Background: Atopic dermatitis (AD) severity in children is influenced by biological, environmental, and psychosocial factors, yet severity-focused, multicenter evidence from Middle Eastern populations remains limited. Objective: To identify early-life, familial, and climatic determinants of clinical severity in pediatric AD. Methods: This multicenter cross-sectional study included 600 children diagnosed with atopic dermatitis according to the Hanifin and Rajka criteria. Disease severity was measured using the SCORAD index and categorized as mild, moderate, or severe. Independent variables included breastfeeding history, parental marital status, residential climate, animal exposure, and family atopy. Ordinal logistic regression models were used to estimate adjusted odds ratios (aORs) controlling for age, sex, and nationality. Results: Compared with bottle-feeding, breastfeeding < 6 months (aOR = 0.02; 95% CI 0.007– 0.079) and ≥ 6 months (aOR = 0.29; 95% CI 0.17– 0.50) were strongly protective against greater AD severity. Children from separated/divorced or widowed households and those living in mountain regions had significantly higher severity than peers from married families and coastal areas. Cat exposure was an independent determinant of greater severity (aOR = 6.48; 95% CI 3.33– 12.64) and higher SCORAD, whereas general animal exposure, consanguinity, sex, and family atopy were not significant. Conclusion: Breastfeeding, family structure, residential climate, and cat exposure are key, potentially modifiable determinants of pediatric AD severity and should inform risk-stratified, context-aware management. Keywords: atopic dermatitis, disease severity, breastfeeding, psychosocial stress, climate factors, pediatric dermatology
Molla et al. (Sun,) studied this question.