PURPOSE OF THE STUDY.
This study investigated the relationship between infant eczema, infant sleeping problems, and the risk of mental health problems at 10 years of age.
Included were newborns (N = 1578) recruited as a birth cohort between 1997 and 1999 from 4 German maternity hospitals.
Participants were followed regularly from birth until 10 years of age. Parental questionnaires were used to gather information regarding physician-diagnosed eczema, parent-reported sleeping problems secondary to pruritus, and known environmental risk factors for atopy. Mental health at 10 years of age was measured by using the validated German Strengths and Difficulties Questionnaire to determine possible/probable versus unlikely mental health problems. Multivariate logistic regression analyses adjusted for environmental and lifestyle factors (exclusive breastfeeding, single parents, and day care attendance), allergic comorbidity, and family history of eczema. Participants with infant eczema with sleep problems or sleep problems caused by pruritus were compared to children with no reported sleep problems and no eczema (reference group).
Of the 1578 participants eligible for analysis at the age of 10 years, 266 had infant eczema (first 2 years of life), 92 had parent-reported sleep problems caused by pruritus, 54 had infant eczema with sleep problems, 385 had ever been diagnosed with eczema, and 1162 never had eczema or sleeping problems (reference group). Children with eczema and/or sleeping problems did not differ significantly in regards to gender, study site, or breastfeeding status compared with those in the reference group. When adjusted for environmental exposures, demographic confounders, and comorbid atopic airway disease, children with infant eczema were at increased risk of hyperactivity/inattention at 10 years of age (odds ratio [OR]: 1.78 [95% confidence interval (95% CI): 1.02–3.09]). Infant eczema with concurrent sleeping problems was related to emotional problems (OR: 2.63 [95% CI: 1.20–5.76]) and conduct problems (OR: 3.03 [95% CI: 1.01–9.12]) at 10 years of age. Participants who had sleep problems but did not have eczema had statistically significant increased rates of hyperactivity/inattentiveness (OR: 3.09 [95% CI: 1.00–9.55]).
Infant eczema, if associated with concurrent sleeping problems caused by pruritus, seems to be a risk factor for the development of certain mental health problems.
The impact of infant eczema and sleep on future mental health problems had not previously been studied in a prospective design. These results are consistent with those from previous cross-sectional and retrospective studies in which infant eczema and mental health problems were linked, and the results are also in concordance with those of previous studies that revealed early childhood sleep problems as a predictor of future anxiety, conduct, and hyperactivity problems. The mechanisms that connected eczema with mental health problems are currently unknown. The authors make an intriguing suggestion that sustained pro-inflammatory cytokine exposure might have an effect on brain development; however, other biopsychosocial possibilities should be examined, including socioeconomic factors and stigmatization by peer groups for children with eczema that could explain the associations revealed in this study.
- Copyright © 2011 by the American Academy of Pediatrics