Mothers of children with atopic dermatitis (AD) report trouble getting a full night of restful sleep, according to new research findings. Parents of children with chronic health conditions generally face numerous demands and stressors. Caregiving can impact family life economically, socially, and cause stress and anxiety in part based on caregiver exhaustion. A limited number of studies have looked at sleep patterns among parents of children with common chronic illnesses.
Atopic dermatitis’ impact on mothers
A longitudinal study of mothers and children in Avon, England analyzed sleep and exhaustion levels in mothers who have children with AD. The study there followed all pregnant women living in Avon, expected to give birth between April 1, 1991, and December 31, 1992. Data collection began in 1990, and analysis was performed through September of 2018. Researchers from the University of California, San Francisco followed 11,649 mother and child pairs over time, from birth to 11 years old.
What is atopic dermatitis?
A common chronic childhood skin condition, AD is a type of eczema denoted by dry itchy skin, often with red or scaly patches. It affects 20% of children, with nearly 90% of all cases of AD diagnosed before age 5.
Eczema and sleep deprivation
Itching and scratching at night commonly contribute to significant sleep problems in all those who have AD. Excessive itchiness and the need to scratch can cause repeated waking throughout the night. The repeated waking and loss of sleep of children living with AD led researchers to investigate the impact of this cycle on caregivers, particularly mothers. They sought to answer the questions: Do mothers of children with atopic dermatitis experience sleep disturbances, and to what extent are these explained by child sleep disturbances?
What was the research looking for?
AD symptoms can flare up at different times. Assessing the impact on maternal sleep over time offered researchers more accurate information and insight into how a child’s disease activity affects the sleep quality of their caregivers.
Research participants agreed to participate in the study before giving birth and no identifying information was shared with the investigators. Questionnaires were sent out 10 times between the ages of 6 months to 11 years old. The initial query was: Has your child had an itchy, dry skin rash in the joints and creases of his body (eg, behind the knees, elbows, under the arms) in the past year?
The remainder of the questions sought to classify the severity of the AD reported by the parent, followed by the measurement of 5 maternal sleep outcomes. Each question had multiple choice answers to select.
Sleep outcome questions:
How many hours of sleep do you get altogether now during an average night?
Can you go to sleep alright?
Do you wake unusually early in the morning even when you haven’t been woken by your child or family?
Do you feel that you are getting enough sleep?
In the past month, how often have you felt exhausted?
Findings supported the hypothesis that mothers of children with active AD had more difficulty falling asleep, measurably insufficient sleep and reported increased daytime exhaustion compared to mothers of children without AD. These results were generally consistent across the varying ages of the child, but maternal sleep disturbances were correlated to the disease severity of the child. Interestingly, maternal sleep disturbances were not necessarily related to the incidence of their child’s sleep disturbances. Other factors were clearly involved.
Sleep deprivation in caregivers
General studies on families with sick children have found that caregivers are chronically sleep-deprived, exhausted, or experience anxiety or depression. This may make them less able to carry out the sometimes time-consuming or complex treatment regimens required to care for their child.
The Avon study found:
5% to 12% reported sleeping less than 6 hours per night
18% to 20% reported early morning awakenings
12% to 13% reported difficulty falling asleep
38% to 43% reported subjectively insufficient sleep
6% to 10% reported daytime exhaustion
Risks for caregivers
In general, parents of children with chronic illnesses are at risk for poor sleep. Impaired sleep, of lesser duration or quality, has been associated with the onset of multiple health conditions; putting parents at increased risk of developing obesity, cardiovascular conditions, and cancer among other medical risks.
As the sleep experiences of the child did not fully explain the presence of maternal sleep disturbances, due to the lack of direct correlation between child sleep interruptions and those of their mothers, further research should be conducted to better evaluate the impact on maternal health and well-being. In addition to clinical care for the child with AD, doctors should more broadly consider the health of the caregiver, inquiring about and informing parents that sleep disturbances and fatigue can affect their own medical conditions.2
Providing educational information and referring caregivers for psychological and/or social support may help to improve the general well-being and sleep quality of caregivers to children with chronic medical conditions.2
Faustine, D., Ramirez, BA et al. Assessment of Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis Available at: https://jamanetwork.com/journals/jamadermatology/fullarticle/2728818. Accessed 4.25.19.
Chamlin, S. Dermatology Practice Update. Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis. Available at: https://www.practiceupdate.com/content/sleep-disturbances-and-exhaustion-in-mothers-of-children-with-atopic-dermatitis/81424. Accessed 5.1.19.