Caring for children with eczema

Consultations tend to focus on the physical aspects of the child’s problems, neglecting those of a psychosocial nature (Fennessy et al., 2000). The health care professional should include in a holistic assessment the following factors:

• A detailed individualised history of the:
  • time, onset, pattern and severity of eczema
  • response to previous and current treatments
  • possible trigger factors
  • the impact of the condition on the child, their parents/carers
  • dietary history
  • growth and development
  • personal and family history of atopic eczema (NICE, 2007)
  
  
• Specific problems such as scratching/poor sleep/family impact.
• Developmental considerations: It is important to highlight that 10% children with severe atopic eczema display retarded growth. NICE (2007) recommends monitoring growth in children with atopic eczema by regular weight and height measurement, to assess for growth retardation. The reasons for growth retardation in severe atopic eczema are not fully understood, but chronic sleep disturbance and stress may contribute (NICE, 2007). Growth retardation also needs to be assessed with consideration to the child’s diet, as children on strict elimination diets (which may not be clinically supervised) often exhibit nutritional deficiencies that may lead to poor growth (Lifschitz, 2008).
• Parental support/self-efficacy (belief in their ability to manage their child’s eczema): managing medication and eczema symptoms and communicating with health care professionals.
• Challenge of parent and child management of scratching and poor understanding of an effective clinical regimen by parent.
• Quality of life impact: this is significant in atopic eczema and affects the entire family including:
  • Sleep disturbance,
  • Major burden of care causing disruption of family life,
  • Economic cost and
  • Treatment adherence: children with eczema are often on multiple medications and parents are given health guidelines that they often struggle to put into practice. Problems of adherence stem more from a disbelief in their ability to use effectively what they are prescribed than from disease activity (Taal et al., 1993).