World Sleep Day is coming, are mothers and AD babies sleeping well? ——Please keep the "Sleep Tips"!

There is an itch that makes me unable to sleep

Every mother with a baby suffering from atopic dermatitis (AD) has experienced emotional ups and downs during the nights when taking care of the child, especially during these special times:

22:00 Gently touching the baby's head, the baby finally fell asleep, like an angel, feeling relieved

24:00 The baby cried and said he was itchy, twisted around in bed, and woke up

01:00 The little hands scratched randomly, and the forehead, neck, and arms were almost scratched. I felt so sad.

04:00 My voice was hoarse, and I fell asleep with tears on my face. I cried too, and I was devastated.

On ordinary nights, children and parents are suffering from AD! Many children with AD have similar experiences. They start to itch as soon as they fall asleep, scratch their ears and cheeks, and sleep restlessly. Such sleep is really a torture! It is reported that 47% to 80% of children with AD have sleep disorders. Common sleep problems include difficulty falling asleep, frequent awakenings at night, and daytime sleepiness. Children with AD are more likely to wake up after falling asleep and more difficult to wake up in the morning.

The quality of life and sleep of family members are also affected by AD children. During the onset of AD, parents' sleep time decreases by an average of 0.66 to 2.6 hours, and 64% of parents of AD children feel frustrated and tired due to sleep problems.

If the baby doesn’t sleep well, the parents will definitely not sleep well either. The whole family will have dark circles under their eyes, feel listless and anxious, and they don’t know when it will end! I would like to ask you a simple question: How long has it been since you slept until you woke up naturally?

What kind of dermatitis and itching will keep babies and mothers awake all night?

AD is a common chronic recurrent, pruritic, inflammatory skin disease with severe itching, recurrent rash and sleep disorders as the main manifestations. The prevalence rate in children is about 15% to 30%. Its pathogenesis is complex and has not yet been fully elucidated.

Just the key words "chronic", "severe itching" and "recurrent attacks" are enough to destroy a mother's will.

The itch of AD is an itch that comes from deep within the nerves. It is different from the local itch on the skin surface caused by mosquito bites, and it is also different from the itch after seafood allergy, which is fierce but can be effectively controlled by anti-allergic drugs. It is persistent and intense, driving people crazy and unable to help scratching. Some people suffer from insomnia due to the itch, and some even become depressed due to the itch.

Sleep disturbance is the second most important factor affecting the quality of life of children with AD after pruritus. Compared with other chronic skin diseases such as psoriasis, urticaria, acne and other chronic diseases such as kidney disease, asthma, epilepsy and diabetes, the quality of life of children with AD is worse.

Sleep is essential for growth and development, and sleep disorders themselves can have a variety of negative effects on children, including a significant increase in the rate of behavioral problems, cognitive dysfunction, and mood changes. 54% of parents of children with AD reported that their children had behavioral problems, such as irritability, bad temper, and harm to other family members during AD attacks. When accompanied by sleep problems, AD is associated with attention deficit hyperactivity disorder and dwarfism. Sleep disorders themselves can aggravate AD, and there is a two-way channel between AD and sleep disorders that influence each other .

How can mothers help AD babies sleep well ? "Sleep Tips" to help!

We know that children with AD will definitely experience itching, which will affect the child's sleep quality and also cause restlessness for the whole family. Therefore, controlling the child's itching is very important to improve the quality of life of the child and his family. However, scratching cannot be a simple way to solve the child's itching, because scratching will aggravate the severity of AD and further make AD more serious. So, please keep this "Sleep Tips"!

Tip 1: Comfortable environment

Control dust mites . Dust mite allergy is one of the causes of itchy skin in patients, and also affects sleep disorders in children with AD. Therefore, it is recommended to control the dust mite concentration in the sleeping environment. Clean bedding is the basis, and parents are advised to change and wash bedding regularly. If conditions permit, they can use a dust mite remover. In addition, it is also necessary to avoid keeping pets, laying carpets, and raising flowers and plants, and to minimize allergens in the living environment.

Control the temperature. "Itching when it's hot" is a personal experience of many babies. Too high a body temperature will evaporate the moisture on the skin surface, making the already dry skin even drier. The thicker the quilt, the better. The thicker the sleeping bag, the more comfortable it is. The higher the air conditioner, the better. The indoor temperature should be around 20℃, and the living environment should be cool, ventilated and clean.

Tip 2: Bathing and moisturizing

Bathing can remove debris and scabs on the skin surface, clean the skin; reduce the colonization of Staphylococcus aureus on the skin surface, reduce the probability of bacterial infection; and increase the moisture content of the skin. Do not scrub during bathing to avoid damaging the skin barrier. The water temperature should be 32~38℃, once a day or every other day, 5~10 minutes each time; it is recommended to use low-sensitivity, non-irritating, weakly acidic (pH 5~6) cleansing products.

Tip 3: Sufficient amount of emollient

Since the skin barrier function of children with AD is damaged, it is recommended to use moisturizers all over the body. External moisturizers can not only prevent the evaporation of skin moisture and increase the skin's moisture content, but also exogenously supplement the skin's lipid content and repair the skin's barrier function. Regarding the use of moisturizers, the emphasis is on "multiple use". It is recommended that children with AD use 150 to 200 grams per week, and the best effect is achieved within 3 to 5 minutes after bathing.

Tip 4: Apply medicine when necessary

If we see some inflammation on the skin, we still need to apply some hormone-containing or non-hormonal ointments. Applying topical medications can eliminate inflammation and repair the skin barrier, thereby effectively removing itching symptoms. The frequency of applying topical medications varies depending on the condition. Please strictly follow the doctor's instructions and drug instructions. Try to apply ointments on visible skin lesions after taking a shower at night, which will help you sleep better.

Currently, the topical drugs commonly used for childhood AD include topical corticosteroids (TCS), topical calcineurin inhibitors (TCIs), and phosphodiesterase-4 inhibitors (PDE4).

TCS: Currently, topical glucocorticoids are the first-line drugs for the treatment of AD. The appropriate strength of the preparation should be selected according to the severity of the skin lesions, age, site of onset, stage of the skin lesions (acute, subacute, chronic), season, etc., and used in sufficient quantity and for a sufficient course of treatment.

TCI: 1% pimecrolimus cream has been approved for use in children aged 3 months and above, and the safety of 0.03% and 0.1% tacrolimus ointment in children over 1 year old has also been confirmed. It is usually used in combination with topical hormones or used sequentially, that is, TCS is used in the short term to control inflammation, and then switched to TCI for active maintenance treatment.

PDE4 inhibitors : The PDE4 inhibitor crisaborole ointment approved in China is used to treat mild to moderate AD in children aged ≥2 years. However, clinically, for children with moderate AD, it is recommended to use TCS preparations for 2 to 4 weeks to control acute inflammation, and then use crisaborole ointment for maintenance treatment.

In general, sleep-related problems not only affect the physical and mental health of children with AD, but also affect their growth and development, cognition, learning, and social behavior, and affect the quality of life of the entire family. Itching must be managed comprehensively through environmental protection, including avoidance of allergens, and even moisturizers and topical medications, rather than solving the problem through scratching. If severe itching affects sleep and is difficult to stop, be sure to go to a regular hospital and choose systemic drug treatment under the guidance of a doctor and pharmacist to control the itching. Moms, act quickly, start with the details, and help your AD baby and yourself create a perfect sleep!

References

[1] Yung-Sen Chang, Bor-Luen Chiang. Sleep disorders and atopic dermatitis: A 2-way street?[J]. J Allergy Clin Immunol, 2018, 142(4):1033-1040.

[2] Lu Qianjin, Chi Chunhua, Ma Lin, et al. Primary care diagnosis and treatment guidelines for atopic dermatitis in children (2023)[J]. Chinese Journal of General Practitioners, 2023, 1: 8-18.

[3] Chinese Medical Doctor Association Dermatologists Branch, Chinese Medical Association Dermatology and Venereology Branch, Chinese Medical Health International Exchange Promotion Association Dermatology Branch, etc. Expert consensus on the management of drug use for the treatment of atopic dermatitis (2024 edition) [J]. Chinese Journal of Dermatology, 2024, 2:97-108.

Li Huanzhou, deputy chief pharmacist, Pharmacy Department, Changzhou Children's Hospital