What’s Really Causing Your Child’s Eczema?

Q&A with Dr. Shane Rainey, Pediatrician

If you’re searching for a more root-cause approach to your child’s health, you’re not alone. Dr. Shane Rainey, a functional medicine pediatrician in Fort Worth, takes a deeper look at common childhood conditions like eczema by addressing what’s happening beneath the surface. Rather than simply treating symptoms, his approach focuses on gut health, immune balance, nutrition, and environmental factors to support long-term healing. In this Q&A, Dr. Rainey shares what eczema really is, what he evaluates first, and practical steps families can take to start improving their child’s skin from the inside out.

Q: What is eczema?

Dr. Rainey:
Eczema is more than just dry skin. At its core, it involves three main things:

• Inflammation
• Skin barrier dysfunction (the skin isn’t able to protect and retain moisture like it should)
• Immune dysregulation (the immune system is overreacting or not responding appropriately)

So what you see on the surface is really just a reflection of what’s happening underneath.

Q: What are the top things you evaluate first when a child presents with eczema?

Dr. Rainey:
I like to zoom out and look at the whole child, not just the skin. Some of the first things I evaluate include:

• Gut health
  I look at antibiotic use, medication history, and anything that may have disrupted the gut microbiome.
• Food triggers vs. true allergies
  Not every flare is a true allergy. Sometimes it’s a sensitivity or inflammatory response.
• Environmental exposures
  This can include air quality, water quality, and other environmental factors in the home.
• Nutrient deficiencies
  I often consider the child’s diet and levels of key nutrients like vitamin D, zinc, and others that support skin and immune health.

Q: Is eczema just a skin issue?

Dr. Rainey:
No, and that’s a really important mindset shift for families. There is a strong gut-skin connection, and eczema is often tied to how the immune system is developing and functioning. The skin is just one way the body is expressing a deeper imbalance.

Q: Is eczema hereditary?

Dr. Rainey:
Genetics can absolutely play a role, but they are only part of the picture. Environmental factors and gut health have a big influence on whether eczema develops and how severe it becomes. Even if no one in the family has eczema, a child can still experience it based on these other factors.

Q: How do gut health and immunity affect eczema?

Dr. Rainey:
I like to think of the gut as the “control center” for the immune system. In fact, about 70–80% of the immune system lives in the gut, so when things are off there, it can show up in other places, including the skin.

An easy way to picture it is this: if the gut is like the foundation of a house, and that foundation is unstable or inflamed, you’ll start to see cracks show up elsewhere. For many kids, eczema is one of those “cracks.”

When the balance of good and bad bacteria in the gut is disrupted, whether from antibiotics, diet, or other factors, it can lead to increased inflammation and a more reactive immune system. That immune response can then show up on the skin as redness, irritation, and itching.

The encouraging part is that when we start supporting gut health, we’re often helping calm the immune system at the same time. And for a lot of kids, that’s when we begin to see real improvement in their eczema.

Q: What role does nutrition play in skin health?

Dr. Rainey:
Nutrition plays a huge role, I am a huge advocate for focusing on diet and eating real, whole foods. The skin relies on certain nutrients to stay strong and resilient.

Some of the most important include:

• Essential fatty acids (like omega-3s)
• Zinc
• Vitamin D
• Antioxidants

When kids are deficient in these, the skin barrier can weaken and inflammation can increase, making eczema worse.

Q: What foods support those key skin nutrients?

Dr. Rainey:
One of the best ways to support skin health is through real, nutrient-dense foods. When we’re thinking about eczema, I like to focus on a few key nutrients and where to find them:

Essential fatty acids (omega-3s)
These help reduce inflammation and support a healthy skin barrier. Foods to include:

• Fatty fish (think like salmon, sardines, etc.)
• Chia seeds and flaxseeds
• Walnuts

Zinc
Zinc plays a big role in skin healing and immune function. Foods to include:

• Grass-fed beef
• Pumpkin seeds
• Chickpeas and lentils
• Eggs

Antioxidants
These help protect the skin from inflammation and oxidative stress. Foods to include:

• Berries (blueberries, strawberries)
• Leafy greens (spinach, kale)
• Colorful vegetables (carrots, bell peppers, sweet potatoes)

Vitamin D
Vitamin D helps regulate the immune system and supports skin repair. Sources include:

• Sunlight exposure (get your kids outside!)
• Fatty fish like salmon
• Egg yolks
• Fortified foods (if tolerated)

Bone broth is another easy win here. It’s rich in amino acids and nutrients that support gut health, and since the gut and skin are so connected, that can go a long way for kids with eczema. Use it to soups, cook rice or pasta in it, add it to sauces, etc.

The goal isn’t perfection, it’s just consistently incorporating a variety of these foods to help support the skin from the inside out.

Q: What if my child is a picky eater and won’t eat these foods?

Dr. Rainey:
This is incredibly common, so first, you’re not alone. I never expect kids to flip a switch overnight and suddenly love salmon and spinach.

Instead of aiming for perfection, I encourage parents to think in terms of small, strategic wins over time.

Here are a few ways to start:

1. Start with what they already like
   If your child already eats something even remotely close to these nutrients, build from there. For example, if they like chicken, you might try incorporating higher-quality versions or pairing it with a small exposure to a new food.
2. Make small upgrades, not big overhauls
   You don’t have to change everything at once. Try swapping one item at a time, like a cleaner yogurt with less sugar, adding a smoothie in the morning, or changing snacks to be less processed foods.
3. Use “hidden nutrition” when needed
   Smoothies are a great way to add things like chia seeds, flaxseeds, or even mild-tasting greens. Add finely chopped walnuts or blueberries to muffins. Or you can also mix ingredients into foods they already enjoy, like adding ground flax to oatmeal or yogurt.
4. Keep exposure low-pressure
   It can take multiple exposures before a child accepts a new food. Keep offering without forcing. Even having the food on their plate is a step in the right direction.
5. Focus on what you can control
   You decide what foods are offered. They decide whether to eat it. Over time, that consistency really matters.
6. And a little tough love here, but if you don’t want them eating Cheetos…. stop buying Cheetos. If it’s in the house, it’s going to be the easy choice every time. Creating the environment is half the battle.
7. Leave healthy food out and visible
8. I have young kids myself, and while I feel fortunate they’re generally good eaters, we still have our battles. One thing my wife and I have found really helpful is simply having healthy food out during snack time. When cut-up fruit, homemade protein balls, chicken, or veggies with dip are sitting on the counter and easy to grab, it gets eaten. Sometimes accessibility makes all the difference.
9. Use supplements as a bridge, not a crutch
   If a child truly isn’t getting key nutrients through food, supplements, including omega-3s, vitamin D, zinc, and a probiotic, can help fill gaps while you continue working on diet. There are a lot of great, high-quality options out there for kids. We carry several of our favorites here at Restore + Revive, and you can also find good options at local health stores. The key is choosing clean, well-sourced products and using them thoughtfully.

At the end of the day, progress is what we’re after. Small changes, done consistently, can still make a big impact on your child’s skin and overall health.

Q: What are the first 3 things you would tell a family to do if their child is struggling with eczema?

Dr. Rainey:
I don’t love a one-size-fits-all answer because every child is different. But if a family can’t see me or another functional medicine provider right away, there are a few simple things I often recommend starting with:

1. Remove artificial fragrances
   This includes laundry detergent, soaps, lotions, and bath products. Fragrance is a very common trigger and easy place to start. If finances don't allow you to swap everything overnight, that is okay! The next time you run out of laundry detergent, buy a cleaner ingredient, fragrance free option.
2. Simplify the diet
   I often suggest removing processed dairy as a trial to see if symptoms improve. While I personally like raw dairy, I know it’s not always accessible or comfortable for everyone, so simply removing dairy for a period of time can be a helpful, no-cost step.
3. Consider key nutrients, probiotics, and supplementation
4. Essential fatty acids (like omega-3s), zinc, and vitamin D all play important roles in skin repair and immune regulation. Adding in a high-quality probiotic can also help support gut balance (especially if there has been a history of antibiotic use), which in turn supports the immune system. For some children, simple and safe supplementation can reduce flare-ups and support overall balance.

A final note from Dr. Rainey

I know how frustrating and overwhelming it can be to deal with a condition like eczema, especially when it’s your child. First, you are not alone, and you should not feel guilty. As a parent, it’s incredibly hard to watch your child uncomfortable, itching, and not feeling their best, and to feel like you’re not seeing improvements.

As a father, I understand that firsthand. There’s nothing easy about navigating your child’s health, especially when it feels like you’ve tried everything.

My hope is that some of these insights and simple strategies give you a starting point and help you feel a little more empowered. Small, consistent changes can make a meaningful difference over time.

If you’re looking for more personalized support, I’d love to help. You can schedule a free meet-and-greet or a functional medicine pediatric appointment with me to take a deeper, root-cause approach to your child’s eczema and overall health.

You can call us at 817-720-6220 Ext. 2 or email integrative@restoreandrevivefw.com.

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