Infantile atopic dermatitis and maternal-infant bonding: a mixed methods study

Ayel Luis R Batac; Kaitlyn A Merrill; Michael A Golding; Manvir Bhamra; Zoe Harbottle; Isac Kopsch; Erik Wilking; Marina Jonsson; Sandra Ekström; Elissa M Abrams; Michelle A Halbrich; Elinor Simons; Leslie E Roos; Jill A Keddy-Grant; Thomas V Gerstner; Jo-Anne St-Vincent; Jennifer L P Protudjer

doi:10.1186/s13223-023-00857-5

Infantile atopic dermatitis and maternal-infant bonding: a mixed methods study

Allergy Asthma Clin Immunol. 2023 Nov 29;19(1):100. doi: 10.1186/s13223-023-00857-5.

Authors

Ayel Luis R Batac^#^{1

2}, Kaitlyn A Merrill^#^{1

2}, Michael A Golding^{3

4}, Manvir Bhamra^{1

2}, Zoe Harbottle^{1

2}, Isac Kopsch⁵, Erik Wilking⁵, Marina Jonsson^{6

7

8}, Sandra Ekström^{6

7

8}, Elissa M Abrams^{2

9

10}, Michelle A Halbrich⁹, Elinor Simons^{2

9

11}, Leslie E Roos^{2

12}, Jill A Keddy-Grant¹³, Thomas V Gerstner⁹, Jo-Anne St-Vincent¹¹, Jennifer L P Protudjer^{1

2

6

14

15}

Affiliations

¹ Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
² Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
³ Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. Michael.Golding@umanitoba.ca.
⁴ Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada. Michael.Golding@umanitoba.ca.
⁵ Karolinska Institutet, Stockholm, Sweden.
⁶ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁷ Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
⁸ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁹ Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁰ Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹¹ Children's Allergy and Asthma Education Centre, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada.
¹² Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada.
¹³ Department of Pediatrics and Child Health, Section of Dermatology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁴ Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁵ George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.

^# Contributed equally.

Abstract

Background: Childhood atopic dermatitis can have a negative effect on caregivers' quality of life and stress levels due to the burdensome nature of its treatment. Given that the condition often emerges in infancy, atopic dermatitis-related stress also carries the potential to negatively affect the developing mother-infant bond. While it is plausible that atopic dermatitis has a negative impact on maternal-infant bonding, these relationships have not been studied directly. In light of this gap, the current study investigated the association between infantile atopic dermatitis and the maternal-infant bond using a mixed-method design.

Methods: Mothers of infants (< 19 months) with atopic dermatitis were recruited from social media and medical clinics between October 2021 and May 2022. Mothers with infants unaffected by inflammatory skin conditions were also recruited to serve as a control group. Participants were asked to complete questionnaires related to their demographics, child's health, and mother-infant bond. Multiple linear regression analyses were used to assess bonding quality among cases and controls. A subset of cases were also asked to participate in semi-structured interviews focused on infantile atopic dermatitis and the maternal-infant bond.

Results: The final sample consisted of 32 cases and 65 controls. Scores on the impaired bonding and risk of abuse subscales did not significantly differ between cases and controls. However, mothers of infants with atopic dermatitis did report lower levels of caregiving anxiety (b = - 1.47, p < 0.01) and pathological anger/rejection (b = - 1.74, p = 0.02) relative to controls. Qualitative findings suggest that the topical therapies required to manage atopic dermatitis may strengthen the bond between some mothers and infants.

Conclusion: Findings suggest that atopic dermatitis does not have a negative impact on maternal-infant bonding and may actually improve bonds in some cases. In light of this finding, clinicians may leverage the potentially positive impact of atopic dermatitis-related caregiving on the maternal-infant bond to encourage caregivers to remain adherent to their child's topical treatments.

Keywords: Atopic dermatitis; Maternal health; Maternal mental health; Maternal-infant bonding; Mixed methods; Postpartum bonding questionnaire.