Childhood eczema is a common condition affecting many children in New Zealand, often beginning within the first year of life. Up to 1 in 5 children may be affected. It typically presents as dry, itchy, and inflamed skin, with symptoms that tend to fluctuate over time—settling and flaring at different stages. The appearance of eczema can vary depending on a child’s age, skin tone, and ethnicity.

Eczema is not contagious, but it can have a significant impact on a child’s comfort, sleep, and overall quality of life. It is frequently associated with other allergic conditions, such as asthma and hay fever. In New Zealand, factors such as climate, environmental allergens, and individual skin sensitivity can all contribute to triggering flare-ups.

With appropriate care, most cases of eczema can be well managed. Treatment focuses on supporting the skin barrier through regular moisturising, minimising exposure to triggers, and using anti-inflammatory treatments when required. Early and consistent management can help reduce flare-ups, minimise the risk of scarring, and promote healthy skin as your child grows.

Psoriasis is a chronic inflammatory skin condition that can affect children of any age. It is caused by an overactive immune system, which leads to skin cells being produced more quickly than usual. Psoriasis is not contagious and cannot be spread from one person to another.

In children, psoriasis can look very different from the classic thick, scaly plaques seen in adults. It commonly appears as well-defined red or pink patches with overlying scale. Common sites include the scalp, elbows, knees and behind the ears. In younger children, the face, skin folds and nappy area can also be affected.

Guttate psoriasis is a common form in children and presents as multiple small, scaly spots scattered over the trunk and limbs. It can sometimes develop after an infection, particularly a streptococcal throat infection.

Psoriasis can sometimes be mistaken for eczema or other skin conditions. Unlike eczema, psoriasis tends to have sharper, more clearly defined edges, although there can be overlap between the two conditions.

Psoriasis can also affect areas beyond the skin. Nail changes such as pitting, ridging or thickening can occur. Some children with psoriasis develop psoriatic arthritis, which can cause persistent joint pain, stiffness or swelling.

Treatment depends on the severity and location of the psoriasis. Moisturisers, topical corticosteroids and other anti-inflammatory creams or ointments are commonly used. More extensive or difficult-to-treat psoriasis may require phototherapy or systemic medications under specialist care.

Psoriasis tends to have periods of improvement and flare-ups. There is currently no cure, but good control of the condition is usually achievable with appropriate treatment. Children with psoriasis should also be supported with gentle skin care and encouraged to maintain a healthy lifestyle.

Acne is a very common skin condition affecting children and teenagers, particularly during puberty. Studies suggest that up to 85% of people experience acne at some stage in their lives. It develops when hair follicles become blocked with oil and dead skin cells, leading to blackheads, whiteheads, and inflamed lesions such as pimples or cysts. Acne most commonly affects the face, chest, and back, and can range from mild to more persistent or severe forms.

Acne is not contagious and is not caused by poor hygiene. While it is not medically harmful, it can have a significant impact on a young person’s confidence and emotional wellbeing. Hormonal changes, genetic factors, and certain skincare or cosmetic products can all contribute to its development.

The good news is that acne is highly treatable. Early and appropriate management can help control breakouts, reduce the risk of scarring, and support long-term skin health. Treatment may include gentle skincare, topical therapies, and, in some cases, oral medications, depending on severity. With the right approach, most young people experience significant improvement over time.

Contact dermatitis is a skin reaction caused by contact with an irritant or an allergen. It can affect children of any age and commonly causes redness, itching, dryness, scaling or small blisters at the site of contact.

There are two main types. Irritant contact dermatitis occurs when something directly damages or irritates the skin. Common triggers include saliva, soaps, detergents, wipes, frequent hand washing and prolonged exposure to moisture. Allergic contact dermatitis occurs when the immune system develops an allergy to a particular substance. Common allergens include fragrances, preservatives, metals such as nickel, adhesives, topical medications and ingredients in personal-care products.

The rash often appears in areas that have come into contact with the trigger. However, allergic contact dermatitis can sometimes spread beyond the original area of contact. In children with eczema, contact dermatitis can be particularly difficult to recognise because it may look similar to an eczema flare.

Treatment involves identifying and avoiding the trigger, together with restoring the skin barrier using regular moisturisers. Topical corticosteroids or other anti-inflammatory treatments may be recommended to settle the inflammation.

If allergic contact dermatitis is suspected, patch testing can help identify the specific allergen responsible. This is different from skin prick testing, which is used to investigate immediate-type allergies.

Contact dermatitis is not contagious. Once the responsible irritant or allergen is identified and avoided, the skin will usually gradually improve, although it can take several weeks for the inflammation to completely settle.

Specialist assessment is recommended if the rash is persistent, recurrent, widespread, significantly affecting quality of life, or not responding to usual eczema treatment.

Patch testing is a specialised test used to identify allergic contact dermatitis. It helps determine whether a child's eczema or skin rash is being triggered or worsened by an allergy to something that comes into contact with their skin.

Unlike skin prick testing, which looks for immediate-type allergies, patch testing assesses a delayed allergic reaction. Common triggers include fragrances, preservatives, metals such as nickel, topical medications, adhesives, rubber chemicals and ingredients found in personal-care products.

During patch testing, small amounts of potential allergens are applied to the skin using adhesive patches, usually on the upper back. The patches remain in place for approximately 48 hours, during which time the child needs to keep the area dry and avoid activities that cause excessive sweating.

The patches are removed and the skin is examined for reactions, usually at 48 hours and again several days later. A positive reaction may appear as a localised red, itchy or inflamed area at the site of a particular allergen.

Patch testing is particularly useful for children with persistent, recurrent or difficult-to-control eczema, especially when the rash has an unusual distribution or does not respond as expected to appropriate treatment.

A positive result needs to be interpreted alongside the child's clinical history and pattern of exposure. Not every positive reaction is necessarily relevant to the child's skin condition, and careful interpretation is important.

Once a relevant allergen is identified, avoiding that ingredient can significantly improve the child's dermatitis and reduce the need for ongoing treatment.

Patch testing is generally safe, although the test itself may temporarily cause itching or irritation. It is different from skin prick testing and is not used to investigate immediate food or environmental allergies.

Infantile haemangiomas are common benign (non-cancerous) birthmarks made up of small blood vessels. They affect around 4–5% of infants and are more commonly seen in girls, premature babies, and those with low birth weight. These marks are often not obvious at birth but typically appear within the first few weeks of life. Signs are typically a raised, red, soft lump, often called a "strawberry mark."

Infantile haemangiomas follow a characteristic natural course. They usually grow rapidly during the first 6 - 9 months of life (proliferative phase), before gradually slowing and then shrinking over time (involution phase). Most will significantly fade by school age, although some may leave behind residual skin changes such as loose skin or faint marks.

Treatment may be recommended if the haemangioma is large, growing rapidly, affecting important areas (such as around the eyes, nose, airway, genital), or causing complications such as ulceration. Options may include topical or oral medications, which are effective in reducing growth and improving appearance. Early specialist assessment helps identify which haemangiomas may benefit from treatment and ensures the best possible outcome.

Food allergy is increasingly common among children in New Zealand, affecting around 1 in 10 infants. It occurs when the immune system reacts to certain foods, most commonly cow’s milk, egg, peanut, tree nuts, soy, fish, and shellfish. Reactions can vary from mild symptoms—such as hives, vomiting, or swelling—to more severe reactions, including anaphylaxis.

Food allergies often develop early in life and can have a significant impact on a child’s nutrition, safety, and family life. Many children will outgrow some food allergies, particularly to milk and egg, while others, such as peanut or tree nut allergy, may persist.

With the right support, food allergies can be safely managed. Specialist assessment is recommended for suspected food allergies to confirm diagnosis and manage risks including guidance on avoidance, recognising allergic reactions, and having an action plan in place. Early assessment and ongoing care can help families feel confident in managing their child’s allergy and maintaining a safe, balanced diet.

Skin prick testing is a simple and commonly used test to investigate immediate-type allergies. It can help identify whether a child is sensitised to specific allergens that may be contributing to symptoms such as eczema, hay fever, asthma, food allergy or allergic reactions.

A small amount of an allergen extract is placed on the skin, usually on the forearm or back, and the skin is gently pricked through the drop. A positive reaction typically produces a small, itchy, raised area (wheal) within about 15–20 minutes.

Skin prick testing can be performed for a range of allergens, including foods, pollens, house dust mites, animal dander and moulds. The allergens tested are selected based on the child's history rather than performing a broad panel of tests without a clinical indication.

Importantly, a positive skin prick test does not necessarily mean that a child has a clinical allergy. It indicates sensitisation to that allergen. The result needs to be interpreted together with the child's symptoms and clinical history. Similarly, a negative test makes an immediate-type allergy less likely but does not exclude every type of allergic reaction.

Skin prick testing is generally quick, well tolerated and safe, although children may experience temporary itching and swelling at the test sites.

Certain medications, particularly antihistamines, can interfere with the results and may need to be stopped before testing. Your doctor will advise you which medications need to be withheld and for how long.

Skin prick testing is different from patch testing, which is used to investigate delayed allergic contact dermatitis.

If your child has experienced a suspected allergic reaction, appropriate allergy specialist assessment can help identify relevant triggers and provide an individualised management plan.

Lichen sclerosus is a chronic inflammatory skin condition that commonly affects the genital and anal area. It can occur in children, particularly before puberty, and is not contagious or caused by poor hygiene.

Children may develop itching, soreness, burning or pain around the vulva or anus. The skin can appear pale or white, thin, shiny or wrinkled, sometimes with small cracks, bruising or bleeding. In girls, the skin around the vulva may become inflamed and the normal anatomy can gradually become less distinct. In boys, it may affect the foreskin and glans.

Lichen sclerosus can sometimes be mistaken for eczema, irritant dermatitis, thrush or recurrent infection. Persistent genital itching, particularly when associated with white or fragile skin, should therefore be assessed by a doctor.

Treatment usually involves a potent topical corticosteroid ointment, prescribed and monitored by a specialist. Treatment is highly effective at controlling inflammation and symptoms and helps prevent scarring and changes to the genital anatomy. Regular moisturisers or barrier ointments can also help protect the skin.

Good skin care, avoiding fragranced products and minimising irritation can help. Lichen sclerosus often improves with treatment, but ongoing maintenance treatment and follow-up are needed, as the condition can recur.

Although lichen sclerosus is benign, long-term follow-up is important, particularly when the condition persists into adulthood, because longstanding disease is associated with a small increased risk of vulval skin cancer later in life.

Early diagnosis and treatment can prevent scarring and help children remain comfortable and symptom-free.

Asthma is a common chronic condition in children that causes inflammation and narrowing of the airways. This can lead to symptoms such as cough, wheeze, shortness of breath and chest tightness. Symptoms can come and go and may vary in severity over time.

In children, asthma symptoms are often triggered or worsened by viral infections, exercise, cold air, pollen, dust mites, smoke and other environmental irritants. Some children mainly experience coughing, particularly at night or with exercise.

Not every child who wheezes has asthma. Preschool children commonly wheeze with viral infections, and many will grow out of this as their airways mature. A diagnosis of asthma is based on the child's pattern of symptoms, examination and response to treatment. In older children, lung function testing such as spirometry can help confirm the diagnosis.

Treatment depends on the child's age and severity of symptoms. This may include reliever medication to open the airways and preventer medication to reduce airway inflammation. Some children only need treatment during periods of increased symptoms, while others require regular preventer medication.

It is important that children with asthma have a written asthma action plan so that families know how to manage worsening symptoms and when to seek medical help. Avoiding cigarette smoke and identifying individual triggers can also help reduce flare-ups.

Asthma symptoms should be reviewed if they are frequent, affecting sleep or exercise, requiring regular reliever medication, or interfering with school and daily activities.

A child with severe difficulty breathing, difficulty speaking or drinking because of breathlessness, marked chest recession, blue lips, or who is becoming unusually tired or drowsy requires urgent medical attention.

With appropriate treatment and an individualised management plan, most children with asthma can participate fully in school, sport and everyday activities.

It is important for children with long-standing asthma to have a primary specialist paediatrician to look after their lung and general health.

Allergic rhinitis, commonly known as hay fever, is a common condition in children caused by an allergic reaction to airborne allergens. Common triggers include grass and tree pollens, weeds, house dust mites and animal dander.

Typical symptoms include sneezing, an itchy or blocked nose, clear runny nasal discharge and itchy, watery or red eyes. Children may also have an itchy throat, cough, reduced sense of smell or difficulty sleeping. Symptoms can be seasonal, particularly with pollen allergies, or occur throughout the year with triggers such as house dust mites.

Allergic rhinitis can affect a child's sleep, concentration, school performance and quality of life. Children may also develop a persistent nasal congestion, mouth breathing or dark circles under the eyes.

Management involves reducing exposure to known triggers where practical and controlling symptoms. With treatment, most children with allergic rhinitis can have a good quality of life. If symptoms are frequent or difficult to control, allergy testing such as skin prick testing can help identify relevant triggers.

Allergic rhinitis commonly occurs alongside asthma and eczema, and good control of nasal allergies can improve overall respiratory and sleep-related symptoms.

Specialist assessment is recommended if symptoms are persistent, affecting sleep or daily activities, associated with recurrent sinus problems, or not responding adequately to usual treatment.

Hay fever can be effectively managed, allowing most children to participate normally in school, sport and everyday activities.

Chronic abdominal pain is common in children and teenagers. It can be caused by many different conditions, ranging from constipation and food intolerance to functional abdominal pain. In many children, no single underlying disease is identified.

Functional abdominal pain is particularly common. This does not mean that the pain is “all in their head”. The gut and brain communicate closely, and factors such as stress, anxiety, poor sleep and changes in gut sensitivity can influence how pain is experienced.

The pain can occur anywhere in the abdomen and may be associated with bloating, nausea, constipation, diarrhoea or changes in appetite. The pattern of symptoms, growth, bowel habits and other associated features are important in determining whether further investigation is required.

A careful history and physical examination, together with monitoring of growth and development is important.

Treatment depends on the underlying cause. This may include managing constipation, reviewing diet, treating reflux or other gastrointestinal conditions, improving sleep and establishing regular meals and bowel habits. For functional abdominal pain, the focus is often on improving daily function and reducing the impact of pain rather than trying to eliminate every episode of discomfort.

Parents should seek medical assessment if abdominal pain is persistent, severe or worsening, or if it is associated with concerning features such as weight loss, poor growth, persistent vomiting, blood in the stool, persistent diarrhoea, fever, significant night-time symptoms, jaundice or recurrent unexplained fevers.

With appropriate assessment and management, most children with chronic abdominal pain can be supported to return to their usual activities and enjoy a good quality of life.

Coeliac disease is a chronic autoimmune condition in which eating gluten causes inflammation and damage to the small intestine. Gluten is found in wheat, barley and rye. It can affect children of any age and may develop even after a child has previously tolerated gluten without problems.

Coeliac disease can cause a wide range of symptoms, and it does not always present with the classic symptoms of diarrhoea and weight loss. Children may have chronic abdominal pain, bloating, nausea, diarrhoea or constipation. Other features can include poor appetite, fatigue, iron deficiency, poor growth or failure to thrive. Some children have few or no obvious gastrointestinal symptoms.

In younger children, coeliac disease may present with poor weight gain, faltering growth, abdominal distension, irritability or constipation. Older children and teenagers may present with abdominal pain, fatigue, headaches, anaemia or difficulty maintaining their growth.

Coeliac disease can also be associated with delayed puberty, recurrent mouth ulcers, abnormal liver enzymes and an itchy skin rash. Some children are identified through screening because they have an increased risk of coeliac disease, particularly those with a close family member with the condition or certain autoimmune or genetic conditions.

Diagnosis usually involves blood tests for coeliac antibodies, followed by further assessment depending on the results. In some children, an upper gastrointestinal endoscopy and small bowel biopsy may be required to confirm the diagnosis.

It is important not to remove gluten from your child's diet before coeliac testing, as this can cause the blood tests to become falsely negative. Your child should continue eating their usual gluten-containing diet until advised otherwise by their doctor.

If coeliac disease is confirmed, treatment involves a strict lifelong gluten-free diet. This should ideally be undertaken with guidance from a dietitian to ensure adequate nutrition and appropriate growth.

With a well-managed gluten-free diet, the intestinal lining can heal and most children can grow and develop normally. Regular follow-up is important to monitor symptoms, growth, nutrition and response to treatment.

Childhood constipation is a common condition, affecting up to 1 in 3 children at some stage. It occurs when bowel movements become infrequent, hard, or difficult to pass, and may sometimes be associated with abdominal pain, reduced appetite, or stool withholding behaviours. Anal fissure can be a painful complication from constipation. 

Constipation often develops during key stages such as the introduction of solid foods, toilet training, or starting school. In most cases, it is functional (not due to an underlying disease) and can be influenced by diet, fluid intake, toileting habits, and a child’s sensitivity to discomfort.

With the right approach, constipation can be effectively managed. Treatment focuses on softening the stool, establishing regular toileting routines, and addressing any withholding behaviours. This may include dietary changes (increasing fibre and fluids), behavioural strategies, and commonly the use of stool softeners or laxatives for a period of time. Early and consistent management is important to prevent ongoing discomfort and help restore healthy bowel habits.

Headaches are common in children and teenagers. Most are not caused by a serious underlying condition. Common types include migraine and tension-type headaches, although headaches can also occur with dehydration, poor sleep, missed meals, vision problems, viral illnesses and other conditions.

Children with migraine may experience throbbing or moderate-to-severe headache, often associated with nausea, vomiting, sensitivity to light or sound, and a desire to rest in a quiet or dark room. Younger children may have less typical symptoms, such as abdominal pain, dizziness or simply appearing tired or unwell.

Headaches can be triggered or worsened by irregular sleep, dehydration, skipping meals, stress, excessive screen time and overuse of pain-relief medications. Keeping a headache diary can help identify patterns and triggers.

Most children with recurrent headaches require a careful history and neurological examination, together with assessment of growth, sleep, hydration, diet and other factors. This will help to whether further investigation is needed.

Treatment focuses on regular sleep and meals, good hydration, identifying triggers and having an appropriate plan for managing acute headaches. Children with frequent or disabling headaches may benefit from preventive treatment. It is important to avoid frequent use of pain-relief medications, as this can itself contribute to medication-overuse headaches.

Medical assessment is recommended if headaches are new, persistent, progressively worsening or interfering significantly with school and daily activities. Urgent assessment is required for a sudden severe headache or headache associated with neurological symptoms, seizures, persistent vomiting, significant visual changes, confusion, fever with neck stiffness, or following significant head injury.

With appropriate assessment and management, most children with recurrent headaches can achieve good control and continue their usual activities.

Migraine is a common neurological condition in children and teenagers that causes recurrent episodes of headache and other symptoms. It is not simply a “bad headache” and can significantly affect a child's school attendance, activities and quality of life.

Children with migraine may experience moderate to severe headache, often with nausea, vomiting, sensitivity to light or sound, dizziness or abdominal discomfort. Younger children may have shorter attacks and may not always describe typical headache symptoms. Some children experience an aura before or during a migraine, such as visual changes, tingling, dizziness or difficulty speaking.

Migraine can be triggered by lack of sleep, dehydration, skipped meals, stress, illness, hormonal changes and certain environmental factors. Keeping a headache diary can help identify individual triggers and patterns.

Treatment involves maintaining regular sleep, meals and hydration, together with managing stress and identifying individual triggers. When a migraine occurs, resting in a quiet, dark environment can be helpful. Simple pain-relief medications may be used early in the attack when appropriate. Children with frequent or disabling migraines may benefit from preventive medication.

It is important to avoid using pain-relief medications too frequently, as this can contribute to medication-overuse headaches.

Medical assessment is recommended if headaches are new, progressively worsening, unusually severe, associated with neurological symptoms, waking a child regularly from sleep, or significantly interfering with school and daily activities.

Although migraine can be challenging, most children can achieve good control with appropriate lifestyle measures and treatment and continue to participate fully in school, sport and everyday activities.

Scabies is a contagious skin infestation caused by a tiny mite called Sarcoptes scabiei. The mites burrow into the outer layer of the skin, where they lay eggs and produce faeces. The body's immune reaction to the mites causes the characteristic intense itch and rash.

Scabies is usually spread through prolonged, close skin-to-skin contact. It is more common in situations where people live in close or crowded conditions. Importantly, scabies is not a reflection of poor hygiene.

The main symptom is intense itching, often worse at night. Small red bumps, blisters, scratch marks and characteristic thin burrows may be seen. In older children, common areas include the finger webs, wrists, elbows, waist, buttocks and genital area. In infants and young children, the scalp, face, palms and soles can also be affected, and the rash can be more widespread. Burrows are characteristic of scabies but may be difficult to identify, particularly in young children.

Once scabies is diagnosed, all household members and close contacts should be treated at the same time, even if they do not have symptoms. This is important because symptoms can take several weeks to develop after becoming infested. Treatment should be used according to the child's age and medical advice.

Recently used clothing, towels and bedding should be washed on a hot cycle (ideally 60°C or above). Items that cannot be washed can be sealed in a plastic bag for several days. Extensive cleaning or fumigation of the home is generally not necessary.

Itching can persist for several weeks after successful treatment, sometimes for up to 6–8 weeks. This is due to the ongoing immune reaction to the mites and does not necessarily mean that treatment has failed. Children with a history of atopic dermatitis may experience a more prolonged period of itching.

If new burrows or typical scabies lesions continue to appear after treatment, or other family members continue to develop symptoms, further medical assessment may be required.