P3.L239: Sleep Problems and Allergic Skin Conditions in Infants and Toddlers

Background: Infant and toddler sleep can be disrupted by physiological and environmental factors. Skin conditions, especially atopic dermatitis (AD), have been associated with sleep difficulties. However, less is known about the specific elements of AD and other skin conditions that may be associated with disrupted sleep, especially in infants and toddlers.

Methods: Mothers of 300 infants (0-11.9 mos, M=5.87) completed an online questionnaire about infant sleep and allergic disease (including atopic dermatitis, itchy, dry, and sensitive skin, food allergies) at baseline, approximately 4 months later at first follow-up (FU1), and approximately 8 months after baseline at second follow-up (FU2). Prevalence of allergic skin conditions was compared in the context of presence or absence of parent-reported child sleep problems, using chi-square, at each follow-up assessment.

Results: Parents reported that 29.3% of infants had a sleep problem at baseline, 29.6% at FU1, and 23.5% at FU2. At baseline, 29.0% of the infants were reported to have AD, itchy, dry, or flaky skin. Having AD, itchy, dry, or flaky skin was associated with having a sleep problem (38.6% vs. 25.0%, chi square = 5.62; p=018).

At FU1, 16.3% were currently reported to have AD, 5.4% itchy skin, 12.9% dry or flaky skin, and 14.2% sensitive skin. Of note, 90% of those who reported their child had itchy skin did not report AD. At FU1, infants and toddlers with a sleep problem were more likely to have itchy skin than those without (11.3% vs. 3.0%, chi-square = 6.74; p = .009).

At FU2, 17.3% were reported to have AD at the time of assessment, 4.4% itchy skin, 8.0% dry or flaky skin, and 16.4% sensitive skin. Similar to FU1, 87% of those who reported itchy skin did not report having AD. At FU2, infants and toddlers with a sleep problem were more likely to have itchy skin than those without (11.3% vs. 2.3%, chi-square = 7.79; p = .005). No other differences in reported sleep problems were found across skin (i.e., AD, dry or flaky skin, sensitive skin) at FU1 or FU2.

Conclusion: Overall, higher parent-reported child sleep problem rates were associated with the report of itchy skin, but not with report of atopic dermatitis, dry and/or flaky skin, or sensitive skin. Further, a large proportion of mothers who reported that their infant or toddler had itchy skin did not also report having atopic dermatitis. Notably, pediatricians are encouraged to assess for itchy skin and its associated sleep problems, even if a child does not meet criteria for atopic dermatitis.