Atopic Dermatitis in Children

Eczema in Kids: A Root-Cause, Research-Based Guide

You notice that your child is in discomfort and itching their dry skin patches as a result of their inflammatory condition, eczema. As a parent, managing eczema in a child brings a unique set of emotional and practical challenges: the distress of seeing your little one uncomfortable or in pain, the confusion over which treatments to trust, and the relentless trial-and-error process of finding what truly works. 

Eczema is remarkably common, affecting up to 10–20% of children worldwide. Though some children may outgrow the condition, many continue to experience flare-ups into adulthood. It is a type of dermatitis that is typically genetic, linked to immune system dysfunction, microbiome imbalance, skin barrier defects, allergens and often begins in childhood. Other forms of dermatitis—such as contact dermatitis—are more often triggered by specific environmental exposures and may not have the same chronic or hereditary components.

The intention with this blog is to help ease that burden. Drawing from the latest research and clinical insights, my goal is to offer a comprehensive, integrative approach to managing eczema in your child. In order to have a better understanding of the Naturopathic approach to treatment, we’ll explore the underlying mechanisms that are at play, followed by assessment and management tools designed to empower you with tools and knowledge to help your child thrive.

Eczema is a multifactorial disorder involving complex interactions between genetics, the immune system, the skin barrier, and environmental triggers. It often begins in early childhood but can persist or even first appear in adulthood. A dysfunctional skin barrier permits irritants, allergens, and microbes to penetrate the skin more easily, triggering immune responses that cause inflammation. In individuals with eczema, the immune system tends to over-react to harmless substances, contributing to chronic skin irritation and itching.

The Gut-Skin Link

An emerging body of research suggests that eczema is not just skin-deep—it may begin in the gut. The gut-skin axis refers to the bi-directional communication between the gut microbiome, intestinal health, immune function, and the skin. When the gut barrier is compromised, a condition where there is increased intestinal permeability, inflammatory compounds and partially digested food particles can enter the bloodstream, triggering systemic immune responses that may manifest in the skin. I recognize this correlation in my practice and absolutely make investigating this area a priority in managing eczema! 

A 2016 study published in Clinical & Experimental Allergy found that infants who later developed eczema had lower levels of beneficial Bifidobacterium and Lactobacillus species in their gut microbiota. Another recently published review in Frontiers in Immunology highlighted that eczema patients frequently exhibit increased intestinal permeability, which correlates with heightened systemic inflammation. Another study in The Journal of Allergy and Clinical Immunology linked gut microbial imbalances in early life with a higher risk of developing not just eczema, but also asthma and allergic rhinitis, again pointing to the interconnected nature of the atopic triad.

As a naturopathic doctor and parent myself, I know how heartbreaking it can be to see your little one struggling with red, itchy, inflamed skin. Eczema is incredibly common in infants and toddlers, and while it often starts as a seemingly harmless rash, it can progress into a chronic condition that deeply affects quality of life for both the child and the family. With early intervention, a supportive care plan, and a deeper understanding of the underlying causes, many children can experience significant relief, often without the need for long-term medication.

The hygiene hypothesis is another theory that suggests a reduced exposure to microbes early in life may contribute to rising rates of allergic and autoimmune conditions, including eczema. While cleanliness is important, especially in infancy, a lack of exposure to beneficial microbes (through nature, pets, or other children) may hinder immune development. Spending time outdoors, playing in dirt, and even allowing some safe exposure to animals can help nurture your child’s natural defenses.

Symptom Tracking

Tracking symptoms and exposures in a journal can be incredibly helpful for identifying patterns and navigating treatment options. Looking for patterns (cyclical, onset), description of the skin irritation/rash, location, scratch patterns, other symptoms and triggers can help to recognize eczema more efficiently. Other factors to consider, is that eczema can often show up differently in infants compared to older children.

Eczema warning signs:

• Dry, rough, or scaly patches, especially on the cheeks, arms, and legs
• Redness and inflammation, sometimes with small bumps that may ooze or crust
• Persistent itching, which may interfere with sleep or feeding
• Darkened, thickened skin (with chronic scratching)

Common Differences in infants vs children: 

Infant Eczema (0–2 years)

• Common areas: cheeks, scalp, forehead, chin - later spreads to arms, legs, trunk.
• Appearance: red, weepy, oozing patches; often crusty or scaly.
• Distribution: tends to affect the face and extensor surfaces (outside of elbows/knees).
• Other features: babies may rub against bedding/furniture to scratch, sleep disturbance is very common.

Older Children (2 years and up)

• Common areas: flexural surfaces (inside of elbows, behind knees), wrists, ankles, neck.
• Appearance: drier, thicker, lichenified plaques (figure 3) from chronic scratching. Less oozing, more scaling.
• Distribution: more localized than in infants, typically in skin folds.
• Other features: more pronounced itching, may flare with triggers like sweat, allergens, or stress.

Common eczema triggers include:

• Food sensitivities or allergies, especially to dairy, eggs, gluten, soy, or nuts
• Soaps, shampoos, or laundry detergents with artificial fragrances or harsh chemicals
• Environmental allergens like dust mites, pet dander, mold, or pollen
• Over-bathing, which can strip the skin’s natural barrier

Key Takeaways: Every child’s skin is unique. What looks mild in one child may feel intensely uncomfortable for another. Tracking your child's skin in a journal is the first step to help provide better detail for your healthcare provider to develop an effective treatment plan for your child. In infants, eczema tends to be more widespread, wet, and oozing, often affecting the face and body. In older children, it usually appears as more chronic, dry, and thickened patches that are localized to the flexural areas, such as the inside of the elbows and behind the knees. Early intervention isn't just about soothing the skin, it's about supporting your child's developing immune system, identifying potential root causes, and helping to prevent the "atopic march" (the progression from eczema to food allergies, asthma, or hay fever).

Further Investigation

If eczema is moderate to severe, persistent, or associated with other symptoms (such as digestive upset, poor weight gain, or respiratory symptoms), further testing may be appropriate:

• IgE allergy testing (especially if hives, wheezing, or anaphylaxis are suspected)
• Food sensitivity panels (IgG or MRT testing) to explore non-IgE mediated responses
• Stool testing to assess the microbiome, inflammation, and digestion

The Naturopathic Approach 

A Naturopathic Doctor can help determine which tests are appropriate and guide you through the next steps in a personalized plan. Some of the strategies that may be incorporated into your treatment plan, based on your child’s needs include:

• Anti-inflammatory nutrition for children (or mom if breastfed infant)
• Pediatric Probiotics
• Soothing, Safe Topicals
• Nutrient support

Supporting your little ones through their eczema can be stressful! Know that you're not alone, and there are empowering options available. By embracing a root-cause, whole-person approach, you can begin to uncover the unique factors contributing to your child’s eczema and take meaningful steps toward healing. From nutritional support and gut health to herbal therapies, stress management, and targeted supplementation, integrative tools offer a comprehensive path forward. Naturopathic medicine helps bridge the gap between conventional care and natural approaches, offering supportive, individualized solutions that support long-term wellness. Healing is possible—and together we can guide that journey!

Are you looking for support for your little ones?  

Reach out to Dr. Shantel Simpson, ND