Tag: eczema

Is Handwashing Drying Your Child’s Skin?

A rash on their hands might mean that you have to change how your kids wash their hands and not that they have to wash less often.

Do your kids get dry, red, and itchy hands, especially during the winter months when it gets cold?

Hand sanitizier and handwashing may be drying your child's skin.

Believe it or not, it’s probably because they are washing their hands very frequently, which is a good thing these days.

Is Handwashing Drying Your Child’s Skin?

Of course, many other things could be causing a rash on your child’s hands, but if the rash is on both hands, is worse each winter, and there are no other symptoms, then it is probably from handwashing.

Is it from excessive handwashing?

Not necessarily.

“The best way to prevent the spread of infections and decrease the risk of getting sick is by washing your hands with plain soap and water, advises the Centers for Disease Control and Prevention (CDC). Washing hands often with soap and water for at least 20 seconds is essential, especially after going to the bathroom; before eating; and after coughing, sneezing, or blowing one’s nose. There is currently no evidence that consumer antiseptic wash products (also known as antibacterial soaps) are any more effective at preventing illness than washing with plain soap and water. In fact, some data suggests that antibacterial ingredients could do more harm than good in the long-term and more research is needed.”

Q&A for Consumers | Hand Sanitizers and COVID-19

You might just need to change up how your child washes their hands, making sure that they:

  • use a moisturizing soap (Dove, Basis) or soap-free cleanser (Cetaphil, Vanicream Free & Clear), avoiding harsher, antibacterial soaps
  • apply moisturizers (Aquaphor, Vanicream, Cetaphil, Cerave, Eucerin) within a few minutes of washing, keeping in mind that greasy ointments typically are the best, followed by creams, and then lotions, although kids sometimes don’t like the feel of greasy ointments
  • avoid the frequent use of hand sanitizers, as they contain high concentrations of alcohol and can be drying, so limit the use of hand sanitizers to when soap and water isn’t available and even then, try to use a hand sanitizer with a moisturizer

But what if your child’s hands do get red and irritated? Simply applying a moisturizer probably isn’t going to be much help then, is it?

Probably not, so that’s when it’s time to also apply a steroid cream to calm the flare up. While you can start with over-the-counter hydrocortizone cream twice a day (don’t apply at same time as the moisturizers), you might need a medium strength prescription steroid cream for all but the mildest cases. In some cases, a more potent steroid might even be needed for a short time.

And of course, you should think about what else might be causing a rash on your child’s hands, especially if they aren’t quickly getting better with steroids and moisturizers:

  • does your child also have ulcers in their mouth or a rash on their feet, which might indicate Hand Foot and Mouth disease?
  • has your child recently been bitten by a tick?
  • does your child have a honey colored crusty rash on one hand, a sign of impetigo?
  • is your child working with new chemicals, solvents, wearing gloves, or doing anything else that could be triggering an allergic reaction or contact dermatitis on their hands?
  • do other people in the house have an itchy rash on their hands and arms, which could be a sign of scabies?

Fortunately, hand dermatitis from excessive hand washing and cold winter weather is typically easy to diagnosis and treat and isn’t often confused with other pediatric conditions.

More on Hand Dermatitis

Understanding and Treating Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

Do your kids have to get up too early because school starts too early?
Do your kids have to get up too early because school starts too early?

Parents often ask for help getting their kids to fall sleep and then stay asleep all night.

At least they do when they are little.

Teens often have trouble sleeping too though, but parents often don’t recognize these sleep problems and might not think to ask for help. They do likely see some of the issues that can be caused by a poor night’s sleep though, which can include irritability, sadness, a poor attention span, and hyperactivity, etc.

Why Teens Don’t Sleep Well

From being over-scheduled and having to get up early for school to staying up late on a screen, there are many reasons why your teen might not be sleeping well.

There are also many different types of sleep problems.

To understand what is causing your child’s sleep problems, ask yourself these questions and share the answers with your pediatrician:

  • Does your teen sleep at least 8 1/2 to 9 1/2 hours each night?
  • Does your teen have trouble falling asleep or does he just wake up a lot in the middle of the night? Or does your teen seem to sleep enough, but is still always tired?
  • Does your teen snore loudly at night – a sign of obstructive sleep apnea?
  • Is your teen taking any medications that could cause insomnia, such as for ADHD (stimulant) or allergies (decongestant)?
  • Does your teen have poorly controlled allergies, asthma (late night coughing), eczema (frequent itching keeping him awake), or reflux?
  • Is your teen drinking any caffeine in the afternoon or evening?
  • Do you think that your teen is depressed or has anxiety, either of which could cause problems sleeping?
  • Have you noticed any symptoms of restless leg syndrome, including a strong urge to move his legs when he is sitting or lying down?
  • Does your teen have too much homework and is staying up late trying to get it all done?
  • What does your teen do just before going to sleep?
  • Does your teen fall asleep easier when he goes to bed much later than his typical bedtime or does he still have trouble falling asleep?
  • Are your teen’s sleep problems new?

And perhaps most importantly, what is your teen’s daily sleep schedule like? What time does he go to sleep and wake up, including weekends, and does he typically take a nap?

Treatments for Teen Sleep Problems

In addition to treating any underlining medical issues that might be causing your teen to have trouble sleeping, it will likely help if your teen learns about sleep hygiene and:

  • goes to bed and wakes up at about the same time each day, instead of trying to catch up on “lost sleep” on the weekends
  • keeps his room bright in the morning (let in the sunshine) and dark at night
  • avoids taking naps, or at least naps that are longer than about 30 to 45 minutes
  • avoids caffeine
  • is physically active for at least one hour each day
  • doesn’t eat a lot just before going to bed
  • turns off all screens (phone, TV, computer, video games, etc.) about 30 minutes before going to sleep
  • doesn’t get in bed until he is actually ready to go to sleep, which means not watching TV, reading, or doing anything else on his bed
  • gets out of bed if he doesn’t fall asleep after 10 to 15 minutes and reads a few pages of a book, before trying to go to sleep again

Did that work?

If you teen is still having sleep problems, encourage them to try some basic relaxation techniques, such as progressive muscle relaxation, guided imagery, and deep breathing or abdominal breathing. You do them at bedtime and again if you wake up in the middle of the night.

I especially like the idea of guided imagery for teens, as they can focus on something they like to do, whether it is building a sandcastle on the beach, or going horseback riding, surfing, hiking, or playing baseball, etc. They should focus on the details of the story they make up, coming back to it if their mind wanders, and hopefully they fall asleep as they get caught up in it.

With the deep breathing technique, they slowly breath in through their nose and out through their mouth. They can hold their breath for a few seconds or breath into their abdomen too (abdominal breathing).

Progressive muscle relaxation is another technique that might help your child relax at bedtime. They simply tense and then relax each muscle group of their body, one at a time, starting with their toes and working their way up. If they make it up to their forehead and aren’t asleep, then they should work their way down, perhaps doing 3 to 5 repetitions for each muscle group,  or try another technique.

And be sure to talk to your pediatrician if your teen continues to struggle with sleep problems.

What To Know About Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

For More Information on Teen Sleep Problems

How To Avoid Peanut Allergies

To prevent peanut allergies, parents of high risk kids are being told to go out of their way to be sure that they actually feed their infants peanut-containing foods!

Infants with eczema are at high risk for developing peanut allergies.
Infants with eczema are at high risk for developing peanut allergies. Photo courtesy of the NIAID.

The worst part of having a severe allergy to peanuts isn’t the high price of EpiPens.

It is that peanut allergies can be deadly, even when you have access to an EpiPen.

And since there is no 100% fool proof way to avoid peanuts and peanut containing foods, doctors have been trying to come up with ways to prevent kids from ever developing peanut allergies.

The first efforts, to avoid peanuts and other high risk foods during pregnancy and early infancy, likely backfired, leading to even more kids with peanut allergies. That’s why recommendations for starting solid foods changed back in 2008, when the American Academy of Pediatrics began to tell parents to no longer delay giving solid foods after age 4 to 6 months and that it wasn’t necessary to delay “the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.”

The latest guidelines are the next evolution of that older advice.

Now, in addition to simply not delaying introducing allergy type foods, as part of a new strategy to prevent peanut allergies, parents of high risk kids are being told to go out of their way to be sure that they actually give their infants peanut-containing foods!

Prevention of Peanut Allergies

Developed by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, with 25 professional organizations, federal agencies, and patient advocacy groups, these clinical practice guidelines recommend that parents:

  1. introduce peanut-containing foods into your infant’s diet as early as 4 to 6 months of age if they have severe eczema, egg allergy, or both (strongly consider allergy testing first)
  2. introduce peanut-containing foods into your infant’s diet around 6 months of age if they have mild to moderate eczema
  3. introduce peanut-containing foods into your infant’s diet in an age-appropriate manner with other solid foods if your infant has no eczema or any food allergy

Keep in mind that it is possible that your baby already has a peanut allergy, so discuss your plan to introduce peanut-containing foods with your pediatrician first. But don’t be in such a rush that you make peanut-containing foods your baby’s first food. Offer a cereal, veggie, fruit, or meat first. If tolerated, and you know that your baby is ready for solid food, and with your pediatricians okay, then consider moving to peanut-containing foods.

And although not always necessary, it is possible to do allergy testing even on younger infants. Testing is an especially good idea if your infant has severe eczema or an egg allergy. For these higher risk kids, referral to an allergy specialist might even be a good idea, where infants can start peanut containing foods in their office (supervised feeding) or as part of a graded oral challenge. Your pediatrician might also consider supervised feeding for your higher risk child who is not allergic to peanuts.

Peanut-Containing Baby Food Recipes

So how do you give a 4 or 6 month old peanut-containing foods?

It’s not like Gerber has any 1st or 2nd foods with peanuts – at least not yet…

So for now, you can:

  • add 2 to 3 tablespoons of hot water to 2 teaspoons of thinned, smooth peanut butter. Stir until the peanut butter dissolves and is well blended. You can feed it to your baby after it has cooled.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of thinned, smooth peanut butter.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of peanut flour or peanut butter powder.

Each of these recipes will provide your baby with about 2g of peanut protein. Since the goal is to give your child about 6 to 7g a week, you should offer them three separate times.

During the first feeding, it is important to only “offer your infant a small part of the peanut serving on the tip of the spoon,” and then wait for at least 10 minutes to make sure there are no signs of an allergic reaction, such as hives, face swelling, trouble breathing, or vomiting, etc.

Of course, because of the risk of choking, you should not give infants or toddlers whole peanuts or chunks of peanut butter.

More Information on Preventing Peanut Allergies

Treating Hard To Control Eczema

While eczema can usually be controlled and most kids eventually outgrow having eczema, you may need some help to really understand how to really manage your child’s eczema effectively.

Eczema or atopic dermatitis very commonly affects kids.

Few conditions are as frustrating for parents and pediatricians, because even when properly treated, you can expect eczema to flare up from time to time after it gets better. Eczema is even worse when it isn’t properly treated though.

What Triggers Your Child’s Eczema?

Like other things that are supposed to have triggers, like asthma and migraines, it is often hard to figure out what triggers a child’s eczema.

Dress in soft, breathable clothing and avoid itchy fabrics like wool, that can further irritate your eczema.

National Eczema Association

Common eczema triggers to avoid might include:

  • harsh soaps and cleansers, shampoos, and body washes, including those with fragrances
  • food allergy triggers – milk and eggs
  • environmental allergy triggers – dust mites and animal dander
  • low humidity
  • temperature extremes – either getting too hot or too cold
  • skin infections

And anything else that might make your child’s skin dry and itchy.

Eczema Treatments for Kids

Although there is no cure for eczema, it is usually possible to control your child’s eczema, including getting rid of all or most of her eczema rash and decreasing how often your child has eczema flares.

These basic treatments include:

  • using lukewarm water for daily baths and showers
  • using a soap substitute or cleanser that is unscented, fragrance-free, and dye-free – Cetaphil, Dove, Aveeno
  • using a tar-based shampoo if your child’s scalp is red and itchy – T-Gel
  • daily use of moisturizers, especially within a few minutes of taking a bath or shower (soak and seal therapy)
  • prompt use of a moderate strength prescription topical steroid (like traimcinolone acetonide 0.1% cream) as soon as your child has a flare, with red, rough itchy skin
  • as needed use of oral antihistamines to help control itching during flares – Benadryl
  • keeping your child’s finger nails short to minimize damage from scratching

A written eczema action plan can make sure that you understand how and when to do each of these treatments.

Best Moisturizers for Eczema

Everyone seems to have their favorite eczema moisturizer.

Which is best?

The best moisturizer is probably the one that your child will use and which works to keep his skin from getting dry. In general though, ointments are better than creams, which are better than lotions.

Some favorites include Aquaphor (too thick and greasy for some people), Vanicream Moisturizing Skin Cream, CeraVe Moisturizing Cream, Eucerin Original, and Cetaphil Moisturizing Cream.

Whichever moisturizer you use, be sure to apply it to your child’s skin within three minutes of his soaking in a bath or shower so that you can seal in the moisture (soak and seal therapy).

Treating Hard To Control Eczema

What to do you do when basic treatments aren’t working?

Although a pediatric dermatologist can evaluate your child to see if she needs a systemic medication, phototherapy, or other treatment, most kids with hard to control eczema simply need more education to make sure they are using standard treatments correctly.

  • Is your child bathing correctly?
  • Are you putting on the right moisturizer, using enough moisturizer, and using it often enough?
  • Is your soap too harsh?
  • Are you afraid to use a topical steroid?
  • Are you applying a steroid over a moisturizer, which can make it less effective?
  • Could you be doing more to avoid triggers?
  • Could stress be triggering your child’s eczema?

What’s next?

A Staph skin infection might be a problem. In addition to oral antibiotics, weekly dilute bleach baths might help if this is an issue for your child.

Your child with hard to control eczema might also benefit from:

  • using more moisturizer over his entire body – don’t spot treat the areas that you think are a problem
  • using a thicker moisturizer – put your jar of Aquaphor in the freezer or refrigerator if your child doesn’t typically like using a moisturizer or complains that it stings or burns
  • a prescription barrier cream to control itching – Atopiclair, MimyX
  • a prescription topical Clacineurin Inhibitors – Elidel, Protopic
  • a 504 school plan
  • changing your laundry routine – wash new clothes, use mild, dye free laundry detergent and rinse twice after washing
  • using sunscreen and rinsing after swimming in a pool or excessive sweating, applying a moisturizing quickly afterwards
  • allergy testing to better identify triggers

You might also talk to your pediatrician about wet wrap therapy. With this treatment, you have your child take a bath or shower, applying a topical steroid to the affected areas and a generous amount of moisturizer to the rest of your child’s skin. Next, cover the area in wet cotton clothing or a wet dressing, and lastly, dress your child in dry cotton clothing, removing them all once the clothing dries out. You can then repeat the whole process or start again the next night, continuing until your child’s eczema is under better control.

Wrap therapy can be done with wet pajamas if you have to cover a big area, tube socks with the end cut off if you just have to do his arms, or cotton gloves for hard to control hand eczema. Some experts even recommend using a chilled wet dressing, putting the wet clothes in the refrigerator for a short time before using them on your child.

If you are at the point of considering wet wrap therapy, seeing a pediatric dermatologist might also be a good idea.

What To Know About Treating Hard To Control Eczema

While eczema can usually be controlled and most kids eventually outgrow having eczema, you may need some help to really understand how to really manage your child’s eczema effectively.

More Information About Treating Hard To Control Eczema

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