| Course | NUR 636 Primary Care of Infants, Children and Adolescents |
|---|---|
| Module | Module 6 |
| Paper type | SOAP note for infant eczema and early peanut introduction |
| Length | About 1,120 words, 7 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 636 Module 6
SOAP Note: Severe Eczema and Early Peanut Introduction in a Four-Month-Old Infant
[Student Name]
Southern New Hampshire University
NUR 636: Primary Care of Infants, Children and Adolescents
Module Six SOAP Note
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
SOAP Note: Severe Eczema and Early Peanut Introduction in a Four-Month-Old Infant
For years, parents of infants at risk for food allergy were told to delay allergenic foods, and many still follow that advice from relatives and older books. Research has since reversed it for peanut: in high-risk infants, early introduction lowers the chance of allergy, while delay may raise it. Infants with severe eczema are at the highest risk, which makes the eczema visit an important moment for allergy prevention as well as skin care. This SOAP note documents a four-month-old with severe eczema whose parents plan to avoid peanut. It argues that treating the skin well and arranging evaluation for early peanut introduction, as current guidelines recommend, gives her the best chance of avoiding a lifelong allergy.
Subjective
Chief concern, from the parents: "Her eczema is getting worse, and we want to know how to keep her from getting a peanut allergy like her cousin."
History of present illness: Ava is a four-month-old girl with dry, red patches that began on her cheeks at six weeks and have spread over the past month to her chest, back, arms and the backs of her knees. She scratches by rubbing her face on the sheets and her sleep is broken by two or three wakings each night. Her parents apply a fragranced lotion once a day and bathe her three times a week with a scented baby wash. There has been no oozing, crusting or fever. She is exclusively breastfed and has not started solid foods. Her mother has avoided nothing in her own diet. Her parents plan to wait until age three to give peanut because her cousin had an anaphylactic reaction to peanut at age two.
Past history: term birth, normal growth, immunizations up to date. No wheezing. Family history: mother had eczema as a child; father has hay fever; cousin with peanut allergy. Medications: none. Allergies: none known.
Objective
Weight 6.4 kg (45th percentile), length 63 cm (50th percentile). Temperature 36.8 degrees Celsius. Skin: ill-defined erythematous, dry, scaly plaques with excoriations on both cheeks, the chest, the upper back, both upper arms and both antecubital and popliteal fossae, covering an estimated 35% of body surface area. Moderate lichenification on the cheeks. No weeping, honey-colored crusting, vesicles or punched-out erosions to suggest infection. The diaper area is spared. The rest of the examination is normal. Using a standard severity scale, her eczema is rated severe, based on extent, intensity and the sleep disturbance reported.
Assessment
1. Atopic dermatitis, severe, with sleep disturbance and no sign of secondary infection. Contributing factors are infrequent moisturizing and fragranced products.
2. High risk for peanut allergy because of severe eczema, with a family history of atopy. In the LEAP trial, 640 infants aged 4 to 11 months with severe eczema, egg allergy or both were randomized to eat peanut regularly or avoid it until age five. Among infants who had a negative skin prick test at entry, peanut allergy at age five developed in 13.7% of the avoidance group and 1.9% of the consumption group; among those with a small positive skin test, the figures were 35.3% and 10.6% (Du Toit et al., 2015). The 2017 NIAID addendum guidelines translate these findings: for infants with severe eczema, egg allergy or both, clinicians should strongly consider peanut-specific IgE testing or skin prick testing and, if appropriate, introduce peanut-containing foods as early as four to six months; for infants with mild to moderate eczema, peanut should be introduced around six months without prior testing (Togias et al., 2017). Ava falls in the highest-risk group.
Plan
Skin care: bathe daily in lukewarm water for five to ten minutes with a fragrance-free cleanser, pat dry and within three minutes apply a thick fragrance-free ointment or cream to the whole body, repeating at least once more each day. Stop scented lotions and washes. For red, itchy patches, apply hydrocortisone 2.5% ointment twice daily to the body and face for up to two weeks, then only as needed for flares; the American Academy of Dermatology guidelines support moisturizers as the foundation of care and topical corticosteroids as first-line treatment for flares (Eichenfield et al., 2014). Keep nails short and dress her in soft cotton. Allergy prevention: referral to pediatric allergy this month for peanut skin prick testing or specific IgE and, depending on the results, a supervised first peanut feeding in the office or instructions for introduction at home. Continue breastfeeding and begin other solid foods when she shows readiness around four to six months. Follow-up in two weeks to assess the skin.
Education
The parents were told that eczema itself does not cause food allergy but that babies with severe eczema are more likely to develop food allergies, and that the old advice to delay peanut has been overturned by strong evidence. They were told that delaying until age three could make an allergy more likely, not less, and that the allergist will decide whether testing is needed first. They were shown how to apply ointment generously and how much steroid to use, using the fingertip unit, and reassured that low-potency steroids used as directed are safe for infants. They were given a written plan and asked not to give peanut at home until after the allergy visit.
Differential and Safety Considerations
Other causes of an itchy rash in a young infant were considered. Seborrheic dermatitis favors the scalp, face creases and diaper area with greasy yellow scale and little itch, and her diaper sparing and intense scratching point away from it. Scabies would show burrows, involve the palms, soles or axillae and usually affect other household members, none of which applied. Contact dermatitis from the scented wash may be adding to the picture, which is one reason to stop fragranced products. Rare immune deficiencies can present with severe eczema, but her normal growth and lack of recurrent infections make them unlikely at this stage.
The family was told which signs need a same-day visit: weeping, yellow crusting, clusters of small blisters or punched-out sores, fever or a baby who seems unwell, because infected eczema, including eczema herpeticum, can progress quickly in infants. They were also taught to recognize an allergic reaction to any new food, such as hives, vomiting, swelling or breathing trouble, even though peanut itself will wait for the allergist.
Conclusion
Ava has severe eczema and is at high risk for peanut allergy. A consistent skin care routine with a low-potency steroid for flares should improve her comfort and sleep, and a timely allergy evaluation, as the NIAID addendum guidelines recommend for infants like her, can open the window for early peanut introduction that the LEAP trial showed so powerfully reduces allergy.
References
Du Toit, G., Roberts, G., Sayre, P. H., Bahnson, H. T., Radulovic, S., Santos, A. F., Brough, H. A., Phippard, D., Basting, M., Feeney, M., Turcanu, V., Sever, M. L., Gomez Lorenzo, M., Plaut, M., & Lack, G. (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803-813. https://doi.org/10.1056/NEJMoa1414850
Eichenfield, L. F., Tom, W. L., Berger, T. G., Krol, A., Paller, A. S., Schwarzenberger, K., Bergman, J. N., Chamlin, S. L., Cohen, D. E., Cooper, K. D., Cordoro, K. M., Davis, D. M., Feldman, S. R., Hanifin, J. M., Margolis, D. J., Silverman, R. A., Simpson, E. L., Williams, H. C., Elmets, C. A., . . . Sidbury, R. (2014). Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. Journal of the American Academy of Dermatology, 71(1), 116-132. https://doi.org/10.1016/j.jaad.2014.03.023
Togias, A., Cooper, S. F., Acebal, M. L., Assa'ad, A., Baker, J. R., Beck, L. A., Block, J., Byrd-Bredbenner, C., Chan, E. S., Eichenfield, L. F., Fleischer, D. M., Fuchs, G. J., Furuta, G. T., Greenhawt, M. J., Gupta, R. S., Habich, M., Jones, S. M., Keaton, K., Muraro, A., . . . Boyce, J. A. (2017). Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Journal of Allergy and Clinical Immunology, 139(1), 29-44. https://doi.org/10.1016/j.jaci.2016.10.010
What the NUR 636 Module 6 instructions ask for
In NUR 636, SOAP notes on skin or allergy concerns usually ask for an infant or child's history from the parents, a focused examination with severity rating, an assessment that includes risk for related conditions and a plan with treatment, prevention and family education. This version tests whether you know current allergy prevention guidance, which has reversed older advice. Expect three to five pages in APA 7. Rate severity with specific findings such as body surface area, give concrete skin care steps and steroid limits, apply the risk-stratified peanut guidance to the infant's category and address the family's beliefs directly, since graders check that the plan reflects current evidence rather than outdated avoidance.
How this NUR 636 Module 6 soap note example is built
This note documents a composite four-month-old with eczema covering about 35% of her body, rated severe, whose parents plan to avoid peanut until age three because a cousin is allergic. The history covers spread, sleep, fragranced products and family atopy. The assessment reports the LEAP trial's results by skin test group, from 13.7% versus 1.9% to 35.3% versus 10.6%, and applies the Togias NIAID addendum guidelines to place her in the highest-risk category. The plan combines daily bathing and ointment, hydrocortisone 2.5% with limits supported by the Eichenfield guideline and an allergy referral before introduction, and education corrects the delay myth. A differential section rules out seborrheic dermatitis and scabies.
Where the NUR 636 Module 6 rubric puts the points
Grading of this NUR 636 note usually covers the history, a severity assessment grounded in examination findings, correct application of current guidelines, a practical treatment plan with limits on steroid use, prevention counseling, family education and APA 7 support. Top-band notes quantify eczema severity, report trial results precisely and match the peanut recommendation to the correct risk category. Graders reward plans that address family misconceptions respectfully and explain why older advice changed. Clear instructions, such as the fingertip unit and the timing of moisturizer after bathing, show that the plan can actually be followed at home. Safety-net advice on infected eczema is often a separate line item.
NUR 636 Module 6 help: the mistakes that cost points
Eczema and allergy notes lose points when severity is described without body surface area or impact, when parents are told to delay allergenic foods, when peanut guidance is applied without regard to risk category or when steroid instructions lack potency, frequency and duration. A common gap is skipping the family's beliefs, so the plan is quietly ignored at home. Quantify severity, give specific skin care steps, state steroid limits, apply the NIAID risk categories, arrange evaluation when indicated and address misconceptions with evidence. If your case involves cow's milk protein allergy, egg allergy or infant reflux, share the details and your NUR 636 template, and the note will follow the guidance for that condition. Include the safety net too.
Get NUR 636 Module 6 written to your instructions
Send the NUR 636 case, your SOAP template and the rubric. The note you receive will rate severity with specific findings, give a practical treatment plan with limits, apply current allergy prevention guidance by risk category and address the family's beliefs, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 636 Module 6 questions, answered
Where can I find a free NUR 636 Module 6 SOAP Note sample?
The full note is on this page: severe eczema in a four-month-old with a skin care plan, the LEAP trial results and early peanut introduction under the NIAID addendum guidelines.
Should babies with eczema avoid peanut?
No. For infants with severe eczema, guidelines recommend evaluation and, if appropriate, introducing peanut as early as four to six months, because early introduction lowers allergy risk.
What did the LEAP trial show?
In high-risk infants, regular peanut consumption from infancy reduced peanut allergy at age five, for example from 13.7% to 1.9% among infants with a negative skin test at entry.
Do infants with mild eczema need allergy testing before peanut?
The NIAID addendum guidelines recommend introducing peanut around six months without prior testing for infants with mild to moderate eczema.
How should infant eczema be treated at home?
Daily lukewarm baths, fragrance-free products, generous moisturizer applied soon after bathing and a low-potency topical steroid for flares, used for limited periods as directed.