Infant eczema, concurrent sleeping problems, and mental health problems at age 10 years: Results from a prospective birth cohort study LISAplus

Background: Cross-sectional studies suggest an association between eczema and mental health problems, possibly modified by sleeping problems. Prospective evidence concerning the relationship between eczema, concurrent sleeping problems and mental health problems is lacking. Methods: Between 1997 and 1999 a population-based birth cohort study was recruited in Munich, Leipzig, Wesel, and Bad Honnef, Germany and followed until age 10 years. Physician-diagnosed eczema, sleeping problems, and a broad set of environmental exposures were assessed at age 6, 12, 18, 24 months and 3, 4, 6, 10 years. At age 10 years, mental health problems were assessed using the parent version of the Strengths and Difficulties Questionnaire (SDQ). We investigated the association between infant eczema (age <2 years), concurrent sleeping problems due to pruritus in infancy, and mental health problems at age 10 years by means of logistic regression modelling adjusting for sociodemographic and environmental exposures, lifestyle factors, allergic comorbidities, and parental history of eczema. Results: From the original cohort of 3097 neonates, 1578 (51%) were followed until age 10 years and eligible for analysis. Infant eczema with concurrent sleeping problems due to pruritus predicted a higher risk for emotional symptoms (odds ratio (OR) 2.63; 95%-confidence interval (95% CI) 1.20–5.76) and for conduct problems at age 10 years (OR 3.03; 95% CI 1.01–9.12). Infant eczema without concurrent sleeping problems tended to increase the risk for hyperactivity/inattention at age 10 years (OR 1.78; 95% CI 0.97–3.24), but was not associated with other possible/probable mental health problems. Children ever diagnosed as having eczema were at increased risk for hyperactivity/inattention at age 10 years (OR 2.12; 95% CI 1.34–3.37).Conclusion: Infant eczema with concurrent sleeping problems may cause specific mental health problems at age 10 years. Future research is necessary to better understand the underlying mechanisms for the observed association and to implement targeted prevention strategies.