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Coping with the symptoms of atopic dermatitis, including patches of itchy rash, can be very stressful for children and teens. In fact, atopic dermatitis can impact the well-being of everyone in the family. One of chronic disease in children ages 5-16 showed that only cerebral palsy had a larger impact than atopic dermatitis on health-related quality of life.

Although this chronic inflammatory skin disease, which is the most common form of eczema, affects people of all ages worldwide, it is most often diagnosed in children. In the United States, about 7% of adults and up to 15% of children have atopic dermatitis. Half of these youngsters are diagnosed by age 5, and many within just weeks of birth.

A lot of the stress associated with atopic dermatitis is related to the psychological and emotional fallout caused by loss of sleep. Usually, the culprit is constant itch, which makes it difficult to fall asleep and to stay asleep. This leads to fatigue and drowsiness and poor performance at school.

Loss of sleep can also cause changes in mood and behavior, affecting relationships. Babies and toddlers may become irritable and fussy, clingy, and restless. Tweens and teens may become distracted and socially isolated, especially those who have frequent flareups, when symptoms get worse.

The National Eczema Association estimates that about 30% of children with atopic dermatitis lose sleep on 5 or more nights each week. The more severe the symptoms, the higher the risk of sleep loss and the changes in mood and behavior that come with it. Children with atopic dermatitis are also at increased risk of bullying and social isolation, depression and anxiety, and attention deficit hyperactivity disorder.

In a study of nearly 5,000 U.S. children and teens with atopic dermatitis, most youngsters did not feel happy or safe at school. Nine-year-olds were more likely to have poor organizational skills, trouble completing tasks, and temper tantrums during conflicts with peers compared with classmates without atopic dermatitis.

Similarly, 15-year-olds were more likely to have trouble getting along with teachers and to have poor impulse control, leading them to say or do things without thought of the consequences. The longer a child had atopic dermatitis, the higher the risk of delinquent behaviors such as damaging property, cheating on a test, getting involved in a fist fight, and being suspended from school.

When a child with atopic dermatitis can't sleep, the well-being of other family members can suffer too. A 2021 study showed that during disease flares, 86% of parents said they lost up to 2.6 hours of sleep per night caring for their child. Many also reported exhaustion, interpersonal conflict, and reduced happiness.

"The terrible burden of atopic dermatitis on the child and the family with respect to sleep and the time commitment to manage the disease is huge," said Amy S. Paller, MD, professor of pediatrics and dermatology at Northwestern University Feinberg School of Medicine in Chicago.

So what can you do?

Although there is no cure for atopic dermatitis, effective treatment can help control symptoms and prevent flare-ups. Your child's skin will look and feel more normal, and itch will fade, improving sleep, mood, and behavior.

"Better long-term control of atopic dermatitis appears to be beneficial for reducing itch, sleep disturbance, and depression and anxiety," confirmed Lawrence Eichenfield, MD, professor of pediatrics and dermatology at the University of California, San Diego School of Medicine.

If itch is interfering with your child's sleep, let your doctor know right away. He or she may recommend changes to your child's treatment plan or, if you're not already seeing a dermatologist, refer you to one. Similarly, let your doctor know if you think your child may be . Changes in appetite as well as sleep, outbursts or crying, low energy, continuous feelings of sadness and hopelessness, and social withdrawal are all signs of this.

Good stress management may also help prevent atopic dermatitis flares. Experts say that the best way to manage stress is for the entire family to model a healthy lifestyle by, for example, eating nutritious, well-balanced meals; getting regular physical exercise; and spending less time in front of a screen.

Check in with older children and teens to make sure they are following the treatment plan. In younger children, make sure to follow the doctor's instructions for and use medication as recommended.

, however, can actually increase stress. Instead, . If the treatment plan is too difficult to follow, let your doctor know. It may be possible to simplify the plan and get better control. Helping your child avoid triggers, such as pet dander, may also help keep itchiness under control.

The National Eczema Association offers resources for parents that include with stress at . Suggestions include meeting with the teacher to set up an action plan that addresses scratching, for instance. You can also prepare a school skin-care kit that provides everything your child will need during the day, such as a mild cleanser if the soap in the school washroom is too harsh, moisturizing cream or ointment, and clothing that protects against scratching.

Sometimes, the stress that comes from having a chronic skin condition can be reduced by connecting with peers who have similar challenges. One week at the American Academy of Dermatology's for children ages 8-16 with atopic dermatitis or other chronic skin conditions such as psoriasis or alopecia can boost self-esteem and ease feelings of being alone. Each camper receives expert medical care, and all costs, including transportation to and from camp, are covered. Ask your dermatologist for a referral.

Further information overall is available from the and the .

Read previous installments in this series:

For Your Patients: Atopic Dermatitis 101

For Your Patients: How Will My Doctor Diagnose Atopic Dermatitis?

For Your Patients: Skin Care to Control the Symptoms of Atopic Dermatitis in Children

For Patients: Identify Your Child's Atopic Dermatitis Triggers

For Your Patients: Which Topical Treatments Work for Atopic Dermatitis?

For Your Patients: Is 'Steroid Phobia' Sabotaging Your Atopic Dermatitis Treatment Plan?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.