Indicators of severe functional restriction

The indicators of severe functional restriction for children are applied as follows; children with severe but well managed eczema may be very well and minimally restricted by their condition. This may be achieved by several hours per day of eczema related skin care by parents or carers. Indicators of severe functional restriction in eczema refer to evidence that significant care is being given. Children may still have limiting eczema despite receiving excellent and time consuming care. Any one of the following features indicates significant care is likely to be being given to the child with eczema:

Children aged 5 and under -:

• Systemic therapy with any of the drugs listed in the ‘Other therapies & treatments’ page.
• Use of bandages or wraps.
• Written evidence of advice from eczema specialist nurse or dermatologist that emollients should be used 4 or more times daily on an on-going basis to control eczema.
• Referral to paediatric dermatologist within last 12 months.
• Wound care management plan in place.

Children aged 6 and over -:

• Systemic therapy with any of the drugs listed in the ‘Other therapies & treatments’ page.

Children aged 6 and over with severe eczema are likely to be receiving significant eczema related skin care. Most children with moderate eczema will be reasonably well controlled and require a lot less care than a child with severe eczema. However there will be some children who appear to be in the moderate category who do require significant care. These can be identified by looking for evidence of the following in the medical evidence -:

• Use of bandages or wraps.
• Under care of dermatologist with a hospital out-patient attendance twice in the last 12 months – children of this age with moderate eczema would not normally see a hospital dermatologist as in most cases eczema is controlled and improving. Those who are seeing a hospital dermatologist are likely to have difficult to control eczema or eczema that is getting worse.
• One admission to hospital in previous 12 months with eczema – children of this age are very unlikely to be admitted to hospital unless their eczema is hard to control or getting worse.
• Prescription of night time antihistamine tablets on an ongoing basis – this identifies a small proportion of children with very disturbed sleep, such children are likely to have eczema at the more severe end of the moderate category and require more care. The antihistamines, if taken, should reduce care required at night.
• More than 4 consultations with the GP about eczema in the last 12 months – children of this age will usually have well controlled eczema that is improving, more than 4 consultations with the GP about the eczema in one year implies that the eczema is hard to control or is significantly affecting the child e.g. behavioural problems. Significant care is likely to be being given in these cases.
• Wound care management plan in place – a wound care management plan is a nursing care plan relating to the care of a wound. It means that the child’s skin has broken down into a wound or open sore. The plan is likely to include details of frequency of wound cleaning and dressing, dressing prescription details and brief notes on the appearance and progress of wound healing.