Children with eczema — and when to call us

About this guide

Eczema is more common in children than in adults — about 1 in 5 children in Singapore are affected. The good news is that a substantial proportion of children improve as they grow older, especially with consistent daily care during the early years.

This guide covers the things that are specific to babies, children, and teenagers with eczema — and the red-flag signs (for any age) that mean you should contact the clinic promptly rather than waiting.

It’s part three of three:

1. Everyday skincare for eczema — the foundation for every age
2. Managing an eczema flare — treatment for when eczema flares up
3. Children with eczema — and when to call us (you are here)

The principles in guides 1 and 2 apply to children too. This piece adds the parts that are different when you’re looking after a young patient — and the urgent signs any parent should know.

How eczema looks at different ages

Eczema tends to settle in different places depending on age:

• Infants and young toddlers (under 2 years): typically on the scalp and face, with cheek involvement very common, and often spreading to the trunk and the outer (extensor) sides of the arms and legs. The nappy area is usually spared.
• Children (2 to 12 years): more commonly on the neck and the flexural areas — the soft insides of the elbows and behind the knees, around the wrists, and sometimes around the eyes.
• Teenagers: flexural pattern usually continues, but may also appear in more localised areas — hands, feet, nipples, or the eyelids.

In Asian skin, eczema can look drier and more scaly than the images you’ll often find online, and patches of inflammation can appear brown, violet, or grey rather than the bright red shown in textbook pictures.

If you’re ever unsure whether a rash on your child is eczema or something else (such as a fungal rash, contact dermatitis, or a reaction to a new product), please bring them in — diagnosis in children isn’t always straightforward from a photo.

Practical tips for children

A few things make a real difference in the day-to-day:

• Keep nails short and clean. Most of the skin damage from eczema comes from scratching, not from the eczema itself. Short nails reduce that damage significantly.
• Cotton mittens or gloves at night during a flare, especially for younger children who scratch in their sleep. Pair with a cool (not cold) room.
• Teach children who are old enough to press, rub, or cool an itchy spot instead of scratching it.
• Moisturise more often than you think you need to — at least twice a day, and every time after bathing or hand-washing. As a rough guide, aim for about 125g per week for infants and 250g per week for older children. Keep a tub at the changing table, by the bath, and by the bed.
• Short, lukewarm baths (not hot), with a fragrance-free non-soap cleanser, and moisturise within minutes of patting dry.
• Cotton clothing and bedding. Wash new clothes before the first wear. Use a fragrance-free detergent and skip fabric softener — these are common irritants in young skin.
• Nursery and school: let caregivers and teachers know about the eczema, the moisturiser routine, and any trigger to watch for. A labelled moisturiser tube kept at childcare helps a lot.

Other allergic conditions — what we now understand

Children with eczema are at somewhat higher risk of developing other allergic conditions — food allergy, asthma, and allergic rhinitis — than children without eczema. For many years this was described as an “atopic march” with a fixed sequence, but research over the past decade has shown the picture is much more varied: only a small minority of children with eczema go on to develop all three, and they don’t always appear in the same order. Food allergy, for example, can develop before, alongside, or after the eczema — not always after.

What this means practically:

• About 1 in 4 children with eczema will develop at least one other allergic condition over time; most will not.
• Early-onset, more severe, or long-persisting eczema tends to carry a somewhat higher risk of additional allergic problems.
• Regular moisturising from early infancy is good skincare practice in babies with a family history of eczema. A Japanese study (Horimukai et al, 2014) found that daily moisturising from birth reduced the rate of eczema developing in high-risk infants.¹ Subsequent larger trials have given mixed results, so we don’t advise this as a guaranteed prevention strategy — but it’s low-risk, low-cost, and worth discussing if eczema or allergy runs in your family.

The main practical point: take eczema seriously and manage it well, but try not to let a diagnosis make you anxious about everything that might come next. Most children with eczema lead ordinary lives, and many outgrow it as they get older.

Food allergies — and how we think about them

This is an area where patients often have more worry than the evidence supports, so it’s worth being clear.

In children with eczema, food allergy is more common than in children without eczema, and a specific food may occasionally worsen a child’s eczema. Common culprits are cow’s milk, egg, peanut, tree nuts, wheat, and soy. Food-related flares can happen quickly — within minutes to a couple of hours of eating — but they can also appear as a delayed worsening over the next 24 to 48 hours. If you notice a clear pattern, repeatedly, please tell us at the consultation.

However, routine blood testing (specific IgE) or skin-prick testing for food allergy is not recommended in most children with eczema. These tests have high false-positive rates, which can lead to unnecessary food elimination that causes nutritional problems — particularly in young children where dairy, egg, or wheat are important calorie and protein sources. Broad elimination diets without clinical guidance can do more harm than good.

Our approach in the clinic is:

1. Optimise the daily skincare routine and flare treatment first. Most paediatric eczema improves substantially with these alone, and food allergy testing before this is usually premature.
2. If a specific food is clearly linked to flares on careful history-taking, we can discuss targeted testing or a short, supervised trial elimination — not a broad “cut everything out” approach.
3. If the eczema is severe or not responding, we may refer — to a private dermatologist for specialist skin-focused care, or in rare severe cases to the emergency department for inpatient management.

Growing out of it

Many children’s eczema improves noticeably as they get older, especially through the primary school years, and some grow out of it entirely. A smaller proportion will have eczema that continues into adulthood, often in a milder, more localised pattern (most commonly hand eczema in adults).

Two things influence how this plays out:

• Consistency of daily skincare — children whose skin barrier is well supported throughout childhood generally do better
• Early and effective flare treatment — repeated severe flares can prolong the course

Teenagers often find adherence harder — they have their own autonomy over the routine, and eczema can carry real psychosocial weight in adolescence. If you have a teenager whose eczema is flaring and whose self-care has drifted, a focused consultation with the teenager themselves (rather than only the parent) is usually more productive.

Red-flag signs — call us promptly for any age

The following signs, in a child or an adult, warrant prompt attention rather than waiting for a routine appointment:

Likely skin infection:

• Honey-coloured crusting, weeping, or oozing on an eczema patch
• Yellow pus, increasing pain, or rapidly spreading redness
• Fever or feeling generally unwell along with worsening eczema

Possible eczema herpeticum (urgent):

• Sudden appearance of many small, dome-shaped blisters or punched-out sores on the eczema skin
• Especially if unwell or feverish
• This can look like a sudden “chickenpox on the eczema” pattern — come in the same day, or go to a paediatric emergency department if out of hours

Flare not settling:

• No improvement after 2 weeks of the treatment we prescribed — come back for review rather than continuing the same treatment indefinitely

Impact on life:

• Significant impact on sleep (frequent waking from itch)
• Significant impact on school, work, or psychosocial wellbeing
• A child who is stopping activities or avoiding social situations because of the skin — this is worth addressing, not tolerating

For severe, widespread flares — or if your child looks unwell with an eczema-related problem — don’t wait. Call us, or go to the nearest emergency department.

Things that may not help

Patients — and parents of young children with eczema — understandably try many different approaches, and we want to acknowledge the effort that goes into that. In our experience, a few things that come up often aren’t well supported by evidence and are unlikely to move the needle on your child’s (or your own) eczema.

• Probiotic supplements for eczema — evidence for preventing or treating eczema is very limited.
• Polynucleotide or stem-cell injections sold privately — the evidence base is thin.
• “Hypoallergenic” baby products with added fragrance — fragrance is a common irritant. Fragrance-free is what actually matters, not the word “hypoallergenic” on the label.
• Complete elimination of a whole food group (e.g., all dairy, all wheat) without clinical guidance — risk of nutritional deficiency, especially in children, often without any improvement in the eczema.

In our view, the most reliable approach at every age remains consistent daily moisturising, appropriate flare treatment, avoiding known triggers, and coming back to see us when something changes. If you’ve tried something else that you feel is genuinely helping your eczema, please tell us — we’d rather discuss it openly than have you stop mentioning it.

Get in touch

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Email — admin@ktmc.sg

References

• Agency for Care Effectiveness (ACE). Mild and moderate atopic dermatitis (eczema) — a journey from flare to care. ACE Clinical Guideline, Ministry of Health, Singapore. February 2026. ace-hta.gov.sg
• ¹ Horimukai K, Morita K, Narita M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824-830.e6. PubMed
• Paller AS, Spergel JM, Mina-Osorio P, Irvine AD. The atopic march and atopic multimorbidity: many trajectories, many pathways. J Allergy Clin Immunol. 2019;143(1):46-55. jacionline.org

This information is for general education only and is not a substitute for medical advice. Paediatric eczema management depends on age, severity, and individual factors — please speak with our team about what’s right for your child. v1.0 · April 2026 · Review due April 2028.