Atopic Dermatitis and Emotional and Behavioral Outcomes in Infants and Toddlers: A U.S. Population-Based Study

BACKGROUND: Infantile atopic dermatitis (AD) is associated with anxiety, depression, and behavioral problems years later. However, its association with early emotional/behavioral signs in infancy and toddlerhood remains underexplored. OBJECTIVES: To evaluate whether AD is associated with emotional and behavioral outcomes in infants and toddlers. METHODS: Multiple independent data sources were examined. First, a retrospective cohort study with 1-year follow-up was conducted using the TriNetX U.S. Collaborative Network, including 12-to-23-month-olds with AD and unaffected controls. One-to-one propensity score matching was performed based on demographics and neurodevelopmental conditions. Cox regression compared hazards of anxiety and disruptive behavioral problems. Additionally, National Health Interview Surveys (NHIS) 1998-2024 were analyzed. Infants 0-23 months and 24-to-35-month-old toddlers were included. Logistic regression, adjusted for sociodemographic factors and neurodevelopmental conditions, compared odds of positive screening scores on an infant emotional and behavioral screening tool between infants with and without AD, and odds of higher scores on an emotional and behavioral assessment between toddlers with and without AD. RESULTS: The TriNetX cohort included 494,292 matched infants. Infants with AD had a higher risk of anxiety and disruptive behavioral problems (hazard ratio [HR] = 1.36; 95% confidence interval [CI], 1.28-1.45). In NHIS samples of 1785 infants and 14,253 toddlers, AD was associated with increased odds of positive emotional/behavioral screening scores in infants (adjusted odds ratio [aOR] = 1.76; 95% CI, 1.23-2.52) and toddlers (aOR = 1.66; 95% CI, 1.47-1.88). CONCLUSIONS: We found consistent evidence that emotional/behavioral dysfunction associated with infantile AD begins in infancy and toddlerhood, supporting the value of early screening. Positive screening may warrant more intensive treatment such as advanced topicals or systemics.