What is eczema (atopic dermatitis)?
Eczema is a chronic (long-lasting) skin condition that comes in many forms.
With eczema, the skin is often dry and very itchy, and a rash usually appears. There are times when the condition is worse, and times when the condition is better. When the condition worsens, it is called a flare-up. Sometimes, an irritating substance on the skin can cause a flare-up. Some children get flare-ups in certain seasons, such as the dry cold weather for some people and the hot, humid weather for others. Some children can get flare-ups year-round. Many flare-ups happen for no obvious reason.
Impact of eczema
While the disease is in the skin, the impact of the disease can affect other aspects of your child’s health and the quality of life for your child and family. This includes:
- a higher risk of skin infections
- interrupted sleep for the caregiver and child due to uncontrolled itching
- discoloured skin
- impact on self-esteem and socialization as eczema can be easily seen by others
- impact on mental health
- reduced school attendance or performance
- reduced participation in sports and hobbies
There is a lot of information available on eczema, and not all of it is accurate, up-to-date or helpful. Sometimes it is complicated and confusing. Sometimes the information from one source is the exact opposite of information from another source, and this adds to the confusion. Your child’s health-care team can guide you to information that is accurate and useful.
Eczema cannot be cured but it can be controlled
Well-controlled eczema means:
- Flare-ups can be healed quickly and are not too severe.
- Itch and scratching are not affecting sleep.
- Eczema is not impacting your child’s ability to grow and develop and participate in all of their activities.
- The quality of life for your child and family is not affected or is only minimally affected.
One of the best ways to keep eczema controlled is to stay on top of it. While this is an investment of time and effort—which can be challenging—the impact on daily life, sleep, comfort and well-being of uncontrolled eczema can be a much higher burden.
Coping as a family
The daily care routine for eczema can be very stressful to you, your child and the rest of your family. This is partly because keeping eczema well-controlled requires daily skin care and consistent use of treatments when there are flare-ups. These steps do not need to take a long time, but the need to do these tasks regularly can feel like a burden. This can create stress as there are many other things that require your time and energy as well, such as work and family responsibilities. Try to build the skin care steps into your daily routine, similar to other daily tasks such as brushing teeth, reading a bedtime story, or doing homework and chores for older children.
Remember that you are not to blame for your child's eczema
Try to find ways to help with your stress and develop coping skills. There are many strategies people use to help with coping. Often though, a big issue is finding time to do the activities or strategies that help manage stress. If you have access to people who are willing to help you, ask them.
Coping strategies
- You could contact recognized support groups in your area, such as the one organized by the Eczema Society of Canada. You can find more information in the resources section of this page. Talking to other parents or families may be helpful as they may have similar experiences to you and understand your concerns and frustrations, but make sure you ask your child's health-care provider about advice other parents give you. Sometimes the advice from other parents does not apply to your child.
- Family counselling may be used to help the family cope. Let your health-care provider know if you think you need help.
- As your child gets older, they may feel self-conscious or uncomfortable with their skin. Talk to your child about their eczema. Explain to them how important the routine and treatment are.
- Having your child participate in their treatment can help them understand the importance of regular skin care, give them the knowledge and skills they need to manage eczema and give them ownership of their condition. It also empowers your child to care for themselves as they grow up. Make sure that the tasks you give your child are age appropriate and that your child is ready and motivated to participate.
- It is very common for parents to want their child to manage their own skin when they get to a certain age. Remember that not all children will be ready for this at the same age or stage. From an early age, children can participate in helping the parent, and when they are ready, they can do their skin care with parent supervision. Eventually, they can take over the entire process but need to:
- be able to recognize an active flare-up
- know which medication is to be used for which body part and how often
- know how to recognize when a flare-up is over and when medication should be stopped
- understand the importance of daily moisturizing and be able to apply moisturizer consistently
- be organized enough to keep track of where medications for eczema are stored and remember to do the steps consistently
Skin care management tasks can feel like a burden for children and teens in the same way they do for parents. This can lead to inconsistent skin care management, which can lead to worsening eczema. Help your child or teen understand the importance of managing eczema to reduce discomfort and the impact of eczema on daily life. Help them also develop strategies to build consistency into the routine. These suggestions can help your child or teen stick to their routine:
- Let them contribute to decision-making about which times of the day they will apply medications and moisturizers.
- Put reminders in place (e.g., sticky notes, alarms on phones).
- “Habit-stack”—add the skin care routine to already well-established habits.
The role of your child's health-care providers
Your child's health-care providers are there to answer any questions that you may have about your child's eczema and treatment. They can also address any concerns that you may have.
- You should take the time to discuss your child's treatment with their health-care provider. They will give you the information you need about any medicine or treatment for your child. They will also explain how to use these medicines properly, such as how to apply an ointment and where to apply it.
- If you are finding your child’s skin care routines overwhelming, ask your child’s health-care provider if there are ways to simplify the schedule.
- Ask your child’s health-care provider to explain or show you what a flare-up looks and feels like. Many children and parents consider that only a “bad” flare-up needs treatment, so the child ends up with mild or medium flare-ups all the time. These may not look as bad but can still disrupt sleep (from itching), make children feel uncomfortable (itching, pain from open wounds) and impact mood, temperament and behaviour.
- Talk to your child’s health-care provider about your routine and family structure. For example, are you a two-parent household or a single parent? Do you or your partner work? Is someone home during the day? Does your child attend school or day care? By talking to your health-care provider about these things, you can help them to better understand how eczema affects your life, your child's life and your family's life.
- It may be helpful to make a list of questions before you attend your child's next appointment. This way, you are less likely to forget when you get to the appointment.
- Tell the health-care provider how often your child has flare-ups, how severe they are and how you manage them. With more information, your health-care provider can give you some more tips to help control the flare-ups.
- Never make changes to your child's treatment plan without talking to their health-care provider first.