Randomised Controlled Feasibility Trial of an Intervention to Reduce Infant Bathing

Abstract

Background Bathing, even in tap water, alters skin physiology. Frequent infant bathing may increase the risk of eczema developing. Objectives To undertake a randomized controlled feasibility trial of an intervention to reduce infant bathing frequency and intensity. Methods In total, 105 pregnant women (aged ≥ 16 years) with a family history of atopy and carrying a healthy singleton fetus (54 male, 51 female) were randomized in a 1 : 1 ratio during pregnancy or postnatally prior to their infant’s first bath. Caregivers in the intervention group were asked to reduce how often they bathed their infants (no more than once a week for the first 6 months of age) and to reduce the intensity of the bathing (keeping baths short, ensuring the water was not too hot and washing in ‘plain’ water being usually sufficient). The control group received the routine postnatal infant care advice offered by their maternity unit. The primary feasibility outcome was the proportion of eligible families willing to be randomized to the intervention. The secondary clinical outcome was a blinded assessment of infant eczema at 6 months of age, using an adaptation of the UK Working Party Diagnostic Criteria for Atopic Dermatitis. The trial was registered with the ISRCTN Registry on 24 July 2023 (ISRCTN51491794). Results Altogether, 261 pregnant women were screened, of whom 21 were ineligible. Of the 240 women included, 105 (43.8%) were randomized to the intervention (n = 52) and control (n = 53) groups. Adherence to the intervention was high, with 80% (n = 35/44) of caregivers in the intervention arm bathing their infant once a week or less compared with 29% (n = 14/49) in the control group. In the intervention group, 95% (n = 38/40) of caregivers agreed or strongly agreed that the intervention was acceptable. There was minimal contamination of the control group as a result of awareness of the trial’s purpose and accessing the intervention (n = 1/46). Follow-up was high, with 88.6% (n = 93/105) of families completing the final 6-month questionnaire and 81.9% (n = 86/105) attending the final visit. Eczema outcomes occurred less frequently in the intervention arm compared with the control arm, respectively: visible eczema 16% (n = 6/38) vs. 29% (n = 14/48); parent-reported eczema 9% (n = 4/44) vs. 12% (n = 6/49); and doctor-diagnosed parent-reported eczema 9% (n = 3/44) vs. 10% (n = 5/49). No noteworthy adverse effects of the intervention were reported. Conclusions These findings support the feasibility of randomizing infants during pregnancy to a reduced frequency and intensity bathing intervention for eczema prevention.