Is it better to breast feed?
Yes, if possible. Although there is no evidence that breast feeding will prevent your child developing eczema, breast feeding does seem to have a protective effect in relation to severity during the early months of life and should therefore be encouraged. However, allergenic food substances can come through in Mother's milk, so breast feeding does not completely protect the infant from exposure to allergens, and some children will have their eczema worsened if they have allergic antibody to milk, egg, or peanut allergenic substances coming through their mother's milk. Allergy tests in the infant can identify if that is a risk factor.

Should my child be on a diet?
Children with atopic eczema should not automatically be put on a special diet. Many parents are concerned that eczema is caused by something the child is eating. While some children will have their eczema worsened by allergic reactions to foods, this should be assessed by allergy testing and a medically supervised food challenge if suspected. Routine exclusion diets and formula changes are usually not helpful.

Eczema in the sun
Eczema usually improves in the sun, especially on vacation. It is important that children with eczema "keep cool" in the hot weather and wear loose cotton clothes. Your child with eczema may develop heat rash easily if the skin is overheated. It is advisable to protect the skin from burning, using a suitable unscented sun-screen product. It is sometimes helpful for the child to wear a loose wet T-shirt in hot weather to cool down the skin and relieve the itching.

Swimming
Swimming in the sea is excellent for eczema. In a pool, the chlorine may irritate the skin. In an attempt to prevent this, apply a thick moisturizer, such as Vaseline beforehand, and afterwards soak in a bath with an oily bath additive.

Taking babies with severe eczema into a swimming pool is not a good idea. Children over 4 years should be actively encouraged to learn to swim and participate in all sporting activities.

Immunizations
Your baby should receive all the routine immunizations, like any other baby. There is no cause for concern. In children with eczema in whom there is a history of egg allergy, the MMR and measles vaccines are safe.

What things make eczema worse?
Eczema is influenced by many environmental factors which are important to take into account in the day to day management of eczema. These factors are problems when they directly contact the skin surface. Aggravating factors include:

• synthetic or woolen fabrics - Children should be dressed in cotton or as high a percentage of cotton as possible.
• biological detergents or fabric conditioners - Use non-biological products.
• irritant foods and drooling - Foods such as citrus fruits and tomatoes can cause eczema around the mouth. This is often made worse by lip-licking and dribbling. It is helpful to apply a protective barrier of Vaseline around the mouth 2-3 times daily and prior to meals. The infant who is drooling often has chapped skin around the mouth, on the chest, or on the hands. Pat dry with a soft cloth and use Vaseline or other moisturizers on the areas.
• cigarette smoke - In an enclosed room, fumes will irritate the skin. It is best to ban smoking within the home.

Other practical advice
School can present problems and it is important to work closely with the teacher. It is best if the child is seated in the center of the class, away from the door, windows, and radiators. They should take their own special soap and moisturizing cream to school. Most children will apply their own creams at break and lunchtime, but this must be supervised. If properly informed, most schools will cooperate and help in this situation. It is important that children do not miss school because of their eczema.

What is the risk of a next child having eczema?
If you have one affected child, the risk of your next child having atopic eczema is about 25%. If both parents are affected the risk rises to about 40%. It is important to remember that the severity of eczema can vary within the same family, so that even if the next child is affected, it may well be much less of a problem.

Are alternative or complementary treatments helpful?
There are no scientific studies which support claims that homeopathy, allergy shots, Chinese herbal medicines, acupuncture, spinal adjustments, or therapeutic touch improve eczema. Eczema waxes and wanes, and there are times when some things seem to help one time but not the next time. Some parents seek alternative medicines out of frustration, but the most reliable success has been when there is focus on treating the sensitive skin. 

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