Breastfeeding and baby eczema: separating evidence from myth

Breastfeeding can be an emotive subject, especially if your little one is unlucky enough to suffer from baby eczema. One of the hardest parts of early parenthood, especially the first time around, is all the conflicting advice you are given. From sleeping positions to the family cat, there will always be two sides and both are likely to be argued vigorously by significant people in your life! Turning online for help can be even worse – there is always someone with a disaster story to tell and someone else saying it’s all a load of nonsense. Here we are going to look at the impact of breastfeeding on both baby eczema and the food allergies often associated with eczema. 

A quick word of reassurance before you start down a guilt spiral!

If you are one of the many women who has found themselves unable to breastfeed you are probably already fearful that you are depriving your child terribly and have failed at the first hurdle of motherhood. The fact is that breast milk is good for your baby. But your job as a parent is to ensure that your baby is well-nourished in a way that works for both you and your baby. If you have to bottle feed, you can rest assured that the formula industry is one of the most rigorously tested and challenged that exists. Formula production companies are held to some of the highest standards out there – baby nutrition is not taken lightly. 

The World Health Organisation (WHO) recommends that you breastfeed exclusively for the first six months and continue to supplement weaning with breastfeeding until the end of the second year. The key word in that sentence is ‘world’. There are many countries where food and clean water is so scarce that mother’s milk is the only guaranteed source of safe hydration and nutrition for infants. In the developed world we have more safe options. You may happily breastfeed for two years or longer, you may stop at a couple of weeks. You may never manage it at all. Every woman’s body and every baby’s ability to feed is different and you must listen to yours.

Can breastfeeding prevent baby eczema?

Although breastfeeding has many other health benefits, more extensive studies are needed to provide reliable evidence regarding its ability to prevent eczema. There have been many studies into this area that have come up with conflicting results. That said, it does seem that breastfeeding during the first four months of life appears to modestly reduce the occurrence of eczema in infants with a family history of atopic disease (eczema, asthma and allergies)¹.

However, no protective effect was found in infants with no atopic family history. In fact, one very large UK cohort study investigating why eczema is more prevalent in babies from high socio-economic circumstances suggests that exclusive breast feeding (but not mixed feeding) is associated with higher levels of eczema in the general population².

Other studies show that breastfeeding for the first 3 months can reduce the severity of eczema at age 6³ and occurrence of eczema at age 16⁴. But keep in mind that the vast majority of children grown out of eczema by the time they start school, so on a population basis this effect is very small.

A possible mechanism for breast milk reducing the risk of eczema in babies with a family history of the eczema and allergy is that it coats the inside of the intestines which is thought to help prevent leaky gut. Food particles that pass into the blood may trigger an attack from the white blood cells (which attack foreign substances when they are detected) and this is what causes an allergic reaction. Interestingly, these reactions are more common in formula fed babies.

In summary

If there is no family history of atopic diseases, whether or not you choose the breastfeed is unlikely to have prevented your baby having eczema. However, if may help to reduce the severity of their eczema in later life. If there is atopy in the family and you could breastfeed exclusively for the first 3 months, the chance of your little one having eczema may have been slightly reduced. But if you continue this beyond 6 months, the risks start to increase again.

If you haven’t been able to breastfeed, for whatever reason, don’t blame yourself for your baby’s eczema. There isn’t a strong correlation between breastfeeding and clear skin, especially where there is no family history of eczema.  In my case, out of the 7 babies in our NCT group, it was only the two who were exclusively breastfed who had eczema. 

My baby has eczema. How long should I breastfeed for?

The duration of exclusive breastfeeding on eczema has also been investigated. A large, long-term study in Belarus found that while exclusive breastfeeding for the first 3 months reduced the occurrence of eczema at 16, there was no additional benefit (in terms of eczema) in continuing beyond 3 months⁴. Weaning at 4-5 months appears to be associated with a reduced risk of eczema⁵. While exclusive breastfeeding beyond six months appears to increase the eczema risk².

Interestingly, this timing is consistent with recent research on minimising the risk of food allergies in eczema kids, which shows that introducing allergenic foods at between 4 and 6 months old reduces the risk of future allergies to these foods. You can read more on recent research into about reducing the risk of food allergies in eczema babies here.

In summary

In terms of eczema, current research shows that there are minimal additional benefits of exclusive breastfeeding beyond 3 months. However, there are plenty of other good reasons to stick with it if you can. But don’t delay weaning as this can increase the risk of eczema persisting.

Is what I’m eating affecting my baby’s eczema?

Possibly.

It seems that breastfed babies whose mothers eat a Mediterranean type diet rich in fruits, vegetables, fish, vitamin D, and probiotics appear to be at lower risk of eczema⁶.

Some, but not all, women secrete allergenic proteins in their breast milk. These appear 2-6 hours after eating the allergenic food and can trigger eczema flares ups in allergic babies. Studies show that around 50% of women secrete peanut proteins, 60% milk proteins and 70% egg proteins⁷. Babies with sensitivities to these allergens, may have eczema flare-ups associated with allergens in their mother’s milk. However, given the delay in the allergens appearing in breast milk, this can be tricky to pin down.

Food allergy symptoms occur in several different body systems; the tummy, airways and skin. An allergic baby will usually have symptoms in more than one body system (colic, reflux, sneezing, wheezing and nasty nappies). If your baby only has eczema, it is unlikely that it is due to a food allergy. If the eczema is consistently coupled with other allergic symptoms, food allergy is a possible trigger. 

However, the symptoms of food allergy are common in babies and are usually not caused by an allergy. A study looking at babies with suspected food allergy based on their symptoms, found that only 10% had a genuine allergy⁷.

Ideally, a food allergy should be confirmed with a skin prick or blood test. You can read more about allergy testing here. If this isn’t possible, a trial maternal elimination diet of the suspected allergen for 2-4 weeks may be in order. In most cases, symptoms will improve in 3-4 days. If symptoms don’t clear up within 2-4 weeks, food allergy is unlikely to be the cause and the allergenic food should be reintroduced. 

Food allergy prevention and breastfeeding

Babies with eczema are at a higher risk of developing food allergies than those without it. However, it’s important to emphasis that no evidence has been found to suggest that routinely excluding allergens from the maternal diet prevents allergies. In actual fact, the opposite may be true and the presence of potential allergens in breastmilk may promote tolerance. There are ongoing studies into this subject⁷.

On this basis, current guidelines for breastfeeding mothers are not to exclude allergens from the maternal diet unless an allergy has been positively diagnosed. If you suspect a food allergy is aggravating your baby’s eczema, talk to your GP before changing anything.

Using breast milk to treat baby eczema

Breast milk has been a used as traditional skin cleanser for time immemorial. These cleansing properties are largely down to the anti-bacterial lauric acid which it contains. Breast milk can either be applied directly to eczema lesions with a clean finger tip or cotton wool ball, or added to your baby’s bath water (use enough milk to make the water cloudy).

The healing properties of breast milk for conditions like conjunctivitis are well documented⁸. However, research into the effectiveness of using breast milk to treat eczema is still very limited. A 2015 study of 100 babies in Iran found that applying breast milk directly to mild or moderate eczema lesions was as effective as applying 1% hydrocortisone cream (a mild topical steroid cream)⁹. Although this study is encouraging, it was very small and more work is needed to confirm the result. That said, given that using breast milk to treat eczema in this way has no adverse side-effects, it’s worth trying.

In conclusion

Proneness to allergies or eczema is primarily influenced by family history, exposure to allergens and genetic factors on both the maternal and paternal sides. Breastfeeding can play a role in passing immunity and microbiota directly to the baby. Unfortunately, there is significant inconsistency in published studies which means it is not possible to draw absolute conclusions. This is an area where additional research is needed before the maternal proneness or breast feeding can be assessed against the development of allergies and eczema.   

Our sources

1. Little, C, et al. “Update: Can Breastfeeding and Maternal Diet Prevent Atopic Dermatitis?” Dermatology Practical & Conceptual, 31 July 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630244/
2. Taylor-Robinson, D C, et al. “Do Early-Life Exposures Explain Why More Advantaged Children Get Eczema? Findings from the U.K. Millennium Cohort Study.” The British Journal of Dermatology, U.S. National Library of Medicine, Mar. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4949701/.
3. Balas, K. et al. “Exclusive breastfeeding in infancy and eczema diagnosis at 6 years of age” Journal of Allergy and Clinical Immunology, 28 February 2019, https://www.jacionline.org/article/S0091-6749(18)32119-5
4. Flohr, C, et al. “Lack of Evidence for a Protective Effect of Prolonged Breastfeeding on Childhood Eczema: Lessons from the International Study of Asthma and Allergies in Childhood (Isaac) Phase Two.” The British Journal of Dermatology, U.S. National Library of Medicine, Dec. 2011, https://pubmed.ncbi.nlm.nih.gov/21883137/
5. Turati, F, et al. “Early Weaning Is Beneficial to Prevent Atopic Dermatitis Occurrence in Young Children.” Allergy, U.S. National Library of Medicine, June 2016,
   https://pubmed.ncbi.nlm.nih.gov/26893011/
6. Little, Colleen, et al. “Update: Can Breastfeeding and Maternal Diet Prevent Atopic Dermatitis?” Dermatology Practical & Conceptual, U.S. National Library of Medicine, 31 July 2017, https://pubmed.ncbi.nlm.nih.gov/25280403/
7. Martín-Muñoz, MF, et al. “Food Allergy in Breastfeeding Babies. Hidden Allergens in Human Milk.” European Annals of Allergy and Clinical Immunology, U.S. National Library of Medicine, July 2016, https://pubmed.ncbi.nlm.nih.gov/27425167/
8. Sugimura, T, et al. “Efficacy and Safety of Breast Milk Eye Drops in Infants with Eye Discharge.” Acta Paediatrica, U.S. National Library of Medicine, Aug. 2015, https://pubmed.ncbi.nlm.nih.gov/33098117/
9. Kasrae, H, et al. “Efficacy of Topical Application of Human Breast Milk on Atopic Eczema Healing among Infants: A Randomized Clinical Trial.” International Journal of Dermatology, U.S. National Library of Medicine, Aug. 2015, https://pubmed.ncbi.nlm.nih.gov/25640116/

As well as sharing our experience of bringing up an eczema child (and favourite allergy-friendly recipes), ScratchSleeves also manufacture and sell our unique stay-on scratch mitts and PJs for itchy babies, toddlers and children. We now stock sizes from 0-adult in a range of colours. Visit our webshop for more information.