Emmett's eczema

**This post is quite long, which was not my intention when I started writing it a few days ago.  However, it sort of evolved into a place for me to collect my thoughts, process all the information I've been taking in, vent my frustrations and form a strategy.  So it's been a bit therapeutic for me to write it.  I hope it's not boring to everyone else.**

Emmett has eczema. For those who aren't familiar with eczema (lucky you!), here's some information from the Eczema Canada website:

Eczema is a recurring, long-term inflammation of the skin, and there is no cure. It usually begins in childhood, appearing within the first 6 months, and can continue through adolescence into adulthood. Although some children may eventually outgrow eczema, about 80% will have dry, irritable skin their whole lives.  

Eczema can be different for everyone who has it. Yet, no matter how severe your eczema is, everyone deals with the same basic symptoms - dry skin, sore rashes, and terrible itching. It can be frustrating and uncomfortable trying to manage eczema and keep 'flare-ups' under control. At its most severe, eczema can cause serious health problems, profoundly affect quality of life, and interfere with normal, everyday activities.    

Eczema is often called the ‘itch that rashes’ rather than the ‘rash that itches’ because the itch starts long before the rash appears. The itch leads to a lot of scratching and that's when the red, raw rash appears.

Eczema may be caused by a combination of environmental, genetic, and immune system factors, and is often accompanied by asthma and/or hay fever.

We noticed that his cheeks were red, dry and bumpy quite a while ago, and I tried just about every cream imaginable to help clear it up. I'm not crazy about putting lots of chemicals and stuff on him, so I tried mostly natural products. Nothing seemed to work, though, and it seemed to be really bothering him, as sometimes he would scratch at his cheeks until they bled. :( So I took him to the doctor in mid-May, and he prescribed a steroid cream for Emmett. He also said to use Vaseline to help keep the moisture in. So much for all-natural products! The prescription cream seems to work quite well, but I really don't like using it, so I try to put it on very sparingly and only when it gets really bad. I did slather him in Vaseline every morning and night though.  However, lately with him trying new foods, it seems to be getting worse.  Luckily it's just on his cheeks so far, and not anywhere else on his body.

So far I can tell that wheat (or gluten) seems to cause a flare-up, and I sort of wonder if banana does as well (I know sugar can cause flare-ups, but would that include the natural sugar in fruit?).  I guess the one advantage to the stage that we're at is that he has a very limited diet, and we're introducing foods slowly, so it's easy to see what he reacts to.  I also wonder if his formula is contributing to it (I've read that milk can be an irritant), but I'm very hesitant to switch that.  One (obvious) reason is that I'm cheap - right now Emmett gets the W*l-M*rt store brand of formula, which I usually buy on sale for about $11 a can (I stock up when it goes on sale).  To switch him to a soy formula would mean paying about $30 for a can, and I think those are smaller cans too.  The other reason I'm not sure about switching is that I've read that soy can also cause eczema flare-ups, so we could go through the hassle (and cost) of switching over, and still might have the same results.

I've been doing tons of research and reading about eczema (I think I google it almost every afternoon while Emmett is napping and Annika is having quiet time), and I feel a bit like hitting my head up against a wall sometimes.  There's so much info and opinions out there, and a lot of it is conflicting, so what's a mother to do?  There are endless creams and ointments that promise results, but how many can we afford ($-wise they're not cheap!) to try?  Some suggest treating from the "inside out" (i.e. eliminating foods, etc), but the kid's gotta eat something, right?  What do I give him if I can't give him milk or soy?  It's not like breastmilk is an option anymore.  It just breaks my heart to see him suffering, scratching himself till he bleeds, and it frustrates me that I can't help him more.

So here's my current "plan of attack" for prevention and treatment.  Some days I feel so helpless to make him feel better, so writing it all out has been good for me, as I can see which areas I can help.

Prevention - to prevent or minimize the occurrence of flare-ups:

• Probiotics - I've started giving Emmett a probiotic.  In my reading, I came across some information that said that probiotics can help the body properly process stuff like milk so it doesn't cause a reaction, especially in young children whose systems are still developing (at least that's my interpretation of what I read, I could be mistaken).  When Emmett was a newborn, we gave him probiotic drops called BioGaia because we thought he was fussy because of his digestive system, and this was supposed to help improve digestion.  We were never really sure if they made a difference, so when the bottle was empty, we didn't bother getting more.  And he seemed to "grow out" of that fussy stage anyway.  But now I went and bought another bottle, and we'll see if it makes a difference for his skin.  It's an easy place to start (just add the drops to his food once a day) anyway. 
• Diet - I'll be watching his reaction to new foods (I started a food journal when he started eating solid foods so I'll be keeping track there), and limiting those that seem to cause a flare-up.  I think I'd like to discuss this a bit more with our doctor, though, just to get his opinion on restricting Emmett's diet at this stage.  I'd also like to ask him if he thinks we should switch formulas.  At least for now limiting his diet is not too difficult, as I make most of his food myself, and he doesn't know what he's missing out on.  This will get harder if it's something we need to continue long-term.   I will also try to include foods in his diet with vitamins A, C, E and Omega 3, all of which are good for the skin.  This will take a bit more research to find out which foods would be good for him, and that he can handle at this stage.
• Environmental factors - I will try to only use natural, fragrance-free products on Emmett's skin, clothes and in our home (as much as possible).  This won't be much of a switch because it's something I already do, as Annika also has sensitive skin, and Carey and I are sensitive to overly-scented products.  And I'm a little bit of a "treehugger" and like natural products anyway!  I will also make sure that Emmett wears 100% cotton clothes and that his room is comfortably cool for sleeping (overheating can also cause flare-ups).  Dust mites can also aggrevate eczema, so I will try to make sure Emmett's room is cleaned and his bedding washed once a week.  I have a bit of a hard time with this one.  Some stuff I've read says that dust can trigger flare-ups, and other stuff says that a little dirt is good for kids, to strengthen their immune systems.  I have always been a believer in the "dirt is good" school of thought, and Annika has never suffered for it (she's never had any sickness other than the occasional cold - never even had an ear infection!).  I figure that cleaning Emmett's room weekly is a good compromise - it will ensure that he has a clean environment for sleeping, but not too clean.  And with my cleaning habits, he'll still be exposed to plenty of "immune-system-builders" (we won't call it dirt ;) ) in the rest of the house.
• Personal care - I will use moisturizer on his whole body at least once a day, to keep his skin healthy and hydrated.  I will also check Emmett's fingernails every 2-3 days and trim or file them as short as possible (when we were at the doctor's office, he actually complimented me on my nail-trimming skills!).  This way if he does start scratching, he is less likely to break the skin.  In regards to bathing, I've read a lot of conflicting opinions about baths.  Some say frequent bathing is good, some say it's bad.  However, since Emmett's eczema is only on his face, I don't think this is much of a concern right now.  We'll continue to give him baths every other day, making sure that the water is lukewarm, not hot, and moisturizing immediately after the bath.  I will also try to apply moisturizer to his face after each time I wipe it.
• Amber necklace - Emmett has a baltic amber teething necklace, and amber is supposed to help with all kinds of things, so I'll try to put it on him as much as possible.  Not sure if this will make a huge difference, but it can't hurt to try.

Treatment - for when a flare-up occurs:

• Lanolin - for Emmett's most recent flare-up, I have been putting lanolin on his cheeks, instead of Vaseline.  I had some leftover from when I was nursing, and I figured if it was safe enough for a newborn baby to ingest, then it would be a good option to try (for those who aren't familiar with lanolin, one of it's uses is to help with sore nipples from breastfeeding).  So far it seems to be working well for him, but I'm going to keep an eye on it, as some people have reported that lanolin actually makes eczema worse (one of the down-sides of reading forums and message boards - you find so much conflicting advice!).  The lanolin has a few functions - it moisturizes his skin, reduces the itchiness and forms a protective barrier that promotes healing.  I've been putting it on him several times a day.  The tricky thing with lanolin is that it's so thick that I have to pat it onto his face, as it doesn't rub in nicely (and I don't want to pull on his already-delicate skin).  The upside is that if my lips get a little dry, I just have to kiss his cheek, and I've got instant lip gloss (have to find some humour in the situation, right?).
• Socks on his hands - the hardest part of a flare-up is watching him scratch at his face until it bleeds.  Even with his nails trimmed short, it can still happen, so when it's really bad, I will put socks on his hands for sleeping, and if necessary, during the day.  It's impossible to tell a baby to stop scratching, but it's also impossible for the skin to heal if he keeps re-opening the wounds.  Hopefully this will limit the amount of damage he does.
• Steroid cream when necessary - if it's really bad, I will put the prescription cream on.  However, this will be my last resort.

So I think that's it.  The one other thing I will be doing is praying that this is something that he grows out of, and that's it's not something we'll have to be dealing with for the rest of his life.  No parent likes to see their child suffer, whether it's a serious illness, just a cold, or itchy skin.  It hurts my heart, and I will do whatever I have to do to make him feel better.