Children with eczema (atopic dermatitis) tend to get patches of dry, itchy skin. The itch can be so uncomfortable it interferes with sleep, making your child feel miserable. Plus, scratching can cause the rashes to get infected.
While there is no known cure for eczema, the condition can be treated so your child feels better. There are also ways to help your child avoid eczema flare-ups.
Eczema treatments usually target four common problems: dryness, itching, irritated skin (inflammation), and infection.
Dryness: repairing the skin barrier
For children with eczema, the skin barrier isn’t holding in water well. As a result, the skin becomes dry and cracked, and is more likely to get infected. Dry skin is also very itchy. Gentle skin care daily is important to improve the skin barrier. As part of this:
Give your child a bath (or shower) every day or every other day for 5-10 minutes in lukewarm water. No soap is needed, but a gentle non-soap cleanser can be used on the sweaty areas (armpits, neck, groin) and on the hands and feet. Use only fragrance-free, hypoallergenic cleansers. Avoid scrubbing your child’s skin with anything rough. Don’t use bubble bath in the bath water.
Pat your child’s skin dry after the bath or shower. If your doctor has prescribed any topical medicines, apply these to the areas of rash (BEFORE applying any moisturizers).
Apply a moisturizer to the whole body immediately after bathing (while the skin is still damp) everyday. This helps “lock in” the moisture of the water. The creamier the moisturizer, the better it will work. Ointments such as petroleum jelly or fragrance-free moisturizing CREAMS are good choices (lotions are thinner and less effective). Most importantly, find a moisturizer that your child likes to use. Moisturizers should be applied once or twice every day, even when the rash is gone.
Dress your child in soft fabrics like 100% cotton. Use mild, fragrance-free laundry detergents. Don’t use fabric softeners or fabric sheets in the dryer. Minimize your child’s exposure to things that are known to commonly be irritating to sensitive skin. This includes fragrance in products and in the air, for example, as well as smoke, dust, wool, and animal dander.
Reducing the itch
Gentle skincare as described above is the first step in making the skin feel less itchy.
Other ways to help reduce the itch:
Prevent scratching. Try to stop your child from scratching as much as possible since scratching can make the skin feel even more itchy. Scratching can also lead to open sores which can lead to skin infections. Keep your child’s nails cut short. Wearing cotton gloves at night can also help.
Wet wrap treatments. Apply wet wraps AFTER bathing and applying topical medicines and moisturizers. Here’s how:
Apply prescribed medicine to areas of rash and apply moisturizer to surrounding skin.
Soak a pair of pajamas or onesies in warm water.
Wring out the pajamas until they are damp and not dripping.
Put the damp pajamas on your child, with dry pajamas on top.
Make sure the room is warm or provide a warm blanket, so your child doesn’t feel cold.
Keep the wet wraps on for at least a half an hour, or leave them on overnight.
After removing the wet wraps, reapply moisturizer.
Antihistamine medicines like diphenhydramine and hydroxyzine may help your child feel drowsy so they fall asleep more easily instead of scratching their skin. Antihistamines do not usually take away the itch, though. Always follow directions about your child’s age and weight and talk with your doctor or pharmacist if you have questions.
Healing irritated skin
Topical steroid medicines (“steroids” or “cortisones”) are applied to the skin to heal irritated eczema rashes (inflammation). These prescription medications are usually used twice a day when the rash is flaring. Topical steroids come in different strengths and forms (such as lotions, ointments, creams, gels, and oils). Your doctor will help you find the right combination for your child’s skin. When used correctly, topical steroids are very safe and effective.
Non-steroid eczema medicines (tacrolimus ointment, pimecrolimus cream, crisaborole ointment) also help heal irritated eczema rashes using different active ingredients than steroids. They can be helpful on mild eczema and on delicate areas of skin, like the eyelids, armpits and groin.
Managing & preventing skin infections
Bacteria and viruses can make eczema rashes worse, and it’s important to watch for signs of infection.
Look for oozing, crusting, pus bumps, blisters or a worsening rash that is not getting better with your usual treatments. Be sure to talk to your doctor if you think your child’s skin is infected. Infections may require antibiotic or antiviral medicines.
Diluted bleach bathsSoaking in a tub with a small amount of bleach added to the water 2-3 times per week can help prevent infections. Bleach baths, which are similar to swimming in a chlorinated pool, are easy to do at home:Add 1/2 cup of plain household bleach (sodium hypochlorite) OR 1/3 cup of concentrated household bleach to a full tub of lukewarm bathwater and stir the water to dilute the bleach. Make sure you use PLAIN bleach; splash-free or scented bleach products are not effective and could lead to more irritation.If using an infant tub, use 2 tablespoons of bleach to a full tub of water.Have your child soak in the bath for 10-15 minutes. Try to soak the entire body. Since the bath is like a swimming pool, it is safe to get your child’s face and scalp wet as well. For babies and young children, use touch supervision to avoid drowning as you would during regular bath time.Rinse the dilute bleach water off at the end of the bath. Then, after pat-drying the skin, apply eczema medicine to areas of rash and a moisturizer all over.
New treatments for eczema
Biologic therapies (“biologics”) are medicines that target the part of the immune system that is causing the irritated skin rash. Dupilumab is the first biologic therapy approved by the U.S. Food & Drug Administration (FDA) for the treatment of eczema in children ages 6 and up. This medication can be very helpful for moderate to severe eczema that is not well controlled with topical medicines and gentle skin care. Talk to your doctor to learn more about this treatment option.
When can I stop treatment for an eczema rash?
Once your child’s skin is no longer itchy and the areas of rash are smooth and soft, you can start to use the medicines less often. It is common for the skin to be discolored after the rash flare heals, but the color will naturally normalize over time. However, since eczema is an ongoing skin problem, it is important to continue your routine of gentle skin care and use of moisturizers every day to minimize future flares and infections.
How can I prevent future eczema flares?
Gentle daily skin care, as described above, is one of the most important things you can do to prevent future eczema flares. Talk with your doctor about a daily routine that is best for your child.
Avoiding triggers is also important to prevent future flares of eczema. Eczema triggers are different for different children. Some parents and physicians may consider allergy testing to further identify triggers that can be avoided. Some triggers include:
Dust mites
Fragrances (including perfumes, colognes, air fresheners, candles, incense)
Heat and sweat
Hormones
Insect bites and stings
Pet dander
Pollen
Tobacco smoke
Wool and synthetic fabrics
In rare cases, certain foods can flare an eczema rash. If you think this might be the case, talk to your doctor before trying any restrictive dietary changes.
Remember
Keep in mind that your child’s eczema may still flare despite your best efforts. Eczema is an ongoing skin problem that requires patience and consistent skin care.
Hives, also known as urticaria, are pink or red bumps in the skin. They are sometimes described as welts. Hives usually appear out of the blue without warning. Each hive tends to flatten out over a few hours, but new bumps can continue to appear for several days or longer.
What do hives look like?
They can be small and round red bumps or larger swellings of all different shapes. Sometimes they are even ring or donut-shaped or shaped like a target. The rings may have normal skin in the middle, or look purplish or bruise-like. Sometimes this purple patch will last longer than the hive itself. Hives are usually itchy. Hives can appear anywhere on the body.
It is common for young children with hives to also get swelling of the hands and feet. This can be uncomfortable, and can cause the child to be fussy and unhappy.
Who gets hives?
Children and adults of any age can get hives. Hives are very common. 15-20% of people will get hives at some time in their lives.
What causes hives?
Hives are a reaction to lots of different triggers. Minor infections from viruses are a common cause of hives in young children. Often the child seems well and has no or very few other sick symptoms before the hives begin.
Other things that can cause hives include: foods, medicines, additives to foods and vitamins such as color dyes, other kinds of minor infections such as dental infections, and in some cases even exercise, stress, sunlight, ice or other cold things touching the skin, or very rarely other underlying illnesses. In up to a third of cases, however, a specific cause for hives cannot be found.
How long do hives last?
In most children, outbreaks of hives will end within 2 weeks. Occasionally the hives can keep coming for weeks to months.
How are hives diagnosed?
Hives are usually easily recognized when seen by a healthcare provider. In most cases, there are no good tests to figure out why a child has hives. If outbreaks of hives are lasting for many weeks, further testing may be recommended depending on if the child has any other symptoms.
Treatment for Hives
If there is a known trigger for the hives, it should be avoided. As mentioned above, most cases of hives in children don’t have a clear trigger that you can avoid.
Antihistamines are the main treatment for hives. Your healthcare provider may recommend over-the-counter cetirizine, loratadine or fexofenadine during the daytime because they do not cause sleepiness. Over-the-counter diphenhydramine may be recommended at night. These medications work best when taken on a regular schedule each day to keep the hives from coming back.
Your doctor may prescribe other treatments for hives that don’t respond to antihistamines.
When should I be worried about hives?
Let a doctor know right away and go to the nearest emergency room if your child has swelling or tingling of the mouth, tongue or throat, trouble breathing, trouble swallowing, and/or vomiting with the hives. These symptoms need emergency care.
Henoch-Schonlein purpura (HSP) is disease that causes small blood vessels to become swollen and irritated—a condition called vasculitis.
It is most common in children between the ages of 3 and 15 years old and is rarely seen in adults. HSP is not contagious and tends to affect boys more than girls.
Cause
The actual cause of HSP is not known. About half the time, however, children who get HSP have a cold or respiratory infection such as strep throat beforehand. HSP has also been linked to bug bites, cold weather, and some vaccinations.
Signs & Symptoms
Usually, the first sign of HSP is a rash called palpable purpura that appears as dark reddish splotches on the feet, legs, and buttocks. A child with HSP may also have joint pain, abdominal pain, and/or kidney problems.
Rash
Nearly every child diagnosed with HSP has a painless rash. The rash usually starts as raised wheals, reddish blotches, and little red dots (petechiae) around the feet and ankles. The rash may also be on the legs and buttocks. In smaller children—especially those who do not yet walk—the rash is often seen on the arms, trunk, and face. The rash usually takes about 10 days to fade.
Joint Pain
The majority of children with HSP experience joint pains. Children typically only have a few affected joints—hips, knees, and ankles. While the joints may swell for 1-3 days, there is no permanent damage.
Abdominal Pain
About 50% of children with HSP will have abdominal pain. Abdominal problems may be fairly mild (e.g., nausea, vomiting, and mild pain). In rare occasions, abdominal problems are much more serious and involve gastrointestinal bleeding or intussusception. Intussusception is when the intestine folds in on itself and may become blocked. Abdominal pain tends to come on about a week after the rash first develops.
Kidney Problems
About 25% to 50% of children with HSP will have kidney problems. Usually, kidney problems due to HSP begin within days to 6 weeks after the rash first appears.
The most common kidney problem seen is blood in the urine. Blood is the urine is not usually visible to the naked eye. About 10% of the time, the urine becomes red or brown from blood. Up to 50% of patients also lose protein in the urine, and about 20% of the time protein lost is excessive.
Excessive loss of protein in urine requires the help of a pediatric nephrologist. Losing a lot of protein means a child is at risk for more serious problems—kidney damage and high blood pressure. Sometimes a pediatric nephrologist will perform a kidney biopsy to look at how severely a HSP affects a child’s kidneys.
Diagnosing HSP
The diagnosis of HSP is almost always based on symptoms. Your pediatrician may do blood and urine tests to help rule out other conditions and to check kidney function. There is not a specific blood test to diagnose HSP. An abdominal ultrasound may be done in patients with severe abdominal pain. In patients who have partial or unusual symptoms, a biopsy of the skin or the kidney may help make the diagnosis.
Treatment
HSP is a mild illness, so it is usually treated with rest, fluids, and over-the-counter pain medicines such as acetaminophen (Tylenol). In severe cases, a child may need to be hospitalized.
Once the symptoms of HSP disappear, children should have their urine checked for blood and protein for at least 6 months after they are first diagnosed—even if their urine was normal at first. This is to make sure that the disease did not damage a child’s kidneys and that they are working properly. Sometimes, HSP in the kidneys persists or comes later and may need additional treatment.
Outlook
Most of the time, HSP improves and goes away completely within a month. Sometimes HSP relapses; this is more common when a child’s kidneys are involved. If HSP does come back, it is usually less severe than the first time.
The long-term prognosis of HSP largely depends on whether the kidneys have been involved and, if so, how severe the involvement is.
Almost all newborns lose some or all of their hair. This is normal and to be expected. The baby hair falls out before the mature hair comes in. So hair loss occurring in the first six months of life is not a cause for concern.
Very commonly, a baby loses her hair where she rubs her scalp against the mattress or as a result of a head banging habit. As she starts to move more and sit up or outgrow this head rubbing or banging behavior, this type of hair loss will correct itself.
Many babies also lose hair on the back of the scalp at age four months as their hair grows at varying times and rates. In very rare cases, babies may be born with alopecia (hair loss), which can occur by itself or in association with certain abnormalities of the nails and the teeth. Later in childhood, hair loss may be due to medications, a scalp injury, or a medical or nutritional problem.
An older child may also lose her hair if it’s braided too tightly or pulled too hard when combing or brushing. Some children (under age three or four) twirl their hair as a comforting habit and innocently may pull it out. Other children (usually older ones) may pull their hair out on purpose but deny doing so, or they simply may be unaware that they are doing it; this often is a signal of emotional stress, which you should discuss with your pediatrician.
Alopecia areata, a condition common in children and teenagers, seems to be an “allergic” reaction to one’s own hair. In this disorder, children lose hair in a circular area, causing a bald spot. In general, when it’s limited to a few patches, the outlook for complete recovery is good. But when the condition persists or worsens, steroid creams and even steroid injections and other forms of therapy at the site of the hair loss often are used. Unfortunately, if the hair loss is extensive, it may be difficult to renew its growth.
Because alopecia and other types of hair loss can be a sign of other medical or nutritional problems, bring these conditions to your pediatrician’s attention whenever they occur after the first six months of age. The doctor will look at your child’s scalp, determine the cause, and prescribe treatment. Sometimes, a referral to a pediatric dermatologist is necessary.
Gangrene describes the death of infected tissue. This tissue damage may be caused by the Clostridium bacterium—most commonly, Clostridium perfringens. When this is the case, the disease is called gas gangrene or clostridial myonecrosis (myo refers to muscle, and necrosis to death). It is a rare but life-threatening infection that occurs when these bacteria multiple and produce toxins, causing tissue injury. This condition is frequently associated with a recent surgical wound or trauma.
Signs and Symptoms
If gas gangrene develops in your child, it will probably begin with pain at the site of the existing wound. Next, your youngster may experience fluid buildup (edema), tenderness, and a worsening of the pain. Her heart rate may increase (tachycardia), along with rapid breathing, sweating, paleness, and fever. If untreated, her condition can get worse and lead to a lowering of blood pressure to dangerous levels (hypotension), kidney failure, an impairment of her mental status, and shock.
The incubation period from the time of infection to the appearance of symptoms can be as short as 6 hours and as long as 3 weeks. In most cases, the period is 2 to 4 days.
When to Call Your Pediatrician
If there are signs of infection, particularly if associated with a skin wound, contact your pediatrician immediately.
How Is the Diagnosis Made?
Your doctor will diagnose gas gangrene based on your child’s symptoms, along with laboratory tests to find Clostridium bacteria such as cultures and smears of a blood sample and secretions from the infected area.
TreatmentGas gangrene must be treated immediately by:Surgically removing the dead and infected tissueAdministering penicillin intravenously Managing shock and other complicationsPossibly treating the patient in a high-pressure oxygen chamber, although the effectiveness of this approach has not been provenWhat Is the Prognosis?Unless properly treated, gas gangrene can become progressively worse, leading to the spread of the infection throughout the body (sepsis) and often death within hours.
Prevention
If your child has a skin injury, wash the area with soap and water and keep it clean. If the wound becomes seriously contaminated, visit your pediatrician or an emergency department, where they likely will flush it with water and start antibiotics such as penicillin or clindamycin.
If your child has bright red cheeks but has not been playing outdoors in the cold, it might be fifth disease. This common childhood illness got its name because it was the fifth disease on a historical list of six common skin rash illnesses in children. It is caused by a virus called parvovirus B19, which is also known as Erythema infectiosum.
The illness usually is not serious. Symptoms of fifth disease may include a mild rash, fever, runny nose, muscle aches, and a headache. Outbreaks in school-aged children are common in late winter and early spring.
How do I know if my child has fifth disease?
Fifth disease starts off like many other viral infections, so it can be hard to know for sure if your child has it. Your doctor will look at the rash and may do blood tests to check for antibodies to the virus.
The rash is the best clue. A bright red rash that first appears is what is known as the “slapped cheek” rash. Sometimes another rash that looks lacy appears a few days later. The second rash often starts on the trunk and spreads to the arms, legs, and even the soles of the feet. It may be itchy but usually goes away after about a week. Even after a child is better, the rash can reappear weeks or months later when your child is hot (during exercise, bathing, etc.).
How does fifth disease spread?
Fifth disease spreads from person to person through respiratory droplets. Symptoms usually show up 4 to 14 days after being exposed to the virus, with the slapped-cheek rash showing up about 4 to 21 days after your child gets infected.
A child is most contagious before the rash appears and is not contagious after the rash appears. Once a person has fifth disease, they usually cannot get it again.
Good hand hygiene is the best way to prevent the spread of fifth disease in school, child care, and at home. Remind children to throw away used tissues and make sure that surfaces and objects that children touch are cleaned and sanitized regularly.
When can my child go back to school or child care?
When you see a rash, your child is no longer contagious. Fifth disease is often mild and goes away with some rest and recovery at home. Your doctor may suggest acetaminophen for fever, aches, or pain.
Does the virus ever cause serious problems?
Yes. The virus can affect the way the body makes red blood cells, the cells that carry oxygen through the body. This puts children who have a blood disorder or weak immune system at serious risk if they catch the virus.
The virus can also cause red blood cell counts to drop so low that a blood transfusion is needed. Children with cancer such as leukemia, HIV infection, and certain types of anemia (low red blood cell counts) such as from sickle cell disease, often must go to the hospital if they catch fifth disease. If your child has any of these conditions, check with your doctor at the first sign of the rash.
What if I get fifth disease when I am pregnant?
Most times, fifth disease does not cause problems for pregnant women and their babies. Rarely, serious problems can occur if the virus gets passed on and makes it hard for the fetus to make red blood cells. This can lead to severe anemia that causes hydrops fetalis, a buildup of fluid that can lead to heart failure or death.
Pregnant women with fifth disease may need to have the following tests:
Ultrasound to see if the baby is having problems.
Amniocentesis, a procedure to take amniotic fluid from the womb.
Cordocentesis, a procedure to check umbilical cord blood and find out how severe your baby’s anemia is. Usually, the anemia is not severe.
If you or your child is diagnosed with fifth disease, you should let any pregnant women know who may have been exposed.
Can fifth disease be confused with another rash?
There are many other skin rash illnesses, but not all of them look the same. Some–like measles, rubella (German measles), and chicken pox (varicella)–are easy to prevent if your child is up to date on immunizations.
Viruses also are to blame for common childhood skin rashes like hand, foot, and mouth disease, roseola, and even cold sores.
When should I call my child’s doctor?
If you think your child may have fifth disease, it’s okay to call your pediatrician with questions. Call right away if your child’s symptoms seem to be getting worse instead of better, you notice joint swelling, your child has chronic anemia, or your child looks very pale.
At least one in 10 children have eczema (also called atopic dermatitis), an ongoing skin problem that causes dry, red, itchy skin. Children with eczema have more sensitive skin than other people. Here’s what parents need to know about the condition.
What causes eczema?
Eczema is caused by problems with the skin barrier. Many children with eczema do not have enough of a special protein called “filaggrin” in the outer layer of skin. Filaggrin helps skin form a strong barrier between the body and the environment. Skin with too little of this protein has a harder time holding in water and keeping out bacteria and environmental irritants.
Both a person’s genes and their environment play a role in eczema. It often runs in families and tends to occur with other allergic conditions such as asthma and allergic rhinitis (hay fever and seasonal allergies). Many children with eczema also have food allergies, but foods themselves do not cause eczema.
What does eczema look like?
Eczema rashes can be different for each child. They can be all over the body or in just a few spots. The eczema rash often worsens at times (called “exacerbations” or “flares”) and then gets better (called “remissions”). Where the rashes develop may change over time:
In babies, eczema usually starts on the scalp and face. Red, dry rashes may show up on the cheeks, forehead, and around the mouth. Eczema usually does not develop in the diaper area.
In young school-aged children, the eczema rash is often in the elbow creases, on the backs of the knees, on the neck, and around the eyes.
Is eczema contagious?
No. Children with eczema are more prone to skin infections, but eczema is NOT contagious. The infections that children with eczema tend to get are often from germs that usually live harmlessly on everyone’s skin. These germs cause more problems for children with eczema because their skin doesn’t always have a strong barrier to keep them out.
How do I know if my child’s skin is infected?
Occasionally bacterial or viral infections develop on top of eczema rashes. Talk to your doctor if you see yellow or honey-colored crusting and scabbing, weepy or oozy skin, blisters or pus bumps, or rash that is not getting better even with the usual treatments.
Do children outgrow eczema?
For some children, eczema starts to go away by age 4. However, some children may continue to have dry, sensitive skin as they grow up. It is hard to predict which children will outgrow the condition and which ones will have eczema as adults.
Remember
Eczema can be frustrating for children and their parents, especially when the itching makes it difficult to sleep. Your pediatrician and pediatric dermatologist can help you manage your child’s eczema symptoms with a good treatment plan and a healthy skin maintenance routine.
A child’s toddler and preschool-age years are filled with new experiences, like a first playdate or first tricycle. Often by around age 5, however, a less-than-fun first also may pop up: a child’s first cold sore.
What are Cold Sores?
Cold sores (also called fever blisters or oral herpes) start as small blisters that form around the lips and mouth. They sometimes appear on the chin, cheeks, and nose, too. After a few days, the blisters usually begin to ooze, then form a crust and heal completely in one to two weeks.
Despite their name, cold sores actually have nothing to do with colds. In children, cold sores are usually caused by the herpes simplex virus type 1 (HSV-1). Genital herpes is usually caused by a different strain, herpes simplex virus type 2 (HSV-2), although both virus strains can cause sores in any part of the body.
Most people are first exposed to HSV between ages 1 and 5 years of age, and more than half of people in the United States are infected with it by the time they become adults. Beyond the uncomfortable sores that the virus can cause, HSV is usually harmless.
How Do Cold Sores Spread?
Cold sores are highly contagious. They can spread through saliva, skin-to-skin contact, or by touching an object handled by someone infected with the virus.
When a child develops a cold sore for the first time (also called primary HSV), the blisters often spread beyond the lips to the mouth and gums. A child may also have a fever, swollen and tender lymph glands, sore throat, irritability and drooling. Sometimes symptoms are so mild, though, parents may not even notice any of them.
When problems can arise:
The virus from cold sores can spread to the eyes, which can lead to HSV keratitis, an infection of the cornea—the clear dome that covers the colored part of the eye. The infection usually heals without damaging the eye, but more severe infections can lead to scarring of the cornea or blindness. HSV keratitis is a major cause of blindness worldwide.
HSV is especially dangerous to babies under 6 months of age. Parents or relatives with cold sores should be especially careful not to kiss babies—their immune systems are not well developed until after about 6 months old. Signs that a baby may have been infected with HSV include low grade fever and one or more small skin blisters. These symptoms can occur 2 to 12 days after HSV exposure. If these occur or if you have any concerns, call your pediatrician.
Do Cold Sores Come Back?
After a child’s first cold sore, the virus settles into bundles of nerve cells in the body—causing no symptoms unless it activates and travels back up to the skin’s surface. While the virus remains in the body for the rest of your life, the recurrence of cold sores is highly variable. Some children may never get another cold sore, while others may have multiple outbreaks a year. When the virus does reactivate, cold sores tend form again at the same spot but usually not inside of the mouth.
The first signs of a flare up include tingling, itching, or burning where the cold sore moves toward the skin. Parents might notice their child keeps touching or scratching a spot on the lip that starts to swell and redden before sores form.
Common Cold Sore Triggers:
Once a child is infected with the cold sore virus, it is more likely to return during times when the body’s immune system is run down or the skin becomes irritated from other causes.
Common cold-sore triggers for children previously exposed to the virus include:
Fatigue and stress
Exposure to intense sunlight, heat, cold, or dryness
Injuries to or breaks in the skin
Illness (i.e., cold or flu)
Dehydration and poor diet
Fluctuating hormones (i.e., during a teen’s menstrual periods, etc.)
What Parents Can Do:
Although there is currently no cure for cold sores, the good news is that they go away on their own. Some may take a little longer than others to heal. Cold sores are typically not treated, because the medications currently available only slightly speed up healing time. Parents can protect against the cold sores’ spread, help relieve the child’s discomfort during a flare-up, and try to avoid possible triggers.
Stop the spread.
Try to prevent your child from scratching or picking at cold sores. This can spread the virus to other parts of the body, such as fingers and eyes, as well as to other children who touch toys and other objects they play with. Wash hands and clean toys regularly.
During a cold sore flare-up, don’t let your child share drinks or utensils, towels, toothpaste or other items to avoid spreading the infection through saliva. Also, wash items such as towels and linens in hot water after use.
Children usually can go to child care or school with an active infection, but your pediatrician may suggest keeping them home if they drool a lot or are having their very first HSV outbreak.
If your child participates in sports that involve skin-to-skin contact such as wrestling, he or she should sit out during an active cold sore infection. Make sure mats and other equipment are cleaned regularly after use.
Ease discomfort.
Apply ice or a warm washcloth to the sores to help ease your child’s cold sore pain.
Chilled or icy treats such as smoothies may be soothing to tender lips and can help avoid dehydration.
Avoid giving your child acidic foods during a cold sore outbreak (e.g., citrus fruits or tomato sauce). These can irritate cold sores.
If your child’s cold sores continue to hurt—especially if he or she does not want to eat or drink because of mouth pain—ask your pediatrician about giving a pain reliever such as acetaminophen or ibuprofen. Your pediatrician may also suggest an over-the-counter cream or a prescription anti-viral cream to help reduce cold sore symptoms and shorten outbreaks by a day or two.
Avoid triggers.
Skin irritation can bring on a cold sore outbreak, so be sure your child uses lotion and a lip balm containing sunscreen or zinc oxide before heading outdoors.
Make sure your child gets enough sleep, exercise, and eats a well-balanced diet.
Help your child manage stress, which can increase the likelihood of cold sore outbreaks.
When to See Your Pediatrician:
During your child’s first cold sore infection: This is especially recommended if your child has a known difficulty in fighting infections or a chronic skin condition such as eczema.
If your newborn develops a blister-like rash or fever: This could be symptoms of a dangerous, neonatal herpes simplex infection.
If there are sores or blisters near your child’s eyes: HSV is the most common cause of corneal infections.
If your child develops a headache, combined with confusion, seizure or fever during a cold sore outbreak: This could signal a dangerous brain infection caused by the virus, including meningitis or encephalitis.
If the sores do not heal on their own within seven to 10 days: Your pediatrician might want to rule out a secondary bacterial infection and/or any other medical condition.
If skin surrounding cold sores becomes reddened, swollen or feels hot to the touch: This may be signs of a secondary bacterial infection. Infection that spreads to the bloodstream and body-wide (sepsis) can also be a concern for children whose immune systems are weakened by certain diseases and medications.
If your child gets frequent cold sores: Children with more than five or six outbreaks a year might benefit from antiviral medications. Talk to your pediatrician about a prescription if your child’s outbreaks are frequent.
Pinworms are parasites that live in the intestines. The infection is spread by ingesting microscopic pinworm eggs. Young children often put their hands in their mouths and may not practice good hand hygiene before eating. An infected child may spread the infection if he gets eggs from the anal area on his hands and touches other children’s hands or food. Eggs can get on objects such as shared toys, bedding, clothing, and toilet seats. Eggs can also get on surfaces when changing children’s soiled underwear or bathing them.
Pinworms are common among preschool age children and adults who care for them. Pinworms are very contagious in a family or child care setting. Child care settings include family child care homes and center-based child care facilities.
Some children have pinworms without noticeable symptoms. The presence of pinworms can be diagnosed by a simple method. After the child has been asleep for 2 to 3 hours, apply transparent tape to the anus (rectum). Do not use translucent tape. The tape will collect any eggs and small, threadlike, white pinworms. Place the tape on a glass slide; seal another piece of tape over it; and take the specimen to a medical provider. The specimen can be examined under a microscope to identify eggs and pinworms.
Perianal Strep
Perianal strep may be suspected in infants and toddlers who have very red, itchy, or painful skin next to the rectum. Other family members may have recent strep throat infections.
Poor Toilet Hygiene
Toilet “accidents” and poor toilet hygiene are common among young children. When girls do not wipe after urinating, and boys or girls do not wipe well after a bowel movement, the skin in the area that is damp or soiled may become irritated, causing itching.
Small/Tight Clothing
If clothing worn over the anal area is too tight, it may irritate the child and cause the child to frequently clutch and pull at the clothing.
What Parents Should Do
Consult the child’s medical provider for testing and treatment.
Follow caregiver recommendations.
Trim the child’s fingernails short.
Be sure to wash the child’s hands in the morning before breakfast and before any other meal or snack.
If pinworms are the problem, wash the child’s bed linen, clothing, and towels in hot water. Use the high heat setting when drying. Do not shake items—this will scatter the eggs.
Sunny days and starlit evenings spent playing, splashing, and exploring can leave kids with more than warm summertime memories. Balmy weather also can lead to itchy, irritated skin.
Check out the list from the American Academy of Pediatrics (AAP) to see how you can help prevent, identify, and soothe these common summertime skin rashes.
1. Heat Rash
Heat rash (also known as prickly heat or miliaria) is seen most often in babies and young children when sweat gland pores become blocked and perspiration can’t escape. The rash looks like patches of small pink or red bumps or blisters under clothing or spots where skin tends to fold—on the neck, elbows, armpits, or thighs—although heat rash can occur on other covered areas.
What parents can do:
Keep kids cool. Dress your child in clothing that keeps the skin cool and dry. If possible, use fans and air conditioning to avoid overheating.
Pay attention to hot spots. Wash areas of the skin that stay wet with sweat, urine, or drool with cool water. Pat them dry.
Keep skin bare. Leave areas open to air without clothing. Do not apply skin ointments.
2. Poison Ivy & Other Plant Rashes
Many children get a burning, intensely itchy rash where their skin touches plants—such as poison ivy, poison oak, sumac—containing a sticky oil called urushiol. An allergic skin reaction causes redness, swelling and blisters. Other plants—such as wild parsnip, giant hogweed, and citrus—contain chemicals that make skin hypersensitive to sunlight and cause a phytophotodermatitis rash.
What parents can do:
Prevent exposure. Teach your child what these plants look like and how to avoid them. Both poison ivy and poison oak have shiny green leaves that grow three to a stem, so you might share the rhyme: “Leaves of three, let them be.” The sumac shrub has stems that contain 7-13 leaves arranged in pairs, while wild parsnip and giant hogweed have clusters of small, flat-topped yellow and white flowers. If you have younger children, inspect the parks they play in and have rash-causing plants removed.
Wash and trim. If your child comes into contact with these plants, wash all of his or her clothes and shoes in soap and water. Also, wash the area of the skin that was exposed with soap and water for at least 10 minutes after the plant or the oil is touched. To discourage scratching and further damage to the skin, keep your child’s fingernails trimmed. This will also prevent the rash from spreading if there is still a small amount of oil under the fingernails.
Soothing salves. If the rash is mild, apply calamine lotion to cut down on the itching. Avoid ointments containing anesthetics or antihistamines—they can cause allergic reactions themselves. Another good option to reduce skin inflammation is 1% hydrocortisone cream.
Talk with your pediatrician. While mild cases can be treated at home, talk with your pediatrician if your child is especially uncomfortable, the rash is severe and/or isn’t going away, if the rash is on your child’s face or groin area, or if you notice signs of infection (i.e., fever, redness, swelling beyond the poison ivy or oak lesions).
3. Eczema
Eczema (also called atopic dermatitis or AD) is a chronic condition common in children that causes patches of dry, scaly red skin and tends to flare up during colder months when there’s less moisture in the air. But dryness caused by air conditioning and pressurized planes during summer travel can cause problems, too. Overheating, sweating and chlorine in swimming pools also can trigger eczema.
What parents can do:
Moisturize. Apply fragrance-free creams or ointments at least once a day or more often if needed. After a bath or swimming, gently pat your child’s skin with a towel and then apply moisturizer to his or her damp skin.
Dress wisely. Choose clothing made of soft, breathable fabrics like cotton when possible. Wash clothes in a detergent free of irritants such as perfumes and dyes.
Don’t scratch. Keep your child’s fingernails short and smooth, and remind him or her not to scratch. Scratching can make the rash worse and lead to infection.
Talk with your pediatrician. Ask your child’s pediatrician if allergies, sometimes triggered by trees and plants that bloom during summer, could be a cause of the eczema. Your child’s pediatrician may recommend medicines to help your child feel better and to keep the symptoms of eczema under control.
4. Insect Bites & Stings
Insects such as bees, wasps, mosquitos, fire ants, and ticks can cause itching and minor discomfort where they prick the skin. For some children, insect bites and stings can cause a severe allergic reaction called anaphylaxis—which includes a rash or hives and life-threatening symptoms such as airway swelling. (For children with a known allergy to insect bites and stings, it is important to have anaphylaxis emergency care plan in place). Other times, diseases spread by insects such as Lyme Disease, Rocky Mountain Spotted Fever, and Zika Virus can cause rashes and other health problems.
What parents can do:
Avoidance. When spending time outdoors, avoid scented soaps and shampoos and brightly colored clothing—they can attract insects. If possible, steer clear of areas where insects nest and gather (i.e., stagnant pools of water, uncovered food, and blooming flowers).
Use insect repellent. Products with DEET can be used on the skin, but look for family-friendly products that contain concentrations of no more than 30% DEET. Wash the insect repellent off with soap and water when your child returns indoors.
Cover up. When in wooded areas or in or near tall grass, stay on cleared trails as much as possible. Have your child wear a long-sleeved shirt, pants, and hat. Avoid wearing sandals in an area where ticks may live.
Look closely. Wear light-colored clothing to make it easier to spot ticks. After coming indoors, check for ticks on your child’s skin—they often hide behind the ears or along the hairline.
Remove stingers and ticks. To remove a visible stinger from skin, gently scrape it off horizontally with a credit card or your fingernail. If you find a tick, gently grasp it with fine-tipped tweezers as close to the skin as possible. Without squeezing the tick’s body, slowly pull it away from the skin.
Clean the skin. After the stinger or tick is out, clean the bitten area with rubbing alcohol or other first aid ointment.
Treat swelling. Apply a cold compress or an ice pack to any swelling for at least 10 minutes.
Help relieve the itch. Applying ice, along with calamine lotion or 1% hydrocortisone cream, can also help relieve itching.
5. Impetigo
Impetigo is a bacterial skin infection that’s more common during hot, humid weather. It causes a rash that may have fluid-filled blisters or an oozing rash covered by crusted yellow scabs. Impetigo is more likely to develop where there is a break in the skin, like around insect bites.
What parents can do:
Clean and cover. Clean the infected area with soap and water. Cover the infected area loosely to help prevent contact that would spread the infection to others or to other parts of the body. Wash your own hands well after treating your child’s sores.
Avoid scratching. Trim your child’s fingernails and discourage scratching. A child can spread the infection to other parts of his or her body by scratching. You can cover the rash loosely with a bandage to discourage your child from touching the rash, but make sure air can flow through so the skin can heal.
Talk with your pediatrician. While mild cases may respond to over-the-counter antibiotics such as bacitracin or bacitracin-polymyxin, impetigo is usually treated with prescription antibiotics—either a skin cream or oral medication. Your pediatrician may order a skin culture (test of your child’s skin) to determine which bacteria are causing the rash.
6. Swimmer’s Itch
Swimmer’s itch (also called clam digger’s itch or cercarial dermatitis) may appear after playing in lakes, oceans, and other bodies of water. The rash is caused by microscopic parasites found in shallow, warmer water near the shoreline where children tend to stay. The parasites burrow into skin, and cause tiny reddish, raised spots on skin not covered by the swimsuit to appear. Welts and blisters may also form.
What parents can do:
Be aware. Don’t swim near or wade in marshy areas where snails are commonly found. Try not to attract birds (by feeding them, for example) where your family swims. Birds may eat the snails and spread the parasites in the water.
Shower or towel dry. Shower or briskly rub the skin with a towel immediately after getting out of the water. The parasites start to burrow when the water on skin begins evaporating. If your skin child’s skin stings with rubbing—and the rash appears under the swimsuit—he or she may instead have Seabather’s Eruption from stinging larvae of sea critters such as jellyfish or sea anemone. Stop rubbing and shower instead.
Don’t scratch. Trim your child’s fingernails and discourage scratching. Home treatments such cool compresses on the affected areas, Epsom salt or oatmeal baths, or baking soda paste may help to relieve the discomfort. If itching is severe, talk with your child’s pediatrician. He or she may suggest prescription-strength lotions or creams to reduce your child’s symptoms.
7. Cutaneous Larva Migrans (Sandworms)
Sandworms may be present in sand contaminated with feces from pets or stray animals. When a child stands or sits in contaminated sand on a beach or in a sandbox, the worms may burrow under the skin, usually around the feet or buttocks. Lines of itchy, reddish rash known as a creeping eruption appear as the worms move under the skin, up to a few centimeters a day. The condition is more common subtropical and tropical areas such as the Caribbean, as well as parts of the southwestern United States.
What parents can do:
Keep shoes on. Don’t let your child play on beaches where people walk their dogs. If your family goes on an outing to a designated pet-friendly beach, make sure your child keeps shoes on and doesn’t sit in the sand without a blanket or towel.
Talk with your pediatrician. Your pediatrician can prescribe anti-parasitic medications such as albendazole or ivermectin to treat the rash. Without treatment, the larvae usually will die off in 5 to 6 weeks. Your pediatrician may suggest a cream to help relieve itching.
8. Folliculitis (Hot Tub Rash)
Folliculitis (hot tub rash) is an itchy, pimply rash that occurs when bacteria in unclean pools and hot tubs gets into hair follicles on the skin. The area where hairs grow from the skin becomes infected and inflamed, sometimes forming small, pus-filled blisters. A similar rash may come from wearing a damp swimsuit that wasn’t washed and dried well after previous use. Hot rub rash typically starts 12-48 hours after being in a hot tub.
What parents can do:
Avoid dirty pools. If you’re unsure whether the acid and chlorine levels are properly controlled in a heated pool, don’t allow your child to go in.
Don’t allow young children in spas or hot tubs. In addition to the risk for drowning and overheating, young children are also at higher risk of bacterial skin infection because they tend to spend more time in the water than teens or adults.
Talk with your pediatrician. Hot tub rash usually clears up without medical treatment. In the meantime, warm compresses and an over-the-counter anti-itch cream recommended by your pediatrician can help your child be more comfortable. If your child’s rash lasts more than a few days, talk with your pediatrician.
9. Molluscum Virus
Molluscum contagiosum is a viral infection that causes pearly bumps on the skin on a child’s chest, back, arms or legs. The dome-shaped bumps, also known as “water warts,” may have a dimple in the center. The poxvirus that causes the bumps is more common in hot, humid climates. Some studies suggest the infection may spread in contaminated swimming pools.
What parents can do:
Wait it out. In most cases, molluscum contagiosum does not need treatment. The bumps usually will go away in 6 to 12 months.
Stop the spread. A child with molluscum contagiosum should not share towels, bedding, or clothing with others to avoid spreading the virus. The bumps are contagious as long as they are present.
Avoid scratching. Scratching the bumps can spread the virus and cause a second, bacterial infection where the skin is open.
A smooth, reddened rash on your child’s feet, sometimes with peeling, cracking skin or scaly skin, could be from a condition called Juvenile Plantar Dermatosis (Sweaty Sock Syndrome). It happens when feet get wet and then dry quickly, again and again—like when shoes are taken on and off coming in and out of the house during summer.
What parents can do:
Breathable footwear. Reduce how often the feet go from wet to dry quickly by having your child wear open or more breathable footwear made of materials like mesh or cotton (i.e., water shoes) and/or thicker more absorbent socks.
Apply ointment. Applying moisturizing ointment or an over-the-counter steroid cream to the affected areas of your child’s foot immediately after taking shoes off or getting out of water can help. If the condition does not improve, or if you notice any sign of infection where your child’s skin is cracking, talk to your pediatrician.
11. Tinea (Ringworm)
Despite having “worm” in its misleading name, tinea (ringworm) is an infection caused by a fungus that thrives in warm, damp conditions. It is similar to athlete’s foot and jock itch and can appear on a child’s scalp or other parts of the body. It’s called ringworm because the rash from the infection tends to form round or oval spots that become smooth in the center as they grow while the border remains red and scaly. The fungus can spread quickly among student athletes, especially during sweaty, summertime practices and games, when they share sports equipment and locker rooms.
What parents can do:
Stop the spread. Check and treat any pets that may have the fungus—look for scaling, itchy, hairless areas on their fur. Family members, playmates, or schoolmates who show symptoms also should be treated. Do not allow your child to share combs, brushes, hair clips, barrettes, or hats. Make sure mats used in sports like wrestling and gymnastics are properly disinfected after use.
Talk with your pediatrician. A single ringworm patch on the body can be treated with an over-the-counter cream recommended by your pediatrician. If there are any patches on the scalp or more than one on the body, or if the rash is getting worse while being treated, your pediatrician may prescribe a stronger medication and special shampoo.
12. Hand, Foot & Mouth Disease
Many parents assume virus season winds down after winter. But some viral illnesses, such as hand, foot, and mouth disease, are more common during summer and early fall. Outbreaks are most common in younger children and can spread in child care centers, preschools, and summer camps. Caused by Enterovirus coxsackie, the illness starts with a fever, sore throat, and runny nose—much like the common cold—but then a rash with tiny blisters may appear on any or all the following places on the body:
In the mouth (inner cheeks, gums, sides of the tongue or back of the mouth)
Fingers or palms of hands
Soles of feet
Buttocks
Symptoms are the worst in the first few days, but they are usually gone within a week. Peeling skin on the fingers, toes, and nails may begin after a week or two, but it is harmless. Parents of children with a history of atopic dermatitis or eczema should be aware that their children may be prone to a more severe outbreak.
What parents can do:
Monitor symptoms. Be sure to call your pediatrician if your child’s fever lasts more than 3 days or if he or she is not drinking fluids. If symptoms are severe, your pediatrician may collect samples from your child’s throat for lab testing.
Ease the pain. For fever and pain, the pediatrician may also recommend acetaminophen or ibuprofen. Liquid mouth-soothing remedies may be useful to alleviate mouth ulcer pain. Do not use regular mouthwashes, because they sting.
Avoid dehydration: Children with hand, foot, and mouth disease need to drink plenty of fluids. Call your pediatrician or go to the ER if you suspect your child is dehydrated. See Signs of Dehydration in Infants & Children for more information.
Inform others. Tell child care providers and playmates’ parents to watch for symptoms of the illness. Children with hand, foot, and mouth disease may spread the virus through the respiratory tract (nose, mouth and lungs) for 1-3 weeks, and in the stool for weeks to months after the infection starts. Once a child’s fever has gone away and he or she is feeling better, there is no need to keep him or her home unless there are still open and oozing blisters.
Remember…
Protecting your child’s skin is a year-round concern, but it’s especially important in the summer months when so much skin is exposed and vulnerable. Fortunately, many summertime rashes clear up quickly on their own. Be sure to talk with your pediatrician about any rash that you’re unsure about—especially if you don’t know what caused it, if it is making your child feel miserable or doesn’t clear up quickly, or if it shows signs of infection or is accompanied by any shortness of breath.
Sandworms may be present in sand contaminated with feces from pets or stray animals. When a child stands or sits in contaminated sand on a beach or in a sandbox, the worms may burrow under the skin, usually around the feet or buttocks. Lines of itchy, reddish rash known as a creeping eruption appear as the worms move under the skin, up to a few centimeters a day. The condition is more common subtropical and tropical areas such as the Caribbean, as well as parts of the southwestern United States.
