Eczema in Babies and Children: Why Does It Happen, How Is It Treated, and Will They Outgrow It?
Updated: 6 hours ago
By Dr Lim Tzyy Huei (林子辉医生) | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia
Childhood eczema, medically known as atopic dermatitis, is one of the most common skin conditions affecting babies and children. In Malaysia, eczema is sometimes called ekzema or ruam ekzema in Malay, and 湿疹 in Chinese.
Many parents become worried when their child’s skin is constantly dry, red and itchy, especially when the eczema keeps returning despite using different creams.
Some children scratch until their skin bleeds, while others struggle to sleep because of persistent itching.
The good news is that childhood eczema can usually be controlled with proper skincare and appropriate treatment, allowing children to sleep comfortably and enjoy their daily activities.
1. What Causes Eczema in Children?
Eczema develops because of a combination of:
A weakened skin barrier that allows moisture to escape easily
An overactive immune response causing skin inflammation
Genetic factors, particularly in families with eczema, asthma or allergic rhinitis
Environmental factors that irritate sensitive skin
Children with eczema have skin that is more easily irritated and becomes dry and inflamed.
Importantly, eczema is not contagious. Your child cannot spread eczema to other children through touching, playing or sharing toys. Eczema is also not caused by poor hygiene.
2. What Does Childhood Eczema Look Like?
The appearance and location of eczema may change as children grow.
Babies and Infants
Eczema commonly affects:
Cheeks and forehead
Scalp
Arms and legs
Trunk
The skin may appear red, rough, dry or occasionally weepy.
Toddlers and Older Children
Eczema often affects:
Behind the knees
Inside the elbows
Wrists and ankles
Neck
Hands and fingers
Repeated scratching can cause the skin to become thickened, darker or rougher over time.
In children with darker skin tones, eczema may appear brown, purple or grey rather than bright red.
3. Why Does My Child’s Eczema Keep Coming Back?
This is one of the most common questions parents ask.
Eczema is a chronic inflammatory skin condition. Even when the visible rash improves, the skin barrier may remain sensitive and prone to inflammation.
Common factors that can worsen eczema include:
Hot weather and excessive sweating
Dry skin
Harsh soaps or fragranced skincare products
Frequent washing without moisturising
Rough fabrics and friction
Certain environmental allergens
Skin infections
Scratching and irritation
In Malaysia’s hot and humid climate, sweating and overheating are particularly common problems.
Not every flare-up is caused by food allergy.
Rather than trying to avoid every possible trigger, it is usually more helpful to identify factors that consistently worsen your child’s skin while maintaining a regular skincare routine.
Eczema often follows a cycle of flare-ups and improvement. Even when the visible rash has settled, the skin barrier may remain sensitive, making repeated flare-ups possible.
To understand why eczema keeps returning and how to achieve better long-term control, you can read my related article: Why Does Eczema Keep Coming Back? Understanding Flare-Ups and How to Manage Them.
4. Is Childhood Eczema Caused by Food Allergy?
Many parents suspect that foods such as eggs, milk, seafood or peanuts are responsible for their child’s eczema.
Although some children with eczema also have food allergies, most eczema flare-ups are not directly caused by food.
Unnecessary food restrictions may affect a child’s nutrition and growth.
Food allergy assessment may be appropriate when:
A child develops hives, facial swelling or vomiting shortly after eating a particular food
Eczema remains moderate to severe despite appropriate treatment, especially in young children
There is a convincing history suggesting a specific food allergy
Parents should not remove major food groups from their child’s diet without medical advice.
Routine food allergy testing is not necessary for every child with eczema.
5. How Should I Care for My Child’s Eczema at Home?
Good daily skincare is the foundation of eczema treatment.
Use Moisturiser Regularly
Apply a fragrance-free moisturiser at least twice daily, even when the skin looks normal.
Thick creams or ointments are generally more effective for very dry skin than light lotions.
Moisturiser helps:
Repair and protect the skin barrier
Reduce dryness and itching
Prevent skin cracking
Reduce the frequency of eczema flare-ups
Bathing and Cleansing
Use lukewarm rather than hot water.
Keep baths or showers short and comfortable.
Choose gentle, fragrance-free cleansers.
Avoid harsh soaps, bubble baths and vigorous scrubbing.
Apply moisturiser soon after bathing.
Clothing and Environment
Choose soft, comfortable clothing, preferably cotton.
Avoid overheating, especially during sleep, and change sweaty clothing when necessary.
Keeping fingernails short can also reduce skin damage caused by scratching.
6. Are Steroid Creams Safe for Babies and Children?
Many parents are understandably concerned about using steroid creams on their child’s skin.
Topical corticosteroids are commonly prescribed to reduce the inflammation responsible for redness, itching and eczema flare-ups.
When the correct strength is used on the appropriate body area for the recommended duration, topical steroid creams are generally safe and effective.
Different areas of the body may require different strengths.
For example:
The face and skin folds usually require milder treatment.
Arms, legs and other body areas may require different strengths depending on eczema severity.
Thickened eczema may need stronger treatment under medical supervision.
Side effects such as skin thinning are mainly associated with inappropriate or prolonged use, especially of stronger steroid preparations.
Avoiding necessary treatment can also allow eczema to worsen, causing persistent scratching, broken skin and infection.
Parents should follow their doctor’s instructions rather than repeatedly stopping treatment too early or using stronger creams without supervision.
Further Reading: Are Steroid Creams Always Harmful?
Many parents worry about using steroid creams on their baby's or child's skin, particularly when eczema keeps coming back.
When used correctly, topical steroid creams are generally safe and effective. Choosing the appropriate strength, applying them to the correct areas and following the recommended treatment duration are important for safe treatment.
For a better understanding of how steroid creams work, their possible side effects and how to use them safely, read my related article: Are Steroid Creams Always Harmful?
7. Why Does Eczema Return After Stopping Steroid Cream?
Sometimes eczema improves quickly with treatment but returns shortly after the cream is stopped.
This does not necessarily mean that the skin has become dependent on steroids.
More commonly, it happens because:
The underlying tendency towards inflammation remains
The skin barrier has not fully recovered
Treatment was stopped before the flare settled
Triggering factors are still present
The eczema requires a longer-term maintenance plan
For children who experience frequent flare-ups, a dermatologist may recommend proactive maintenance treatment, such as applying a prescribed anti-inflammatory cream twice weekly to areas that repeatedly develop eczema.
This approach can help reduce future flare-ups while limiting repeated courses of treatment.
8. What If Moisturisers and Steroid Creams Are Not Enough?
Some children continue to experience frequent or severe eczema despite appropriate skincare.
Depending on the child’s age, eczema severity and previous treatment response, additional options may include:
Non-Steroid Anti-Inflammatory Creams
Medications such as tacrolimus or pimecrolimus may be considered for selected children, particularly when eczema frequently affects sensitive areas such as the face or skin folds.
Wet Wrap Therapy
This may help children with severe itching or widespread eczema during difficult flare-ups. It should be performed under appropriate medical guidance, particularly when medicated creams are used.
Advanced Treatment for Severe Eczema
Children with persistent moderate-to-severe eczema may require specialist treatment, including newer targeted therapies such as dupilumab or other age-appropriate medicines.
The choice depends on the child’s age, severity, medical history, treatment availability and individual needs.
Not every child with eczema requires advanced treatment. However, children with severe eczema should not have to continue suffering when effective treatment options are available.
9. Can Eczema Become Infected?
Yes. Repeated scratching can damage the skin barrier and allow bacteria or viruses to cause infection.
Warning signs include:
Increasing pain or tenderness
Yellow crusting or pus
Rapidly worsening redness or swelling
Fever or a child becoming unwell
Sudden clusters of painful blisters or punched-out sores
Painful, rapidly spreading blisters or erosions, particularly with fever, may indicate a serious viral infection known as eczema herpeticum, which requires urgent medical assessment.
Not every weeping eczema rash requires antibiotics. The treatment depends on whether an infection is actually present.
10. Will My Child Eventually Outgrow Eczema?
Many children experience significant improvement as they grow older.
Some may have very little eczema by their school years, while others continue to experience occasional flare-ups during adolescence or adulthood.
It is difficult to predict exactly when eczema will improve.
Children with more severe or persistent eczema, or those with associated allergic conditions, may have a greater chance of ongoing symptoms.
However, even when eczema does not completely disappear, it can often be managed successfully.
The aim of treatment is to keep the skin comfortable, reduce itching, improve sleep and minimise the impact of eczema on everyday life.
11. When Should My Child See a Dermatologist?
Consider specialist assessment if:
Eczema keeps returning despite regular moisturising and appropriate treatment
Your child scratches until the skin bleeds
Itching frequently interrupts sleep
Eczema affects large areas of the body
The rash frequently becomes infected
Eczema affects the child’s confidence, mood or school activities
You are worried about long-term steroid use
The diagnosis is uncertain
A dermatologist can assess the severity of eczema, review the current skincare routine and develop a treatment plan suitable for the child’s age and needs.
Living With Childhood Eczema: A Message to Parents
Caring for a child with eczema can be exhausting.
Repeated flare-ups, sleepless nights, frequent moisturising and concerns about medication can place significant stress on the whole family.
Parents sometimes feel frustrated when the rash improves and then returns again.
It is important to understand that eczema is not caused by poor parenting or inadequate cleanliness.
The goal is not to achieve perfect skin every day, but to keep your child comfortable, sleeping well and able to enjoy childhood without constant itching.
With proper education, regular skincare and appropriate medical treatment, most children can achieve good eczema control.
Consult a Dermatologist in Batu Pahat
If your baby or child has persistent eczema, frequent flare-ups or troublesome itching, an assessment by a dermatologist can help identify the underlying problems and guide suitable treatment.
Dr Lim Tzyy Huei (林子辉医生) Consultant DermatologistPantai Hospital Batu Pahat, Johor
Children with eczema can be assessed and managed with an individualised treatment plan based on their age, skin condition and eczema severity.
Medical Disclaimer: This article is intended for general patient education and does not replace individual medical assessment or treatment advice.
