3 August, 2016
Eczema – can it be avoided?
The bad news is that eczema is increasingly common and makes children miserable – they don’t sleep well, they itch, they suffer and they become irritable. Australia and New Zealand have some of the highest incidences of eczema in the developed world – up to 25% of children are affected. The good news is that it is generally treatable – if you stay away from foods and skin products that irritate your child’s skin, use good skin care, and support the immune system and gut flora. Moreover children usually outgrow eczema by the time they turn 6 years old. But what if you could reduce the risk of your child developing eczema in the first place and avoid 6 years of itchiness and suffering?
Eczema affects up to ¼ of all infants and can last through childhood. Risk factors include not being breastfed, vitamin D deficiency, having parents who smoke, not spending enough time playing in dirt, antibiotics given in early life and paracetamol used in the pregnancy or early life – all of these factors affect the baby’s immune system and gut flora. In my experience most babies with eczema are reacting to an allergen, either a food (think dairy!) or something in their environment. In 80% of my young patients, the eczema improves once they are no longer exposed to cow’s milk protein – either by the breastfeeding mum avoiding all dairy in her diet or changing the formula fed baby to a non-dairy formula. We are of course a mammal species and as such have evolved to drink the milk of our mothers. No other mammalian species drinks milk from a different species. Imagine an elephant calf suckling on a giraffe or a calf on a cat. It is just not done. Each species produces the optimal milk for their own young – with growth factors, immune cells and hormones, designed specifically for their babies. So it is no surprise that cow’s milk does not agree with many human infants and they may react with eczema.
So here are my recommendations for eczema prevention:
- Take probiotics while pregnant – L. rhamnosus given to pregnant mothers reduces the risk of eczema in the baby by up to 50% (1).
- Plan on a natural birth. Babies born via C-section have a gut flora that resembles skin rather than gut flora – and whose skin you ask? The hospital staff’s. That is because they do not travel through the birth canal and pick up their mother’s flora on the way, but are born through a cut in the skin and are handled and held by nurses and doctors. C sections can be life-saving and are sometimes needed – but the current trend of up to 50% C section rates in some regions and hospitals does not appear to be based on medical indications. It increases the risk of eczema up to 43% (3). If your baby is born by C section, give him or her a supplement of bifidobacter probiotics.
- Breastfeed – the longer the better. Breastfeeding is most likely to be successful if there is immediate skin to skin contact between the mum and the baby and they are left alone as much as possible. All the weighing, washing, dressing can wait a bit. As long as the baby is not in distress of course. Breastmilk promotes the growth of specific gut bacteria that are beneficial for the baby’s immune system. Hundreds of different oligosaccharides and other immune factors in breastmilk have evolved over millions of years to specifically support the growth of bifidobacter infantis. Breastmilk contains beneficial bacteria from the mother’s diet (and probiotic supplements if she is taking any). Breastfeed exclusively for 6 months and then continue along with solid foods for at least 1-2 years. Long-term breastfeeding may not be the cultural norm, but there is nothing wrong with it. Studies from Scandinavian countries have shown that the longer a child is breastfed the lower the risk of allergies throughout childhood and even at 17 years of age the child has a 50% lowered risk.
- Introduce small amounts of allergens into the breastfeeding mother’s diet, and once the child eats solids the child’s as well. It appears that the immune system response is modulated by intermittent early exposure. Do stop if the child has a reaction, such as eczema or mucus in the bowel motions – which are signs of inflammation (5).
Let your child play with dogs, in dirt, take them to parks and gardens and let them roll in the mud. The more the immune system is trained early on to recognise germs and learns which ones to fight and which ones to accept, the less likely the child is to develop allergies. Children who grow up with dogs have less allergies, because dogs are dirty (6). The same theory explains why poorer countries with less hygiene and more infectious diseases have lower rates of allergies (7). Read “The Dirt Cure” by Maya Shetreat-Klein to learn more about all the benefits of not keeping your kids too clean (Simon and Schuster, 2016).
- Feed your children a whole-foods diet which means plenty of fresh vegetables, no processed or packaged foods, no additives, and low in sugar. Let them drink water.
- Make sure your child gets enough vitamins and minerals, especially, zinc which is low in Australian, New Zealand and US soils and is essential for the immune system and skin healing. If your child has white spots on the fingernails, ask your GP to check the zinc level. You should be able to get most of your vitamins and minerals from a healthy and varied diet. But if the food is grown on mineral-deficient soils, the foods will be low in those minerals. Soils in Australia and New Zealand are low in zinc, selenium, and iodine. If you live somewhere else, research your soil quality to find out what minerals you may need to supplement (under medical supervision as you can overdose even on minerals).
- Encourage your child to play outdoors – apart from the positive effects of exercise on your child’s overall health, mood, learning, and sleep; time spent in the sunshine is needed to produce vitamin D. The lower your vitamin D, the worse your allergies and eczema. In the winter the sun is not strong enough to produce sufficient vitamin D and your child will probably need a supplement – or a trip to a sunny island. In Northern Europe it is public health policy to routinely supplement all children in order to prevent infections, allergies, rickets and other vitamin D deficiency related health problems. In the summer expose your child’s skin to sunshine without letting the skin burn. Check your UV meter and don’t overdo the sun.
- Avoid chemicals that irritate the immune system and the skin: washing powders, fabric softeners, soaps, shampoos, creams that contain perfumes, phthalates, SLS, paraffin, Cap B, propylene glycol. Your baby does not need any fancy products: water and a tiny bit of natural soap for really dirty parts are sufficient. Apart from disrupting the skin barrier these chemicals can also affect your hormones, not a good idea.
- Do not smoke. Ever. It is not good for yourself or your kids. Call the Quitline now.
Even hours after you have had a cigarette and this includes electronic ones, you exhale toxic chemicals and those around you will inhale them. This is called third-hand smoke. As if first and second hand smoke were not bad enough! It also sets a bad example. Do you really want your child to become addicted?
Written by Dr Leila Masson, Paediatrician
Dr Leila Masson is a consultant paediatrician in Bondi Beach and the author of
“Children’s Health A-Z” www.drleilamasson.com
- Pelucchi C, Chatenoud L, Turati F, Galeone C, Moja L, Bach JF, la Vecchia C. Probiotic supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis. Epidemiology 2012;23:4012-14.
- Wickens et al. A protective effect of lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years. Clinical and Experimental Allergy 2012 (42); 1071-1079
- Renz-Polster, H., David, M. R., Buist, A. S., Vollmer, W. M., O’Connor, E. A., Frazier, E. A. and Wall, M. A. (2005), Caesarean section delivery and the risk of allergic disorders in childhood. Clinical & Experimental Allergy, 35: 1466–1472. doi:10.1111/j.1365-2222.2005.02356.x
- Saarinen UM. Breastfeeding as a prophylactic against atopic disease: Prospective follow-up study until 17 years old. Lancet 346: 1065-69, 1995
- Perkin MR, Logan K et al. Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. N Engl J Med 2016; 374:1733-1743May 5, 2016DOI: 10.1056/NEJMoa1514210
- Fall T, Lundholm C, Örtqvist A, et al. Early Exposure to Dogs and Farm Animals and the Risk of Childhood Asthma. JAMA Pediatr.2015;169(11):e153219. doi:10.1001/jamapediatrics.2015.3219.
- Graham-Rowe D. Lifestyle: When allergies go west. Nature 479, S2–S4 (24 November 2011) doi:10.1038/479S2a. Published online 23 November 2011