the rash.. I use steroid cream on alternate day or when the rash is persistent and looks inflamed. I read that wet dressings are effective but I don’t know how to do it. I just like to encourage you that steroid is not that bad if used appropriately, you can read about steroid safety here.
I also set up a bedtime routine of reading books, singing songs, turning off all the lights and playing baby christian songs. We also pray for good night’s sleep!
Heat and perspiration is the most common trigger of eczema and that’s exactly what gets my baby Marcie scratching. To keep the room cool, especially when it’s summer all year round in Singapore, you would have to on the air-conditioner. However, that makes the air dry and from experience, I realized that a humidifier did help my baby to sleep better. Here’s various pros and cons of a humidifier.
Pros
Helps combat dry skin, caused by air-conditioning. Dry skin is prone to irritation and lead to scratching. Doctor Claudia Aguirre commented in 2012’s twitterverse 1st Eczema twitter party hosted on this blog that should the humidity falls below 40%, moisture will start to strip away from skin, for full twitter party transcript see here.
Cons
Dust mites thrive in humid environments, so if your child is tested to be allergic to dust mite, you would need to find the right level of humidity to get the air moist, without encouraging dust mite to thrive (usually 30% to 50% humidity)
Too humid environment encourages growth of mold, which may be a possible trigger of eczema
And as I always emphasize, it is important to have your child tested to know what triggers the eczema. You can check out my Top 10 Eczema Tips and posts on Skin Prick Test and Itch Triggers.
We use bath oil, instead of soap for shower; A few times, we slipped cos the floor is really bath oily!
Having fun in water
Even a simple task like bathing can generate lots of different views. If you read online, you will find some people saying that children with eczema should bathe every few days while others say that up to 3 baths a day is acceptable. From what I understand from Marcie’s doctor, the important thing for bathing is to moisturize immediately after shower. As a quick guide, below are my top 5 FAQs on showering baby with eczema:
FAQ 1: How often to shower baby?
The general guide is not to lose moisture through showering but to retain or increase moisture from the routine. Frequent showering will lose moisture but for babies whose itch is triggered by heat and sweat like Marcie, she showers about twice a day. Once in the morning to get her off to a fresh start and once before bedtime to (hopefully) reduce scratching at night.
FAQ 2: What water temperature for the baby bath?
Lukewarm is recommended; warm is a no-no, again due to loss of moisture. Heat actually temporarily numbs the skin and reduces sensitivity of the itch nerves (from what I read). However, its permanent effect is a loss of moisture.
FAQ 3: What bath lotion to use?
Soap-free and perfume free. I use Dermaveen Colloidal Oatmeal bath oil (you can also try Aveeno’s) which is soap-free, moisturizing, non-greasy, lower skin pH and seals the moisture after baby’s bath.
FAQ 4: How long to bathe?
Usually soak for 10-15 minutes. As your baby gets older, she may no longer fit into the bath tub or prefers to bathe standing. Now Marcie will sit in the bath tub if she has toys to play or we blow bubbles to keep her amazed and seated in the tub.
FAQ 5: What to do after shower?
Don’t slip if you have just used the colloidal oatmeal bath lotion!
Wrap baby in towel, pat dry, don’t rub towel against skin. Moisturize immediately (you can refer to this post on the choice of moisturizer).
Update: About a year and half after this post, I’ve interviewed Dr Jennifer Shu and you can refer to her advice for bathing for babies with eczema here.
When it's daytime, the scratching is still there. Anything to not scratch?
Keeping your baby’s fingers busy would likely be a big thing for you, as it is for me. Your baby may have already formed the habit of scratching, such as Marcie has. Marcie started scratching intensely from 3 months old and now scratches our hands, her legs or anything that is close to her. Our little relief from scratching came when she’s 8 months old, when she started to explore the world around her. I’m sure you would have your own ways to keep your baby’s fingers occupied, but here’s mine!
1. Let your baby play with cold teether
Teether with Water
Teething ring filled with water that can be placed in the fridge worked wonders for Marcie from about 5-7 months old. Besides the obvious use for biting, Marcie loves holding cold stuff. Now, at 15 months when she’s scratching say in a cafe, I’d buy a small bottled cold drink for her to hold. That can buy me enough time to feed her and myself.
2. Never mind that the magazine or tissue is torn
Babies somehow love to tear tissue paper, magazines and pamphlets. Marcie has not only torn them but also eaten quite a fair bit of her books. To date, Marcie has eaten rubber ball, phone leather straps, paper and plastic film! As much as I don’t like her biting inedible stuff, I figured that it beats scratching her scalp out.
3. Have her hammer some balls!
Hammering toy
Hammering toys are a hit for babies of about 12 months. Your baby can learn to grip the hammer, practice her hand eye co-ordination to hit the balls, get a kick watching the balls roll down and probably end up biting the balls or the hammer! Main point is it keeps your baby occupied and her fingers active.
4. Never leave the home without finger food
Banana Milk Rusks
Graduate Puffs
One item that I definitely have to bring out is biscuits. Teething rusks that your baby can hold and eat on her own will occupy her hands. Marcie’s favorite is banana flavored teething rusks, followed by small star shaped puffs and baby rice rusks. I never leave home without them.
5. Catch the Wind in the stroller
Stroller Fan
If your baby has a tendency to scratch her head in the stroller, letting her play with the stroller fan is a good idea. Marcie has destroyed one fan by pulling out and tearing the wings but I’m fine as long as she’s not scratching her head. Do peep into the stroller every now and then as you never know when your baby will wake up and start scratching.
6. Or Read a Buggy Book
Buggy Book
Your baby may like flipping the book and Marcie particularly likes this peek-a-boo book as there are felt flaps to flip up to reveal hidden kids. Of course, she chews the book too!
7. Offer a Juice Cup but Watch out for the straw chewer
Juice Straw Cup
Baby loves juice and Marcie likes it cold best. I offer about 120ml to her daily and juice is another item I never leave home without. Once she has finished her juice, ate enough of finger food, I will offer her water bottle. Sometimes, I let her play with straws but watch out that your baby doesn’t chew and swallow the plastic straw of the juice cup (which Marcie did and ate the straw up too, I suppose it feels like jelly beans?)
8. Move and Groove and Play
Chasing after a car
Trust me. It gets easier when your baby is able to crawl and walk. Having more things to do such as crawling after a toy, kicking a ball will definitely take your baby’s mind off the scratching.
9. Hit the TV
This one is not an ideal thing to do but will certainly give you some time to work in the kitchen while your baby watches the TV and hit on the ‘items’ she wants to catch from the screen. My LCD screen hasn’t broke but is always dirty with food stained hand prints.
10. Push a chair
Junior Chair
This one works too! Marcie also pushes her high chair and crawls under the table.
There may be some items listed here that you find questionable, such as biting stuff and hitting TV. You don’t have to agree with all of them as these are the tricks that I use to keep Marcie busy. To me, raising a kid with eczema involves more trade-offs and these are some that I’m willing to compromise. Have a good day with your child and enjoy your time together.
