The National Institute for Health and Clinical Excellence has issued clinical guidance on the management of atopic eczema in children from birth up to 12 years. The guidance provides information on the diagnosis and assessment, and management of the condition and on educating children, carers and parents. The guidance states that emollients should form the basis of atopic eczema management and should be used at all times, even when the eczema is clear. Management should be stepped up or down, acoording to the severity of symptoms. The guidance makes some of the following recommendations for the various treatment options available: • Patients should be offered a choice of unperfumed emollients, and may include a combination of products or one product for all purposes. Leave-on emollients should be prescribed in large quantities (250–500 g weekly) and easily available to use at nursery, pre-school or school. • The potency of topical corticosteroids should be tailored to the severity of the child’s atopic eczema, which may vary according to body site. It is recommended that topical corticosteroids for atopic eczema should be prescribed for application only once or twice daily. Potent topical corticosteroids should not be used in children aged under 12 months without specialist dermatological supervision. Healthcare professionals who dispense topical corticosteroids should apply labels stating the potency class of the preparations to the container (for example, the tube), not the outer packaging. • Topical tacrolimus and pimecrolimus are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity. Topical tacrolimus is recommended, within its licensed indications, as an option for the second-line treatment of moderate to severe atopic eczema in adults and children aged 2 years and older that has not been controlled by topical corticosteroids, where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy. • Pimecrolimus is recommended, within its licensed indications, as an option for the second-line treatment of moderate atopic eczema on the face and neck in children aged 2–16 years that has not been controlled by topical corticosteroids, where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy • Oral antihistamines should not be used routinely in the management of atopic eczema in children. Healthcare professionals should offer a 1 month trial of a non-sedating antihistamine to chil¬dren with severe atopic eczema or children with mild or moderate atopic eczema where there is severe itching or urticaria. Treatment can be continued, if successful, while symptoms persist, and should be reviewed every 3 months. • Healthcare professionals should provide clear information on how to access appropriate treatment when a child’s atopic eczema becomes infected. Flucloxacillin should be used as the first-line treatment for bacterial infections in children with atopic eczema for both Staphylococcus aureus and streptococcal infections. Erythromycin should be used in children who are allergic to flucloxacillin or in the case of flucloxacillin resistance. Clarithromycin should be used if erythromycin is not well tolerated. Topical antibiotics should not be used for longer than 2 weeks.