Starting nursery: An eczema parent’s guide.

Whether you are returning to work after maternity leave or you have other commitments requiring your attention – sending your child off to nursery can be anxiety inducing for anyone. Add eczema into the mix and you are likely to be even more fretful. We’ve spoken to nursery manager and eczema sufferer, Annette Milburn, for her top tips on managing eczema at nursery.

Choosing a nursery

For any parent, finding the right nursery that offers the best care and education can be a challenge. It can be even harder to find a nursery that will give the best care and attention to a child with eczema. Forums across the internet show how concerned parents are about finding the right nursery and making sure that they do all they can to help alleviate the symptoms of eczema.

Ultimately, you need to feel confident that the nursery has the skills, experience and willingness to be proactive in the management of eczema. Visit a number of local nurseries, ask if they have looked after any children with eczema before and what routines were in place for them.

Try to get a feel for how seriously they take the issue of eczema, and gauge their level of knowledge on the subject. See if they are familiar with the common emollients and ask them about the skincare regimes they have put in place for other children.

Before your child starts nursery be sure to spend some time with their keyworker and supervisor so you can discuss your concerns. Open and blame free dialogue is important.

The key to keeping a child’s eczema under control at nursery is open and effective communication with the staff. For example, if your child has not slept well because of their symptoms, you need to be sure that nursery staff can accommodate extra naps or a less active day. Or, if your child’s eczema flares unexpected, you need to be able to discuss possible causes openly. Make sure that you feel comfortable that you will be able to have these discussions should the need arise.

Nursery eczema triggers and how to minimise them

Temperature

Early Years environments are often hot – especially in the baby and toddler rooms. Heat often exacerbates eczema symptoms and increased itchiness is inevitable as a result. Layers are your friend when it comes to dressing for nursery. Start with a base of light cotton of a baby vest or a cotton t-shirt and underwear. Then add easy to remove thin layers in eczema friendly fabrics. Make sure that your child’s key worker is aware of the issue so they can adjust layers as necessary. Be sure to label the top layers so they don’t go missing.

Children will be moving between indoors and outdoors. This change in temperature is another trigger for itchiness, again the layering will help. Make sure your little one has a waterproof coat for outdoor play but avoid anything too thick and heavy. Whilst woollen duffle coats may look adorable they are not kind to itchy skin! Provide a few pairs of mittens/gloves so that there is always a dry pair available.

Laundry detergent

Towels, sheets and dressing up clothes may be washed in a detergent that causes flares. If your little one has a particular passion for dressing up in a certain outfit at nursery, it is worth asking if you can take it home and wash it once a week.

Likewise, you can provide your own towels and sheets. Most nurseries will be able to accommodate these requests, as long as everything is clearly labelled. However, nurseries are busy places with lots of staff so, even with the best intentions, the occasional mix-up will happen. Be kind to the staff when this happens, they are probably just as cross with themselves as you are.

Food allergies

Whether food is provided by the nursery or by the parents, nursery staff are typically very aware of food allergies. It is more than likely that your nursery has a strict ‘no nuts’ policy already. It will also have processes in place to manage other food allergies. This might include personal placemats for each child clearly marked with food allergies and close supervision of meal times.

Sensory play

Sensory play is key in childhood development and to that end the play trays are likely to be stocked with soaps, paints, sand, coloured water and salty playdough (especially drying on little hands). Most nurseries will be able to make sure that these trays are eczema friendly. Some nurseries also use foodstuffs in their sensory play – tomatoes, potatoes and citrus fruits are particularly problematic for eczema children. If necessary, you can work with the nursery to provide eczema friendly versions of all of the above.

Hand washing and drying

Hand washing is encouraged at nurseries for obvious reasons. Repeated handwashing alone can dry the skin and some soaps can cause reactions. Keep an eye on your little ones hands while they are attending nursery. In our experience sudden flare-ups on our itchy boy’s hands were inevitably linked to a change in the hand soap. You can find out more about eczema and handwashing here. Most nurseries will be happy for you to provide a soap, but be prepared for it to be used by the other children who will love the novelty of a different hand washing option.

When it comes to drying, single use paper towels are the norm in most Early Year settings. What small child likes a noisy hand dryer!?). As these aren’t especially effective for getting hands completely dry this can also be a source of sore hands. Again, you can provide micro fibre hand towel or even a regular flannel for your little one to dry their hands with.

Sunscreen

Some nurseries provide sunscreen, others ask for parents to provide it. Either way, for children with eczema, it’s better to provide a sunscreen that you know won’t irritate your child’s skin. Ask staff to apply your child’s cream first to avoid cross-contamination. See here for tips on finding eczema friendly sunscreens.

Bugs and illnesses

One thing you can be sure of is that the first year in nursery is going to boost the whole family’s immune system! Coughs, colds, stomach bugs, chicken pox, headlice… They are all rife and it is inevitable your little one will catch some if not all of them. (And pass them on to the rest of the family) Whilst this sounds terrifying and a good reason to quit your job and stay at home, it is important to realise that this will improve dramatically after the siox months and your child will be in much better shape to face the inevitable wave of bugs they will encounter all over again when they start school.

You will have already realised that any sort of bug has the potential bring on a eczema flare-up. So starting it’s useful to be ready to deal with a worsening of your little one’s eczema when they start nursery. Make sure that you are on top of their skincare regime to minimise the risk of a major flare up.

Many of these bugs are seasonal. Coughs and colds more common in winter, and chickenpox waves most common in late autumn and early spring. Snotty noses are a given and usually nothing to worry about as long as you are armed with plenty of tissues! A layer of vaseline around the nose will help to minimise skin aggravation from the snot.

Stress

Stress is a well known eczema trigger and the first few weeks at nursery are bound to be a little stressful for both you and your little one. Make sure you are as calm as possible, so your child doesn’t pick up on your stress. In the run up to nursery starting make sure that you are on top of your child’s skincare routine. This will make sure that any stress related flare-ups are minimised.

Drop off is typically the most stressful time for your little one. However, nursery staff are experienced in keeping this as low stress as possible. They are masters of the art of distraction! Before your child starts, have a plan of action agreed with your child’s keywork for drop off. Personally, I prefered the ‘dump and run’ approach. If things were looking like they could escalate, I called the nursery 5 minutes later to check the kids had settled. They always had.

Applying emollients while at nursery

Because emollients can be classed as medication, this can be a tricky area to negotiate. Depending on your nursery’s medical policy, applying emollients may entail a lot of paperwork, emollients to be supplied with the pharmacy label attached and need witnesses and multiple signatures for each application. It is important to talk to the nursery about these issues and find out what their individual policy is. The medicine policy will be a part of the overall health and safety policy of the nursery.

If your child’s skin is broken and weeping, the nursery may need to take additional precautions, such as wearing gloves to apply emollients. This is to protect both your child and the staff from the risk of infection. If your child is sensitive to latex, it would be wise to check that the gloves used by staff are latex free.

If the nursery is reluctant to apply emollients, it may help to remind the staff that eczema can be considered a disability under the Equality Act and Early Years providers should make reasonable adjustments for the condition. However, it may be wiser to find a different nursery that is more open to your child’s needs.

Questions from peers

Children are naturally inquisitive and are likely to notice any differences and ask about them. This may be awkward for your child and they may not know how to respond.
Good, supportive teaching around eczema is essential in Early Years environments. If the staff and children are able to hold open and informative dialogue with your child’s peers then the questions can be handled kindly and quickly.

A final word

We spoke to Annette – a nursery manager who suffers with eczema herself. She had this to say which we hope you will find encouraging and comforting. “As an educationalist, and considering the well-being of learners, it is important to ensure that the child is well. If a child is struggling to focus because they are itching, or their skin is sore then this will impact their learning. Children do not like to feel different from their peers and therefore adaptations should be inclusive and an environment of equity be fostered. Educationalists strive to provide environments where all can thrive and, in this case, it will be achieved by close collaboration with parents/carers and sensitivity.”

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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. We now stock sizes from 0-adult in a range of colours. Visit our webshop for more information.