Eczema in babies: what to expect in the first year

A baby’s first year comes with a lot of rashes, and most of them are harmless and short-lived. Eczema is the one that tends to stick around, come back and itch. This article is about that first year specifically: where eczema shows up on a tiny baby, how to tell it from cradle cap, what the research says about moisturizing to prevent it, and when to bring your baby in.

Where does eczema show up on a baby?

On an infant, eczema has a favourite map. The Canadian Paediatric Society says it usually appears on the forehead, cheeks or scalp, and can spread to the arms, legs, chest and other areas. A 2022 review in the Canadian Medical Association Journal describes the typical infant pattern as the cheeks, the outer sides of the arms and legs, and the trunk. The folds of the elbows and knees, the classic spots in older kids, usually come later.

One area is usually left alone: the Eczema Society of Canada notes that the diaper area is often spared, because the skin stays moist under the diaper. A rash in the diaper zone is more often diaper rash, which is a separate problem.

What the skin looks like varies. The Canadian Paediatric Society describes dry, thickened, scaly or rough skin, or tiny red bumps that can blister, ooze or become infected.

How do you know a baby is itchy?

Babies can’t tell you, and in the early months they can’t scratch well with their hands. So the itch shows up in other ways:

• rubbing the cheeks or head against the mattress, your shoulder or a car seat
• wriggling, squirming or kicking when undressed
• fussiness and broken sleep, especially at night
• red, rubbed patches on the cheeks with a shiny, raw look

Itch is the key difference between eczema and many other baby rashes. If the rash seems to bother your baby, that’s worth noting before you see the doctor.

Is it cradle cap or eczema?

This is the most common mix-up in the first months. Cradle cap is the everyday name for a form of seborrheic dermatitis in infants (a harmless, non-infectious condition of the oil-rich areas of the skin, not caused by poor washing).

Here’s how they usually differ:

• Look: the NHS describes cradle cap as patches of greasy, scaly skin, with white or yellow greasy scales that may form crusts. Eczema is drier, rougher and often redder.
• Place: cradle cap starts on the scalp and can spread to the eyebrows, forehead, behind the ears, the neck folds and the diaper area, according to the UK National Eczema Society. Eczema favours the cheeks and outer limbs, and usually skips the diaper area.
• Itch: the NHS is clear that cradle cap is not itchy or painful and doesn’t bother your baby. Eczema itches.
• Timing: the National Eczema Society says cradle cap usually appears before three months and clears by 6 to 12 months.

Cradle cap doesn’t need treatment and goes away on its own, the Canadian Paediatric Society says. If you want to loosen the scales, you can soften them with a bland oil before a mild shampoo and brush gently with a soft brush. The NHS advises against picking at the crusts and against using peanut oil or olive oil. The two conditions can also overlap, and the National Eczema Society notes that very widespread cradle cap can be an early sign of atopic eczema in some babies, especially in families with eczema, asthma or hay fever. If you can’t tell which one you’re looking at, that’s a perfectly good reason to ask.

Can moisturizing a newborn prevent eczema?

You may have heard that rubbing moisturizer on a baby from birth can stop eczema from starting. The idea made sense: eczema starts with a leaky skin barrier (the outer layer that keeps water in and irritants out), so shoring up that barrier early might head it off. A few small early studies looked promising.

Larger trials have since tested it properly. A 2022 Cochrane review, which pooled randomized trials in babies who didn’t have eczema, concluded that daily moisturizing in the first year probably does not prevent eczema. It also found that it probably increases the chance of skin infection a little, and may increase the chance of food allergy, though that result was very uncertain. The reviewers noted that most of the trials enrolled babies considered at higher risk, and that other skin care approaches still need study.

Two things to keep straight here. First, this is about preventing eczema in healthy skin. The same reviewers stress that skin care is still important for treating eczema. Second, it doesn’t mean you did anything wrong if you moisturized, or didn’t. It just means there’s no need to start a daily routine on a newborn with healthy skin in the hope of prevention.

How do you care for a baby who has eczema?

Once eczema is there, moisturizer becomes the main tool. The Canadian Medical Association Journal review found that any type of emollient (a moisturizing lotion, cream, gel or ointment) applied twice a day helps manage eczema in babies, and the best one is the one you’ll use consistently. The Canadian Paediatric Society suggests a daily warm bath, patting the skin dry rather than rubbing, then applying an unscented moisturizer to hold water in. Loose cotton clothes help, and wool is best avoided.

A couple of baby-specific tips:

• Wash your hands before you apply moisturizer, as the Eczema Society of Canada suggests, so you’re not spreading irritants onto the skin.
• Keep your baby’s nails short, and consider soft sleeves or mitts at night if scratching starts.
• Choose fragrance-free products for everything that touches the skin. The baby care page on this site lists products whose claims have been reviewed.

If a flare doesn’t settle with moisturizer alone, don’t stop there. The Eczema Society of Canada points out that there are treatments approved for infants to calm inflammation, and a family doctor or paediatrician can prescribe them and show you how to use them.

When should your baby see a doctor?

Babies are small and things can change fast, so the bar for asking is low. Book an appointment if:

• you’re not sure whether the rash is eczema, cradle cap or something else
• the rash persists and your baby seems uncomfortable, or is losing sleep
• the rash is spreading, or isn’t getting better after a couple of weeks of gentle care
• cradle cap hasn’t cleared after a few months or has spread over much of the body

Go promptly, the same day if you can, if the skin weeps, crusts yellow, bleeds, swells, feels hot or smells odd, or if your baby has a fever or seems unwell. Those can be signs of infection, and in a baby they shouldn’t wait.

Eczema in the first year usually looks like dry, itchy patches on the cheeks, scalp and outer limbs, while cradle cap is greasy, yellowish and doesn’t bother the baby. Moisturizing a healthy newborn probably won’t prevent eczema, but moisturizing a baby who has it is exactly the right thing to do. And when in doubt, ask: a quick look from your doctor or public health nurse can save weeks of guessing.