A Basic Review of Eczema & A New Blankie

Eczema (also known as “atopic dermatitis”) is a skin condition where allergens or other irritants make your child’s skin itchy, red, rough, and/or flakey. Doctors sometimes refer to it as “an itch that rashes” because the scratching or rubbing usually comes before any changes in the skin. In its mildest form it is often just considered “sensitive skin”, but in its most severe form it can require hospitalization and serious drugs to alter a child’s immune system.

In order to prevent an eczema flare, or to relieve mild irritation, it is important to keep the skin moisturized, as well as avoiding “triggers” which the skin responds to by becoming inflamed. Common triggers are: chemicals, harsh soaps or cleaning products, perfumes/fragrances, dyes, synthetic fabrics (e.g. polyester), wool, sweat, dry air, stress, sudden temperature changes, and anything the child is allergic to (e.g. food allergies and/or pet dander).

How do you avoid so many things? For serious eczema, an allergist can help you identify specific triggers that make your child’s eczema worse. However, everybody can take some simple steps to help their child with sensitive skin:

1. Daily bath to clean the skin. Eczematous skin gets infected easily, since open areas take away your immune system’s biggest barrier. Use warm water (not too hot or cold), and bath briefly, since long baths can make the skin worse. Use soap-free cleansers (e.g. original Dove bar or Cetaphil). As soon as the child gets out of the bath, pat the skin dry (rubbing makes things worse) and cover it in a layer of moisturizer (ointments lock in the moisture best, which is why so many people love Aquaphor for their sensitive skin).
2. Always use dye-free, fragrance-free soaps and cleansers, especially for the laundry. Many people use Dreft detergent for their baby’s clothes, but this is full of chemicals. Run all of the baby’s laundry through an extra rinse cycle to be sure to get rid of any chemical residue.
3. Re-apply your moisturizer (e.g. Aquaphor) a few times a day.
4. Keep fingernails short to avoid scratching.
5. Many older children (and adults) with eczema report their symptoms worsen at night, so make sleeping conditions as comfortable as possible. A cool mist humidifier can help keep the air cool and moist. Use distilled water in the humidifier, do not use any menthol or scented discs in it, and clean out the reservoir with vinegar every 3 days. Children age 2 and older may be helped by taking an antihistamine before bed (discuss this with your pediatrician before giving it to your child).

Babies have a larger surface area to body mass ratio then older kids/adults, and their skin is thinner. This makes them especially susceptible to irritants, and you want to avoid using medicated creams as much as possible, since more is absorbed into their system then in older children/adults. 

A mother whose baby has severe eczema created a blanket to help relieve her child’s skin irritation, and she gave me a blanket to try out. It is the Elli & Nooli Organic Cotton Pique Blanket (http://www.amazon.com/Loopiblanket-Organic-Blanket-Pacifire-Fastner/dp/B008MBMYZ8/ref=sr_1_2?s=baby-products&ie=UTF8&qid=1346005373&sr=1-2&keywords=elli+%26+nooli). 

I brought it to work to try with a few patients, and then brought it home to my toddler son. It is designed for infants, but since it is big enough to swaddle them comfortably, it is actually big enough (30” x 40”) to cover my toddler in bed (although he will soon outgrow it). This is now my son’s favorite blanket, and since giving it to him over a month ago, he insists on using it every night to sleep. He reports that it is “comfy”. The certified organic cotton means that it is less irritating than other fabrics, as well as being chemical-free and pesticide-free. The pique weave (tight weave forming raised mini squares all over) keeps air flowing under the blanket, and even allows some air exchange through the blanket. It keeps my child warm, without over-heating, so he is not sweating at night, despite living in a house with no air conditioner during a heat wave (for the past 2 weeks only, we are moving soon). Overall, I really like this blanket, and would recommend it for babies with sensitive skin.

Please note that although this post mentions many brands (e.g. Dove, Cetaphil, Aquaphor, Elli & Nooli), this is NOT a sponsored post, and I have no financial stake in any of these companies.

Coughs, Colds, and Croup

Even though it's a beautiful summer here in Southern California, we are still seeing some coughs, colds, and croup, so here are my tips to help keep your family comfortable as they clear their viruses:

Helping a child with nose congestion:

-          Use a nasal saline mist (such as Little Noses nasal saline mist) to spray moisture into each nostril and help clear her out. I like the mists more than the drops because you can hold the canister right below her nose and spray it in, without touching the canister to the actual nose, and without sticking anything directly up the nose. These are also sterile, so you don't have to worry about the water source.

-          Use a humidifier. Only put distilled or sterile water into it (not tap water). Clean it at least every 3 days. Do NOT use the menthol or eucalyptus discs/drops that come with some humidifiers.

-          If she suffers from allergies and is over age 4, you can use an over the counter antihistamine to help decongest her (e.g. children’s Benadryl). Under age 4: ask your pediatrician about these. Do NOT use the over the counter medications known as “decongestants” or “medicated cough syrups”, as these have been shown to have more risks than benefits in children under age 6 years old.

-          If he is very congested you can steam up your bathroom and sit in the bathroom with your child. Make sure the air is okay and the child does not have any access to the hot water. Never leave a child alone in the steam!
-    If you want to, you can use a vapor rub on the feet or chest of a child. It has not been proven to help or hurt. However, do not let the rub get near her nose or mouth! Vapor rub placed under the nose has been reported to cause wheezing in some children, and it is dangerous to ingest. Call poison control if your child eats any of this, or gets it in their eye 1-800-222-1222 (an important number to keep in your cell phone for emergencies).

-          Children under age 2 years usually can not blow their noses, so help decongest them (e.g. get the boogies out) by using a Nose Frida (http://www.fridababy.com/) which is a device you put in the nostril and use to literally suck the snot out. Sounds gross, but there is a filter (which needs to be changed every day) which prevents you from getting any snot in your mouth. You can do this before feeds and before sleep, or just as needed to clear out the mucus in your baby’s nose. I like this better than traditional nasal aspirators because it’s much easier to clean, is difficult to put it too far into the baby’s nose, and it gets a lot more of the snot out. The key to good suction is to hold the other nostril closed, when you suck out boogers from the first nostril (should take less than 1 second).

The Snot Sucker

Helping a child with a “wet” or “phlegmy” cough:

-          Do all of the above for nasal congestion plus the following:

-          Have her sleep propped up at 30 degrees so the mucus drains easily (if over 1 year of age).

-          Give children over age 1 year a big spoonful of honey twice a day. The honey has now been shown to help relieve cough symptoms in kids & help them sleep, in 2 published randomized control trials (scientific studies). The honey they used was NOT "raw", which can have dangerous bacteria in it.
-     Warm liquids, such as chamomile (caffeine-free) tea and lemon, or chicken soup, can help people feel better. 

-          Zinc may help shorten colds and soothe sore throats, but this has not been proven conclusively. You can get this in some non-medicated cough syrups, such as Zarbees (for over age 1 since it also contains honey), or in zinc lollipops (over age 2, observing child while they eat them) at CVS (I haven’t seen them anyplace else- let us know in the comments if you find them in other places). If he is over age 7 years you can give him the zinc cough drops that are available at all pharmacies.

Helping a child with a dry, barking, or croupy cough:

-          Do all of the above for nasal congestion & wet coughs plus the following:

-          Use a cool-mist humidifier. Use distilled/sterile water in it. Clean it at least every 3 days by rinsing out the water tank with distilled vinegar and then washing that out.

-          If the child is having a coughing fit, or breathing like Darth Vader, take him for a walk outside in the cool air, or hold him in front of an open freezer for a few minutes, to reduce the swelling in his throat. If that is not helping, call your pediatrician for immediate medical advice, or call 911 if he is actually having trouble breathing.

Check out other mom pediatrician blogs on the topic, such as this one from Dr. Stuppy:
http://pediatricpartners.blogspot.com/2013/12/but-snot-is-green-or-how-can-we-treat.html

Other Important Stuff:

-          If your child is wheezing, noisy breathing, breathing hard, breathing quickly, breathing with flared nostrils, or other signs/symptoms not mentioned, please call your pediatrician or 911, or take them to the ER immediately. This information is not intended to act as a substitution for speaking to your physician or using common sense!

-          If your child is breathing so hard that they have trouble walking or talking, or if their lips or fingernails turn blue, please call 911 for immediate medical assistance.

-          Some of the products listed above can be found on my pinterest health board: http://pinterest.com/motek42/kids-health/. I have not been paid to review any of these products and I do not get money from their sales- I am just letting you know what has worked in my experience.