Managing Atopic Dermatitis in Infants: Key Questions and Answers

Atopic dermatitis

Dr.
Zhou: Hello.
My child is almost 5 months old.
During the health check last week, the doctor mentioned that he has atopic dermatitis (current condition: red rashes on the face, rough skin on hands and feet, prone to sneezing, eyelids easily become red, sometimes has dark circles).
I would like to ask: 1.
Is it currently okay for him to eat rice cereal and drink fruit juice or fruit puree (I have been giving it to him since he turned 4 months)? 2.
He is currently on S-26 formula; should we switch to a hypoallergenic formula (Nestlé Nan)? 3.
The pharmacist suggested that increasing calcium intake could reduce allergy symptoms; is this true? 4.
The doctor recommended applying Vaseline, but the pharmacist said Vaseline might be too greasy and suggested using Bepanthen cream instead.
Which advice is correct? 5.
Are dust mite-proof bedding products effective? How should I choose them? 6.
What other precautions should I take? Thank you.

Sandra, 30~39 year old female. Ask Date: 2000/11/22

Dr. Zhou Zuyou reply Pediatrics

1.
It is recommended to delay the introduction of solid foods for children with allergic tendencies by 1-2 months.

2.
Hypoallergenic formula can be consumed until the age of 3, which is said to reduce the risk of allergies by half.

3.
Calcium can improve respiratory allergy symptoms, but its effect on atopic dermatitis is less significant.

4.
Both options are acceptable; using sheep oil or baby oil is also fine.

5.
The structure of the bed should be made of wood, metal, or waterbed materials, and the mattress should be covered with a dust mite-proof cover.
Avoid using materials such as cotton, fleece, or spring mattresses, and wash them regularly.
It is best to use pillows made of synthetic fibers and cover them with dust mite-proof pillowcases to prevent dust mites from entering.
Avoid using materials like cotton batting or feathers.

6.
Allergy testing can be conducted after the age of 2, and it is advisable to avoid exposure to identified allergens.

Director of Pediatrics, Tainan Hospital, Department of Health, Hong Shao-Hui.

Reply Date: 2000/11/22

More Info

Managing atopic dermatitis (AD) in infants can be challenging for parents, especially when it comes to understanding dietary choices, skincare, and environmental factors. Here’s a comprehensive response to your questions based on current medical knowledge and practices.

1. Dietary Considerations: Introducing solid foods, such as rice cereal and fruit purees, is typically recommended around 4 to 6 months of age. However, if your infant has been diagnosed with atopic dermatitis, it is essential to introduce new foods cautiously. Start with single-ingredient purees and monitor for any allergic reactions, such as increased redness or itching. If your child has a history of food allergies or eczema, consult your pediatrician or a pediatric allergist before introducing new foods.

2. Formula Choices: If your infant is currently on S-26 formula and has been diagnosed with atopic dermatitis, switching to a hypoallergenic formula, such as Nestlé Nan or other extensively hydrolyzed formulas, may be beneficial. These formulas are designed to reduce the risk of allergic reactions and may help in managing symptoms of atopic dermatitis. Discuss this option with your pediatrician to determine the best course of action for your child.

3. Calcium and Allergies: While calcium is essential for overall health, there is limited evidence to suggest that increased calcium intake directly reduces allergic symptoms. A balanced diet that includes adequate nutrients is crucial for your child's growth and immune function. If you have concerns about your child's diet and allergies, consulting a pediatric nutritionist may provide tailored advice.

4. Moisturizers: The use of moisturizers is a cornerstone in managing atopic dermatitis. While Vaseline (petroleum jelly) is an effective occlusive agent that helps lock in moisture, some parents find it too greasy for daily use. Alternatives like CeraVe or Aquaphor can be effective as well. The choice between Vaseline and other creams often comes down to personal preference and how your child's skin responds. It’s essential to apply moisturizers immediately after bathing when the skin is still damp to maximize hydration.

5. Dust Mite Allergens: Dust mites are common triggers for atopic dermatitis and other allergic conditions. Using dust mite-proof covers for pillows and mattresses can help reduce exposure. When selecting bedding, look for products labeled as hypoallergenic or specifically designed to block dust mites. Regular washing of bedding in hot water (at least 130°F) can also help minimize dust mite populations.

6. Additional Considerations:
- Bathing Practices: Bathe your infant in lukewarm water and limit bath time to 10-15 minutes. Use mild, fragrance-free cleansers and apply moisturizer immediately after bathing.

- Clothing Choices: Dress your child in soft, breathable fabrics like cotton. Avoid wool and synthetic fibers, which can irritate the skin.

- Environmental Control: Maintain a humid environment, especially during dry seasons, to help keep the skin hydrated. Consider using a humidifier in your child's room.

- Monitoring Symptoms: Keep a diary of your child's symptoms, dietary changes, and any potential triggers. This can help identify patterns and inform discussions with your healthcare provider.

In summary, managing atopic dermatitis in infants involves a multifaceted approach that includes careful dietary management, appropriate skincare, and environmental controls. Regular follow-ups with your pediatrician or a dermatologist are crucial to monitor your child's condition and adjust treatment as necessary. Always consult your healthcare provider before making significant changes to your child's diet or treatment plan.

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