Eczema atopic & seborrheic dermatitis

My doctor says my 10-week-old son has eczema and prescribed some cream. What is eczema and will he have it all his life?

Eczema means a scaly rash. Most doctors mean “atopic eczema” when they say “eczema”. There are other scaly rashes that are called eczema. A similar rash to atopic eczema that affects babies is seborrheic dermatitis. As both these types of eczema (atopic eczema and seborrheic dermatitis) improve on corticosteroid creams, knowing which form of eczema it is may not seem important. However, the course of these 2 conditions will be very different. Atopic eczema is part of atopy and babies who have it may develop asthma, hayfever and an undue tendency to allergies. Seborrheic dermatitis tends to disappear by 2 years, only to reappear in adolescence as dandruff.

It is important to emphasize that your child may grow out of his eczema and never have any of these other conditions in later life, no matter which of these 2 scaling rashes he has.

Eczema does not produce permanent scarring by itself. It is itchy and if scratched, it may become infected and require antibiotics. If this secondary infection is severe it may cause scarring. Babies with eczema in the nappy region (usually due to seborrheic dermatitis) may have recurrent and very difficult to control nappy rash. This will require antiseptic baths as well as the corticosteroid creams- this needs medical attention and advice.

Gastro-oesophageal reflux in babies

Our 2-month-old baby cries a lot and the doctor has diagnosed reflux and given an antacid. The baby vomits a lot and seems unhappy but is growing satisfactorily. Can you explain reflux to me?

The full name for this condition is Gastro-oesophageal-reflux. Other kinds of reflux can occur elsewhere in the body. I don’t blame your doctor for using the shortened name and I will too for this answer. In this condition stomach contents pass back up (reflux) from the stomach into the gullet (oesophagus).

Such reflux is common in babies as they take a large quantity of fluid for their size. If an adult was to take the same amount of fluid per kilogram body weight, he/she would drink 7 + litres per day.

This huge intake of fluid puts a lot of pressure on the valve-like mechanism that normally stops fluid from passing from the stomach and back into the gullet. Forty percent of babies vomit after feeds because of this reflux and in most cases it does not cause a problem. There are 3 complications of reflux that do cause problems:

The acid made in the stomach may cause irritation to the lower part of the gullet. This is painful and makes the baby irritable. It seems this is what your doctor suspects.

The refluxed stomach contents may come up to the point where the gullet and the windpipe branch of the lower throat. This causes a potential for those contents to be inhaled. The first part of the windpipe has a trapdoor (epiglottis) which closes when we are eating, vomiting or refluxing. If this fails then we can inhale the refluxed material causing chest disease. This is quite rare in normal babies – only 1 in 500 refluxing infants have this complication.

The baby may bring back so much of his/her milk, that not enough is consumed. This would make the baby hungry and demanding. After some time growth would be noted to be inadequate. This complication is extremely rare- in 40 years of paediatric practice, I don’t think I have ever seen it.

Reflux disappears spontaneously as the baby drinks less per kilogram and adopts the upright position. The average age of it stopping is 10 months but there is a wide range of ages at which it stops. Most adults have occasional episode of reflux when we are aware of fluid coming back up into our throats – we just swallow it and do not worry.