Eczema in babies and pregnancy

Many parents are concerned that their baby will have eczema, especially if they have had eczema themselves or if they already have another child with eczema. This leaflet gives some guidance about the risk of your baby developing eczema and what you can do to possibly reduce that risk.

What is the risk that my baby will develop eczema?

There is no definite way of predicating if your baby will have eczema. We know that "genetic"(inherited) factors are important. These genetic factors probably make a child more susceptible to developing eczema, asthma or hayfever but there are also a number of factors in the environment, which will trigger eczema in a susceptible child. Since we do not yet know which genes are responsible for eczema and how they are passed on, it is difficult to give accurate figures on the risk of your baby getting eczema. We know that the risk of your baby getting eczema is much greater in families who already have eczema, asthma or hay fever.

As a rough guide:

If you as parents and any other of your children do not have eczema, asthma or hayfever, there is probably a 1:10 chance that your baby could develop eczema.

If only one parent has eczema, asthma or hayfever then there is a 1:4 chance that your baby could develop eczema.

If both parents have eczema, asthma or hayfever then there is a 1:2 chance that your baby could develop eczema.

If another child has eczema, asthma or hayfever then there is a 1:2 chance that your baby could develop eczema.

If your child is going to get eczema, he / she is most likely to develop it in the first 2 years of life.

Practical Measures which may reduce the risk of eczema in your baby

During the Pregnancy:

If because of your family history your new baby is at a high risk of developing eczema, there is some evidence that reducing dust mite around the home might reduce that risk. Peanuts should be avoided throughout pregnancy, as there is some evidence that this may prevent peanut allergy developing in your child.

After your baby is born:

Diet - there is no good evidence that cow's milk protein will increase your baby's risk of developing eczema. Breast-feeding is best for baby for many reasons, and you should not withhold cows milk protein if your child needs it. Some children with eczema are allergic to cow's milk but this usually becomes clear in the 1st year of life. Early introduction of solids appears to increase the risk. We therefore advise that breast is best but please don't feel guilty if you choose not to breast-feed. If you do decide to breast-feed we advise you continue exclusively for 4-6months with regular weight checks and a varied maternal diet with plenty of fluids.

Weaning - The normal introduction of solids should begin between 4-6 months. It is best to wait nearer to 6 months for a potentially high-risk baby. The relationship between weaning and the development of food allergic disease has been studied and it has been suggested that a system of introducing one food group at a time and leaving the most common provoking foods until last is better.

Introduce one food at a time, giving it daily for one week before you decide whether it has an adverse effect (skin rash, loose watery, offensive stools). If you observe an immediate reaction such as swelling and redness of the lips and face, do not give that food and seek medical advice before trying it again. A vitamin and iron supplement should also be introduced at 6 months e.g. 0.3ml Abidec and 2ml Niferex.

Introduce foods in the following order:
1. Milk free baby rice mixed with water or expressed milk.
2. Pureed root vegetables - potatoes, carrots, parsnips, swede, turnip.
3. Pureed fruit - apple, pear, banana, but not citrus fruits - orange, blackcurrants, grapefruit until 9 months.
4. Other vegetables - peas, beans, lentils, broccoli etc.
5. Other cereals - e.g. oats, maize, but not wheat until 8 months.
6. Lamb, turkey and then other meats.
7. Fish not until 10months
8. Milk and milk products not until 10months. If breast milk has diminished before that a supplementary feed (Soya formula or hydrolysate formula) will be needed. Seek advice from a children's dietician. When introducing dairy products try yoghurt first, then cow's milk and then all milk containing foods. Goat's or ewe's milk is not recommended. They are unsuitable without considerable modification until 1 year and even then, must be boiled.
9. Eggs - not until 1 year.
10. The introduction of peanuts and peanut products to the diets of children with an atopic family history should be delayed until 3 years of age or at an age recommended by your doctor.

Both you and your baby should have a good well balanced diet and if restricted diets are used you should always ask to be referred to a dietician for further advice.

Skin Care - when your baby is born it is important to keep things simple. They may have some areas of dry skin just like many babies but it is important that you avoid products that may irritate and dry the skin such as soaps, detergents, wool and extremes of temperature. Use a simple moisturiser such as White Soft Paraffin 50% / Liquid Paraffin 50% after bathing. This may protect the skin and prevent potential allergens such as house dust mite and pollen from triggering the eczema.

Environment - if you are planning to decorate the baby's room, this is an ideal opportunity to reduce the levels of house dust mite (one of the common allergens which may trigger eczema flares). If the room is already furnished please read our leaflet on reducing house dust mites.

1. Remove soft furnishing and carpets and keep things simple.
2. Vacuum daily, when the baby is not in the room.
3. Use a cotton or plastic playmat, which can be washed easily rather than play on the carpet.
4. Blinds at the windows or curtains that can be washed regularly.
5. Bedding that can be washed at high temperature.
6. Covers for the bedding.
7. Damp dust. Wash soft toys weekly or keep only a couple of the favourite ones in the bedroom.
8. Air the room well, open windows, keep the room cool.
9. Keep pets out of the bedroom

If after taking some of the above measures your baby does develop some patches of eczema, don't feel guilty you might still have reduced the severity of their condition. Remember that 60-70% of children eventually grow out of it. Avoid using creams or ointments you already have, if you have eczema yourself, as they may be too strong for your baby's skin. Ask your health visitor, nurse or doctor for advice.

While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Please consult your doctor if you have any concerns about your skin health. He or she will be able to advise in greater detail.