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Q . What is Eczema ?

Synonym : Dermatitis (‘Derma’ – skin; ‘itis’ – inflammation)

Eczema / Dermatitis is an inflammatory response of the skin to any factor which is within or outside the baby’s body. Though this condition can have different presentations, the basic changes noticed on the skin are redness, swelling with or without oozing / discharge. Itching is almost invariably present in all the cases.

Types of Eczemas

Based on the various causative factors, there are different types of eczemas: 

*  Irritant dermatitis : Irritant dermatitis  occurs when any external factor (contactant) comes in contact with the skin and irritates it. The commonest example of this type of eczema is nappy dermatitis  (Please refer the section on Nappy Rash, page no.34). Harsh cleansing solutions, e.g. soaps, detergents can also lead to irritant dermatitis, whereby the affected area would appear red, swollen with or without oozing.
*  Allergic contact dermatitis : A child might be allergic to certain substances which when come in contact with the skin, makes the skin to react in the form of eczema. A common example is allergy to nickel containing articles, for e.g. buttons, studs, zips, safety pins, buckles, etc.
*  Infectious eczematoid dermatitis: A child can develop eczema at the contact site of pus discharge. For e.g. irritation might develop on the ear (pinna) following an ear discharge.

*  Atopic dermatitis : Among all the forms of eczemas, this is the most commonly observed and a recurring form of dermatitis in children. About 10% to 20% of children in the developed countries suffer from atopic dermatitis. Even in the developing countries, it is more often noted in a higher socio-economic group.

Q. How does a child get Atopic Eczema / Dermatitis?

Atopic eczema is an  inherited disorder.  If one of the parents or any other close relations of the child has a history of atopy  (i.e. either atopic eczema and/or asthma and/or hay fever), the chances that the child will have atopic dermatitis are high.

Q. How does one know that the child is suffering from Atopic Dermatitis?

In most of the cases, the rash of atopic eczema is evident before the age of 6 months.

In infants below 6 months of age,  the face  (especially the cheek area) is typically involved. There are reddish, dry, sometimes slightly scaly patches. At times, oozing can also occur. Itching is a predominant symptom, making the child rub or scratch the area.

As the child grows older, the rash can appear on the limbs. Very often, the front of the elbows and back of knees are affected.

Children suffering from atopic dermatitis,  in general have a dry and sensitive skin. Such children have an irritable skin, which is waiting to erupt into an itchy rash at the slightest trigger.

Q. What are the trigger factors for development of atopic dermatitis?

Most atopics (individuals suffering from atopic dermatitis / asthma / hay fever) worsen during winter season, when as such the skin is prone to dryness.
Sweating can aggravate the eczema.
Atopic children are intolerant to woolens, synthetic and dyed fabrics.
Simultaneous upper respiratory tract infections (cough and cold),
 teething or vaccinations can trigger a rash.
A stray mosquito bite on the exposed areas of the body can potentially trigger a rash all over the body.
Harsh soaps, prolonged exposure to water (especially hot water) can  irritate the atopic skin.
Tobacco smoke can also irritate the sensitive atopic skin.
Most atopics would flare up upon contact with dust (house mite dust).

Q. How Does One Treat This Eczema?

During a bath, restrict the bath time. Do not use hot water for bathing. Luke warm water is ideal. Avoid soaps (ask your dermatologist to recommend a non-soapy cleanser e.g. cetaphil lotion).
Pat dry the skin and generously moisturize the damp skin all over with an ointment / cream (meant for dry skin). Clothe the baby with natural fabrics like cotton. Avoid woolens and synthetic fabrics.
Try to prevent the baby from scratching the rash, by keeping the baby’s nails short and clean (this would also prevent the rash from worsening and getting infected).
If the baby is too troubled with the rash and the itching,  consult your dermatologist, who will most probably prescribe an  anti-allergic syrup (which will not only control the itch, but also put the child to sleep) and also a steroid cream to apply on the rash for a short period of time.


Q. How can one prevent the rash from recurring?
Unfortunately, atopic eczema (being an inherited condition) is a chronic and recurring skin disorder. Certain precautions can help in preventing recurrences :

Always keep the baby’s skin well moisturized. Prevent dryness of skin.
Use fragrance free, non-soapy cleansers for bathing.
Always use cottons for the baby.
Avoid mosquito bites by following mosquito repellent measures. Apply mosquito repellent creams on exposed skin areas, especially at dusk and dawn.
Try to maintain a dust free environment. Avoid having carpets. Do not let the child play with soft toys, which can accumulate dust particles in them.
Direct contact with furred animals should also be prevented.
The role of diet in aggravation of atopic dermatitis has always been a topic of debate with two extreme viewpoints. One could observe one’s own baby for any definite correlation between the diet and the worsening of eczema.
The foodstuffs that are generally implicated as allergens in atopic dermatitis are egg, peanut, milk, fish, shellfish and food additives











Q . What is CRADLE CRAP ?
Cradle crap is a  condition  in  which greasy surface scales appear on the  scalp. Cradle  crap does not doom your infant to a  lifetime  of dandruff. Mild cradle crap often responds well to  a  brisk  massage with mineral oil or petroleum jelly to  loosen   scales  followed  by  a thorough shampoo to remove them and   the oil. Tough  cases  in which the flaking is heavy and/or brownish patches and  yellow  crustinoes are present, may benefit from a daily use of anti-seborrheic shampoo.

If the cradle crap is severe, the seborrheic rash may spread    to  the face , neck  or  buttock. If  this  occurs , your  baby's  doctor   will probably prescribe a topical ointment. Occasionally, cradle  crap  will persist through the 1st year. Since the condition   causes  no discomfort , it is therefore considered only a cosmetic problem.

Q. How do I know if my baby has fever? And how do I take the baby's temperature?

A. A fever is the body's normal response to illness and it is a sign that the body is fighting the infection. If the baby feels warm, and you suspect a fever, take the baby's temperature.

The common ways of taking temperature are:

       1. Orally - in the mouth
     2. Axillary - under the armpit
     3. Rectally - in the rectum
     4. Tympanic _ in the ear

The rectal temperature is more reliable than the oral or axillary temperature. The rectal temperature can be taken in the following procedure : 

1. Clean the digital thermometer, lubricate it with petroleum jelly.
2. After removing the baby's diaper off, lay the hold face down across your lap or table.
3. Spread  the  child's buttocks and insert the thermometer gently into the rectum, upto an inch. Do not force or poke the thermometer,as you could injure the child.
4. Hold the child still and press the buttocks together to stabilize the thermometer for 2-3 minutes and then remove it.
5. Read the thermometer at the eye level, rotate until you can see the silver lining.

Generally a temperature of 100.4 degree F or greater is a fever. If your baby is under 3 months of age and has a fever higher than 100.4 degree F, it is important to contact your doctor. Toddlers can run very high fevers in response to illness. Toddlers with high fevers should be given medicine that controls the fever, and if lethargic should also be taken to the doctor.

Q. What is SIDS  or Sudden Infant Death Syndrome ?
SIDS or Sudden Infant Death Syndrome or cot death is defined as a sudden death of the infant that is unexplained either by the baby's history, a post mortem examination or the examination of the scene of death.
Although rare, it is a major cause of infant death between the age of 2 weeks and 12 months. The  risk  of  average baby dying of SIDS is very small - about 1.7 in 1000. Researchers are  now  convinced  that SIDS  baby ,only  appear   healthy , but  actually   they  have   some underlying defect, that predisposes  them to  sudden  death. At   high risk  are  those  babies , who  have  survived   a  very  serious ,  life threatening event related to injury  or  accident  during which they have stopped breathing, turned blue and required resuscitation. At  lesser are  small or  premature  infants  or  those  from  multiple birth. SIDS strikes males more often than female infants.Babies of women who have poor  ante-natal  care   or who  have  smoked  during pregnancy, or have severe aneamia during pregnancy are susceptible to SIDS.

A great deal of research is being done to determine, just what it is that causes SIDS.

Factors Which Can Cause This Syndrome :
1. Delay in the maturation of the brainstem of the baby predisposes a baby to SIDS.
2. Baby sleeping face down particularly on a soft surface, in which recesses can form a major factor of suffocation.
3. A mild cold or infection or overheating may compound the risk when the infant sleeps tummy down.

Q. The  soft  spot   on  the  babies  head  seems  so  vulnerable ,   and sometimes it pulsates which is very scary ?
A. The soft spot which actually are two openings  in  the  skull , where the bones haven't yet fused. During child birth, the fontanelle allows the foetal head to mould to fit through the birth canal, something a solidly fused skull couldn't do. Later they allow for the tremendous brain growth of the first year. The larger of the two openings is the auterior fontanel , is  on  top of  the  newborns  head. It  is  diamond shaped and may  be  too  wide. It  starts  to  close   when  infant  is 6 months old and is usually closed by eighteen months. When  the  baby cries , the  fontanelle which normally appears  flat seems to bulge. A depressed  auterior  fontanelle is a sign of dehydration. A fontanelle which bulges persistently may indicate increased pressure inside the head and requires urgent medical attention. The posterior fontanelle, a  smaller   triangular  opening  towards  the  back of  the head is less noticeable and it is generally closed by 3rd month.

Q. Is honey safe to give to my baby of 3 months ?
A. Honey is a health risk in the first year. It may contain the spores of  Clostridium Botulinum. which  though harmless  to the  adult  can cause a condition called Botulism (with constipation weakened sucking, poor appetite and lethargy) in babies. This can lead to pneumonia and dehydration. Some  doctors okay honey at 8 months, others recommend waiting till the child is a year old.