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Summary   Background  The Patient‐Oriented Eczema Measure ( POEM ), scored 0–28, is the core outcome instrument recommended for measuring patient‐reported atopic eczema symptoms in clinical trials. To date, two published studies have broadly concurred that the minimally important change ( MIC ) of the  POEM  is three points. Further assessment of the  MIC  of  POEM  in different populations, and using a variety of methods, will improve interpretability of the  POEM  in research and clinical practice.    Objectives  To calculate the smallest detectable change in the  POEM  and estimate the  MIC  of the  POEM  using a variety of methods in a trial dataset of children with moderate‐to‐severe atopic eczema.    Methods  This study used distribution‐based and anchor‐based methods to calculate the  MIC  of the  POEM  in children with moderate‐to‐severe eczema.    Results  Data were collected from 300 children. The smallest detectable change was 2·13. The  MIC  estimates were 1·07 (using 0·2  SD  of baseline  POEM  scores) and 2·68 (using 0·5  SD  of baseline  POEM  scores) based on distribution‐based methods; were 3·09–6·13 based on patient‐/parent‐reported anchor‐based methods; and were 3·23–5·38 based on investigator‐reported anchor‐based methods.    Conclusions  We recommend the following thresholds be used to interpret changes in  POEM  scores: ≤ 2, unlikely to be a change beyond measurement error; 2·1–2·9, a small change detected that is likely to be beyond measurement error but may not be clinically important; 3–3·9, probably a clinically important change; ≥ 4, very likely to be a clinically important change.

How should minimally important change scores for the Patient‐Oriented Eczema Measure be interpreted? A validation using varied methods