Managing your child’s eczema? A psychodermatologist explains the important link between skin and stress

If your child is suffering from eczema, you know the struggle: the endless scratching, the sleepless nights, the constant overwhelm of prescriptions and appointments and tricks you’ve been meaning to try. You’re likely already working with a pediatrician or dermatologist to find the right treatment plan—and that’s the best first step. But did you know there’s a huge connection between stress and eczema? That means your child’s mental health—and your own–could be impacting their atopic dermatitis, too.

Like many of life’s little problems that seem to spiral out of control, inflammatory skin conditions like eczema and mental health share a mind-body feedback loop: Inflammation in the skin can communicate with the brain—causing anxiety, depression, tiredness and foggy thinking. At the same time, all that stress can trigger more inflammation…which causes more stress…which triggers more inflammation…and the vicious cycle continues.

The science on this is clear—and that’s why organizations like the American Academy of Dermatology and the National Eczema Association promote stress-reduction methods like solid sleep and mindfulness as important tools for treating conditions like eczema.

What’s a lot less clear is exactly how this information should be applied to young kids. Sure, we know that sleep is essential for skin repair and a daily meditation practice can significantly reduce stress—but where does that leave our littlest ones, the ones who suffer from high rates of eczema but aren’t exactly pros when it comes to their wellness routines? The ones who aren’t always capable of articulating how they’re feeling? The ones whose sleep patterns are understandably unpredictable?

“Family dynamics come into major play when working to reduce stress in kids,” explains Amy Wechsler, M.D., a psychodermatologist (she’s double board-certified in dermatology and psychiatry, and specializes in the intersection of both fields) and author of The Mind-Beauty Connection.

Much like the body and mind are connected, so are you and your child. Here’s what you need to know about how stress affects their skin—and how your stress affects their skin—when it comes to managing eczema.

Stress increases cortisol, which causes trouble for the skin

When it comes to cortisol—the body’s chief stress hormone—balance is everything. “Too much cortisol causes trouble,” explains Dr. Wechsler. “You want it around when you need it, and gone when you don’t.”

Cortisol gets pumped up in stressful situations: When the body is under physical or emotional duress (yes, like when your babe wakes up screaming in the middle of the night), it goes into fight-or-flight mode and amps the production of stress hormones like adrenaline and cortisol. But when the body produces too much cortisol, it can suppress the immune system and cause an inflammatory response in the skin.

Dr. Wechsler says it’s especially important to help kids avoid chronic stress, which happens when they’re under prolonged or back-to-back attacks without relief. “Chronic stress can cause the epidermis to become leaky,” says Dr. Wechsler. “The skin becomes more dry and also lets in potential allergens and sensitizers—the exact opposite of what’s good for an eczema patient,” she says.

Sleep is essential for keeping cortisol levels low

So how, exactly, can we keep cortisol levels under control in kids? One very simple answer is solid sleep—for both little ones and their parents. “It would be difficult to overstate the importance of sleep,” says Dr. Wechsler. “Cortisol is lowest during sleep, which is why good sleep is so important. It gives the body a break and allows time for the skin to heal.”

Think of it like this: The more hours of restorative sleep your child is getting, the less time they’re spending with raised cortisol and the more time they’re spending with the good molecules that heal—like endorphins, growth hormones and oxytocin.

Plus, Dr. Wechsler points out that when a child isn’t sleeping, the parents usually aren’t sleeping either—which can increase stress in the parents that trickles down to the child. (Keep reading for more on how stress flows both ways in the parent-child dyad.)

Your all-important mission: Figure out the best sleep strategy for your family—by any means necessary. Considering co-sleeping? Research shows that mamas who co-sleep get more sleep than those who don’t. Perhaps you need an expert intervention? A sleep consultant can personalize a sleep strategy that’s unique to your child.

Address the itch to improve sleep and reduce stress

Another big barrier to sleep—and healing? The awful itch factor that many kids with eczema experience, which can disrupt sleep and set off another snowball effect. “It’s another chicken and egg thing, because if kids are really itchy with eczema, that can impact their sleep,” says Dr. Wechsler. “And then if they’re not sleeping well, they’re not healing as fast—because healing happens during sleep.”

Keep in mind that itchiness is subjective and will present differently for every kid: Some might have large patches of eczema that aren’t bothersome at all, while others might have small, isolated flare-ups that keep them up at all hours of the night and distracted during the day. (Which both—you guessed it!—lead to more stress.)

To break the itch-scratch cycle, Dr. Wechsler says it’s important to address food and environmental allergies, implement an eczema-friendly skincare routine and enlist help from an oral antihistamine when necessary (just ask your ped). “When we follow this protocol, it’s common to see itchy skin—and sleepless nights—improve very quickly,” says Dr. Wechsler.

Mindfulness and meditation provide major health benefits for kids

Breathwork, mindfulness, meditation and gentle movement aren’t the typical activities that come to mind for kids—especially babies and toddlers. But we’re doing our kids a major disservice if we underestimate their interest and ability to learn these techniques, which can help them feel better in their bodies and boost their overall health—skin included.

There’s plenty of fascinating research on the power of mindfulness for stress reduction in kids—like a new study out of Stanford University School of Medicine that shows kids who practice mindfulness not only sleep longer, but also gain a better awareness of their stress and stronger skills for coping with it.

So what’s the key to teaching stress reduction techniques? “I’ve found that kids are surprisingly capable in these areas, especially when we model it for them,” says Dr. Wechsler. Getting started doesn’t need to feel formal or forced; start small and introduce little habits into your daily routine, then build until these techniques are organically woven throughout every day.

Stack your child’s shelves with books that introduce mindfulness (try Listen Like An Elephant or Breathe Like a Bear from Kira Willey), grab a deck of mindfulness cards for kids and play quick games (like “drop anchor”) and mini moments (like “the mindful bite”). Look to technology for help, too: Queue up CosmicKids yoga and mindfulness classes on YouTube (there’s a theme for every kid’s interest), and start a shared breathwork practice with apps like Breathwrk or Mindful Mamas.

Don’t underestimate the healing power of your touch

Applying lotion (and then applying it again and again) is a fact of life for many families with eczema—but it’s also an opportunity to elevate a simple skincare task into something more special.

“Kids need their parents’ hands on them,” says Dr. Wechsler. “A gentle body rub while massaging in cream after a bath can be a very relaxing experience that lowers cortisol levels, increases circulation and boosts helpful hormones like oxytocin and endorphins.”

Of course, it’s important to use the right body lotion or oil on eczematous skin—something that offers maximum benefits without any stinging or discomfort. Dr. Wechsler suggests pure safflower oil or a fragrance-free cream like Cetaphil Pro Eczema Soothing Moisturizer or Eucerin Baby Eczema Relief Flare-Up Treatment).

To reduce stress in your child, start with yourself first

You’re devoted to taking care of your child—but when’s the last time you checked in on the person who’s responsible for them? “Sometimes you’re so focused on your kid that you forget about yourself,” says Dr. Wechsler. “But we can’t talk about managing the toddler’s stress without talking about managing the parents’ stress, too.” Once again, it’s all interconnected.

Dr. Wechsler explains that when parents struggle to manage their own stress or mental health, it can negatively impact their child’s treatment—whether it’s by failing to stay on top of their at-home skin treatment plan, or by projecting your own stress and compounding theirs.

Let’s look at scratching as an example. For a child with itchy eczema, the urge to scratch can be overwhelming and hard to ignore. And for the parent, all that scratching can be triggering: You’re worried they’ll damage their skin or cause an infection! It’s irritating! You’ve reminded them dozens of times not to do it and they just. won’t. listen!

In these trying times, it’s more important than ever to stay calm and collected. Dr. Wechsler says problems arise when parents aren’t able to react mindfully, but find themselves snapping, nagging or bringing negative attention to the issue (which can increase stress in the child) instead. To model a healthy response, Dr. Wechsler suggests taking a few deep breaths and then calmly redirecting the child to a tactile, hands-on activity (great for diverting their minds and fingers away from the itch) or teaching them to grab a cooling ice pack to calm the flare-up.

And just remember to keep things in perspective. “I have seen cases of children in my practice who have mild eczema and are totally fine, but then it’s the parents who are really upset and not handling their emotions well,” says Dr. Wechsler. “Kids pick up on reactions and emotions. If the parents are showing their child their anxiety, worry or stress, the child will often feel that way, too.” She suggests working through those emotions when you’re alone with a partner, friend or therapist.

If you feel overwhelmed or extremely anxious about your child’s skin condition, Dr. Wechsler recommends checking in with yourself first. “Just take a moment to reflect and notice how you’re feeling and how you’re sleeping,” she says. If you’re struggling, identify the areas where you can get help—and don’t be ashamed to ask for it. To take the absolute best care of the little one you love, it’s essential to start with yourself.