Steroid Cream Worked — Then the Itching Came Back. Why Can Baby Eczema Return So Quickly?

For a few days, it can feel as though you have finally won. Your baby’s red patches begin fading, the angry inflammation settles, the scratching slows down, and everyone in the house may even get a little more sleep. The steroid cream appears to have done exactly what you hoped it would do, and you begin thinking the eczema is finally behind you. Then, sometimes only days after treatment finishes, your baby starts scratching again and those familiar red patches begin returning. For many parents, this is the moment when relief turns into frustration and the question becomes: why did my baby’s eczema come back so quickly after steroid cream?

The return of eczema does not necessarily mean the steroid cream failed. Topical corticosteroids are commonly used to reduce the inflammation associated with eczema flares, and when they are prescribed appropriately they can be an important part of treatment. But reducing inflammation is not the same as permanently removing every factor that contributed to the flare in the first place. Your baby may still have eczema-prone skin, a vulnerable skin barrier and daily exposures that continue placing pressure on that skin. Understanding this difference can help explain why a treatment can work very well and yet the itching can still return.

What Steroid Cream Is Actually Doing

When eczema becomes red, inflamed and intensely itchy, inflammation is a major part of what you are seeing. Topical corticosteroids work by reducing that inflammation, which is why the skin can improve noticeably during treatment. The redness may decrease, swelling can settle, and as inflammation comes under better control the urge to scratch may also reduce. This can create a dramatic visible improvement, particularly when a flare was quite active. But the medication is treating an important part of the eczema process rather than permanently changing your baby’s underlying tendency to develop eczema.

That distinction matters because eczema is usually a recurring condition rather than a rash that is simply removed once and never returns. A baby can respond beautifully to treatment and still experience another flare later. The more useful question becomes what allowed the inflammation to build again after it had settled. That moves the conversation beyond whether the steroid “worked” and towards what the skin needs between flares. Ongoing supportive care remains important even when the redness has faded.

The Redness Can Disappear Before the Skin Is Fully Resilient

One of the easiest mistakes to make is judging the health of the skin entirely by its colour. When the redness disappears, the skin looks healed, and naturally parents may assume everything underneath has returned to normal. Yet eczema-prone skin can continue to have barrier abnormalities even when an obvious flare has improved. The skin may still lose moisture more readily and remain more susceptible to environmental irritation. That means apparently clear skin can still require ongoing supportive care.

This is one reason regular moisturising remains important even when eczema appears much better. Think of the period after a flare as part of recovery rather than the moment all care stops. Supporting the barrier between flares may help the skin cope better with the ordinary pressures that have not disappeared. The absence of redness is encouraging, but it does not necessarily mean the underlying vulnerability has disappeared with it. Consistency matters during the quieter periods too.

Why Does the Itching Sometimes Return First?

Parents often notice scratching before they notice another obvious rash. Their baby starts rubbing a cheek, scratching behind a knee or becoming restless at night, yet the skin initially looks almost normal. A day or two later, the familiar redness becomes more noticeable and the parent realises another flare may be developing. This can make the eczema seem as though it suddenly returned overnight. In reality, the itch may have been an earlier signal that the skin was becoming uncomfortable again.

We explored this pattern in Baby Itching but No Rash? 6 Reasons Skin Can Itch Even When It Looks Normal. Itching can occur before dramatic visible changes, particularly when dryness, heat or irritation is beginning to increase. Once the child starts scratching, the physical damage caused by scratching can place even more pressure on the barrier. The developing flare and the scratching can then reinforce each other. Watching behaviour as well as redness can therefore help parents recognise changes earlier.

The Itch-Scratch Cycle May Start All Over Again

When eczema itches, babies scratch, rub or twist themselves against whatever surface is available. That rubbing can damage the outer skin barrier, and damaged skin may become even more irritated and uncomfortable. The child then scratches again, creating the familiar itch-scratch cycle. Even after a successful period of treatment, this cycle can restart if dryness or another trigger makes the skin itchy again. Once repeated scratching begins, a relatively small irritation can become much harder to settle.

This is particularly frustrating at night because babies can scratch repeatedly while half asleep. Fingernails may create tiny breaks in the skin, while rubbing against sheets can produce friction over a much larger area. Our article Baby Scratching All Night? Why Itching Gets Worse After Bedtime and What Parents Can Do looks more closely at this nighttime pattern. Keeping nails short can reduce some physical damage, but it does not remove the sensation causing the baby to scratch. The underlying skin still needs appropriate support and, when a new flare develops, appropriate treatment.

Moisturising and Steroid Treatment Have Different Jobs

Parents are sometimes given the impression that they must choose between moisturiser and steroid cream, but the two have different roles. During an eczema flare, prescribed topical corticosteroids help control inflammation, while moisturisers help address dryness and support the skin barrier. A moisturiser should not be expected to perform the same anti-inflammatory job as a prescribed corticosteroid. In the same way, treating inflammation does not remove the ongoing need to support eczema-prone skin between flares. Understanding these separate roles can make the whole routine feel much less confusing.

This is especially important when parents become worried about using prescribed medication and try to replace it with moisturiser alone during significant inflammation. Parents should follow the treatment plan provided by their doctor rather than shortening, extending or changing corticosteroid treatment based on an article online. If you are uncomfortable with the prescribed treatment, discuss those concerns with the healthcare professional who knows your child. Good eczema care should combine appropriate medical treatment with ongoing supportive skin care rather than forcing parents to choose between them. The two approaches can work alongside each other.

Could Stopping Treatment Too Early Be Part of the Problem?

Sometimes parents stop a prescribed steroid cream as soon as the skin looks slightly better because they are understandably concerned about using medication on a baby. If the inflammation has not been adequately controlled, however, symptoms may return quickly. The correct duration and strength depend on the location, severity, age of the child and treatment prescribed. This is why there is no universal number of days that an internet article should tell every parent to use a corticosteroid. Your child’s treatment instructions should come from the healthcare professional managing their eczema.

If eczema repeatedly rebounds very quickly after treatment stops, tell your doctor exactly what is happening. Explain how long you used the prescribed treatment, where it was applied, how quickly the skin improved and how soon the itching returned. That information can help the clinician determine whether the treatment plan needs adjustment or whether another factor is contributing. Do not simply keep restarting or extending medication indefinitely without guidance. Recurring symptoms deserve a treatment review rather than guesswork.

But Sometimes Treatment Was Used Correctly and the Eczema Still Returns

This is the part that can make parents feel as though they must have done something wrong. You may have followed the instructions perfectly, treated the flare until it settled and continued moisturising, yet the eczema still returned. That does not automatically mean the treatment was inappropriate. Eczema has a tendency to recur because the underlying predisposition remains. New combinations of triggers and environmental pressures can produce another flare even after the previous one was properly treated.

Think about what changed in the days before the itching returned. Perhaps the weather became hotter, your baby started sweating more, teething increased saliva around the face, or the child spent longer in warm clothing. Perhaps a new laundry product was introduced, bath time became longer, or scratching increased during sleep. None of these factors has to be the single cause of the eczema. Several small pressures can accumulate until vulnerable skin becomes inflamed again.

Heat and Sweat Can Restart the Cycle

Heat is one of the most commonly overlooked pressures around eczema-prone skin. Babies can become warm in car seats, prams, sleepwear, bedding and during prolonged cuddling or feeding. Sweat can then collect around the neck, behind the knees, inside elbow creases and beneath clothing. For already vulnerable skin, that combination of warmth, moisture and friction can make itching more intense. The baby scratches, the barrier becomes stressed again, and another flare can begin developing.

If eczema repeatedly returns after warm nights or hot days, read Could Heat and Sweat Be Making Your Baby’s Itching Worse? Signs Parents Often Miss. Look at the timing rather than assuming the steroid suddenly stopped working. If the medication successfully controlled the previous inflammation, a new environmental load may simply be helping create another flare. Keeping your baby comfortably cool and changing damp clothing can reduce one avoidable pressure. This is not a replacement for eczema treatment, but it can support the skin between flares.

Bath Time Can Quietly Work Against Recovering Skin

A long hot bath can feel soothing while your baby is in the water, but the skin may feel considerably different afterwards. Hot water, excessive cleanser, fragranced bath products and vigorous towel drying can all add unnecessary stress to eczema-prone skin. If those habits continue after a flare has settled, the recovering barrier may repeatedly face the same pressures. Parents may then see another flare and conclude that the medication only provided temporary relief. Sometimes the wider routine simply continued working against the skin.

Our guide Why Does My Baby Get Itchy After a Bath? 7 Bath-Time Mistakes Worth Checking explains how bath temperature, duration, cleansing and post-bath care can influence itching. A short lukewarm bath followed by gentle drying and prompt moisturising is generally more supportive of eczema-prone skin than prolonged hot bathing. Bath time does not need to become a medical procedure. It simply should not repeatedly strip or irritate skin that is trying to recover. Small routine changes can sometimes remove a surprisingly consistent source of pressure.

Laundry Products May Still Be Touching the Skin All Day

Think about how many hours your baby spends inside washed fabrics. Bodysuits, pyjamas, sheets, blankets, towels, bibs and clothing can remain against the skin almost continuously. If a laundry product contains fragrance or leaves something your child’s skin finds irritating, that exposure does not disappear because an eczema flare has been treated. The steroid may reduce inflammation while it is being used, but the environmental pressure can continue. Once treatment finishes, vulnerable skin may begin reacting again.

This is why we explored Is Laundry Detergent Making Your Baby Itch? How Clothes, Sheets and Residue Can Irritate Sensitive Skin. A mild fragrance-free laundry routine can be worth considering when persistent itching follows clothing or bedding contact. This does not mean detergent is responsible for every eczema recurrence. It simply demonstrates why treating the visible inflammation and investigating repeated exposures are different parts of eczema management. The cream treats the flare, while the environment may help determine how soon another flare develops.

Saliva Can Keep Facial Eczema Coming Back

The cheeks, mouth and chin are especially difficult areas during infancy because saliva can remain on them throughout the day. Teething and normal developmental drooling can increase this exposure considerably. Parents wipe the skin, the baby rubs the face, saliva returns, and the cycle repeats many times. If facial eczema was recently treated, this constant moisture and friction may continue placing pressure on the recovering barrier. The result can look like the same eczema returning immediately after treatment.

The answer is not to stop your baby drooling, which obviously is not realistic. Instead, reduce unnecessary rubbing and gently manage prolonged wetness around vulnerable areas. Keep the established skincare routine consistent and use prescribed eczema treatment when directed. If facial eczema repeatedly returns despite appropriate care, discuss the pattern with your healthcare professional. The face is sensitive, and medication strength and treatment decisions should be professionally guided.

The Same Patch Returning Can Be an Important Clue

Parents often notice that eczema returns to exactly the same locations. It might repeatedly appear behind one knee, around the wrists, in elbow creases or on one cheek. Those areas may have a weaker barrier, experience more friction or repeatedly encounter the same environmental pressure. Once the skin has been damaged there, it may also remain more vulnerable for some time. Recurrence in the same place can therefore provide useful clues about what that area experiences every day.

Look at clothing seams, elastic, sweat, saliva and repetitive movement around the location. Ask whether your baby rubs or scratches that particular area when tired. Notice whether it becomes warmer or damper than surrounding skin. These observations cannot diagnose eczema triggers on their own, but they can help identify patterns. Sometimes the location of the flare tells you where to start looking.

Why Moisture Alone May Not Prevent the Next Flare

Moisturising is an important foundation of eczema care, but parents can become discouraged when they moisturise diligently and the itching still returns. That can happen because eczema is not simply a shortage of moisture. Barrier dysfunction, inflammation, environmental irritants, scratching and microbial pressures can all be involved. A moisturiser can support hydration without controlling every one of those processes. Expecting it to do so places an impossible burden on one part of the routine.

We explored this problem in Moisturising Your Baby Again and Again but They’re Still Itchy? Here’s What Moisture Alone May Miss. If active inflammation returns, moisturiser should not automatically be used instead of prescribed treatment. At the same time, prescribed treatment does not eliminate the importance of ongoing barrier care. These approaches work alongside each other. The goal is not to find one magical product that replaces everything else.

What About Steroid Rebound?

The word “rebound” is used widely online, and this can make parents understandably anxious. Sometimes people use it simply to describe eczema returning after corticosteroid treatment stops, but recurrence of eczema does not automatically mean the skin has developed steroid withdrawal. Topical steroid withdrawal is a specific and complex issue that should not be self-diagnosed from ordinary recurrence of eczema symptoms. The fact that a child’s eczema flares again after treatment does not by itself establish that corticosteroids caused the flare. Parents deserve that distinction because frightening online stories can otherwise make necessary treatment decisions much harder.

If your baby develops unusual, severe or rapidly worsening symptoms after changes to corticosteroid treatment, speak with the prescribing clinician or a dermatologist. Do not abruptly change a treatment plan because a social media post resembles one part of your child’s experience. Likewise, do not dismiss genuine concerns if the pattern seems different from your baby’s usual eczema. Take photographs, record the treatment used and note when symptoms changed. Good clinical information is far more useful than trying to diagnose steroid withdrawal from pictures online.

Could Food Be Causing the Eczema to Return?

This question often appears once topical treatment has worked but the eczema keeps coming back. Food allergy can coexist with eczema, particularly in some children with more significant disease, but recurring eczema alone does not prove that a particular food is responsible. Removing milk, egg, wheat or multiple foods without appropriate assessment can create unnecessary nutritional restrictions. The relationship between food allergy and eczema deserves careful evaluation rather than assumption. A baby’s diet should not become the next uncontrolled experiment simply because a flare returned.

If a particular food repeatedly produces immediate hives, swelling, vomiting, breathing problems or another clear reaction, seek professional medical advice. Significant breathing difficulty or swelling involving the lips, tongue or throat requires urgent medical attention. For less obvious questions about food and eczema, discuss the pattern with your child’s doctor, dietitian or allergy specialist where appropriate. A food diary may sometimes help provide context, but it should not become a reason to progressively eliminate foods without guidance. Food questions deserve proper assessment rather than fear-driven restriction.

The Gut and Immune System Are Part of the Wider Picture

Skin does not operate independently from the rest of the body. The immune system is intimately involved in eczema, and researchers continue investigating the relationships between the gut microbiome, immune development, skin barrier and allergic disease. This does not mean every eczema flare can be fixed by treating the gut or buying a probiotic. It means the biology of eczema is broader than simply having dry skin on the surface. Parents should be cautious of anyone promising that one supplement or restrictive diet can permanently remove a complex condition.

This wider perspective is particularly useful when eczema keeps recurring despite a thoughtful topical routine. It encourages parents to consider the child as a whole without abandoning evidence-based treatment of the skin. Appropriate medical care, nutrition, barrier support and reducing meaningful environmental loads can coexist. There is no need to choose between understanding internal influences and treating the visible inflammation properly. Both can be part of a sensible, measured approach.

Think of Eczema as a Threshold Rather Than an On-Off Switch

One of the most useful ways to understand recurring baby eczema is to imagine a threshold. Your baby may cope with a certain amount of dryness, heat, sweat, friction, saliva and other everyday pressures without developing an obvious flare. As those pressures accumulate, the skin moves closer to the point where symptoms become visible. Eventually the combined load exceeds what the skin can comfortably tolerate, and itching and inflammation appear. Treatment can bring the inflammation back down, but the pressures that helped build the load may still remain.

This explains why the same routine can seem perfectly fine one week and suddenly become problematic the next. Perhaps the weather became hotter while teething increased drooling and poor sleep increased scratching. No single factor needed to cause the flare by itself. Together they may have pushed vulnerable skin beyond its threshold. Reducing several smaller pressures can therefore sometimes be more realistic than searching endlessly for one hidden trigger.

Do Not Turn Your Home Into an Eczema Investigation Laboratory

Once parents understand that many things can influence eczema, another problem can appear. Suddenly every food, detergent, fabric, bath product and room temperature becomes suspicious. Parents begin changing five things at once, and when the eczema improves nobody knows what helped. If it worsens, nobody knows what caused that either. This can make family life exhausting without producing much useful information.

Change obvious, low-risk environmental pressures systematically rather than trying to eliminate everything simultaneously. Keep the basic skincare routine consistent while observing patterns around heat, sweat, bathing, clothing and scratching. Record meaningful changes if the eczema is difficult to understand. Bring those observations to your healthcare professional when needed. The purpose of looking for patterns is to reduce confusion, not create more of it.

Repair: What Happens After the Inflammation Settles Matters

The first part of our Skin Trifecta framework is Repair. Once an eczema flare has settled, supporting the physical skin barrier remains important because eczema-prone skin can continue to be vulnerable. Repair means reducing unnecessary damage while helping the outer barrier retain moisture and function more effectively. It includes gentle bathing, regular supportive skincare and reducing repeated friction or environmental irritation. Repair is therefore something that continues between obvious flares rather than beginning only when the skin turns red.

This distinction can change how parents think about successful treatment. The steroid cream may have controlled the inflammatory fire, but the ground underneath still needs care. If the barrier becomes dry and repeatedly irritated again, another flare may develop. Supporting recovery after the visible redness disappears gives the skin a better environment. It does not guarantee eczema will never return, but it addresses one of the underlying vulnerabilities.

Nourish: Keep Supporting the Skin When It Looks Good

The second part is Nourish. Parents naturally become more attentive when the skin looks terrible and less attentive when it looks clear. Yet the quiet period between flares can be one of the most important times for consistent supportive care. Regular moisturising helps dry eczema-prone skin retain hydration and remain more comfortable. Nourish means giving the skin ongoing support rather than waiting for another crisis.

This is not about layering ten different products onto a baby. A simple routine that the skin tolerates and the family can maintain is usually more useful than constant product switching. Consistency also makes it easier to identify whether something else is changing the pattern. If the skincare remains stable while heat or laundry exposure changes, the relationship becomes easier to observe. Simplicity can be surprisingly powerful when eczema feels complicated.

Defend: Scratched Skin Needs Protection Without Harshness

The third part is Defend. When itching returns and scratching begins, tiny breaks can appear in the skin surface, making an already vulnerable barrier more exposed. Defend focuses on helping the skin defend against bacteria, fungus and other microbes while avoiding harsh stripping or unnecessary irritation. This does not mean trying to sterilise your baby’s skin. Healthy skin protection depends on maintaining the barrier, not attacking everything that lives on the surface.

If scratching creates broken, weeping, painful or crusted skin, however, ordinary skincare may no longer be enough. Infection can complicate eczema and may require medical treatment. Increasing redness, warmth, swelling, pus, crusting or a baby who appears unwell should be assessed by a healthcare professional. Defend therefore includes recognising when supportive skincare has reached its limits. Proper medical treatment and gentle skin support should work together when needed.

Why Repair, Nourish and Defend Need to Continue Between Flares

This is where the Skin Trifecta differs from simply reacting every time eczema becomes red. Repair supports the barrier, Nourish supports dry and stressed skin, and Defend helps the skin defend against bacteria, fungus and other microbes. These needs do not suddenly disappear because a flare looks better. In fact, the period after successful treatment may be exactly when consistent support matters most. The objective is to create a stronger everyday environment around vulnerable skin.

None of this means the Skin Trifecta replaces medical eczema treatment. If your doctor has prescribed a corticosteroid or another treatment for active eczema, use it according to their instructions. Repair, Nourish and Defend provide a framework for thinking about supportive everyday care around that treatment. This distinction is particularly important when discussing babies and young children. Parents should never feel pressured to choose between appropriate medicine and thoughtful barrier support.

Where Itch-A-Bye Baby Repair Cream Fits

Itch-A-Bye Baby Repair Cream was developed as supportive everyday skincare for babies and young children with Dry, Itchy and eczema-prone skin. It is made with all-natural ingredients and plant botanicals and is fragrance free and non-steroidal. Rather than positioning it as a replacement for prescribed eczema treatment, we position Itch-A-Bye around the Skin Trifecta of Repair, Nourish and Defend. Its role is to support vulnerable skin as part of a wider routine.

Repair focuses on supporting the physical skin barrier, Nourish supports dry and stressed skin, and Defend helps the skin defend against bacteria, fungus and other microbes. If active eczema requires prescribed anti-inflammatory treatment, Itch-A-Bye should not be used as an excuse to avoid that treatment. Instead, discuss with your healthcare professional how supportive skincare should fit around your baby’s medical eczema plan. You can learn more about the philosophy behind the formulation on our How It Works page. The aim is supportive daily care rather than promising a miracle cure.

When Should You Go Back to Your Doctor?

If your baby’s eczema returns very quickly every time prescribed treatment stops, that is useful information for your healthcare professional. Tell them exactly how often this happens, which areas return first, how intense the itching becomes and whether sleep is being affected. Also explain how the medication was used and whether moisturising continued between flares. Photographs taken before, during and after treatment can sometimes make the pattern much easier to demonstrate. Recurrence should lead to a constructive review rather than repeated guessing at home.

Seek medical attention sooner if the skin becomes painful, swollen, weeping, crusted, blistered or rapidly worse, or if your baby appears unwell. Severe widespread symptoms, suspected infection or unusual changes should not be managed simply by repeatedly applying different over-the-counter creams. If you are concerned about the safety or frequency of prescribed steroid use, raise those concerns directly with your doctor or dermatologist. They can review the potency, location, duration and overall eczema management plan. Parents deserve clear instructions rather than fear or confusion around medication.

Do Not Measure Success Only by How Quickly the Redness Disappears

A dramatic improvement in redness is encouraging, but it is only one part of eczema management. Pay attention to whether your baby is sleeping more comfortably, scratching less and tolerating normal clothing and bathing without becoming irritated. Notice whether the skin remains soft and comfortable between flares rather than waiting for the next obvious red patch. Those everyday signs can tell you whether the wider routine is supporting the child. Clear-looking skin that remains intensely itchy still deserves attention.

This broader definition of success can also reduce the temptation to continually chase cosmetic perfection. Baby eczema often moves through better and worse periods. The goal is not to guarantee that your child never develops another red patch. It is to control active disease appropriately, reduce avoidable pressures and support the skin so flares become more manageable. That is a much more realistic framework for families living with recurring eczema.

The Bigger Question Is Why the Skin Keeps Reaching Its Threshold

This is the central idea behind our book Beyond the Skin Barrier. Persistent eczema becomes easier to understand when we stop viewing every flare as an isolated failure of the last cream that was used. The book explores the relationship between the developing skin barrier, immune signalling, the gut-skin axis and microbiome, food sensitivities and allergies, environmental pressures and other influences that may affect eczema-prone babies. It does not argue that every child needs an extensive investigation or that prescribed treatment should be abandoned. Instead, it provides a wider framework for understanding recurring symptoms.

The threshold model helps parents ask a more useful question: what combination of pressures keeps pushing my baby’s skin back towards another flare? For one child, heat and scratching may dominate, while another may struggle more with saliva, dryness or environmental irritation. Some children require additional medical or allergy assessment, while others improve significantly when a few obvious daily pressures are reduced. Understanding that individuality helps explain why another family’s miracle solution may do very little for your baby. The goal is to understand the pattern rather than continually chase somebody else’s answer.

Steroid Cream Working and Eczema Returning Are Not Contradictions

This may be the most useful concept to take from the entire discussion. A prescribed steroid cream can successfully reduce an eczema flare, and your baby can still develop eczema again later. Those two facts do not contradict each other. Treatment addresses active inflammation, while the underlying tendency towards eczema and the pressures surrounding vulnerable skin can continue. Recurrence therefore does not automatically mean the medication damaged the skin or that everything you did was wasted.

What happens between flares matters. Continue the supportive routine recommended for your child, reduce obvious environmental pressures and watch for early signs that itching is returning. Use prescribed medication according to professional instructions rather than internet anecdotes or guesswork. If the pattern is frequent or difficult to control, return to your healthcare professional and review the management plan. Eczema care should become clearer with good information, not more frightening.

Look Beyond the Moment the Steroid Cream Stops

If your baby’s eczema improved with steroid cream and then the itching returned, do not focus only on the day the medication ended. Look at what the skin experienced before, during and after that point. Was the barrier still dry, was your baby overheating, did scratching restart at night, or were saliva, bathing, clothing or laundry exposures continuing to irritate the same areas? Sometimes several small pressures have quietly rebuilt while everyone was watching the redness disappear. Understanding those pressures can help you support the skin more effectively between medically treated flares.

For everyday topical support, you can explore Itch-A-Bye Baby Repair Cream here and learn more about our Repair, Nourish and Defend approach here. For a deeper explanation of why recurring baby eczema may involve more than what appears on the surface, you can read Beyond the Skin Barrier free here or explore the printed paperback edition here. These resources are designed to complement appropriate professional care, not replace it. The more you understand the pattern behind recurring itching, the easier it becomes to separate treating the flare from supporting the skin that remains after the flare has gone.

This article is educational and informational and is not medical advice. Do not start, stop, reduce or extend prescribed corticosteroid treatment based on this article. Seek guidance from a qualified healthcare professional for your child’s individual eczema treatment, suspected infection, allergies, dietary changes or persistent symptoms.