Is Eczema in Infancy the Spark that Ignites a Child’s Allergies? (Pedcast by Sonya Corina Williams)

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You are just not paying attention if you haven’t noticed that more children today have eczema and allergies than in past generations. Allergy is one of the most common chronic health problems children today have. Interestingly, most children with allergies have eczema before their allergies develop. A coincidence or does this tell us something fundamental about what triggers allergy?  Stay tuned and my outstanding intern Sonya Corina Williams and I are about to tell you the answer to this interesting and practical question.

Musical Intro

What is the Allergic March?

For a long time, pediatricians have recognized that children who develop rough itchy skin, a condition called eczema, frequently turn out to suffer from food allergies, seasonal hay fever, and asthma. This sequence is so common that is has been coined with the name, the allergic march because as the child gets older, these maladies typically appear in a predictable order- eczema first, then food allergies, then hay fever, and finally asthma. The child literally marches from one condition to another. Fortunately, not every child who develops eczema in infancy gets all the rest of these problems but pediatricians have also noticed that the more intense the eczema, the more likely these other conditions develop. They must all be related in some way, right?   All of these problems are signs of a child’s immune system acting up, overreacting to substances that should not provoke reactions but somehow do. Substances like milk, peanuts, grass pollen, or cat dander. Until recently, it was thought that allergies are mostly a manifestation of a child’s genes that drives the child’s immune system to overreact but recent evidence points to an additional mechanism which we are about to talk about.  And, if you think about it, the child’s immune system overreaction happens where the child’s body interacts with the outside world- their skin that touches various surfaces, the inside of their intestines where various foods pass through, and the inside of their noses and bronchioles where dusts and other airborne substances settle; all places where stuff from the outside world touches the child. So, you can see that the outside has something to do with provoking allergies and when it happens, it happens in a very predictable way, usually in the baby’s skin first. It turns out that the baby’s rough skin may be the initiating event to the entire process as you are about to see.

 

 

What is Eczema and why does the Allergic March Start in the Skin?

 

So why does the allergic march start with eczema? It may seem like eczema is just a skin-deep issue, right? Well let’s delve into the issue of eczema a little further. The word eczema comes the Greek meaning “bubbling up” and for a long time, there has been a debate among doctors as to whether eczema starts under the skin surface and bubbles up, hence the name, or whether eczema is actually a surface barrier problem where the skin ‘s outer barrier is failing and therefore letting allergens get through and provoking allergic reactions. This is known as the barrier hypothesis. Recent evidence confirms that the basic problem in eczema is a  ‘barrier problem’ and here is why it mostly affects young babies.  A baby’s skin is much thinner than an older child’s skin and is more prone to drying and cracking allowing allergens to touch the deeper part of the skin. This actually makes sense when you think about it. Just close your eyes and run your hand gently over the skin of a child with eczema and you can tell that the surface barrier, the epidermis of their skin, has a lot of cracks compared to a child without eczema. Could those cracks actually be letting allergens touch the baby’s deeper skin and start the allergies …and… could prevention of cracking by frequent application of moisturizers prevent the entire allergic march? The answer is a resounding YES!  Evidence is growing that meticulous skin care in infancy can preserve the skin barrier and prevent the child from having allergic diseases. This information is earth for shaking for today’s children since about 20% of the children in the US suffer from either hay fever, food allergy or asthma. So, here is the important point; It looks like the skin care practices parents use on their children in infancy, when their skin is thin and vulnerable to cracking, may be the key to them avoiding asthma, hay fever, and food allergies. Changing a simple thing like skin care can potentially avoid chronic diseases that affect 1 in 5 children….amazing!

 

Tackling the Problem with Some Practical Tips

 

Now to the most important part of this pedcast – How do you as a parent prevent your children from developing eczema and what are the actionable steps you can take to protect your kids from the experiencing the allergic march? The answer is surprisingly easy and inexpensive. In fact, we shouldn’t be surprised to learn that parents through the ages in multiple cultures discovered the secret long ago… moisturizers, oils of various sorts applied to the baby’s skin when they are very young! The Middle Eastern moms have traditionally used oil of chamomile, moms in Southeast Asia have preferred to use coconut oil, African moms turned to shea butter, and the moms of the Mediterranean have preferred using olive oil. It really is that simple. Today in America, moms seem to prefer commercial moisturizers that have long shelf lives and are expensive. I’m not sure that’s so smart given the preservatives used to store these oils and maybe we should start to rethink that practice.  But that’s your choice. Here is what I suggest to the parents of the children I care for as far as skin care:

 

Doc Smo’s recommendations for skin care in contemporary America

  1. Keep bathing to a minimum. Only bathe your baby when they start to smell like they need a bath which can be as infrequent as once a week.  And make sure to use as cool a water as possible because hot water will remove the natural oils from your baby’s skin and that is exactly what you as a parent don’t want to do. Removing the natural oils can lead to drying and cracking and maybe even… the allergic march.
  2. When you do bathe your baby or young child, try and be as gentle as possible with a minimum of soap. Babies don’t need their skin scrubbed, mostly just a rinse to remove some of the surface bacteria. Babies don’t get dirty, just smelly and germy. Remember this Doc Smo pearl: Hot water, soap, and scrubbing are great for cleaning pots and pans in the kitchen but not for your baby’s skin.
  3. One of the best times to apply oils to a baby is after bathing. This is a strategy called “soak and seal”. ‘Soak’ to soften and hydrate the skin, and then use a good ointment to ‘seal’ in the moisture. The moisturizer of choice actually doesn’t matter too much – you can use food oils like the ancients did-things like coconut, shea butter, or olive oil or you can even use one of the numerous lotions made for babies. Even, simple Vaseline can be a good option.  The frequency of moisturizing is probably more important than the actual moisturizer that you chose.
  4. A good rule of thumb is to minimize your child’s skin exposure to chemicals, so choose moisturizers, laundry detergents, and diapers that have minimal chemicals or smells. Your baby’s skin is far more delicate than yours, so it’s worth keeping in mind what chemicals come into contact with their thin skin.
  5. Unfortunately, despite following all these recommendations, some babies still develop eczema. Don’t feel bad if your baby does. Skin care is not the whole issue when it comes to eczema but it is important factor.

Outro

Well, that’s it for today! It’s really not so hard to prevent eczema in many kids, and by doing so, prevent a whole slew of potential allergenic issues in their futures. Babies are oiled and moisturized around the world and have been for centuries! So, let’s learn from these ancient practices that have worked for generations around the world.  If you find the information you get from Portable Practical Pediatrics valuable, please take a moment to rate it where you get your podcasts. This is Dr. Paul Smolen, reminding you that its not a sin, to take great care with your children’s skin. Until next time.

Many thanks to Sonya Corina Williams for her help in researching and writing of this podcast.

 

 

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