Baby Eczema (Atopic Dermatitis) Management
Caring for your baby's eczema — the daily skincare routine, getting topical steroids right without fear, recognising infection, and when to step up.
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- Dr Jubal John, FRACP
- Category
- medical guides
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Take-home
Eczema affects around **1 in 5 (~20%) children under 2 years (ASCIA)** and usually starts in the first year of life. Two things make the difference: daily, generous moisturiser as a routine (not just when skin looks bad), and a topical corticosteroid (TCS) used promptly and correctly when there’s a flare. Used properly, TCS are safe and effective: “steroid phobia” is the most common reason eczema doesn’t improve. Infantile eczema usually improves significantly between ages 2 and 5 years (ASCIA), and most eventually outgrow it. Severe or refractory eczema may have a food-allergy component, see cow’s milk protein allergy.
What eczema is, briefly
Eczema is a chronic inflammatory skin condition driven by a weakened skin barrier (often genetic) plus an inflammatory response. Skin loses water faster, lets allergens and irritants in, and the immune system reacts with itch, redness and rash. Not infectious, not contagious, not caused by anything you did. It runs in families with eczema, asthma, hay fever or food allergies, together called atopic conditions.
Where it shows up in babies: face (especially cheeks), scalp, outer arms and legs, trunk. In older children: flexures (inner elbows, behind knees).
Why early control matters: the atopic march
Eczema is often the first step in a sequence: eczema → food allergy → asthma → hay fever. Two practical implications:
- Good early eczema control reduces later food allergy rates. Damaged skin is now thought to be a major route by which the immune system first encounters food allergens.
- Timely introduction of allergy foods between 4–12 months also reduces food allergy risk, especially if there is eczema. See starting solids.
Daily skincare: the foundation
This is the single most important thing. Skincare controls eczema; the steroid treats flares. Get the routine right and you’ll need much less steroid.
The daily routine, three steps
- Bathe daily in lukewarm (not hot) water for a few minutes, using a bath oil or a soap-free, fragrance-free wash rather than soap. No bubble baths or scented products.
- Pat dry, leaving the skin slightly damp, don’t rub.
- Moisturise generously straight afterwards, and again through the day. Use a thick, fragrance-free cream or ointment (lotions are too thin) over the whole body, not just the visible patches, far more than feels normal.
The best moisturiser is the one your baby tolerates and you’ll actually use. Avoid products with fragrance, food extracts, essential oils or “natural” herbal additives, even ones marketed for sensitive skin can flare eczema. If a product seems to sting, switch. Your pharmacist or the RCH eczema fact sheet can suggest specific products and how much to use.
Topical corticosteroids (TCS)
Daily moisturiser prevents flares; TCS treat flares. Both are needed.
Steroid phobia is the most common reason eczema isn't controlled
The dermatology and paediatric consensus is clear: TCS used correctly are safe, effective, and far less harmful than uncontrolled eczema. Long-standing untreated eczema causes thickening, infection, sleep loss, and a higher risk of food allergy. Side effects (skin thinning, stretch marks) are real but rare with appropriate use. Worry about doing too little, not too much.
Strengths your prescriber will choose between
Topical steroids come in mild, moderate and potent strengths. The right one depends on the body part (gentler strengths for the face, neck and skin folds; stronger ones for the trunk and limbs) and the severity of the flare. Your GP, paediatrician or dermatologist will choose the specific product and strength and write it down for you, matching it to your baby is their job, not something to pick off a website.
How much, how often, how long
The simple version
- Apply steroid only to the active patches, once or twice a day.
- Apply moisturiser everywhere: including over the steroid once it has soaked in.
- Keep going until the skin is smooth and itch-free, then a couple of days more. Stopping at the first sign of clearing is the most common reason a flare bounces straight back.
A useful measure for how much steroid is the fingertip unit: the amount squeezed onto an adult fingertip, which covers about two palm-sized areas. Your prescriber will show you how many your baby needs and how long to use it.
Topical calcineurin inhibitors (pimecrolimus, tacrolimus) are non-steroid alternatives sometimes used on the face or around the eyes. Initiated by a doctor.
For frequent flares, your paediatrician or dermatologist may recommend proactive (weekend) therapy: TCS twice a week to known trouble areas even when the skin looks clear.
Stepping up: wet wraps and bleach baths
When the standard routine isn’t enough, two next-tier options exist. Both are usually started under medical supervision, not from a website:
- Wet wraps: a damp cotton layer (tubifast or cotton suit) over moisturiser + TCS, covered by a dry layer, left on for 1–2 hours or overnight. Cools, soothes, and prevents scratching. Ask your MCH nurse or paediatrician to demonstrate.
- Dilute bleach baths are sometimes used for recurrent skin infection, a very weak dilution (weaker than a swimming pool), a few times a week. The exact recipe matters, so get it from your doctor rather than a website, and never use scented or gel bleaches.
Triggers: what to think about
Most flares have a trigger, but the trigger varies between children. Always managed routinely: dryness (handled by daily moisturiser), heat and sweat, soaps and detergents (fragrance-free wash, no fabric softener, double-rinse), wool and synthetic fabrics (use cotton or bamboo). Sometimes a contributor: drool, dust mites, pet dander, pollen, illness. Worth investigating in moderate-to-severe eczema: food allergens, with cow’s milk first on the list in babies under 12 months (see CMPA). Rarely the issue despite popular belief: gluten, sugar, “toxins” in vaccines or water.
A structured food-allergy review is worth considering when eczema is moderate-to-severe despite good daily care, when there are gut symptoms (reflux that won’t settle, blood or mucus in poo, slow weight gain), or with a strong family history. Don’t put your baby on a restrictive diet without medical supervision: empty exclusion of multiple foods often causes nutritional problems and rarely helps.
Recognising infection
A flare that won’t respond to standard treatment may be infected.
Bacterial superinfection (impetiginised eczema)
Yellow crusting, weeping, pus, increasing pain, sometimes fever. Treated with topical or oral antibiotics plus the usual eczema regimen. Same-day GP review.
Eczema herpeticum, a medical emergency
A herpes simplex virus infection of eczematous skin. Looks like clusters of small, painful, identical “punched-out” blisters or sores spreading rapidly, often on the face or around the eye, in an unwell baby (fever, irritable, off feeds). Needs same-day hospital review and antiviral treatment: go to ED.
When to seek help: the safety net
Green — usually fine
Manage at home
- Mild flare responding to your usual moisturiser + TCS
- Eczema you can predict and control
Amber — be alert
Book a review (your GP first, who can refer to us or dermatology)
- Not improving despite daily moisturiser + TCS used correctly
- You’re unsure about steroid plan or want a technique check
- Suspected food trigger
- Eczema affecting sleep regularly
- Yellow crusting / infection signs (same-day GP)
Red — act now
Same-day or emergency
- Eczema herpeticum, clusters of small painful blisters, especially face / around eye, with an unwell baby, go to ED
- Severe infection, fever, lethargy, spreading red skin
- Severe flare with significant skin breakdown
- Anaphylaxis to a food, call 000
Common questions
“Will steroids damage my baby’s skin?” Used appropriately, right strength, right area, until clear + 2 days. TCS are safe. Untreated eczema is harder on the skin than appropriately-treated eczema.
“Should I hold off on egg or peanut because of the eczema?” No. Current guidelines say introduce these between 4–12 months even if there is eczema: especially if there is eczema. See starting solids.
“Will my baby outgrow it?” Most do — ASCIA notes infantile eczema usually improves significantly between ages 2 and 5 years, with further improvement through childhood and adolescence.
Related reading
- Cow’s milk protein allergy, the food allergy most likely to drive moderate-severe baby eczema
- Starting solids, including allergy-prevention timing
- Cradle cap, nappy rash, common newborn findings
- External: RCH Kids Health Info — Eczema, ASCIA — Eczema, Eczema Association of Australasia
Eczema not responding to your routine?
A structured paediatric review covers routine, steroid use, triggers, and whether wet wraps are needed.