10 Strategic Steps to Pinpoint the Underlying Cause(s) of Baby Skin Irritations

10 Strategic Steps to Pinpoint  the Underlying Cause(s) of  Baby Skin Irritations

1. Prevent the Scratching.

For me, this was by far the most important step. Scratching can cause serious injuries, can lead to infections and can prevent topical medicines from working. The itching can make it hard for baby to sleep, which also keeps you up at night, affecting everyone’s health. So what’s the answer when cutting nails short still doesn’t work; when mittens are used to rub skin raw or just fall off; when swaddling blankets unravel and are too hot anyway; and when holding limbs down tight creates heat plus friction, making eczema worse…? I see you because I was you.

I also happen to be a professional dressmaker of over 12 years and in those moments of utter desperation, I helped my 2-month old, Anthony the best way I knew how. I invented the CozeeCoo®, which comfortably held my baby's hands away from his face while retaining movement in his arms, elbows, hips and legs. For more information please visit www.cozeecoo.com. 

If you don’t have the CozeeCoo® yet, here are some alternative steps to try (if you haven’t already) in the meantime to stop the scratching. They ultimately did not work for me, but they might help you:

• Baby nail clippers and nail files
• Baby mittens or baby socks over the hands
• Onesies with mitten cuffs
  
• Protective sleeves with mitten cuffs
• A light-weight swaddling blanket
• A Velcro swaddle blanket to tightly hold the arms down
• Sterile bandages over the wound sites
• A baby bouncer/rocker (so you can have at least one free hand while you still impressively hold their two hands down with your one).

 

2. Document Your Baby's Skin Condition with Notes and Pictures.

You have a brand new, precious baby and it's likely you're getting very little sleep. Let notes and pictures help guide you and doctors to the answers you are looking for.

Here are some quick tips on how to document effectively:

• Document what you see as significant. Try to write notes in the same place the moment you think of it. 
• Get as detailed as you can with baby's skin reactions, dates and times. For example, maybe baby's skin condition was there since birth. Perhaps their skin reacted shortly after breastfeeding, having formula or shortly after bath time... was it 10-15 minutes later or 2 hours later? The reaction time matters (more in #8). 
• Consider dedicating a photo album just to your baby's skin. Many cameras including phone cameras automatically timestamp pictures, which can provide a useful visual timeline for your doctor(s). If you’d like to see Anthony’s documented notes, I wrote a blog called Discovering My Baby's Eczema Triggers and Food Allergies -A 1 Year Timeline with Pictures.

 

3. Find a Good Team of Specialty Doctors, If You Can.

If you can, in addition to your baby’s pediatrician, also seek several specialty doctor’s opinions such as specifically a pediatric dermatologist, a referred allergist, and if possible, a registered dietician. 

Here’s why:

• Pediatric Dermatologist:
  • Dermatology is the study of skin diseases and disorders, hair, nails and some cosmetic problems. A dermatologist can cancel out any life threatening diseases, can test for infections (specifically what kinds) and prescribe medications for immediate concerns.
  • A Pediatric Dermatologist is educated in caring for a baby’s sensitive skin. Their goal is long term health rather than cosmetic, which focuses on appearance. Since babies cannot verbally communicate their concerns, pediatric dermatologists are practiced in observing and examining signs of medical issues while also communicating clearly with the caregivers.
• Allergist:
  • An allergist can conduct allergy skin-prick tests and/or allergy blood tests to confirm suspected allergies. It should be noted allergens can be passed down through breastmilk. Challenges can be done to understand the severity of an allergy. Allergists can also prescribe Epinephrine Auto-Injectors (Epipens) in case of anaphylaxis (severe allergic reaction that compromises breathing). Always seek emergency medical attention after using an Epipen as it will only last for approximately 10-20 minutes.
• Registered Dietician:
  • A dietician can ensure that your baby (and the mother if she’s breastfeeding) are well nourished. When embracing the elimination diet it’s important that eliminated foods are replaced with allergy-free, nutritional substitutes to avoid malnourishment.
  • A registered dietician holds a licensed degree in their field and uses evidence-based practice guidelines (scientific research) to consult their clients. The title of a nutritionist on the other hand is not a legally regulated title, meaning anyone can use it.

If you are able to get this team of specialty doctors together, here’s what you do next:

• Compare notes (including your own from strategy #2) so everyone can work  together to make informed decisions. 
• Chose to work with doctors who welcome questions and take the time to go over your baby’s skin irritation (family) history. 
• Ask how you can care for your child's skin while you're trying to pinpoint the underlying cause(s).
• Make pinpointing the underlying cause(s) your goal and don't compromise!

Sometimes finding our dream team is not as straightforward as we might hope. After all we must consider insurance, money, networks, availability, referrals, language barriers, locations, mutual respect, different communication styles, etc. In the meantime, please know that progress can still happen. It may be in the form of what not to do. Make sure conditions are confirmed with positive test results before using written prescriptions. Test medications on small areas first -one at a time- before fully using them as recommended. Collect information, filter opinions and create a thoughtful game plan for your family's next steps.

 

4. Research the Differences Between Allergies, Non-IgE Allergies & Eczema.

Allergies and eczema are treated and controlled differently. Because they can each lead to dangerous health concerns, telling them apart is very important. There can be confusion between these labels because:

• The resulting skin irritations can look the same.
• Eczema is often generalized as an umbrella/blanket term for visible skin irritations 4
• An allergy can trigger an eczema reaction depending on if the child is breastfeeding, the age of the child and the amount of exposure.

That being said, there are several ways to tell allergies and eczema apart. This includes testing for antibodies (more in strategy #5), observing their reaction times (more in strategy #8) and by researching each with credible resources. To get you started I wrote out my own findings in this blog: A Mother Clearly Defines Baby Allergies, Non IgE Allergies and Baby Eczema -with the linked sources.

5. Consider an Allergy Skin-Prick Test and/or Blood Test.

Consider an allergy skin-prick test (if your baby’s skin has already improved to physically test on) and/or blood test. Both allergy skin-prick tests and allergy blood tests look for antibodies that the body produces against allergens. These tests are very helpful because if your baby has had reactions shortly after a suspected irritant and then they test positive for it, it is very likely your baby has an allergy to that ingredient/allergen. I say likely because the test results do not completely confirm an allergy since about 50-60 percent of results are “false positive” 5. This is why allergists interpret positive results alongside baby’s medical history. 

The next step would be to test the severity of that allergy through a “challenge”. A challenge is the monitored ingestion of a suspected allergen to determine what actions need to take place in case of an accidental ingestion. Your baby may need to carry an Epinephrine Auto-Injector (Epipen) with them, an over the counter allergy relief medicine or nothing at all.

If you’re interested, I share my family’s personal allergy skin-prick test experiences in: How to Prepare Your Baby for an Allergy Skin-Prick Test.

6. Consider the Process of Elimination.

This strategy is the most likely and fastest way to stop a severe skin irritation cycle that a baby is suffering from. It involves surrounding the baby with minimal ingredients from their daily lives for at least 2-4 weeks (so ingredients can completely leave your baby’s system and have time to heal from reactions). By eliminating the bulleted list below, you’ll greatly increase the chances of removing your child’s underlying skin irritation “triggers”, “intolerances”, and/or “allergies”. For foods this includes breastmilk composition, AKA: the mother’s diet. To be clear: I’m not at all suggesting that you stop breastfeeding. Simply alter your diet. Such a diet is literally coined an “elimination diet”1. This is where consulting a dietician (strategy #3) is helpful as it’s important to still get all the nutrients you and baby need. One resource that I am thankful to have found is Free to Feed Founded by Dr Trillitye Paullin (Dr. Trill). She discuses a lot of what this blog covers with the wonderful incentive to support breastfeeding for babies with allergies.

If your baby is formula fed, according to Action Against Allergy, hydrolyzed infant formulas 2 can be better than conventional milk-based formulas because the milk protein is broken down into smaller proteins. Please also check out CozeeCoo®'s guest blog, My Top Formula Choices with a mother's wholesome, organic perspective. 

Continue your note taking throughout (strategy #2). Later you’ll be able to systematically reintroduce ingredients to distinguish the culprit ingredients from the approved ones (more in strategy #8). Once you know the culprit ingredients, we’ll go over how to build your baby’s immune system against them instead of completely cutting them out as this can cause more severe reactions later in life (more in strategy #9). 

*Please note that for minor eczema flares (instead of severe conditions) it is recommended to eliminate, test and/or reintroduce one food ingredient at a time instead of all of them at once. This way mama and baby still have many resources to get all their nutrients.* For severe cases, here’s the process of elimination method:

• Eliminate your suspected triggers (use your notes from strategy #2)
• Eliminate the top most common household irritants (See My Household Minimal Ingredients Notes -For Babies plus refer to: https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy/art-20049365). 
• Eliminate the top most common food allergens (wheat, egg, cow’s milk, soy, peanut, tree nuts and seafood (fish/shellfish) 3. This includes the mother’s diet if she’s breastfeeding. If you feel you may need help eliminating alcohol and/or smoking please visit (https://www.nhs.uk/live-well/alcohol-support/ and/or https://smokefree.gov/).

 

7. Discover Allergy-Friendly Recipes & Products.

To help with the process of elimination menu changes, I shared Allergy-Friendly Baking Recipes that I developed for my family, which we continue to enjoy. My “Allergy-Friendly” ingredients excludes eggs, tree nuts, peanuts, seeds, dairy, soy, corn, gluten, shellfish, chickpeas and oats. If you suspect or find that your baby may be allergic to nickel, please research lists of foods that have a higher nickel content than others. If it’s helpful, you could begin with this article. 

You can enjoy most fruits, vegetables, meats, beans, rice, quinoa and buckwheat. That's so many amazing, healthy and tasty options! I enjoyed dried fruits for my sweet tooth and found allergy-friendly chocolate by Enjoy Life and Scharffen Berger (in the baking aisle). Many foods you know and love can still be eaten -just with different ingredients.

For most general recipes, an egg can be replaced with one banana. All purpose flour can be replaced with brown rice flour. You can even make this yourself by buzzing uncooked brown rice in a blender or smoothie machine. Do you love your frothed lattes? You just need proteins in the milk to get the froth. I used yellow pea milk (I know that sounds odd when said aloud -but it works). If you suspect your baby is OK with seeds, hemp milk also works and if oats are OK then use oat milk. Our current allergist just told me that seed oils do not contain the proteins that most people react to, meaning these are OK to consume. We live in a great time for alternative, allergy-free options because there are plenty.

I also think you’ll be pleased to know that restaurant experiences restored my faith in humanity. People are incredibly accommodating and happy to help unique and extreme diet needs -I'm sure it helped when I expressed my undeniable gratitude.

Testing Anthony’s diet while I was still breastfeeding meant that (thankfully) his severe eczema triggers and allergic reactions were nowhere near as bad as they could have been if he had directly ingested them. Once 6 month old Anthony’s skin had improved, my new diet slowly became his new pureed diet. We started with pureed avocado and cooked apple sauce. Cooked foods are easier on a baby’s tummy since they’re already partly broken down and can help with preventing constipation. Alternative foods I baked, pureed and strained were squash, carrots, sweet potatoes, zucchini, green beans, cauliflower and pumpkin.

   

8. Systematically Reintroduce Ingredients after an Elimination Diet.

Once your baby’s skin improves through the process of elimination, you can systematically reintroduce household and food ingredients to either confirm them as an approved ingredient or a culprit ingredient. Please consider the results of allergy tests and challenges first. Give at least 1 week for each ingredient to possibly react. Immediate reactions are considered allergies whereas delayed reactions of up to 3 days (Anthony had delayed reactions of up to 6 days with soy) are considered eczema triggers (refer to #4). If you test an ingredient and after seven days, baby does not react, then you’ve been approved to continue using that ingredient! If you test an ingredient and baby does react then you have discovered a culprit ingredient! Give at least 2-4 weeks for a culprit ingredient to completely leave baby’s system before testing a new ingredient.

Admittedly, I have been so relieved by Anthony’s clear skin that I still have a list of eczema trigger reintroduction ingredients to test and challenge. So with these next sentences I’m also talking to myself… Reintroducing ingredients will help bring us to our main goal of pinpointing our baby’s skin irritations. This can only help our understanding for when we’re in different environments other than our home. By reintroducing the foods, we’re also giving our baby more options for gaining nutrients. For example, I suspect Anthony may be fine with oats now but I have yet to test it again. I say again because oats were a culprit ingredient at age 6 months, which resulted in head to toe red spots. However, as our child ages, the likelihood of them growing out of their allergies and ingredient triggers improves. Eczema can get better, however it is considered a chronic condition. At one year, Anthony’s body might have tolerated the eczema trigger of oats in small doses. However, I did not expose him to oats to find out and he is almost 4 now, which brings me to #9... 

 

9. Build Your Baby’s Immune System?

Currently, the standard treatment of a food allergy is to avoid it and use an Epipen for anaphylaxis. At the same time, there is the idea of building the immune system to better tolerate food allergies and/or eczema food triggers by ingesting very small amounts of it over time. This strategy is called Oral Immunotherapy (OIT). It’s gaining attention and was recently approved by the FDA for a peanut OIT. Professional OIT is only available for children age 4-17 and the doses must be used indefinitely in order to work. Side effects typically include the gastrointestinal tract, esophagus disease and triggering an allergic reaction.

Some doctors warn that avoiding eczema triggers can eventually lead to them becoming allergies and developing asthma. Different doctors use different methods and ultimately it’s up to you to decide. Just like the other strategies, I suggest doing your own research. To help get you started, here's an article by the American Academy of Allergy Asthma and Immunology: https://www.aaaai.org/conditions-and-treatments/library/allergy-library/oit

For Anthony’s allergies, we have challenged eggs so far and thankfully he passed for eating eggs in baked goods! His allergist is hopeful that he will eventually pass for almonds and peanuts. However other tree nuts and seeds will likely be a lifelong journey.

As for the Oral Immunotherapy with allergies, I don’t think I’m personally sold on it at this time. But if this changes I'll update this post. Regarding eczema triggers, however, I attempted to give Anthony small amounts and each time he broke out from head to toe in red, itchy spots with dry skin that lasted up to a week. Complete avoidance/elimination of Anthony’s eczema triggers and food allergies have left his skin looking wonderful. This feels great but I was recently pressured by an allergist to continue exposing Anthony to small doses... at the time I was torn and didn't do this until Anthony was a bit older. Now we test a serving size of an eczema trigger about every other month. As Anthony grows up his tolerance seems to be better and better, thankfully.

 

10. Remember, You Are Not Alone. 

You are going to figure this all out -and with help! Over 26 million babies worldwide are diagnosed with eczema each year 6 7. You are definitely not alone. I love messages, comments and/or questions if you'd like to reach out in the comments below. The CozeeCoo Facebook also hosts a community of people trying to find answers for their baby’s skin irritations, just like you.

 

And there you have it; 10 Strategic Steps to Pinpoint the Underlying Cause(s) of Baby Skin Irritations 

 

 

For those who have gone through this, did I miss anything essential? 

Please let me know.

 

 

Curious about my full story? Please check it out.

 

Jennifer Stelmakh

CEO & Inventor at CozeeCoo™

Helping babies thrive.