When your kid is clawing at their skin at 2 a.m., you want two things: what’s causing it and what stops it fast. This guide gives you a parent-tested, NHS-aligned plan to identify the usual suspects, calm the itch safely, prevent spread at home and school, and spot the few cases that need urgent care. I’ve been through this in Bristol with my two-Alden’s head lice era and Thalia’s eczema flares-so the steps below are practical, not theoretical.

TL;DR: Fast answers for tired parents

- Most common culprits: eczema/dry skin, head lice, contact dermatitis (soaps, grass, nickel), hives from viral bugs or allergies, heat rash in hot weather; less common but important: scabies, threadworms, chickenpox, impetigo.

- Quick relief tonight: cool the skin, moisturise thickly and often, trim nails, cotton gloves/socks at night, lukewarm 5-10 minute bath, fragrance-free products only.

- Medicines: age-appropriate liquid non-drowsy antihistamines can help hives/allergy itch; mild steroids help eczema flares (OTC hydrocortisone 1% is UK-licensed for 10+; younger kids need GP advice). Avoid ibuprofen in chickenpox; use paracetamol for fever/pain.

- Contagious? Lice and scabies spread by close contact; threadworms spread in families; chickenpox-keep home until spots crust (usually 5 days). Schools shouldn’t exclude for head lice; treat and return.

- See a doctor fast if: purple rash that doesn’t fade on glass test, swelling of lips/tongue or breathing trouble, widespread blistering/painful skin, a very unwell child with fever, infected skin (oozing, hot, painful), or intense night-time itch with a spreading rash not improving in 48-72 hours.

What’s causing the itch? A quick parent map

Start with the basics: where is the itch, when did it start, what changed this week (new soap, pet, school outbreak note), and does your child feel otherwise well? That short checklist points you to the likely cause nine times out of ten.

• Scalp itch with white specks stuck to hair (not easily brushed out) → head lice.
• Itch worse at night, small burrows or a bumpy line on wrists, between fingers, armpits, waistline → scabies.
• Dry, rough, red patches in elbow/knee creases, neck, wrists, ankles; family history of allergies → eczema/atopic dermatitis.
• Sudden raised, map-like welts (hives) that come and go in hours → urticaria from viral illness or allergy.
• Itchy bottom at night, restless sleep → threadworms (especially school-age).
• Fluid-filled blisters that scab, low energy, mild fever → chickenpox.
• Honey-coloured crusts around nose/mouth, easily spread → impetigo (needs antibiotics).
• Prickly stingy bumps after heat/sweat → heat rash.
• Pearly, dimpled bumps that sometimes itch → molluscum contagiosum (harmless, slow to clear).

Here’s a quick side-by-side to help you choose first steps at home versus calling the GP. This blends everyday parent cues with guidance you’ll find from NHS, NICE, the British Association of Dermatologists, and UKHSA.

Note on trends: UKHSA reported increased scabies activity in some regions over recent winters, so if itching is severe at night and multiple family members are affected, act early.

First 24 hours: stop the scratching safely

When itch is raging, the goal is comfort and skin protection. Here’s a simple sequence that works in real homes.

1. Cool the skin. Use a clean, cool, damp cloth for 5-10 minutes on the itchy area. Keep the bedroom cool (18-20°C). Avoid hot baths, heaters, heavy duvets.
2. Seal in moisture. Within 3 minutes of a short lukewarm bath or shower, apply a thick, fragrance-free emollient. Greasier = better for severe dryness. Reapply thin layers every few hours.
3. Block the damage. Trim nails, file smooth. For night-time, cotton gloves or socks on hands reduce scratching injuries. For toddlers, sew mitts onto pyjama sleeves.
4. Choose the right wash. Skip soap and bubble bath. Use an emollient wash or a gentle, fragrance-free cleanser. Keep baths to 5-10 minutes.
5. Add targeted relief. For hives/allergy itch, an age-appropriate non-drowsy antihistamine (like cetirizine or loratadine) can help. For eczema flares, a short, appropriate course of mild topical steroid can calm inflammation fast-ask your pharmacist or GP for the right product and age guidance. For chickenpox, consider an aqueous cream with menthol (0.5%) on itchy spots; avoid ibuprofen, use paracetamol for fever/pain.
6. Keep hands busy. Offer a squishy stress ball, fidget toy, or cool spoon to press on itch instead of scratching. Works better than nagging.

Wet-wrap tip (for moderate eczema flares): after moisturising, dampen a layer of cotton tubular bandage or pyjamas with warm water, wring, put on over the cream, then add a dry layer on top for 1-2 hours (or overnight if advised). This boosts moisture and calms itch. Confirm suitability with your GP for young children or on delicate areas.

Medicine safety in brief (UK context):

• Antihistamines: Pharmacists can advise by age/weight. Non-drowsy options are usually preferred in the day; short courses of sedating options at night can help sleep for older kids. Under 2 years, check with a clinician first.
• Topical steroids: OTC hydrocortisone 1% is licensed for age 10+ and not for face/genitals without medical advice. Younger kids or severe flares need GP-prescribed options with a plan (area, amount, duration).
• Pain/fever: Use paracetamol as directed by age/weight. Avoid ibuprofen in chickenpox because of rare skin complications flagged by NHS and MHRA.

Evidence notes parents ask me about: the big UK SWET trial found water softeners didn’t improve eczema, and dermatology guidance is consistent on daily emollients and steroid “bursts” for flares as the most effective basics.

The playbook by condition: what to do, what to avoid

Eczema (atopic dermatitis). Signs: dry, itchy patches-often in creases-plus a family pattern of asthma/hay fever. What works: daily emollients (think at least 250-500 g/week in bad phases), soap substitutes, short lukewarm baths, and a short steroid course for flares. Consider mupirocin only if your GP suspects local infection; avoid routine antibiotic creams. Watch for infection: yellow crust, oozing, heat, pain-see GP. For face/eyelids or babies, get personalised advice. Don’t fear prescribed steroids used correctly; under-treating itch leads to skin damage and poor sleep.

Head lice. We had the classic “Monday letter from school” in Bristol more than once. Signs: scalp itch; live lice or nits glued to hair. Two good options: (1) wet combing with conditioner and a metal nit comb every 3-4 days for 2 weeks (until no lice found twice), or (2) licensed physical insecticides (e.g., dimeticone) used exactly as per instructions, repeating the application if the product requires. Check close contacts. No need to exclude from school per NHS-start treatment and carry on. Avoid tea tree oil; it doesn’t reliably work and can irritate.

Scabies. Signs: intense itch worse at night, often with burrows in finger webs, wrists, armpits, waist; others at home may itch. Action: treat everyone in the household on the same day with a prescribed permethrin 5% cream (or pharmacist/GP guidance), applied neck-down (including under nails), left on for 8-12 hours, then repeated in 7 days. Hot-wash clothes/bedding/towels (>50°C) used in the previous 3 days or seal in bags for 72 hours. Itch can last weeks even after mites are gone; antihistamines and emollients help. Children can return to school the day after first treatment.

Hives (urticaria). Signs: raised welts that move around, itch like mad, and fade within 24 hours. Many cases follow a virus. Treat with a non-drowsy antihistamine and cool compresses; most settle in a few days. Seek urgent care for lip/tongue swelling, breathing trouble, or vomiting/dizziness (anaphylaxis). Chronic hives (over 6 weeks) need GP review for step-up antihistamines and to rule out triggers.

Contact dermatitis. Signs: itchy rash exactly where something touches-soap, fragrance, nickel snaps, wet wipes, even face paint. Fix the trigger and the rash often settles within days. Switch to fragrance-free products, rinse new clothes before wearing, choose nickel-free accessories, and protect with cotton layers. Persistent cases may need a GP and possibly a dermatology patch test.

Threadworms (pinworms). Signs: night-time bottom itch; little white threads at the anus or in poo. Treat the whole household at the same time; pharmacists can supply mebendazole for age 2+. Repeat in 2 weeks. Hygiene blitz for 2 weeks: morning showers to remove eggs, daily underwear change, short nails, no nail-biting, hot-wash bedding/towels, wipe bathroom surfaces. Itch may persist briefly as skin heals.

Chickenpox. Signs: crops of itchy blisters on trunk/face that crust over; fever/tiredness. Comfort care: paracetamol for fever/pain, cool baths, menthol aqueous cream on itchy areas, moisturisers. A sedating antihistamine at night may help sleep for older children. Avoid ibuprofen unless a clinician specifically advises. Keep home until spots crust (typically 5 days). Call the GP urgently for babies, children with immune problems, or if your child is very unwell, breathless, dehydrated, or has severe pain.

Heat rash (prickly heat). Signs: tiny red bumps with prickling/stinging after heat or sweat. Cool the room, light cotton layers, cool showers, and a bland moisturiser. Usually clears fast.

Molluscum contagiosum. Signs: small pearly bumps with a central dimple; can itch when the body is clearing them. Usually no treatment needed; avoid scratching to prevent spread and infection. See GP if irritated, infected, or near eyes.

Impetigo. Signs: itchy, crusty, spreading sores around nose/mouth or anywhere after scratching. Needs antibiotics-contact the GP. Keep at home for 48 hours after starting treatment and until lesions are crusted.

Bed bugs. Signs: itchy bites in lines or clusters, often on exposed skin, new after travel or second-hand furniture. Wash/bag bedding, vacuum seams, and consider professional pest control. Symptomatic relief is the same: cool compresses and moisturisers; antihistamines for itch if needed.

Prevention and daily routines that actually work

Build a simple routine and the itch battle gets easier. This is what stuck for us with Thalia’s eczema and what I see help other families.

• Emollient habit: keep a pump by the sink and bed. Aim for at least twice daily on good days, up to four times on flare days. Greasy ointments at night, creams/lotions in the day if your child dislikes the feel.
• Bath smart: short, lukewarm, no bubbles. Use an emollient wash or a gentle fragrance-free cleanser. Pat dry; moisturise within 3 minutes.
• Clothes and laundry: soft cotton next to skin; avoid scratchy wool. Fragrance-free detergent, skip fabric softeners. Rinse swimwear and moisturise after pools.
• School coordination: ask if the teacher can keep moisturiser in class. For lice, do quick checks with a nit comb after school on outbreak weeks-Mondays were our hotspot.
• Home environment: keep bedrooms cool; short nails; hands busy at story time. Humidifiers rarely needed in the UK climate unless heating is very drying.
• Evidence-based extras: water softeners didn’t help eczema in the UK SWET study; probiotics have mixed evidence-don’t expect miracles. Tea tree oil can irritate and isn’t recommended for kids’ skin.
• Save money: large tubs of generic emollients are fine; the best moisturiser is the one you’ll use lots of. Ask your pharmacist about cost-effective options.

When to worry, FAQs, and what to do next

Red flags-get urgent help:

• Purple rash that doesn’t fade on a glass test.
• Swelling of lips/tongue or breathing problems; sudden severe allergy symptoms.
• Widespread painful rash, blistering, or skin peeling.
• Very unwell child with fever, floppy, hard to wake, or not drinking/weeing.
• Suspected infected eczema or impetigo: hot, red, oozy, painful skin.

Mini‑FAQ:

• What’s the best antihistamine for kids? Non-drowsy ones like cetirizine or loratadine are usually first choice in the day; check age limits and doses with a pharmacist. Sedating options can help night itch in older kids for short spells. Under 2 years, ask a clinician.
• Should I bathe more or less? Short daily lukewarm baths or showers are fine if you moisturise right after. Hot water and long soaks make itch worse.
• Do I need special water softeners or shower filters? Evidence from UK trials says no for eczema outcomes. Spend the money on good emollients instead.
• School rules-can my child attend? Head lice: yes, treat and attend. Scabies: back the day after first full-body treatment. Impetigo: stay home for 48 hours after starting antibiotics. Chickenpox: home until spots are crusted (usually 5 days).
• Are topical steroids dangerous? Used correctly (right strength, right area, right duration), they’re safe and prevent complications of uncontrolled inflammation. Your GP or pharmacist can create a clear plan.
• What about oatmeal baths? Colloidal oatmeal can soothe itch for some kids; patch test first if your child has oat allergy.
• Why is the itch worse at night? Skin loses moisture and the body’s anti-itch signals dip overnight. That’s why nighttime routines-cool room, moisturise, cotton gloves-matter.

Next steps by situation:

• If you think it’s eczema: start the emollient routine today; note triggers; ask your pharmacist about a suitable mild steroid plan if age-appropriate; book a GP review if no improvement in 1-2 weeks or you see infection.
• If you find nits or lice: choose either wet-combing (set calendar reminders every 3-4 days for 2 weeks) or a licensed lotion; treat close contacts; tell friends discreetly so they can check too.
• If multiple family members itch at night: call the GP/pharmacist about scabies; plan same-day treatment for everyone and do the laundry steps once.
• If the itch is sudden hives: give a non-drowsy antihistamine; keep a simple diary of new foods/medicines/viral symptoms; seek urgent care for breathing or facial swelling.
• If it’s bottom itch at night: talk to your pharmacist about threadworm treatment if age 2+; do the two-week hygiene blitz; repeat treatment in two weeks.

Troubleshooting stubborn itch:

• “We moisturise but it’s still bad.” Use more and greasier for a week; switch to fragrance-free everything; add a short steroid burst for flares with clinician guidance; consider wet wraps.
• “Treatments keep failing.” Double-check technique and timing (lice lotions often need a repeat; scabies always needs a second application and treating everyone). Recheck the diagnosis with your GP-sometimes eczema plus impetigo, or scabies mislabelled as eczema, keeps the cycle going.
• “Is it an allergy?” Eczema is rarely driven by a single food trigger. If there’s a clear, reproducible link to a food or there are immediate hives/vomiting, discuss proper testing with your GP; avoid random restrictions.
• “We’re losing sleep.” Prioritise night comfort measures: cool room, moisturise before bed, cotton gloves, sedating antihistamine short-term if appropriate, and a simple reward chart for “no scratching hands” moments to keep things positive.

Final thought from a fellow parent: stay practical. The basics-cooling the skin, thick moisturisers, smart hygiene, and targeted treatments-solve most cases of itching in children. And when they don’t, you’ve got a clear plan for who to call and what to ask.