A smartphone program helped reduce short-term eczema relapses in young children, what ECEC services can take from it

A large randomised controlled trial has found that a structured, smartphone-based eczema education program for caregivers reduced relapse risk over the first 12 weeks for children aged 0–6 years with moderate-to-severe atopic dermatitis. While the benefit did not remain statistically significant beyond 12 weeks, the study adds to growing evidence that scalable digital education can strengthen early flare recognition and timely management, an insight with practical implications for early childhood education and care (ECEC) services working alongside families.

 

Atopic dermatitis, commonly referred to as eczema is a chronic inflammatory condition that can involve intense itch and recurring flare-ups. The JMIR authors describe it as a global concern affecting up to 20% of children worldwide. 

 

For ECEC services, eczema can be more than a skin issue. Persistent discomfort can affect sleep, participation, behaviour and wellbeing, and can increase the need for close communication with families about triggers, treatment plans and signs of worsening.

 

Published in Journal of Medical Internet Research, the trial enrolled 615 children aged 0–6 years across 12 tertiary paediatric dermatology centres in China. Children were randomised 1:1 to receive either:

 

• standard care plus a smartphone-based digital eczema education program for caregivers, or
• standard care alone via conventional face-to-face consultation. 

 

The education program ran for 12 weeks and included structured multimedia content and action prompts, delivered multiple times per week, as well as a pathway for expedited clinician consultation during flares. 

 

What the study found

 

• Lower relapse at 12 weeks
• Relapse at 12 weeks occurred less often in the digital education group (16.6%) compared with the control group (24.0%), with a relative risk of 0.69. 
• A time-to-event analysis over the first 100 days showed better relapse-free survival for the digital education group, including in an adjusted model. 
• No statistically significant differences beyond 12 weeks
  While relapse rates remained numerically lower at later time points (including 24, 36 and 52 weeks), differences were not statistically significant. 
• Strong caregiver engagement, with real-world constraints
  Engagement tracking found that 58% of caregivers maintained regular use of the digital platform, averaging 1.64 sessions per week, and around 26.7% used the expedited consultation portal during flares. 

 

The authors conclude that the program likely reduced short-term relapse by supporting caregiver recognition of early worsening and prompt action, though they note that maintaining long-term benefit will likely require stronger reinforcement strategies and sustained engagement. 

 

Why this matters for early childhood services

 

ECEC services do not diagnose or prescribe treatments. However, they do play a key role in:

 

• supporting children’s comfort and participation
• observing and responding to signs of worsening (in line with service policies and scope)
• partnering with families to implement agreed health and care plans
• keeping consistent routines that may influence flare triggers, such as heat, sweat, irritants, scratching during rest times.

 

Quality Area 2 of the National Quality Standard focuses on safeguarding and promoting children’s health and safety and protecting children from harm. Quality Area 6 reinforces the importance of collaborative partnerships with families to support children’s wellbeing and inclusion. 

 

Operationally, services are also required to have policies and procedures for dealing with medical conditions, including requirements relating to medical management plans and family involvement. 

 

The key message for ECEC is not “use an app”. It is that structured education and timely action can reduce relapse risk in the short term, suggesting services can help by strengthening everyday systems that support families’ eczema management.

 

1) Strengthen enrolment and plan-sharing pathways

 

Ensure families of children with eczema are supported to provide (and regularly update) relevant documentation and practical instructions, including what the service should do if symptoms escalate. National guidance emphasises discussing medical issues and management during enrolment and maintaining clear documentation where required. 

 

2) Improve “early flare” recognition through shared language

 

The study’s proposed mechanism—earlier recognition and action—translates well to service practice. Consistent educator awareness of a child’s early warning signs can support quicker family communication and timely plan-based responses. 

 

Practical examples include documenting patterns such as:

 

• increased scratching or skin rubbing
• sleep disruption or irritability linked to discomfort
• heat-related flare patterns (outdoor play, bedding, layered clothing)
• changes in skin appearance that families have flagged as “early signs”.

 

3) Build routines that reduce preventable triggers

 

Where families identify common triggers, services can align routines within reasonable control, such as gentle hygiene practices, minimising irritant exposures, monitoring heat load, and supporting children to use safe comfort strategies (for example, distraction, sensory tools, or cool quiet spaces) consistent with the child’s plan.

 

4) Use digital tools thoughtfully, with consent and privacy front of mind

 

Digital education platforms may appeal to families because they are accessible and can reinforce consistent messages. But ECEC services should be cautious about:

 

• encouraging families to share sensitive health information via unsecured channels
• storing screenshots or app data in ways that breach privacy expectations
• relying on third-party tools without clear consent and governance.

 

Any service use of digital communication should be guided by service policy, consent processes and secure recordkeeping practices.

 

Limitations leaders should understand before interpreting the results:

 

• The trial was conducted in China, within a tertiary dermatology care context, and results may not generalise to all populations or service settings. 
• Almost half of participants did not complete 52-week follow-up, which affects long-term certainty. 
• The measurable benefit was strongest in the short term; the authors call for research into “booster” strategies and sustained engagement approaches. 

 

This study reinforces a familiar service truth: consistency, shared understanding and early response matter, especially for chronic conditions that flare.

 

When services maintain strong medical-condition processes, communicate early and often with families, and support children’s comfort and participation through everyday routines, they contribute meaningfully to children’s wellbeing—while staying within scope and aligning with the National Quality Framework. 

 

References – Yang H, Shu H, Wang LH, et al. Smartphone-Based Digital Eczema Education Program for Atopic Dermatitis in Children Aged 0 to 6 Years: Multicenter, Randomized, Parallel Controlled Clinical Study. 

 

This article is general information only and does not replace medical advice. Families should be encouraged to follow their health professional’s guidance for diagnosis and treatment.