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Under Your Skin: Maternal Stress, Childhood Eczema
By Russell H. Greenfield, MD, Dr. Greenfield is Clinical Assistant Professor, School of Medicine, University of North Carolina in Chapel Hill, and Visiting Assistant Professor, University of Arizona, College of Medicine in Tucson; he reports no financial relationship relevant to this field of study.
Source: Faught J, et al: Stress in mothers of young children with eczema. Arch Dis Child. 2007;92:683-686.
Faught and colleagues, of this small australian trial, sought to measure stress levels in mothers of young children (ages one month to 5 years) with eczema, to examine the relationship between severity of eczema and maternal stress levels, and to compare these levels of stress with those reported for other chronic diseases of childhood. Mothers (n = 33, mean age 33.8 years) were recruited from hospital-based outpatient clinics (55%) or while their child was hospitalized for eczema management (45%). Maternal stress was determined using a validated measure (the Parenting Stress Index-Long Form, or PSI), and results were compared with published data for healthy children and those with specific health disorders. Eczema severity was gauged using the Eczema Area and Severity Index (EASI) score and the Investigators' Global Assessment (IGA) score.
The mean age of children in the study was 2.8 years, and severity of eczema was in the low-to-moderate range. Mothers of the children with eczema had significantly higher total stress scores (mean PSI of 259.6) compared to mothers of healthy children (mean PSI = 222.8), as well as mothers whose children had other significant chronic maladies such as insulin-dependent diabetes (IDDM, mean PSI = 218.1) and profound deafness (mean PSI = 221.7). Their stress scores were comparable to those of parents whose children suffer with severe developmental disorders, as well as those requiring home enteral feeding. Almost half the mothers of children with eczema had stress level scores indicating a need for professional intervention. Higher levels of stress were associated with more severe eczema, but total stress scores were not significantly correlated with age of the child. As a concluding statement, Faught et al strongly recommend that moderate-to-severe childhood eczema be widely regarded as the significant chronic disease it is, and that focused attention be paid to the caregivers (most often the child's mother), for whom stress levels are equivalent to those typically associated with the care of children with severe developmental and physical disorders.
Prior data show that a diagnosis of eczema in childhood has ramifications far beyond the physical that include family dynamics, financial considerations, and emotional challenges to the primary caregiver, who often experiences significant anxiety, as well as depression. With an estimated prevalence of 10-16% in westernized countries, it is clear that most primary care providers, and many specialists alike, come in contact with people touched by this disorder. Many, however, likely perceive eczema as a trivial cutaneous disorder causing mild-to-moderate discomfort, and perhaps a mild degree of disfigurement. The chronic nature of the disorder, the meticulous skin care that is warranted, the frequent flare-ups requiring treatment, the frequent behavioral issues noted in children with eczema (increased incidence of irritability and fearfulness, as well as impaired sleep), and the indirect effects on family members all take a toll, apparently even more of a toll than that usually associated with childhood disorders like IDDM. Prior to publication of these data, it seems reasonable to assume that most practitioners had little concept of the extent of the impact of childhood eczema beyond that on the child with the disorder.
Results of the trial are compelling, but the sample size is small, and only one practitioner assessed eczema severity. The message is clear, however. Practitioners must attend to those caring for young children with eczema and help them manage the significant family-wide stress associated with the disorder. Faught et al recommend support groups, appropriate spousal support, and referral to sources of credible information. In addition, a practitioner's compassionate demeanor, along with careful consideration of proven stress management techniques (such as breath work, meditation, and counseling) may go a long way towards validating the caregivers' experience, and so help them better cope with their circumstances.