Evaluation of sleep quality, social-emotional development, and parental stress levels of children with atopic dermatitis

Abstract

Atopic dermatitis (AD) is a common inflammatory skin disease in early childhood that may affect sleep and emotional well-being. This study aimed to assess sleep quality, parental stress, and social-emotional development in infants and toddlers with AD compared to healthy controls. In this case-control study, 109 children aged 3 months to 2 years with AD and 65 age- and sex-matched healthy controls were assessed using validated parent-report questionnaires: the Expanded Brief Infant Sleep Questionnaire(BISQ), the Parenting Stress Index-Short Form(PSI-SF), and the Ages & Stages Questionnaire-Social Emotional(ASQ: SE). Children with AD showed significantly poorer sleep quality(p = 0.006), increased night awakenings(p = 0.013), and shorter sleep durations(p = 0.010) than controls. Mothers of children with AD reported significantly higher stress levels(p < 0.001). Social-emotional developmental delays were more common among children with AD(p = 0.037) and were especially prevalent in those with poor sleep(p = 0.002). Multivariate logistic regression analysis revealed that a diagnosis of AD(OR = 2.12, 95% CI: 1.05-4.29, p = 0.035) and lower paternal education(OR = 4.60, 95% CI: 1.01-20.77, p = 0.047) were independently associated with poor sleep. Among children with AD, poor sleep was associated with a more than 13-fold increased risk of socio-emotional delay(OR: 13.23, 95% CI: 1.69-103.45, p = 0.014).

Conclusion: Infants and toddlers with AD are at elevated risk for poor sleep, parental stress, and social-emotional challenges. These findings highlight the need for early multidisciplinary interventions targeting both dermatological and developmental aspects of AD.

Trial registration: Not applicable.

What is known: • Children with atopic dermatitis (AD) often experience impaired sleep and increased parental stress; however, evidence on how these factors affect early social-emotional development in infants and toddlers remains limited.

What is new: • Infants and toddlers with AD and poor sleep were found to be more than 13 times more likely to have social-emotional delays, highlighting the need for early recognition and integrated interventions in this vulnerable population.

Keywords: Atopic dermatitis; Parental stress; Sleep disturbances; Social-emotional development.