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1 ''Can't play with the sand at nursery. I get all scratchy and red and sore. Not fair'' - Sophie ''My teacher helps with my creams when I'm too dry'' - Daniel

2 Dear Early Years Professionals, This helpful booklet was produced by us based on our children s experiences of coping with eczema. It includes useful information and strategies to support children in learning environments, encourage confidence, increase concentration and help increase the awareness of the effects of eczema on education. Anne, Morag, Gill, Fadzai & Alana Contents What is eczema Eczema in Scotland... 3 The effects of eczema on learning and playing... 4 The itch-scratch cycle... 5 Common triggers at schools and nurseries... 6 You can help... 7 Advice... 8 Support sheet... 9 How seasons can affect eczema What our children say

3 What is eczema? Eczema is an inflammatory condition of the skin. The most common form is atopic eczema and it mainly affects children but can continue into adulthood. It is a chronic condition. The skin becomes itchy, red, dry and cracked. It can bleed and become infected. People with atopic eczema often have other allergic conditions such as asthma or food allergies. There is no cure for eczema, but it can be managed with proper care and knowledge. It is not contagious or due to poor hygiene. My eczema is like a bee; they fly about and they sting me, ouch, ouch, ouch. Eczema in Scotland 25% of primary school age children and 10% of teenagers have eczema, with 80,000 of them suffering from its more severe form. 20% of children with eczema are bullied at school. 1 in 2 has low self-esteem. 37% of parents/carers admit to feelings of helplessness, frustration and anger. I don t like when my hands feel rough - Zoe, age 5 3

4 The effects of eczema on learning and play s Tirednes Frustration Late arrivals Poor concentration Slower pace of work Discomfort Tearfulness ssment Embarra Shyness ss Self-consciousne Sleep-deprivation. Sleeping with an itchy skin is very hard for the child and the family often starts the day with only a few hours of rest. Stress. Symptoms and treatment of eczema can be stressful. The routines (bath, bandages, creams, etc) are heavy and time-consuming and there is the constant worry of an infection. Emotional and social consequences. Low confidence and isolation can be some of the consequences of eczema, both for children and their parents/carers. It is difficult to hold a pencil and keep up with my work when the 4 eczema on my hands has flared up - Isla, age 9

5 The itch-scratch cycle The itch-scratch cycle highlights how the skin can deteriorate in spite of daily treatments to maintain it such as emollients, steroids, ointments or bandages. Skin is fragile Skin is dry Antibiotics Antihistamines Hospital visits Itch, scratch, itch, scratch Skin becomes infected Skin is sore Skin can break One stage doesn t necessarily lead to another in every child, however an awareness of these stages can help you understand how a child is feeling on the inside and how this affects their behaviour on the outside. It s a jaggy hedgehog or plant as it is jaggy and sore to touch when I am having a flare-up - Mia, 4 years old 5

6 Common Triggers at schools & nurseries Life at school or at nursery can be a challenge for the child with eczema. Some products and foods used in the classroom can also spark or exacerbate the flare-ups. Stress & Emotions Anxiety about tests, homework, friendships, inclusion in activities, bullying because of eczema. Certain Snacks / Food For example: nuts, milk, dairy products, citrus fruits, gluten, chocolate. Room Temperature / Weather Being too hot or too cold. Common Products & Materials Face paints, lanolin, sand, bubbles, latex, grass, play dough, colouring products, hand wash, sun tan lotion, rough paper towels. Always ask the parents /carers about known allergies and triggers... and tell them if you notice something new or have any concerns. 6 It hurts when you touch it - Iamba, age 5

7 You can help As an Early Years Professional, you can develop some simple strategies which can greatly help maintain the child s well-being and reassure their parents/carers. Here are some ideas: Avoiding products that contain harsh substances such as alcohol, perfume eg. soaps (parents may be able to provide soap substitutes). Protect the child s hands with non-latex gloves during messy play or painting. Check for food allergies/intolerances and talk about alternatives with the parents/carers. Write down a plan with the parents and review it. This may involve some basic care such as applying creams at break time or changing bandages. Educate all children about skin conditions to encourage the inclusion of children who look different. Build the confidence and self-esteem of the child with eczema with lots of praise and encouragement. Get in touch with Eczema Outreach Scotland for further information (see back page). It s sore - Kashmera age 4 7

8 ADVICE Build trust with the child Show that you understand how they might be feeling Agree on a signal with the child So that they can let you know they are uncomfortable Change activity/environment Don t say don t scratch Try to distract the child Facilitate the child s skincare routine Moisturisers, creams, ointments, whatever the child uses Temperature Use a fan if too hot Don t sit next to radiators Warm hands after playing outside in cold weather, snow, etc. Offer plenty of water Be mindful of the discomfort Refer to the itch-scratch cycle Be aware of allergies Ask the child and the parents/carers. I think people stare at my Eczema 8 so I cover up as much as I can - Isla, age 9

9 Support sheet Communication with parents/carers is key to helping children with eczema. The more you know about a particular child s circumstances, the better prepared you will be to make learning a positive experience. CHILD S NAME Child s Name Eczema medications/treatments PARENT S/CARER S NAME Does your child s eczema require regular application of an emollient (moisturiser)? What strategies have you found successful in coping with/minimizing scratching? Do you know of any allergens (dust, pollen, pet dander, food) that aggravate your child s eczema? Are there any other aggravating factors or anything else you would like to share that you feel might be helpful? Does your child have any limitations on activities because of eczema? Is your child s sleep affected by eczema? Can this contribute to tiredness, absences, or sleepiness in class? Has your child previously experienced any problems in school emotionally, socially, etc? Do you have any suggestions or insights you would like to share about helping your child cope with eczema at school? Notes Inspired from the National Eczema Association s Tools for schools 9

10 How the seasons can affect eczema Autumn & Winter I find that my daughter s skin gets worse and sorer. The impact of the whole skin care routine affects time and emotions. A bath every cold morning and I must ensure she has antihistamine to see her through the day Fadzai, mum of Iamba Mia asks for creams more regularly as her skin becomes dry, cold and itchy Alana, mum of Mia Her skin needs much more moisturiser and bathing and she doesn t want to do this. She usually ends up on antibiotics for weeks at a time Anne, mum of Isla Zoe s skin is so sore and red in the colder months especially her hands, face (around her eyes) and the backs of her legs. Gill, mum of Zoe In summer, she tends to flare up again and I have to make sure she is always moisturised and hydrated with water Fadzai, mum of Iamba Spring & Summer We always carry water spray bottle with us as Mia gets hot and agitated, it helps to cool her down Alana, mum of Mia We get much less sleep as she is hot in bed even with no blankets. She scratches all through the night and is very tired the next day Anne, mum of Isla Zoe s skin is less problematic in the warmer months but sleeping is often effected as she is too hot! Gill, mum of Zoe My eczema sometimes stops me sleeping as my 10 legs are really itchy - Zoe, age 5

11 What children say... Are things different at school/nursery because of your eczema? Yes because I look not nice. Everyone s skin is beautiful but mine - Mya That I haf to go to the offise because I start scratching so I have to put my crem on. Can t sit still or concentrate. When I get super-hot I cry and the teacher stops the class. Everyone hates this - Josh -Peter What s annoying about your eczema? Can t play with the sand at nursery. I get all scratchy and red and sore. Not fair People make fun of it - Nial - Sophie I feel sad and grumpy. It annoys me when you put cream on and it keeps itching - Iamba, age 5 11

12 ''When I get super hot I cry but someone always makes me cool down'' - Peter SC10 Number SC042392