Eczema

Eczema is a common problem in children. It can be very distressing for the child as well as for the parents. Good thing about ‘childhood eczema’ is that most children grow out of it.
How does eczema present?
It is characterised by dry skin, itching and excoriation (scratches). In poorly controlled cases it can lead to thickening and scarring of the skin. Any part of the skin may be involved but common sites are face and skin creases including back of the knee (as seen in the picture). Eczema (atopic eczema) may present at any age but in about 75% of the children some signs pointing to the diagnosis of eczema are present by 6 months of age.
What causes eczema in children?
What causes eczema is not clear but it tends to run in families. Other substances such as dust, pets, wool and rarely certain diet can also trigger eczema.
Treatment
Children with eczema have a dry, irritable skin. Constant care is required to prevent flare ups. Here is a list of things which you can do to keep your child’s eczema under control:

1. Avoid wool and acrylic materials.


2. Avoid perfumed products and strong cleansers.


3. Use mainly cotton clothes. Cotton materials rarely irritate skin.


4. Use very mild soap and avoid bubble bath.


5. Use plenty of emollients (such as E45) – they should be applied at least twice daily even when the skin is free of eczema.

Use of topical steroids (applied over the skin)
These are essential part of management but should be used with caution. Parents should understand that the overuse of topical steroids is unlikely if it is used appropriately where and when there is a flare up. Ointment based, low potency topical steroids should be used as prescribed by your doctor for a flare up. Oral steroids are usually not given for eczema.
Severe cases
Hospital admission for wet dressing may be needed in severe cases. Antibiotics (given by mouth) may be necessary for weeping eczema (suggestive of bacterial infection). Your doctor may prescribe a sedative for the child to take at night to help with itching as itching is common at night. Dietary exclusion should only be undertaken in severe cases and only if parents report worsening of eczema after eating certain food products. If anyone is interested in knowing the details about dietary exclusion, it will be published later on this blog.
It is important to keep your child’s eczema under control to avoid severe flare ups. Therefore, use emollients liberally and do not wait for the eczema to get worse. During flare ups do not hesitate to use topical steroids as advised by your doctor. In most cases good control of the condition is achievable with above mentioned measures. You can only wait and see if your child grows out of it.

Diarrhoea

Diarrhoea (loose stools) is very common in young children. It can be acute (sudden onset and lasts for less than 2 weeks) or chronic (lasts longer). This post is about ‘acute diarrhoea’ in children. The main aim of treatment in diarrhoea is to give plenty of fluids to prevent dehydration.
What causes diarrhoea?
Most common cause of diarrhoea in children is a virus (most commonly rota virus). Virus spreads through contaminated water or food and also from person to person through contact. Food poisoning can also cause diarrhoea. Bacteria such as salmonella and campylobacter cause food poisoning. Non-infectious diarrhoea is uncommon in children and will be explained in subsequent blogs.
Signs and Symptoms
Children with viral diarrhoea present with frequent, loose, watery stools. In case of rota virus stools may be blackish green in colour and may be foul smelling. Child might experience vomiting and stomach cramps. Fever is also common. If your child does not take plenty of fluids, signs of dehydration (sunken eyes, dry lips and tongue, reduced urine out-put, lethargy) may become evident.
Warning signs
A child who does not drink or has had severe diarrhoea and vomiting is more likely to have severe dehydration. Signs of severe dehydration include drowsiness, cold feet and hands, irritability and passing very little urine. In presence of these signs you should contact your doctor immediately.
Treatment
What can you do at home?

1. Give your child plenty of fluids to drink. ORS (oral rehydration solution) is the best rehydration solution which can be used during this illness. ORS contains salts and glucose needed for the body. It comes under various trade names (Dioralyte, Rehydrat, Electral etc) in sachets to be mixed with water to give your child as a drink.
2. Each time after passing stools give 50-100 mls of fluids to replace the loss. If he/ she is vomiting give smaller amount (5mls/5min).
3. If your child is not taking solids do not worry (as long as he/she is taking fluids).
4. If you are breast feeding continue to do so.
5. Wash their hands thoroughly with soap and water after toilet and before food.
6. Avoid sending them to school/ nursery/ swimming pools.

When does the child need hospital treatment?
If you notice any of the above mentioned ‘warning signs’, you need to see the doctor. If your child is severely dehydrated he may need fluids given through his veins (i.e. through the blood circulation via IV cannula). Calories and salts can be given in this way to the child in the hospital. If you notice blood in stools you need to contact the doctor as this could be due to bacteria and may be more dangerous.Medication is not usually needed in children to stop diarrhoea.Main stay of treatment is maintaining hydration.
‘Toddlers diarrhoea’ will be explained in the subsequent blogs.