Eczema, particularly if severe, can make starting solids extremely challenging and uncomfortable. Check out these tips to minimize discomfort and maximize enjoyment during mealtime courtesy of Solid Starts allergist Dr. Sakina Bajowala and Solid Starts mom Mindy Lee. Plus, good news: Most infantile eczema significantly improves as baby grows older...so clear skin is likely in baby's future.
Babies with severe eczema are more likely to have food allergies than babies without eczema. Further, in consultation with a pediatric allergist, babies with eczema may benefit from the early introduction of food allergens—especially egg and peanut—to help prevent those food allergies from developing. For more on allergy prevention, see our Allergies page.
When working with a pediatric allergist, keep allergy testing focused on foods that you suspect of allergy. Focused testing on allergens that have already caused symptoms or are strongly associated with a known allergen is less likely to yield false positive results. Comparatively, broad screening test panels (both skin tests and blood tests) are fraught with false positive results and can result in unnecessary dietary restriction. Medically supervised oral food challenges are the gold standard for determining if a food is an allergenic trigger and which foods are safe to eat.
Before you serve food to baby, apply a thin layer of barrier ointment—such as pure petroleum jelly or a plant-based oil/wax balm—to baby’s face. This layer of protection will help prevent contact rashes and serve as a barrier between acids and allergens in the food and baby’s sensitive skin.
While it may be tempting to wipe off sauce or yogurt from baby’s cheeks and chin, try not to wipe the skin repeatedly during meals. Scrubbing or repeatedly wiping food off baby’s face can irritate the skin and annoy baby, which can also lead to a negative association with the high chair and eating. Use a barrier ointment before meals as described above and wait until the meal is finished to clean up.
When you wipe baby’s face after a meal, use lukewarm water—not hot—and, if needed, a gentle cleanser free of fragrance and dyes. Pat baby’s skin dry and apply a generous amount of hypoallergenic moisturizer.
If baby’s fingers are sore or irritated, have a bowl of cool water nearby during the meal so baby can dip their hands in and cool off the skin.
Many babies prefer to eat with their fingers because it’s easier, faster, and doesn’t require the fine motor skills needed for independent utensil use, but utensils help minimize skin contact with food. Model eating with utensils, pre-load forks, spoons, and chopsticks and pass over in the air to baby. Try using multiple utensils at mealtime so baby always has one to hold while you load the next one.
Keep a journal or use the Solid Starts app to track patterns. Doing so may help you better understand your child’s reactions to some foods.
Follow your clinician's guidance when it comes to treating baby's eczema with topical moisturizers and treatments. Studies have shown that twice weekly application of a small amount of topical anti-inflammatory ointments to areas prone to eczema flare-ups can result in lower cumulative steroid exposure than as-needed application of these medications.
During a flare up, minimize acidic foods like tomato or pineapple and save the cayenne pepper for another meal. During flare ups, direct contact with acidic and spicy foods can cause stinging or burning. The same goes for extra juicy or sticky foods.
Help your child learn words to match their experiences, things like “itchy” and “sting.” While the comprehension may take some time, it will help your soon-to-be toddler tell you when they are itchy or feel a flare-up coming.
If mealtime is turning into a negative experience because your child is getting too itchy or their skin starts flaring uncomfortably, it’s okay to stop the meal and take a break. Don’t force things. You can always come back to the table later.
Eczema may appear redder and more inflamed if baby overheats, cries, or rubs against something, so don't jump to blame baby's diet. While there will be foods that are more triggering or flare up your child’s eczema more than others, unless your medical professional has advised otherwise, don’t eliminate these foods from the child’s diet. Doing so can lead to unnecessary food restriction. In fact, avoiding the food might increase the risk of allergy development.
It's actually a bit more complicated than that... It is true that a minority of babies with moderate-severe eczema may actually have clinically significant food allergies. For these babies with difficult to control eczema that doesn't respond well to emollients and medications, targeted allergy testing to identify possible trigger foods might be helpful. However, for most babies with eczema, attempting to limit certain foods from the diet in an attempt to clear up the skin actually does more harm than good. Studies have shown that elimination diets in babies with eczema can increase the risk of developing life-threatening food allergy, because they remove the preventive benefits of sustained allergen exposure over time. Therefore, we would say the best recipe for eczema control in babies is equal parts barrier protection (with regular application of moisturizers), limiting contact irritants (friction, heat, fragrance, etc.), judicious application of topical anti-inflammatory medications, and dietary diversity. Mix well, and serve often!
If things are challenging or you suspect that baby may develop a negative association with eating, ask your health care provider for a referral to a feeding therapist to support you in your journey.
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