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The Combined Approach, but in being so effective may prevent future difficulties as the child grows up. The treatment approach for adults has been successfully adapted for children, as set out in Chapter 5. The younger the child, the more it is necessary to adapt the adult programme, but the principles can be applied in practice to patients of all ages. Just as in adults, children present with 'itch scratching' and 'circumstance scratching'. Children as young as three years old can learn the 'pinch' technique described above, and benefit from active participation in their treatment. Probably the most important general rule with children is however the total avoidance of the negative entreaty,

H O ^ hH O C/3

n > C/5 n

'Stop scratching!'

Fig 3.5 Key Messages

Habit reversal is easy to understand %

Applies to the chronic syndrome • A combined approach is essential All ages can be treated

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which is replaced by a range of interventions that are characteristically positive and active. Clearly with children it is necessary to work with their parents, and in so doing the beliefs of the parents must be taken into account. This is particularly vital if either or both parents has suffered also with atopic eczema. If a parent has chronic atopic eczema themselves at the time a child is brought for treatment, serious consideration needs to be given to treating the parent first. Fortunately treating very young patients can be considerably helped by their behaviour changing quickly. What can be achieved in two days with a child of two years can take weeks for an adult of 20. However the healing process in the skin still requires adequate treatment with emollients and topical steroids, and this process can last as long as it takes for adults (Fig 3.5). Subsequently, as for adults, the follow-up programme for children requires continuing vigilance and prompt treatment of relapses. Habit reversal is not involved in such situations, providing the response is early and adequate. The debilitating syndrome of long-standing atopic skin disease can then be avoided altogether.

Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients