Randomised Controlled Feasibility Trial of an Intervention to Reduce Infant Bathing

Br J Dermatol. 2026 Jun 26:ljag248. doi: 10.1093/bjd/ljag248. Online ahead of print.

ABSTRACT

BACKGROUND: Bathing, even in tap water, alters skin physiology. Frequent infant bathing may increase the risk of eczema developing.

OBJECTIVE: To undertake a randomised controlled feasibility trial of an intervention to reduce infant bathing frequency and intensity.

METHODS: Randomised controlled trial. 105 pregnant women (≥ 16 years) with family history of atopy, carrying a healthy singleton child (54 male, 51 female) were randomised in a 1:1 ratio during pregnancy, or postnatally prior to the first infant bath. The intervention group were asked to reduce bathing frequency (no more than once a week for the first six months of age) and intensity (keep baths short, not too hot and washing in plain water is usually sufficient). The control group received the routine postnatal infant care advice offered in their maternity unit.The primary feasibility outcome was the proportion of eligible families willing to be randomised to the intervention. The secondary clinical outcome was a blinded assessment of infant eczema at age 6 months, using an adaptation of the UK Working Party Diagnostic Criteria for Atopic Dermatitis.

RESULTS: : 261 pregnant women were screened, of whom 21 were ineligible and 105/240 (44%) were randomised to the intervention (52) and control (53) groups. Adherence to the intervention was high with 79.6% (35/44) in the intervention arm bathing their infant once a week or less, compared to 28.6% (14/49) in the control group. In the intervention group 95% (38/40) agreed or strongly agreed that the intervention was acceptable. There was minimal contamination of the control group (1/46). Follow-up was high with 89% (93/105) of families completing the final 6-month questionnaire and 82% (86/105) attended the final visit. Eczema outcomes occurred less frequently in the intervention arm compared to the control arm: visible eczema 15.8% (6/38) vs 29.2% (14/48); parent reported eczema 9.1% (4/44) vs 12.2% (6/49); and doctor diagnosed parent reported eczema 6.8% (3/44) vs 10.2% (5/49). No noteworthy adverse effects of the intervention were reported.

CONCLUSIONS: These findings support the feasibility of randomising infants during pregnancy to a reduced frequency and intensity bathing intervention for eczema prevention.

TRIAL REGISTRATION: ISRCTN51491794 (Registered 24/07/2023).

PMID:42359599 | DOI:10.1093/bjd/ljag248