During a recent bout of sickness and diarrhoea, my daughter’s eczema almost disappeared. She ate hardly anything during this time. Could this mean that her eczema is related to the food she eats? Unfortunately, this is not the likeliest explanation for the improvement in your daughter’s eczema.

Diet has not been shown to be a major factor in causing eczema, despite many people’s view to the contrary. You have to remember that eczema fluctuates in severity all the time, often for reasons that we cannot explain.

It is always tempting to look at ‘what happened the day before’ as the cause of a flare or an improvement, and doctors are no different from you in wanting a simple explanation.

Any infections (including tummy upsets) can improve eczema or cause a flare, presumably owing to the effect that they can have on the body’s immune system or the fact that having a high temperature may make the skin more itchy.

It is equally likely that your daughter’s sickness had no effect on her eczema but that it was simply improving spontaneously at that time.

Could something in my son’s diet be causing his eczema? Although you don’t say how old your son is, the answer is probably that his diet is not having an effect. Diet may be important in the initial triggering of eczema in infants with an inherited susceptibility, but it seems to have little to do with keeping eczema going or triggering it in older children.

It is true that many parents, and indeed some doctors, think that diet is very important in eczema, but evidence from research studies over the past few years does not support this view. Life would be a lot easier if diet did have a major impact, but we have to believe the evidence from these wellconducted studies.

We have used special diets in the past, but they are normally disappointing in terms of improving the eczema and are difficult to stick to, especially for children of school age.

Our advice to you is that if there is a clear history of your son’s eczema always worsening after eating a certain food, it is worth a 3-month trial of excluding that food – after taking advice from a dietitian.

If there is no improvement in his eczema after 3 months, that food should be gradually reintroduced. It cannot be overemphasised that all attempts at dietary manipulation should be made under the control of a dietitian to ensure that there is adequate calorie, protein, calcium and vitamin replacement.

We have seen children with malnutrition and even rickets from unsupervised severe exclusion diets, and unfortunately they both still had bad eczema.

Will altering my diet during breast-feeding stop my baby from developing eczema? What else can I do to avoid triggering the condition? Eczema is an inherited condition, but it is also influenced by environmental factors. We do not understand why it develops at a certain age in any one individual.

There are important trigger factors, but little is known about them. It has been suggested that the early diet of a child, particularly an exposure to dairy products, might be important in triggering eczema.

There is scant evidence to support the idea that if you changed to a diet free from milk and eggs during breast-feeding, it might provide some protection against your baby developing eczema, especially if both you and the baby’s father have a history of the condition.

This view is still controversial, and we would not recommend such a diet routinely. It would certainly need to be done under the guidance of a dietitian.

Is breast-feeding better than bottle-feeding for helping to prevent my baby getting eczema? This is a bit controversial now! The old answer was that the evidence seemed to suggest it was of benefit, although some research studies failed to show any advantage.

Recently, however, a big study in New Zealand showed that breast-feeding was linked to a greater chance of a baby getting eczema than bottle-feeding. More research is needed before a definite answer can be given to this simple question as it relates to eczema. Breast-feeding does, however, have many other advantages, so we wouldn’t yet go against the motto ‘breast is best’.

I want to continue breast-feeding my baby, but the eczema on my nipples is making this very difficult. Have you any advice that could help? Breast-feeding with eczema on the nipple or areolar tissue round it can be troublesome from time to time because this area can easily become infected with thrush, making it cracked and sore.

Ask your doctor to examine your baby’s mouth as well as your breasts as thrush may be present there too. There are topical creams that can be prescribed to resolve the infection.

During treatment, breast-feeding from the affected side should be temporarily stopped and expressing carried out instead, either manually or with the aid of an electric or hand pump.

Your baby will be able to feed sufficiently from one breast only as the extra demand will increase the milk supply. Any expressed milk may be given to your baby or frozen for future use.

As the skin heals, breastfeeding can be resumed, but care must be taken that your baby is well positioned and correctly attached on the breast at each feed to minimise any trauma or friction to the nipple. Further assistance with breast-feeding can be obtained from your local breast-feeding counsellor.

My baby has developed eczema. Could it be something to do with what I ate during pregnancy? It sounds as though you are feeling guilty, as if your baby’s eczema is your fault. There is no good evidence that what you eat during pregnancy has any effect on the subsequent development of eczema in a baby. Relax – it is not your ‘fault’.