Eczema Treatment for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

What is eczema? Atopic dermatitis, more commonly known as eczema, is a common skin condition that can plague everyone from babies to grown-ups. It can be as mild as a nuisance, or more serve with skin so dry it cracks, bleeds or gets infected. Most kids will get an itchy skin rash at some point in childhood, but about one out of every 10 kids will develop eczema.

Eczema causes are unknown, but it’s believed to be a combination between genetics and a trigger, which could be certain foods, seasonal or environmental allergies, stress, hormones and weather. Diagnosing eczema can be tricky because each child has a unique combination of symptoms that can vary in severity, and there is no test to diagnose it definitively. If you suspect your child has eczema, consult your pediatrician. They will conduct a physical examination, and help you identify things in your child’s environment that may be contributing to skin irritation.

Eczema is not contagious, so there is no need to keep a child with eczema home from daycare or school.

Eczema symptoms

Eczema symptoms typically appear within the first few months of life, and almost always before a child turns 5. More than half of all children who suffer from eczema will outgrow it by the time they’re teenagers.

Between 2 and 6 months of age, kids with eczema will have itchy, dry, red skin and small bumps. These eczema symptoms can appear on their cheeks, forehead or scalp. It may spread to the arms, legs and trunk; in the bends of the elbows; behind the knees; or on the backs of the wrists and ankles.

Eczema symptoms tend to worsen and improve over time. For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups into adolescence and early adulthood. In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

How to treat eczema

There is no known eczema cure. However, your child’s pediatrician may prescribe a topical corticosteroid, also known as cortisone or steroid creams or ointments, which are commonly used to treat eczema. These “eczema creams” are usually applied directly to the affected area twice a day. Continue using these corticosteroids for as long as your doctor suggests.

These creams and ointments vary in strength, so do not apply a topical corticosteroid intended for someone else.

Your doctor may suggest nonsteroidal medications instead of a topical steroid. These may also prescribe antihistamines to help control itching, or an oral or topical antibiotic to prevent or treat secondary infections common in kids with eczema.

How to help your child with eczema

  1. Avoid frequent hot baths or showers, which dry out the skin. Use warm waters and mild soaps during bath time. Gently pat their skin dry, instead of scrubbing or toweling.
  2. Avoid fabrics that may irritate their skin including wool or coarsely woven materials. Favor materials that “breathe” such as cotton.
  3. Apply moisturizing ointments like petroleum jelly, lotions or creams to their skin two to three times per day. Always apply within a few minutes of bathing after a gently pat dry, before the skin has fully dried. Do this in addition to using a cream prescribed by their pediatrician.
  4. Apply a cool compress to the skin to ease itching.
  5. Eliminate known allergens from your home, including certain foods, dust or pet dander.
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How to Deal With a Toddler Who is a Picky Eater

By Dr. Eric Ball, a CHOC Children’s pediatrician

Most babies are great eaters. The average twelve-month-old will eat most of what he is offered. At my son’s first birthday party, I remember that he happily ate broccoli and strawberries, and only nibbling on his birthday cake. Three months later, my wife and I were begging him to just try or lick a piece of broccoli. What happened?

Some studies suggest that over 90 percent of toddlers and preschoolers are described by their parents as picky. I have a few theories about what happens to these formerly stellar eaters:

  • Children’s growth velocity slows down dramatically after their first birthday. The average child gains 15 pounds in the first year of life and only 5 pounds in the second year. Most of the food your baby ate went to growth, whereas most of a toddler’s food will go to running around and playing. Therefore, a toddler’s hunger will be variable. There will be days when they are hungrier than other days. It is normal for toddlers to have meals― or even days― when they eat little. There are also days when a toddler might eat more during a meal than their parents.
  • The last thing a toddler wants to do is sit in a highchair for thirty minutes and eat a meal. They want to play and explore. The average toddler or preschooler will eat just enough to get the energy to play more. When their tank is refilled, off they go!
  • Kids get smarter as they get older. Eventually my son realized that chicken nuggets taste better than broccoli. Since toddlers have no knowledge of nutrition, they want to eat what they like the most. At this stage, the biggest pitfall parents can make is to start allowing their toddlers to decide what food will be served. They will obviously choose the junk food that tastes best to them.

So, what do you do with your newly picky eater? I was raised in a strict household where my brothers and I were forced into eating our food. My brothers and I all struggled with obesity as children and were all very picky eaters. My wife’s family had one rule for the table, “Eat what you want, leave the rest.” There was no arguing or bargaining around the dinner table in their home. My wife and her brother were always a healthy weight and ate a good variety of foods. Here are some tips that I learned from my wife’s family that I try to pass onto my patients and my own children:

As parents, we are in control of the quality of the food offered to our children, and they are almost 100 percent in control of the quantity that they eat.

Toddlers have a fierce independent streak and the more they are pushed, the more they push back. Do not bribe, coerce, or force your children to eat. Sit your toddler down for three well rounded meals per day and at least one healthy snack per day. Make sure that he is offered a variety of healthy foods at each meal. If he eats what is served, that is fantastic. If he does not eat what is served, that is okay, too, but do not offer him anything else. We parents are not short order cooks. If the family is eating chicken, rice and broccoli, then that is what the toddler should be served. If he is offered macaroni and cheese after he whines that he does not like chicken, then you have essentially taught him that in order to get macaroni and cheese, simply whine and refuse your food. This is the first step in the making of a picky eater. It is better to excuse him from the table if he does not want what he is served rather than give him something else. Children do not starve themselves to death. Place the dinner plate in the refrigerator, and he can have a second chance at eating his dinner later that evening if he decides he’s hungry.

Maximize your opportunities for successful meals by not filling up on liquid calories and snacks.

I do not serve milk or juice with meals, only water. When my son was a toddler, if he had milk with his dinner, he would chug the milk until he was almost completely full, and then eat little or no food A ten-ounce cup of whole milk has more calories than an equivalent sized soda. I would save milk or juice for snack time and limit my children to no more than 16 ounces of milk per day. In fact, I filled a 16-ounce measuring cup with milk each morning so that my children could see exactly how much milk would be allotted for the day. When the cup was empty, the milk for the day was over.

Give your toddler mutually acceptable choices for snack foods.

I will offer my children an apple or a pear for a snack. If they respond that they want Goldfish crackers, I will remind them again that their choices are between an apple and a pear.

Eat as a family whenever possible.

Children are much more likely to eat their food if they see others eating the same food. It is hard to expect a toddler to eat peas if he is the only one eating them. Even if work schedules make a true family meal impossible, try to have one parent sit with the children and eat small portions of what the children are served.

Allow children to participate in food preparation.

Most people are more willing to eat something of which they have ownership. Even something as simple as having your toddler stir the peas and corn may increase the odds that he will eat them.

If there are foods that you do not want your children to eat, do not buy those foods.

Good nutrition starts at the grocery store. If a child’s only options for snacks are fruits or vegetables, it is likely that he will eat them. Most toddlers and preschoolers eventually are smart enough and agile enough to find that stash of Oreos in the cabinet.

In medical school, I was repeatedly taught that parents should not make mealtime a battle. That lesson didn’t fully sink in until I had my own children and I realized how quickly a lovely family meal could degenerate into a stress-filled ordeal. By applying the simple family rule of “Eat what you want, leave the rest,” mealtime at our home is once again a pleasant experience.

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The Latest Guidelines on Cold and Cough Medicine for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

When your child is sick, all you want to do as a parent is make them feel better. As a pediatrician and parent, I understand that frustration. Today, parents are inundated with countless over-the-counter products marketed as safe for kids. Unfortunately, we now know that these pediatric versions of adult medication may do more harm than good.

The U.S. Food and Drug Administration do not recommend over-the-counter medicines for cough and cold in children under 2 years old. For older children, consult your pediatrician or pharmacist before offering any over-the-counter medication. Do not give medicines containing codeine or hydrocodone to anyone under 18 years old. These are opioids and are not advised for children.

Why can’t I give my child cold and cough medicine?

There have been few studies that have actually looked at the effectiveness of cold and cough medications in alleviating cold symptoms in children. Of the studies performed, every study done since 1985 has shown no benefit to any of these medications compared to a placebo. In other words, each study showed that a sugar pill had the same effects as the cold medications. Cough medications did not stop coughs, decongestants did not make children less congested, and expectorants did not make mucous any more manageable. Even if the medications did work, they would only treat symptoms of a cold; they do not cure or shorten the duration of the illness. Children get better with time.

When the original dosing studies for these over-the-counter cough and cold medications were performed, safe dosages were established only for adults. The FDA licensed the medications for children in 1976 without any studies establishing safe doses for children. Pediatric dosing was extrapolated from adult dosing using a crude formula: half of the adult dose for children between 6 and 11 years of age and a quarter of the adult dose for children between 2 and 5 years of age. For children under 2 years of age, parents were instructed to ‘contact your doctor.’ These extrapolated doses are imprecise and potentially dangerous; it puts children at much higher risk for adverse effects and accidental overdose.

So, what can I do about a cough or cold?

There is no cure for the common cold, but there are some things you can do while the virus runs its course.

  • Make sure your child drinks plenty of fluids. This will serve to thin mucous and keep him well hydrated.
  • Saline drops or sprays can offer temporary relief of a stuffy nose.
  • A bulb syringe can be used for children too young to blow their noses.
  • A humidifier is often helpful for decreasing congestion at night.
  • Acetaminophen or ibuprofen (for children over six months old) are safe and effective in relieving pain or fever associated with a cold. CHOC offers downloadable guides on acetaminophen (Tylenol) dosing, as well as a guide on ibuprofen (Advil) and naproxen (Aleve).

Not every cough and cold warrants a trip to the pediatrician’s office. Here are a few warning signs that it’s time to make an appointment:

When to call the doctor for a cough or cold:

  • A fever in a baby less than 2 months old
  • A fever of 100.4 degrees or higher lasting more than three days.
  • Labored breathing including wheezing, fast breathing or shortness of breath
  • Dehydration along with not eating or drinking
  • Constant ear pain

The dangers of over-the-counter medicine for children

Since 2000, poison control centers have reported hundreds of thousands of calls related to over-the-counter cold medications in children. The FDA has reported 123 deaths related to decongestants and antihistamines since 1969. Since appropriate dosing has not been established, side effects tend to be more severe in children. Cough suppressants, which are derived from narcotic-type medications, often cause drowsiness, confusion, and other neurologic effects. Decongestants are related to amphetamine-type medications and cause agitation, insomnia, restlessness, and high blood pressure. Antihistamines, which are often marketed as bedtime medication, cause drowsiness in some children and agitation in others. Expectorants can cause gastrointestinal effects, such as nausea, vomiting, and diarrhea.

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