IT can be tough bringing up a child - and when that child has eczema, it just gets tougher.
And the difficulties for parents of the two million UK children with the itchy skin condition aren't just because they have to see their child suffer and apply daily treatments, as new research has revealed that more than half of mums of children with eczema worry their child's condition is holding them back and they're missing out on everyday activities.
One in five children has eczema, and a poll of some of their mums by Lloydspharmacy has found that 57% think certain normal childhood activities could worsen the condition, with 36% saying their child misses out on swimming because of their eczema, 25% don't play outside, 24% aren't allowed to pet animals, and 23% miss out on staying at friends' houses.
Two-fifths (38%) of mums were concerned about people's reactions to their child's symptoms, and 33% said eczema affected the clothes their child wore, made bathtime difficult (31%), interrupted their sleep (29%), caused them to miss school (9%) and made playing sports difficult (14%).
Consultant dermatologist Dr Bav Shergill, a spokesperson for the British Association of Dermatologists, understands the difficulties of coping with eczema.
He says: "Caring for a child with eczema can be very tough for parents. Eczema can be very distressing both because of its visual appearance, as it can look very red and sore, and the discomfort and disruption it causes to the lives of both the child and parents alike.
"But parents shouldn't be dismayed, as there are many treatments that help to manage eczema effectively."
While the cause of eczema is still not fully understood, atopic (a genetic disposition to develop an allergic reaction) conditions such as eczema, asthma and hayfever often runs in families.
The condition begins in the first year of life in about 60% of children, and within the first five years in 85%, and the basic problem is that the function of the skin as a barrier to the outside world doesn't work well.
As a result, irritant and allergy-inducing substances enter the skin, and may cause dryness and inflammation.
Triggers can include environmental factors such as heat, dust, and contact with irritants like soap or detergents, being unwell, bacterial infections, skin dryness, and possibly stress.
The Lloydspharmacy survey found most mums (88%) use some sort of treatment to help manage their child's eczema, with 61% using emollients (the medical term for a moisturising treatment), and a third (34%) using a topical steroid cream.
However, a third (33%) said they didn't know if the method they were using was having any effect.
Shergill says a good moisturising regime is the number one treatment for eczema, using emollient applied directly to the skin.
"The smoothness and softness of the skin depends partly on the amount of water in the surface layer," he says.
"Emollients help to improve the barrier function of the skin by preventing water loss, and by helping to keep out other things such as irritants and allergic substances which cause eczema to flare."
The dryer the skin, the more often an emollient should be used, and Shergill advises parents to be generous with the amount of emollient used, and generally apply it at least twice a day, especially on exposed areas of skin such as the hands and face.
A good time to apply emollient is when the skin contains the most water, about five to 10 minutes after a bath, once the skin has cooled.
Smooth emollients on to the skin in the direction of the hair growth, rather than rubbing them in, as this stops the moisturiser clogging up the hair follicles.
Many emollients are available through the NHS or over-the-counter, and Shergill advises parents to try a few until they find one or two that suit their child.
A further treatment is topical corticosteroids, and Shergill explains: "Many people think topical corticosteroids cause damage to the skin and therefore avoid using them altogether, or use them in tiny, inadequate quantities.
"While it's true that these anti-inflammatory creams can thin the skin if the wrong one (e.g. very strong) is used in the wrong place, such as the centre of the face, for too long, they are very safe when used properly."
He suggests parents learn more about the different strengths of topical corticosteroids from their doctor, find one that suits their child, and only use it for a few days at a time so the eczema under the skin is also treated.
"Always build in a break period of a few days rather than using a steroid cream continuously," he advises.
"That way, it's very unlikely your child will develop any side-effects."
Soaps and bubble baths should be avoided by people with eczema, as they can take away too much protective oil from the skin. Instead, use soap substitutes such as cream moisturisers or thicker emollients mixed with water.
Activities such as swimming need not be prohibited by parents, Shergill says, but precautions should be taken.
"Swimming is good, but the combination of water and chlorine can irritate and dry out the skin, so put plenty of moisturiser on your child's skin before they go swimming, and again straight after they've dried off after the shower."
Overall, Shergill says parents need to come to terms with the condition, and always make sure their child avoids known irritants and allergens.
Parents can help by keeping the house as dust-free as possible, making sure their child's bedroom is well ventilated, and dressing them in soft cotton clothes.
Many children will eventually grow out of eczema - 75% with atopic eczema are clear by their teens - and Shergill stresses: "Plenty of good advice is available from your doctor or skin specialist, and there's lots of additional treatments for eczema that doesn't seem to respond to usual first-line treatment.
"Don't give up!"
:: For more information about eczema, visit the British Association of Dermatologists website at www.bad.org.uk :: The Lloydspharmacy new free Skin Service offers advice including treatments and application techniques for conditions including eczema. For more information, visit www.lloydspharmacy.com Ask the expert Q: "What is a birth plan, and do I really need one when I give birth? Do midwives have to abide by whatever I put in it?"
A: Senior midwife Lesley Gilchrist, who appears in Channel 4's One Born Every Minute and is founder of the new birthing service Bespoke Birthing, which is in the process of being set up at www.bespokebirthing.co.uk, says: "A birth plan is a list of wishes you and your partner have for the birth of your baby, including information such as whether you'd like to have skin-to-skin contact with your baby after the birth, delivery of your placenta, and who you'd like your birth partner to be.
"They also cover things such as forceps delivery and caesarean section.
"The purpose of a birth plan is twofold. Firstly, as you may not be in a position to discuss things during labour, they ensure those caring for you are aware of your wishes for giving birth.
"Secondly, they contain topics that may require further explanation such as episiotomy and assisted delivery.
"Unfortunately the internet contains a great deal of inaccurate information, so ideally a birth plan should be completed with the help of a midwife. This gives you the opportunity to discuss any concerns you may have about the birth and clarify when, how and why certain procedures may happen.
"As long as you're fully informed about the decisions you make, then a midwife can't undertake any procedure without your consent and should therefore abide by your birth plan. For this reason, you need to be aware of the risks and benefits of each topic."