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1. Schedule an appointment with your pediatrician: Atopic dermatitis can mimic many other diseases so it is very important to receive a formal diagnosis for your child. Sometimes eczema is a sign of a more serious disease, so tell your doctor if you child isn't gaining weight, has had severe recurrent bacterial infections, or if any genetic diseases run in your family.
2. Moisturize, moisturize, moisturize: See the scaling and flaking on your child's skin? That's a sign that there are microscopic breaks in your child's skin, and that means water can evaporate from your child's skin very quickly. What to do? Pick up a great FRAGRANCE-FREE moisturizer from your local pharmacy. I love Cetaphil Cream (in the tub, not the pump), but Eucerin, Aquaphor, Vaseline, petrolatum all work great! Smear it on your child liberally head to toe (care to avoid eyes, mouth, anus) as often as you think about it, but at least twice per day.
3. Reduce bath times and use a non-soap cleanser: Remember, bathing is very drying to the skin, so shorten bath time to about 10-15 minutes. If your child isn't dirty, it's okay to bathe every other day rather than daily! Use a fragrance-free, non-soap cleanser if possible (I love Cetaphil face wash for dry skin — in the face wash cleanser aisle) Is there a right way to dry your child? Yes! Try not to rub the skin put instead pat dry after a bath (to avoid irritating the skin more), and don't forget to apply a MOISTURIZER after bath time!
4. Avoid known rrritants: Usual culprits? Fragrances, fragrances, fragrances found in soaps and detergents. Buy detergents that are labeled "free and clear" or for "sensitive skin." Smoke, extreme hot or cold, sweat, wool clothing or synthetic fabrics are also known irritants. Go for breathable cotton clothes whenever you have a choice.
5. Stop the scratching: Cut fingernails short to minimize how much your child can claw at their skin. Try covering an affected area while it's healing so your child can't scratch. If all else fails, an oral antihistamine can be effective in reducing the itch. Try a non-sedating variety like cetirizine (marketed as Zyrtec) or loratadine (marketed as Claritin) for daytime, and sedating antihistamines such as diphenhydramine (marketed as Benadryl) at night. Call you doctor for correct dosing information.
6. To test or not to test for allergies: The younger your child is, the more likely allergies are a contributing factor. The food most likely to trigger eczema is eggs, but other foods may also contribute. Food allergy is NOT a common trigger in older patients, but environmental allergies like those to pet dander, pollen or dust mites may be a factor. While knowing if your child has an allergy that is affecting their eczema might help you eliminate this trigger, it won't "cure" them.
7. When to call the pediatrician again? You've been diagnosed, you've tried everything listed here, and your child's skin is still as red as Santa's suit.
   • Your pediatrician may prescribe a topical steroid cream. These creams should be used only for short periods of time under the care of a doctor. While "short burst" use of the cream is safe and effective, long-term use can cause thinning of the skin, striae (stretch marks), growth suppression, or hormonal imbalances that should be monitored closely with the help of your doctor. Let your doctor know if your child is experiencing any side effects of treatment. Furthermore, never use these creams on your child's face, armpits, or genitals! Those areas are just too sensitive.
   • For children 2 years and older your doctor my prescribe medications such as tacrolimus (Protopic) or pimecrolimus (Elidel). These medications work in a different way than from steroid creams and can be used on all body locations without the skin atrophy that steroid creams may cause. However, these agents can cause sensitivity to the sun, so sun protection is a must!
   • If skin has become infected, your doctor may prescribe a topical or oral antibiotic. So make sure if you see any signs of infection on your child's skin to make an appointment right away. We don't want an infection on the skin to move into the child's blood stream!

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• Keep young infants out of direct sunshine as much as possible.
• Cover up with light-weight clothing and hats.
• Limit sun exposure between the peak UV ray hours of 10 a.m.-4 p.m.
• Wear sunglasses that provide maximum UV protection, even for children.
• Wear sunscreen:
  • Use sunscreen with a minimum SPF 15---the higher the better.
  • Use sunscreen that protects for both UVB and UVA rays.
  • Use sunscreen on all uncovered areas of the body, being extra careful around the eyes (especially with younger children/infants).
  • Put sunscreen on 30 minutes before going outside
  • Reapply sunscreen at least every 2 hours, more often if swimming or with excessive sweating.
  • Always read and follow the instructions on the product label.

• Use insect repellent:
  • Repellents containing DEET are the most effective.
  • DEET content can vary significantly from less than 10% to more than 30%
  • The higher the DEET percentage, the longer lasting the repellent
  • DEET content greater than 30% is not recommended for children
  • Repellents containing DEET are not recommended for infants < 2 months
  • Always read and follow the instructions on the product label with regard to application and removal of insect repellent.
• Repellents made from essential plant oils, such as Citronella, are generally less effective and shorter acting. Insect deterrents such as ultrasonic devices, "bug zappers" and wristbands are even less effective.