Safe Use of Topical Medications and Creams in Children: A Practical Guide for Parents

When your child has a rash, eczema flare-up, or teething pain, it’s natural to reach for a cream or ointment to help. But what seems like a simple fix can turn dangerous if you don’t know the risks. Topical medications-creams, gels, and lotions applied to the skin-are often seen as harmless, especially compared to pills. But for kids, especially babies under 1 year, these products can be far more powerful-and far more risky-than most parents realize.

Why Children’s Skin Is Different

Children’s skin isn’t just smaller skin. It’s fundamentally different. Babies have thinner outer layers, less fat underneath, and skin that absorbs things more easily. A child’s surface-area-to-body-weight ratio is 3 to 5 times higher than an adult’s. That means a small amount of cream applied to their skin can enter their bloodstream in amounts that would be harmless on an adult. For infants under 12 months, this absorption can be even higher-up to 10 times more than in older kids, especially if the skin is cracked, inflamed, or wet.

This isn’t theoretical. It’s why a dab of lidocaine gel meant for a small area can cause seizures. Why a thin layer of hydrocortisone cream used daily for weeks can shut down a child’s stress response system. And why a teething gel containing benzocaine can drop oxygen levels dangerously low in minutes.

Top 3 Dangerous Ingredients to Avoid in Kids

• Benzocaine: Found in teething gels, sore throat sprays, and some numbing creams. The FDA banned its use in children under 2 years in 2018 after over 400 documented cases of methemoglobinemia-a condition where blood can’t carry oxygen properly. Symptoms? Blue lips, drowsiness, trouble breathing. In severe cases, it can be fatal.
• High-potency corticosteroids: Creams like clobetasol (class I) or betamethasone (class II) are powerful. Used even once on a baby’s face or diaper area, they can suppress the HPA axis, the body’s natural hormone system. This can lead to slow growth, high blood pressure, or even adrenal crisis. The AAP says these should never be used on children under 2 without direct medical supervision.
• Lidocaine (over 4%) and dibucaine: While low-dose lidocaine (1-4%) is sometimes used for minor procedures under medical guidance, anything stronger or used too often can cause toxicity. Over 10 deaths in children were linked to ingestion of these products before child-resistant packaging became mandatory in 1994. Even now, accidental overdoses happen when parents apply too much or use it too frequently.

What’s Safe? Alternatives That Actually Work

Just because some products are dangerous doesn’t mean you can’t treat your child’s skin. There are safer options.

• Low-potency hydrocortisone (0.5%-1%): This is the only steroid generally considered safe for short-term use in infants over 3 months. Use it only on small areas, for no more than 5-7 days, and never on the face unless directed by a doctor.
• Calcineurin inhibitors (tacrolimus 0.03%, pimecrolimus): These are non-steroid creams approved for children as young as 3 months. They’re especially useful for eczema on the face and neck, where steroids carry higher risks. Studies show they have 72% less systemic absorption than even low-dose steroids. While they carry a black box warning about cancer risk, 15 years of real-world use have shown no confirmed cases linked to the medication.
• Non-pharmacological options: For teething, chilled (not frozen) silicone teethers work better than any gel. For diaper rash, frequent changes and zinc oxide paste are more effective-and safer-than medicated powders or sprays. For dry skin, fragrance-free moisturizers like CeraVe or Eucerin are often enough.

Dosing Matters More Than You Think

Parents often use a “pea-sized” amount. That’s not precise enough. The standard unit doctors use is the fingertip unit (FTU).

One FTU is the amount of cream squeezed from a standard tube that covers the distance from the tip of your index finger to the first crease. One FTU covers an area about the size of two adult palms. For a 10kg child, the maximum daily dose of a low-potency steroid is 2g total-roughly 4 FTUs. Apply more than that, and you’re increasing absorption risk dramatically.

And never use occlusion-wrapping the area in plastic wrap, Tegaderm, or tight clothing-unless a doctor specifically says to. Occlusion can boost absorption by 300-500%. For a baby with eczema, whose skin is already more permeable, this can push a safe dose into the toxic range.

Storage and Prevention: The Simple Things That Save Lives

Most poisonings happen not because of misuse, but because the product was left out.

• Always return topical medications to their child-resistant container immediately after use.
• Store them out of reach-even if you think your child can’t open them. 78% of exposures happen because the product was left on the counter, bedside table, or bathroom sink after application.
• Never share prescriptions. Grandparents or babysitters may use leftover cream from another child. That’s how a 6-month-old ends up with a steroid overdose.
• Check expiration dates. Old creams can break down and become more irritating or even toxic.

What to Do If Something Goes Wrong

If your child shows any of these signs after using a topical product:

• Blue or gray skin, especially around lips or fingernails
• Unusual drowsiness or difficulty waking up
• Fast or shallow breathing
• Seizures or uncontrolled movements

Call Poison Control immediately (1-800-222-1222 in the U.S.) or go to the nearest emergency room. For benzocaine toxicity, methylene blue is the antidote-but it must be given quickly. Don’t wait to see if it gets better.

The Bigger Picture: Why This Keeps Happening

Despite clear guidelines, unsafe products are still easy to find. In the U.S., 45% of topical corticosteroids are sold over-the-counter without prescriptions. In India, it’s 78%. Many OTC labels still don’t list age restrictions. A 2021 study found only 37% of topical pain relievers included any pediatric dosing instructions.

And the market is growing. The pediatric topical medication industry is projected to hit $18.7 billion by 2027. But safety innovations lag. Only 18.3% of new products launched in 2024 include child-safe packaging or clear pediatric warnings-down from 22% in 2020.

Until regulations catch up, parents have to be the first line of defense. Know what’s in the product. Know how much to use. Know where to store it. And know when to call a doctor instead of reaching for the medicine cabinet.