Baby eczema: signs, daily skin care, triggers and when to get help

Atopic eczema (also called atopic dermatitis) is a common skin condition that makes skin dry, itchy and inflamed. Australia's ASCIA eczema FAQ says it affects around 20% of children under 2 and usually starts in the first 6 months of life. It isn't contagious, it comes and goes in flare-ups, and many children improve as they grow: Australia's ASCIA says eczema that starts in infancy usually improves a lot between 2 and 5 years of age, and the AAP says it starts to go away by age 4 for some children.

There's no cure, but daily care makes a real difference: a plain moisturiser at least twice a day, a soap substitute instead of soap, and keeping your baby cool. Steroid creams, used as a doctor directs, calm flares safely. This guide covers what eczema looks like on different skin tones, triggers, daily care, steroid creams, wet wraps, food allergy, sleep, and the signs of infected eczema that need a doctor the same day.

What does eczema look like on a baby?

The NHS atopic eczema page says eczema can make skin itchy, dry, cracked, crusty, scaly or thickened, and it may blister or bleed. Because it itches, babies may rub their face against you or the crib sheet, or wriggle and scratch.

Where it shows up changes with age:

The AAP's eczema page says eczema in babies usually starts on the scalp and face and usually doesn't develop in the diaper area. The Royal Children's Hospital Melbourne in Australia says most eczema starts before a child is one, and in toddlers it moves to the skin creases. NICE guidance notes that in children aged 18 months or under it often shows on the cheeks and the outer surfaces of the limbs.

What does eczema look like on brown or black skin?

Redness can be hard to see on darker skin. The NHS says eczema can look red, white, purple or gray, or lighter or darker than the skin around it, depending on skin tone. Its photos of eczema on dark brown skin show gray, white, dry patches, and areas that are both darker and lighter than the surrounding skin, with cracked, thickened texture.

NICE says that in Asian, Black Caribbean and Black African children, eczema can affect the outer surfaces of the arms and legs rather than the creases, and circular (discoid) patches or patterns around the hair follicles may be more common. It also says eczema can make skin temporarily lighter or darker. The AAP says this discolouration usually returns to normal over time once a flare heals.

On any skin tone, feel as well as look: rough, dry or thickened patches, and a baby who keeps scratching or rubbing, are useful clues.

Is it eczema or another rash?

The AAP says eczema usually doesn't develop in the diaper area, so a rash only where the diaper touches is more likely diaper rash. Scaly patches on the scalp may be cradle cap, which has its own guide. Newborn rashes covers the many harmless spots of the first weeks. The NHS suggests seeing a doctor if you think your baby has eczema.

What causes eczema, and what triggers a flare?

The AAP says eczema is caused by problems with the skin barrier, which then doesn't hold in water well or keep out irritants, and that both genes and environment play a part. The NHS says a baby is more likely to have it if a parent has eczema, or a close family member has asthma or hay fever.

Australia's ASCIA fast facts on eczema say there's usually no single trigger for a flare. Common ones named by the NHS, the RCH, Australia's ASCIA and the AAP include:

• Heat. The RCH says overheating from clothes, bedding or heaters is the most common trigger.
• Dry skin and changes in temperature.
• Soap, bubble bath, detergents and antiseptic washes.
• Wool, acrylic and other rough or synthetic fabrics.
• Dribble, pacifiers and food around the mouth.
• Dust mites, pollen and pet fur.
• Infections, including viral infections and skin infections.
• Fragrance and tobacco smoke (AAP).
• Sand, sitting on carpet or grass, and chlorinated pools (Australia's ASCIA).

For dribble and messy meals, the RCH suggests a thick moisturiser or barrier ointment around the mouth before eating, then wiping the mouth with a soft, wet cloth afterwards and reapplying. The NHS emollients page also suggests protecting a baby's hands and cheeks with an emollient before mealtimes.

How do I care for my baby's eczema every day?

Daily care helps repair the skin barrier. The AAP says gentle daily skin care is one of the most important ways to prevent future flares, so keep it up even when the skin looks clear.

Moisturise at least twice a day

The NHS says to apply moisturisers (emollients) as often as possible, at least twice a day, and to keep going even when the eczema improves. Its emollients page says they're very safe and you can't overuse them. The RCH recommends a thick, plain, fragrance-free moisturiser once or twice a day even when there are no patches, and says some children need it more often.

1. Choose thick over thin. The AAP's treatment guide says ointments such as petroleum jelly or fragrance-free creams work better than lotions. The NHS says ointments shouldn't go on weeping eczema.
2. Apply after the bath. Pat the skin dry and moisturise straight away, while it's still slightly damp, as the AAP and Australia's ASCIA suggest.
3. Smooth it on. NICE says to smooth emollients onto the skin rather than rubbing them in, and to cover the whole body.
4. Keep the pot clean. The NHS says to use a clean spoon or a pump, not fingers, and not to share emollients.

Skip creams made with food ingredients such as milk, nut oils, coconut, almond or wheatgerm, as the RCH and Australia's ASCIA advise. Australia's ASCIA's solids and allergy guide says some research shows babies with eczema can develop a food allergy when a food is in contact with their skin, including in moisturisers and bath products. The NHS also says not to use aqueous cream, as it can irritate the skin.

Bathing and soap substitutes

The NHS says everyday soaps, shampoos and shower gels usually dry out the skin. The NHS says to wash with an emollient instead of soap, and NICE says babies under 12 months should use leave-on emollients or emollient soap substitutes instead of shampoo. They don't foam, but the NHS says they clean just as well.

Sources differ on the details:

Emollients make the bath and your baby slippery, and the NHS warns about slipping. Keep a firm hold: the AAP advises touch supervision, the same as any bath time. See bathing a newborn for safe bath basics.

Clothes, heat and fire safety

• Dress your baby in one or two thin layers of cotton, as the RCH suggests, and tell childcare educators how to dress them.
• The AAP suggests mild, fragrance-free laundry detergent and no fabric softener.
• Keep your baby cool. The NHS says being hot makes eczema itchier.
• Keep away from flames and heaters. The NHS says clothing and bedding with emollient on them catch fire more easily, and washing doesn't remove it completely.

How are eczema flares treated?

The RCH says to treat a flare as soon as it starts, because prompt treatment makes your baby more comfortable and lowers the chance of infection. Moisturiser continues throughout; on top of it, your doctor may suggest a steroid cream and sometimes wet wraps.

Are steroid creams safe for babies?

Yes, when a doctor prescribes or recommends them and you use them as directed. They're the main treatment for flares, alongside moisturiser.

• The RCH says steroid treatments are safe for children when used as directed by a doctor or health professional, and that weak cortisone treatments won't affect a child's growth and development.
• NICE says doctors should explain that the benefits outweigh possible harms when the creams are applied correctly, and that potent steroid creams shouldn't be used in babies under 12 months without specialist supervision.
• The RCH clinical guideline says topical steroids don't cause skin thinning or similar changes when used as per guidelines, with rare complications reported after prolonged, excessive use of potent steroids.
• The AAP calls them very effective and safe when used appropriately.

Use them only on a doctor's advice. The NHS hydrocortisone page says children under 10 should only use hydrocortisone if a doctor or pharmacist advises it, and not to use it on the face without advice. Weaker creams are generally used on the face. How much to use, how often and for how long is something your doctor or pharmacist will explain, so follow their plan and the label.

Sources differ on order: the RCH and AAP say to apply the steroid first and the moisturiser after, while the NHS says to wait 20 to 30 minutes between them and ask your doctor which goes first. Non-steroid prescription creams exist, but NICE recommends them only as a second-line option from age 2, started with specialist advice.

If eczema keeps flaring, the RCH suggests asking your doctor for an Eczema Action Plan, a written plan for daily care and flares.

What are wet wraps, and should I use them?

Wet wraps (wet dressings) are a damp layer of fabric over moisturiser, with a dry layer on top. The RCH guideline says they help return moisture to the skin and reduce irritation and itch. Use them only if your doctor, nurse or skin specialist has shown you how.

• What NICE says. Whole-body wet wraps shouldn't be a first treatment for children, and should be started by a health professional trained in their use.
• What the RCH says. Its fact sheet describes a wet dressing at bedtime, usually needed for only three to five nights during a flare, and a cool, wet towel on itchy areas for 5 to 10 minutes before moisturising. Its clinical guideline says parents need to be taught how to make and apply them.
• What the AAP says. Damp pyjamas go on after prescribed cream and moisturiser, with dry pyjamas on top, and moisturiser is reapplied afterwards.

Ask before using wraps on skin that looks infected: NICE advises against occlusive medicated dressings on infected eczema. For a baby, keep the crib set up as usual and don't add loose blankets to keep them warm; Red Nose in Australia advises no loose blankets, pillows or soft items in the crib.

Does food cause eczema in babies?

No, but the two are linked. Australia's ASCIA eczema and food allergy fast facts say food allergy doesn't cause eczema, though it can sometimes trigger a flare. Australia's ASCIA says around 30% of babies with eczema and a family history of allergy develop a food allergy, compared with 10% of babies overall. The AAP also says foods themselves don't cause eczema.

• Food allergy usually shows quickly. Australia's ASCIA says most food allergy causes symptoms within 30 minutes of eating, such as hives, vomiting and irritability, and only occasionally causes delayed eczema flares.
• Tests can mislead. Australia's ASCIA says skin or blood allergy tests don't predict which foods make eczema worse, so testing should only be done and interpreted by an allergy specialist.
• Don't cut foods on your own. Australia's ASCIA says removing foods without the right substitutes can cause poor growth, and stopping a food your baby eats regularly can lead to a new allergy to it. The RCH says cutting out foods is ineffective for most eczema.
• Good eczema care may help. Australia's ASCIA says managing eczema well in babies may reduce the chance of food allergy developing.

Guidance on starting allergy foods for babies with eczema differs between Australia, the UK and the US. Introducing allergens sets out each country's advice, and peanuts for babies covers peanut.

Australia's ASCIA says a mild rash only around the mouth during or straight after eating, with no other allergy signs, may not be an allergic reaction, and the RCH says skin reactions to acidic foods aren't food allergies.

Call 911 for sudden swelling of the lips, tongue or throat, difficult or noisy breathing, wheeze or a persistent cough, a hoarse voice or cry, or a baby who becomes pale, floppy or drowsy or collapses after a food. Lay your baby flat and use an adrenaline device if one has been prescribed. Australia's ASCIA anaphylaxis FAQ lists these as signs of anaphylaxis, and the NHS lists swollen lips among reasons to call an ambulance. Hives or welts, swelling of the face or eyes, or vomiting with normal breathing means stop the food and get medical help today.

How can I help a baby with itchy eczema sleep?

The RCH says eczema itch can keep babies awake at night, and Australia's ASCIA describes a scratch–itch cycle: scratching releases chemicals that make skin itchier, which disrupts sleep. These steps help:

1. Moisturise before bed, after the bath, and use any prescribed cream as directed.
2. Keep nails short. The NHS suggests anti-scratch mittens for babies, and the AAP suggests cotton gloves at night.
3. Dress for cool. The AAP's eczema sleep tips suggest cool, loose, irritant-free sleepwear with tags removed, and a steady, cool room.
4. Rub, don't scratch. The NHS suggests gently rubbing an itchy area with a finger instead of scratching; with a baby, a gentle press or stroke and some distraction can help.
5. Treat flares early, as the RCH advises, so the itch settles sooner.

Safe sleep doesn't change: your baby sleeps on their back, in their own crib or bassinet, on a firm, flat mattress, with nothing soft or loose in the crib, and in your room for at least the first 6 months, as Red Nose in Australia advises. See safe sleep.

Don't give antihistamines or other medicines to help your baby sleep unless a doctor advises it. Australia's ASCIA says sedating antihistamines generally aren't recommended and shouldn't be used in young children without specialist supervision. If itch is wrecking sleep for weeks, raise it with your doctor or pediatrician.

What does infected eczema look like?

Broken, scratched skin can become infected. The RCH says infected eczema may ooze watery fluid and crust over, and that infections are more common when eczema isn't well controlled.

Bacterial infection. The NHS lists blistering, crusting, leaking fluid, pus-filled spots, pain, swelling or warmth, sudden worsening or spreading, a high temperature or seeming generally unwell. The AAP describes yellow or honey-colored crusts. On brown or black skin, the NHS says redness may be harder to see, so look for swelling, warmth, crusting and pain.

Eczema herpeticum. This is eczema infected with the cold sore virus (herpes simplex). NICE lists the signs as:

• painful eczema that is rapidly getting worse
• clusters of blisters that look like early cold sores
• punched-out sores: small, round, shallow, even-looking erosions, usually 1 to 3 mm across, which can join up and crust
• possibly a fever, lethargy or distress.

DermNet says it's more common in babies and children with eczema, often affects the face and neck, and appears 5 to 12 days after contact with someone who may or may not have a visible cold sore. DermNet calls it one of the few skin emergencies, and NICE says a child with suspected eczema herpeticum should start treatment straight away and be referred for specialist advice the same day, including a same-day eye check if it's around the eyes. DermNet also notes that coxsackievirus A16, a cause of hand, foot and mouth disease, can occasionally cause a similar rash on eczema.

To lower the risk, the RCH says not to let anyone with a cold sore kiss your baby. After an infection, NICE suggests getting fresh supplies of creams, because pots can become contaminated.

When to get help

These tiers follow the NHS urgent-help guide and the sources above. Where sources differ, we use the stricter tier.

Call 911 now if your baby:

• is under 3 months and has a temperature of 38°C (100.4°F) or higher
• is 3 to 6 months old and has a temperature of 39°C (102.2°F) or higher
• is floppy, much sleepier than usual, hard to wake or can't be woken
• is struggling to breathe, or has blue, gray, pale or blotchy skin, lips or tongue
• has a rash that doesn't fade when you press a glass against it
• has sudden swelling of the lips, tongue or throat, noisy breathing, or becomes pale and floppy after a food

These come from the NHS urgent-help guide and Australia's ASCIA's anaphylaxis advice.

Get medical help today (same-day doctor, after-hours doctor or your pediatrician's after-hours nurse line; go to the emergency room if you can't be seen) if your baby has eczema and:

• you think it could be eczema herpeticum: painful, rapidly worsening eczema, clusters of blisters, or punched-out sores, especially near the eyes
• it's weeping, crusting, blistered or has pus-filled spots
• it's painful, swollen or feels warm, or suddenly gets worse or spreads
• they have a high temperature or seem generally unwell (use the emergency tier above for a baby under 6 months with the temperatures listed there)
• they have hives or welts, swelling of the face or eyes, or vomiting after a food, with normal breathing (stop the food and watch closely)
• they're refusing feeds or feeding much less than usual

The NHS lists the infection signs for an urgent doctor appointment or a call to its helpline and says they can mean infected eczema or eczema herpeticum.

Talk to your doctor or pediatrician if:

• you think your baby has eczema
• treatment isn't helping, or eczema hasn't improved within a week, which Australia's ASCIA says is a reason to see your doctor
• flares keep coming back or itch is disturbing sleep, so you can ask for an Eczema Action Plan
• you're thinking of cutting a food, or your baby has severe eczema and you're about to start solids or allergy foods

Broken nights with an itchy baby are exhausting. If you're struggling, talk to your doctor or call your pediatrician's office.

What's worth noting down?

A photo of the same patch every few days, in the same light, shows whether treatment is working, especially on darker skin where color changes are subtle. Note new products, detergents, foods, illnesses and hot days alongside flares, plus which creams you used and when. These notes help your doctor or pediatrician adjust the plan.