Creating a Toolbox to Manage Itch
“It’s bone deep and
nothing touches it. I grind
up hot peppers and rub
them on my skin because
the pain and burning is
better than the itch and
helps me forget it.”
The Itch-Scratch Cycle
For many families, managing itch is the hardest part of dealing with eczema. The itch can be extremely uncomfortable, and the urge to scratch can be very strong. Scratching feels good and relieves the itch temporarily. But it can also cause more damage to the skin barrier, increase inflammation and make itch worse. Some people call this the “itch-scratch cycle” of eczema.
Parents commonly find themselves telling children to stop scratching. Frustration with scratching is normal, because parents want their children’s skin to heal. The problem is, “don’t scratch” doesn’t usually work. It’s very hard for children to resist scratching when they are itchy. They may feel ashamed or frustrated that others don’t understand how they feel. This can increase their stress – which triggers even more itch.
A first step in helping your child to manage itch is to think about it as a team approach.
Let your child know that you understand how hard it is not to scratch when they are itchy, and you are not angry at them. This can reduce stress.
Explain to your child that scratching makes the rash and itch worse. That is why you will work as a team to find other ways to feel better when they are itchy.
Change the focus to what you and your child CAN do to relieve the itch. This can reduce arguments about scratching and empower your child.
The strategies below can all be part of your child’s toolbox for managing itch. No one tool will work perfectly, but you can partner with your child to find strategies that help them feel more comfortable and in control.
Understanding How Eczema Treatments Reduce Itch
The most important part of managing itch is having a good eczema management plan for your child.
The immune system, genes and the environment can all contribute to dry, itchy skin for children with eczema.
An overactive immune system triggers inflammation that damages the skin barrier and causes a red, itchy rash.
The damaged skin barrier loses water more easily, so skin is more dry and itchy.
Bacteria and viruses can get in more easily and cause infections.
For some people, triggers (such as irritants in clothing or skincare products, allergens in the environment or stress) can cause flares and itch.
Even though there is no “cure” for eczema, the different parts of your child’s eczema treatment plan work together to keep itch and other symptoms under improved control.
Baths and showers help: put moisture back into the skin and wash off irritants.
Moisturizer helps: seal water in the skin and strengthen the skin barrier, to protect against itch.
Bleach baths help: lower inflammation.
Topical steroids and non-steroid eczema medicines help: reduce inflammation so the skin is less red, sore and itchy.
Wet wraps help: keep water in the skin, let the skin heal, protect from scratching and reduce itch.
Biologic therapies (such as Dupilumab) and JAK inhibitors help: target the part of the immune system that is causing the itchy skin rash.
Avoiding triggers helps: reduce skin irritation, flares, and itch.
There are also ways to prevent damage to the skin due to scratching:
For infants and toddlers, it can help to keep the skin covered with long clothing and onesies to make it harder to scratch.
Consider scratch sleeves or pajamas with mitts for nighttime.
Keep children’s fingernails and toenails cut short and file them with a soft nail file.
Talk to your child’s healthcare provider if you have any questions or worries about your child’s eczema treatment plan, or challenges following the plan in daily life.
Additional resources for understanding how eczema treatments work:
GPER: https://www.gper.org/itch
Boston Children’s Hospital: Atopic Dermatitis: A Guide for Your Family (PDF)
National Eczema Association: https://nationaleczema.org
American Academy of Pediatrics: https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/How-to-Treat-and-Control-Eczema-Rashes-in-Children.aspx
Increasing Awareness of Itching and Scratching
Sometimes your child may be very aware they are scratching and other times they may be scratching without even realizing it. This is very common. Increasing awareness of scratching can help them to take other steps to manage the itch instead of scratching.
When you notice your child is scratching, remember that “don’t scratch” is not usually very helpful.
Instead, you could try: “You look itchy. Let’s do something to help you feel better.”
Some families develop a special signal with their child (such as a gentle hand on their shoulder), to alert them that they are scratching and that it would be a good time to do something to manage the itch. Include your child in deciding what this signal should be - it’s important they feel this is a team effort!
It can also help to identify common triggers of scratching. Sometimes itch just happens - that’s what eczema does. But there may also be certain triggers - such as situations, emotions, or environmental conditions that make itch worse.
You might notice that your child scratches more when:
They feel stress, such as before a test or when a toddler is having a tantrum.
Their hands aren’t busy, such as when watching TV.
Their skin is uncovered, such as during diaper changes or when they get out of the shower.
They are tired.
They are hot or sweaty, such as after recess or a basketball game.
Noticing these patterns can help to make a plan to handle these situations. For older children, it can help to keep a “scientific journal” or “detective notes” for a week to notice common triggers.
The next sections will help you in developing an itch management plan that works for your child.
Finding Quick Relief
When your child is itchy, it helps to have strategies to relieve the itch enough to break the itch-scratch cycle.
Examples of strategies to bring quick relief could include:
Putting a cold wet cloth or an ice pack over the itchy area for about 5-10 minutes.
Rubbing in moisturizer.
Taking a short shower or bath.
Changing into comfortable clothes.
Covering the skin.
Moving to a cooler place when it’s hot.
Patting the skin or place a hand firmly on the skin (instead of scratching).
For some children, understanding how these strategies work increases their sense of control. For example, “Sometimes the itchy messages from our skin to our brain become so strong that it’s hard to think about anything else. One way to block some of the itchy messages is by sending a different message to the brain, like a cold message from an ice pack.”
After your child gets some relief, it can be helpful to use other strategies such as distraction with a favorite activity or keeping hands busy to help prevent more scratching.
Praise your child when they tell you they are itchy or try a new strategy to feel better. Building new habits is hard work and takes time!
Keeping the Mind and Hands Busy with Distraction
Distraction works by shifting attention away from itch to other things. Distraction often works best if the itch is not too intense, or if you have also taken steps to make the skin feel better.
Play with toys
Play a game with your parents
Go for a walk
Try to solve brain teasers or crossword puzzles
Do something with your friends
Listen to favorite music
Read a good book
Watch a funny movie
Call a relative or friend
Activities that keep the hands busy are really useful, because they prevent your child from using their hands to scratch.
Sing songs with hand movements
Play with a fidget toy
Squeeze a stress ball
Draw or sketch
Build with blocks or Legos®
Make origami designs
Knit or crochet
Ask your child to “help you” with a task that involves their hands
It can help to plan ahead by keeping distractions and hand-held activities available in common “trigger situations,” such as:
Pad and pen to doodle while watching TV
Stress ball in their desk at school (with teacher’s permission)
Special toys your child only gets during diaper changes
Hand-held electronics for special situations like car rides, when it may be harder for parents to manage scratching
For children who scratch when clothes are off after the bath or during skincare: play a couple of favorite songs and make a game out of completing skincare and getting clothes back on before the songs end
Using Mind Body Relaxation Skills to Turn Down Itch and Stress
The relationship between eczema and stress
Having eczema can be stressful. Additionally, stress can trigger eczema or make it worse, creating a challenging cycle.
When we experience a stressful situation, the body increases production of stress hormones such as adrenaline and cortisol. This is called the fight-or-flight response. It’s helpful when there is an immediate threat, like if a wild animal was chasing you. The problem is, our bodies respond in the same way even if the stressful event is something like talking in front of a big group of people, or an ongoing stressor like having eczema.
For people with eczema, when the body produces too much of these stress hormones, it also affects the immune system, including increased inflammation and itch.
Chronic, or ongoing stress, can keep the body on high alert for longer periods of time. This can have an impact on the immune system that worsens eczema symptoms.
You might notice the stress-itch response in your child’s everyday life. For example:
Your child gets itchy during a test at school and finds it hard to concentrate.
Or you may find it hard to manage your toddler’s temper tantrums because they start scratching when they feel frustrated.
Mind-Body Relaxation Skills to Manage Itch
Mind-body relaxation skills can be used to re-set the nervous system so it returns to a state of calm. For people with eczema, mind body skills can also focus attention away from itch. Practicing relaxation is like learning to play a sport or an instrument. It takes practice. At first, have your child practice these skills when they are not very stressed or itchy. Once your child is used to the feel of relaxation they can use these tools at bedtime or whenever they need them.
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Belly Breathing
Using your breath to trigger the relaxation response and increase comfort.
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Imagery
Using the imagination to create relaxing or healing images, using all of your senses. The body responds as if you are actually in the scene you are imagining, so you can feel more calm and comfortable.
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Mindfulness
Using your senses to focus on what is happening around you, what your body is doing and how you are feeling in the present moment, without judgement.
Handling Scratching During Tantrums and Meltdowns in Young Children
Tantrums are a way that young children let out strong emotions before they can express or handle them in another way. Children with eczema may be more prone to tantrums when they are itchy or aren’t sleeping well.
Tantrums can be stressful for any parent to manage. For parents of children with eczema, there is the added challenge that children may scratch more during tantrums, when they are feeling frustrated, mad or upset. Parents often face the dilemma of not wanting to “give in” to stop the tantrum (which teaches the child that the tantrum works), but also not wanting their child to damage their skin.
The best approach is typically to help children develop other ways to express and manage frustration, while also attending to their unique eczema needs.
Ideas to prevent tantrums
Follow a regular schedule and routines for meals, naps, skincare and bedtime.
Give warnings for transitions (such as cleaning up toys to get ready for bath time).
Give acceptable choices to increase control (such as grapes or apples for snack).
Know your child’s limits - if they are really tired, hungry, or itchy, it may not be the best time to run extra errands.
Help children to label and name their emotions in everyday life, to learn these feelings are normal and can be managed.
Practice and model calm down activities before a tantrum begins. This could include relaxed breaths, or going to a “calming corner” to take a break.
What to do during a tantrum
Stay calm. Your child will pick up on your cues.
If your child is not yet in a full-blown tantrum, try distracting them with another activity or moving to another location.
Try labeling the emotion to show you understand “I can tell you are angry that you can’t have that toy right now.”
Ignore behaviors that are not dangerous, such as whining, screaming or throwing themselves on the floor. Ignoring means turning your eye gaze away from your child, starting another activity, and not speaking with your child.
Keep your child safe. Remove dangerous objects. You might need to hold your child so they don’t hurt themselves.
Handling scratching during a tantrum
If your child is doing some mild scratching during the tantrum, it’s usually best to ignore the scratching. You don’t want to give the scratching extra attention.
If your child is scratching intensely, you may need to step in to protect their skin. Try to do this without giving a lot of attention. For example, tell them in a matter of fact voice that you are going to hold them or put a cool pack on their skin while they calm down. Then, don’t talk or engage with them until they calm down.
What to do after a tantrum
As soon as your child stops the tantrum or shows positive behaviors, give specific praise for behaviors you want to see again. “Thank you for talking in your indoor voice.”
If your child is able to do so, talk about the situation that triggered the meltdown. Acknowledge and label their feelings. Let your child know you understand their frustration. Then, talk with them about other ways they could express their feelings or solve the problem.
If the tantrum started because of something that your child was asked to do, go back to the original request after they calm down. This can give them a chance to show positive behavior, earn praise and feel proud of themselves.
Putting it all together: Creating your child’s toolbox for managing itch
Just like you can’t build a house with just one tool, you may need a collection of different tools to manage itch. You can work as a team with your child to discover which tools work best for them in different situations. Remember to praise your child when they try using one of their tools. The goal is to empower them to take steps to feel more comfortable and in control.
