The Eczema Epidemic: Why Eczema in Kids is on the Rise

By Diane Angela Fong, ND

Pediatric eczema is becoming alarmingly common, affecting millions of children worldwide and leaving many parents searching for answers. Once relatively rare, eczema rates among children have surged in recent decades, turning it into a widespread and growing "epidemic." This rise suggests that modern-day factors—ranging from C-sections to environmental shifts—are increasingly triggering this uncomfortable and often persistent skin condition.

In this blog, we’ll dive into the latest research to uncover what may be fueling this surge of eczema in kids, examining both known and surprising causes. We’ll also explore actionable steps that parents and caregivers can take to help reduce eczema risks and protect children’s skin health.

Rising Rates of Eczema in Kids

The prevalence of eczema among children in the United States has grown substantially over the past few decades. According to data from the National Health Interview Survey, the percentage of children diagnosed with eczema has increased from 8% to 15% since 1997. (National Eczema Association). This upward trend is not limited to the U.S.; globally, studies indicate similar increases. Research published in Clinical & Experimental Allergy found that the prevalence of eczema symptoms increased by approximately 0.98% per decade among adolescents and 1.2% per decade among children over a 27-year period (Clinical & Experimental Allergy).

These rising rates suggest that changes in modern living conditions, healthcare practices, and environmental exposures are playing a significant role in this increase.

1. Genetic Predisposition and the Filaggrin Mutation

Genetic susceptibility is a well-established factor in eczema. Mutations in the filaggrin gene (FLG), which is essential for maintaining the skin’s protective barrier, are common among individuals with eczema. Studies show that 20-30% of children with eczema have a filaggrin mutation, making their skin more vulnerable to allergens and irritants (The New England Journal of Medicine).

While the prevalence of the filaggrin mutation itself has remained stable over time, modern environmental and lifestyle factors are amplifying its impact. Increased exposure to pollutants, changes in diet, and the widespread use of indoor heating and air conditioning can make the already compromised skin barrier even more reactive. Additionally, the hygiene hypothesis suggests that reduced exposure to microbes in childhood may make the immune system more prone to allergic reactions, further intensifying eczema symptoms in children with the FLG mutation. Together, these external factors may be contributing to a higher prevalence and severity of eczema among children with this genetic predisposition.

2. Delivery Method: Increased Rates of C-Sections

Infants delivered by C-section are at a higher risk for eczema. Children born via C-section miss out on exposure to beneficial bacteria in the birth canal, which supports the development of a balanced microbiome. Research has found that about 28% of cesarean-born infants within 1 year of age developed eczema, significantly higher than the 20% rate or occurrence seen in vaginal-born infants.

The rates of C-sections have increased significantly over the past few decades, which may contribute to the growing prevalence of eczema. According to the World Health Organization (WHO), caesarean section rates have been steadily increasing worldwide, with over 1 in 5 births now occurring by C-section, according to WHO research. This rise is projected to continue, potentially reaching nearly one-third of all births by 2030. In the United States, the C-section rate has also risen substantially, with about 32% of births now delivered via C-section (CDC). These higher rates mean that more infants are starting life with a microbiome imbalance, potentially increasing their susceptibility to eczema and other allergic conditions.

3. Infant Feeding: Formula vs. Breastfeeding

Breastfeeding provides essential antibodies and anti-inflammatory agents that support immune health and skin barrier function, offering protection against conditions like eczema. A large-scale, randomized trial (known as the PROBIT study) found that exclusive breastfeeding for the first three months significantly reduced the incidence of atopic dermatitis (eczema) by up to 30% in early childhood.

Breastfeeding rates and durations have fluctuated over time, influenced by various factors. According to the Centers for Disease Control and Prevention (CDC), the percentage of infants ever breastfed in the United States has remained relatively stable in recent years, with 84.1% of infants born in 2021 being breastfed at some point. However, the duration of breastfeeding often declines sharply over time. For instance, while 84.1% of infants born in 2021 were ever breastfed, only 59.8% were still being breastfed at six months, and 39.5% at twelve months. Exclusive breastfeeding rates also drop significantly, with 46.5% of infants exclusively breastfed through three months and 27.2% through six months.

These statistics suggest that while initiation rates are high, many mothers transition to formula feeding or introduce supplementary feeding earlier than recommended. Factors contributing to shorter breastfeeding durations include lack of societal support, workplace constraints, and limited access to breastfeeding resources. Addressing these challenges is crucial to support longer breastfeeding durations, which can help reduce the risk of eczema and other health issues in infants.

4. Antibiotic Use: In Utero, During Labor, and Early Infancy

The use of antibiotics in early life can disrupt the developing microbiome, making infants more susceptible to immune dysregulation. A 2013 study found that there was a significant dose–response association, suggesting a 7% increase in the risk of eczema for each additional antibiotic course received during the first year of life.

In a large study involving over 900,000 children, researchers found that when mothers took antibiotics during pregnancy, it increased their child’s risk of developing eczema, asthma, and other allergies. Importantly, the more often a child was exposed to antibiotics before birth, the higher their risk of these conditions, suggesting that prenatal antibiotic exposure may have a cumulative effect on the likelihood of childhood allergic diseases.

In one study, researchers found that 30 days after stopping antibiotic treatment, the fecal microbiota regained an average of 88% of its original composition, increasing slightly to 89% after 60 days. However, the microbiota did not fully return to its original state within the timeframe observed. This demonstrates that even a single short course of antibiotics can immediately disrupt the gut microbiome, potentially leading to lasting effects with significant metabolic or immune consequences.

Over the past few decades, antibiotic use during pregnancy and labor has increased significantly. This rise is partly due to updated medical practices aimed at preventing infections, such as Group B Streptococcus (GBS) transmission during childbirth. The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for GBS in the later stages of pregnancy, and those who test positive receive intrapartum antibiotic prophylaxis. This standard practice has led to a substantial increase in antibiotic administration during labor, which can influence the infant’s microbiome development.

A large study of nearly one million pregnancies in Denmark from 2000 to 2010 found that the percentage of pregnant women filling antibiotic prescriptions increased significantly over the decade, rising from 28.4% in 2000 to 37.0% in 2010, with certain groups, such as young, obese, and lower-educated women, showing higher rates of antibiotic use. This trend highlights a growing reliance on antibiotics during critical periods of fetal development, potentially impacting immune function in ways that increase susceptibility to conditions like eczema. While antibiotics are essential for preventing infections, their increased use raises concerns about the unintended consequences for the developing immune system, particularly when used during pregnancy and infancy.

5. Environmental Toxins: Pollutants and Household Chemicals

Exposure to environmental toxins, such as BPA and phthalates, has been linked to immune dysfunction and eczema. These chemicals disrupt the skin barrier and immune system, potentially increasing the risk of eczema, particularly in children. Research published in Environmental Health Perspectives found that children with higher BPA exposure had an elevated risk of developing eczema, underscoring the role of environmental pollutants in skin health. Other environmental pollutants, such as polycyclic aromatic hydrocarbons (PAHs) and certain air pollutants, are also associated with eczema. A study published in the Journal of Clinical Investigation showed that PAHs and other pollutants can influence allergic diseases, including atopic eczema, by promoting oxidative stress and initiating proinflammatory responses. Moreover, research in the International Journal of Environmental Research and Public Health found that pollutants like particulate matter and nitrogen dioxide can impair skin barrier function and exacerbate eczema symptoms.

The prevalence of such environmental toxins is increasing. According to the Centers for Disease Control and Prevention's (CDC) Fourth National Report on Human Exposure to Environmental Chemicals, exposure to various chemicals, including BPA and phthalates, has risen in the U.S. population between 1999 and 2016. Additionally, the Environmental Working Group has highlighted the presence of numerous industrial chemicals in blood and urine samples, indicating widespread human exposure to pollutants. The World Health Organization (WHO) also reports that 99% of the global population is now exposed to air pollution levels exceeding safe limits, further contributing to health issues like eczema.

6. Mold Exposure in Modern Homes

Modern homes, often constructed with moisture-retaining materials like drywall and fiberboard, create ideal environments for mold growth. The prevalence of mold in homes is significant; estimates suggest that approximately 47% of U.S. homes have some form of mold or dampness issue.

Mold exposure has been strongly linked to eczema, particularly in children. A 2016 study published in Pediatric Allergy and Immunology found that children living in homes with visible mold had a 55% increased risk of developing eczema. A study found that prenatal mold exposure significantly increased the risk of developing atopic dermatitis. Infants exposed to mold in utero showed higher levels of total serum IgE at one year, indicating an IgE-mediated allergic response. The study suggests that avoiding mold exposure during pregnancy may help prevent atopic dermatitis in infants.

Mold spores and volatile organic compounds (VOCs) from mold can trigger immune responses and increase inflammation, disrupting the skin barrier. Reducing mold exposure, especially in homes with young children, can help mitigate this risk.

7. Increased Sensitization Due to Modern Factors

Modern factors, such as increased indoor time, improved insulation, and reduced ventilation in energy-efficient homes, contribute to higher indoor allergen concentrations. Research published in the Journal of Allergy and Clinical Immunology has shown that high concentrations of indoor allergens, like dust mites and pet dander, are associated with greater sensitization, particularly in children. This prolonged exposure can lead to sensitization, where the immune system becomes overly reactive to specific allergens, causing skin inflammation and itching.

Additionally, urbanization is associated with higher eczema rates in children, likely due to increased air pollution and limited exposure to natural environments. A systematic review highlighted that eczema is more prevalent in urban areas than in rural ones. This trend is also supported by findings in The Journal of Allergy and Clinical Immunology, which identified urban pollutants and limited biodiversity exposure as factors affecting immune development.

Modern food production practices may also contribute to increased sensitization to foods. The gut microbiota is essential for developing immune tolerance to food proteins, but modern processed foods can impair this function, as shown in studies published in Foods. Furthermore, antibiotics and pesticides used in agriculture can impact immune health by altering the gut microbiome, which plays a crucial role in immune system regulation. A study in Microorganisms found that antibiotic residues in food can modify gut bacteria. Research in Metabolites indicates that pesticide exposure may influence immune responses, increasing the risk of allergies. The role of gut microbiota in food sensitization is also well-documented. A study in Nature Reviews Immunology noted that early disruptions in the microbiome, potentially from dietary and environmental factors, can lead to food allergies and sensitivities.

8. Hygiene Hypothesis: Limited Exposure to Microbes

The hygiene hypothesis suggests that reduced microbial exposure in childhood, due to improved sanitation, frequent use of antibacterial products, and urban lifestyles, can limit immune development. Over the past few decades, changes in lifestyle and housing conditions have led to less interaction with natural environments and diverse microbes, which are crucial for developing a balanced immune system. Research shows that children with more microbial exposure—such as those in larger families, those attending daycare early, or those living in rural areas—are less likely to develop eczema.

In modern urban settings, children are increasingly exposed to sterile indoor environments with fewer beneficial microbes, while also having higher exposure to allergens and pollutants. Additionally, the increased use of antibacterial products, especially in Western countries, may reduce the diversity of microbes that children encounter, potentially disrupting the development of immune tolerance. Studies have shown that children raised on farms, where exposure to soil microbes and animal-associated bacteria is higher, have significantly lower rates of allergic diseases, including eczema, supporting the hygiene hypothesis.

Addressing the Pediatric Eczema Epidemic

Addressing the pediatric eczema epidemic requires a multifaceted approach. Proactive measures such as promoting breastfeeding, judicious use of antibiotics, reducing mold and allergen exposure, increasing exposure to beneficial microbes, and limiting environmental toxins can help lower the risk of eczema in children. By understanding the underlying causes, parents can make informed choices to support their children’s skin health.

If you have a child with eczema or are an adult who has dealt with eczema since childhood, our team can help you evaluate whether any of these root causes are at the core of your eczema. Start your journey to clear, healthy skin with our Free Resources:

• FREE Live Eczema Relief Workshop – Learn strategies to manage eczema naturally

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Want a more personalized approach? Book a one-on-one consultation with me at 30% off using code BLOG30 for a tailored evaluation and guidance specific to your needs.

GOT QUESTIONS?

Dr. Fong is going live to discuss this topic on her weekly Live with the Eczema Doc on Wednesday, November 5, at 12:30 PM PST! Watch the live or check out the replay here:

About the Author:

Dr. Diane Angela Fong, ND, is a naturopathic doctor specializing in eczema and chronic inflammatory conditions. She is the CEO and founder of Cleanbody, a wellness company dedicated to treating and preventing chronic diseases. Dr. Fong developed the Cleanbody Method, a transformative three-step process: Evaluate (uncovering the root causes of chronic disease through lab testing and comprehensive assessments), Optimize (strengthening health foundations by addressing nutrition, lifestyle, and toxic exposures), and Support (restoring optimal organ function through targeted healing protocols). Driven by a mission to educate and empower individuals with eczema and other chronic inflammatory diseases, Dr. Fong provides comprehensive support to help patients achieve lasting relief and better health. Learn more at www.cleanbody.health.

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