Growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula in infants with cow's milk protein allergy.

Objective: To evaluate growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula (eHCF) in infants with cow's milk protein allergy (CMPA). Methods: A total of 226 infants (mean ± SD age: 106.5 ± 39.5 days, 52.7% were girls) with CMPA who received eHCF comprising at least half of the daily dietary intake were included. Data on anthropometrics [weight for age (WFA), length for age (LFA) and weight for length (WFL) z-scores] were recorded at baseline (visit 1), while data on infant feeding and stool records, anthropometrics and Infant Feeding and Stool Patterns and Formula Satisfaction Questionnaires were recorded at visit 2 (on Days 15 ± 5) and visit 3 (on Days 30 ± 5). Results: From baseline to visit 2 and visit 3, WFA z-scores (from -0.60 ± 1.13 to -0.54 ± 1.09 at visit 2, and to -0.44 ± 1.05 at visit 3, p < 0.001) and WFL z-scores (from -0.80 ± 1.30 to -0.71 ± 1.22 at visit 2, and to -0.64 ± 1.13 at visit 3, p = 0.002) were significantly increased. At least half of infants never experienced irritability or feeding refusal (55.7%) and spit-up after feeding (50.2%). The majority of mothers were satisfied with the study formula (93.2%), and wished to continue using it (92.2%). Conclusions: In conclusion, eHCF was well-accepted and tolerated by an intended use population of infants ≤ 6 months of age with CMPA and enabled adequate volume consumption and improved growth indices within 30 days of utilization alongside a favorable gastrointestinal tolerance and a high level of parental satisfaction.

Characteristics of children with cat sensitivity: a prospective cross-sectional study.

BACKGROUND: Animal dander is one of the most common respiratory allergens in children, and there is evidence that cat sensitivity is a risk factor for asthma and allergic rhinitis. In this study, it was aimed to evaluate children with cat sensitivity and to identify their demographic and clinical characteristics. METHODS: Patients who were found to be sensitive to cats following skin prick tests performed in our allergy clinic over a period of one year (and two control groups), were included in the study. Patients in the study and control groups filled in a questionnaire including demographic and clinical characteristics. RESULTS: The prevalence of cat sensitivity in our allergy clinic was 6% (182/3033). The most common diagnoses in patients were 41.8% allergic rhinitis, 25.8% asthma, and 13.2% allergic rhinitis + asthma. Allergic rhinitis symptoms were the most prevalent symptom associated with cat contact (29.4%), whereas 28% of the patients were asymptomatic. Only 17.3% had a cat at home and 13.4% had cat exposure apart from home but having a cat at home was significantly higher than the control groups (p < 0.05). Eosinophilia was present in 54.6% of the patients, and 17.3% had blood tIgE levels of >1000 IU/mL. Eosinophilia and tIgE levels were significantly higher than both control groups (p < 0.05). DISCUSSION: Cat ownership can affect the development of cat sensitivity but the majority of patients with cat sensitivity are not cat owners. Elevated tIgE levels (> 1000 IU/mL) may be associated with cat sensitivity, these patients should be evaluated for cat sensitivity, even if they do not report symptoms with cat contact.

Demographic and clinical characteristics of newborn pneumothorax patients and their effects on respiratory function tests during childhood.

PURPOSE: Pneumothorax is defined as the presence of air between the parietal and visceral leaves of the pleura, resulting in lung collapse. The aim of this study was to evaluate the respiratory functions of these patients when they reach school age and to reveal whether they cause permanent respiratory pathology. METHODS: The files of 229 patients who were hospitalised in a neonatal intensive care clinic had received a diagnosis of pneumothorax and had undergone tube thoracostomy were included in a retrospective cohort review. The respiratory functions of participants in the control and patient groups were evaluated using spirometry in a prospective cross-sectional study design. RESULTS: The study found the rates of pneumothorax to be higher in males, term infants and after caesarean delivery, mortality was 31%. Among patients who underwent spirometry, those with a history of pneumothorax had lower forced expiratory volume at timed intervals of 0.5 to 1.0 (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF) and forced expiratory flow 25-75% (MEF25-75). FEV1/FVC ratio was significantly lower (p < 0.05). CONCLUSION: Patients treated for pneumothorax in the neonatal period should be evaluated for obstructive pulmonary diseases during childhood using respiratory function tests.

Preschool children with asthma during the Covid-19 pandemic: fewer infections, less wheezing.

INTRODUCTION: A few studies have already investigated preschool children with asthma during the pandemic. The purpose of this research was to investigate how preschool children with asthma were affected by the precautionary measures adopted during the pandemic. METHODS: Preschool children with asthma aged 18-60 months evaluated in our clinic in March-May 2019, before the Covid-19 pandemic, were included in the study. The lockdown continued during March, April, and May 2020. The questionnaires and asthma symptom control tests for preschool children with asthma in 2019 and 2020 were then evaluated. RESULTS: Sixty-three preschool children with asthma, 37 boys and 26 girls, aged 18-60 months (median 47) were included in the study. The median number of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs), and the use of antibiotics were significantly lower in 2020 than 2019 (p<.01). The median numbers of the pediatric emergency department (PED) visits and hospitalizations were also lower in 2020 than in 2019 (p<.05). In 2019, 31 children with asthma were well controlled, 28 were partly controlled, and 4 were uncontrolled, compared to 58 well controlled, four partly controlled, and one uncontrolled in 2020 (p<.01). CONCLUSIONS: Preschool children with asthma have been positively affected in terms of PED admission, hospitalization, and asthma symptom control in association with the Covid-19 pandemic and the resulting lockdown measures. This study revealed that wheezing decreased significantly in the absence of respiratory infection in preschool children with asthma. Namely, fewer infections meant less wheezing.

Knowledge and Attitudes of Pediatric Residents to Smoking Intervention in Adolescents.

OBJECTIVE: Tobacco use is an important, preventable public health problem, and its use usually begins in adolescence. For this reason, smoking intervention for tobacco control is considered one of the fields of pediatrics. This study aims to examine the knowledge and attitudes of pediatric residents toward tobacco control and smoking intervention. MATERIALS AND METHODS: In this multicenter study, pediatric residents were asked about their knowledge and attitudes toward adolescent smoking intervention and tobacco control through an online questionnaire. RESULTS: A total of 271 pediatric residents participated in the study, and 56% of the residents stated that they asked adolescents with respiratory tract symptoms whether they smoked or not. However, 22% of pediatric residents stated that they asked the same question to adolescents regardless of their symptoms, 92% of residents were unaware of the International Diagnostic Code for tobacco use, and 86% of the participants reported that they did not receive any training on tobacco control. It was determined that the residents, who knew the national smoking cessation hotline, were female, smokers, and seniors. They asked the adolescents whether they smoked or not and the results were statistically significant (P < .05). CONCLUSION: The results show that pediatric residents have insufficient knowledge about tobacco control and cannot guide adolescents in smoking intervention. This research reveals that pediatric residents need a training program for adolescent smoking intervention in the pediatric resident curriculum. Pediatricians who are well trained in adolescent tobacco control can make important contributions to the prevention of tobacco use in adults.

Improvement in school-aged children with asthma during the Covid-19 pandemic.

INTRODUCTION: The coronavirus 2019 disease (Covid-19) pandemic led to a number of measures being introduced in many countries worldwide. Lockdowns were imposed on individuals aged <18 years, education was delivered online, and mask-wearing was made compulsory in public places, resulting in an unprecedented period for children. Real-life data showing how children with asthma are affected by major changes are limited. This study investigated how asthmatic children are affected by pandemic conditions based on real-life data. METHODS: Patients with asthma aged 6-18 years followed up from March to May 2019-before the Covid-19 pandemic-were included in the study. Data from March to May 2020 and 2019 were then compared to reveal the effects of pandemic-related lifestyle changes on symptoms, frequency of exacerbations, and drug use in asthmatic children. RESULTS: Eighty-six children with asthma aged 6-18 years were included in this study. Time spent inside the home was significantly higher in 2020 than in 2019. Rescue medication requirements and emergency department visits were significantly lower in 2020 compared to 2019 (p < 0.001). The number of well-controlled patients with asthma was higher in 2020 than in 2019 (p < 0.0001). The number of patients using prophylactic drugs within the previous 3 months was lower in 2020 compared to 2019 (p = 0.007). CONCLUSION: The present study yielded valuable insights, based on real-life data, into the condition of children over the age of 6 years during the Covid-19 pandemic. Numbers of asthmatic exacerbations, rescue drug use, and asthma control were positively affected in school-aged children with asthma during the pandemic.

Clinical Features and Clinical Course of Food Protein-Induced Allergic Proctocolitis: 10-Year Experience of a Tertiary Medical Center.

BACKGROUND: Food protein-induced allergic proctocolitis (FPIAP) is a food allergy characterized by bloody stools in well-appearing breast-fed infants. OBJECTIVE: To determine the clinical course of FPIAP and the factors affecting the development of tolerance. METHODS: Over a 10-year period, patients with a diagnosis of FPIAP who were followed at the outpatient Allergy-Immunology clinic in a tertiary care children's hospital in Turkey were retrospectively analyzed. RESULTS: The frequency of FPIAP was 0.18% among 64,549 patients. The median age of symptom onset was 2 months (interquartile range, 1.0-3.5 months), and the median age of tolerance development was 12 months (interquartile range, 8.0-17.21 months). The occurrence of symptoms in the neonatal period was associated with a history of premature birth (odds ratio, 3.75; 95% CI, 1.33-10.59; P = .031) and neonatal intensive care unit hospitalization (odds ratio, 4.72; 95% CI, 1.78-12.53; P = .002). Use of a cow's milk-based formula was associated with a higher risk of the onset of symptoms after 1 month (odds ratio, 2.69; 95% CI, 1.19-6.07; P = .016). The use of an amino acid-based formula and the presence of diarrhea at admission were associated with later development of tolerance (P = .023 and P < .001, respectively). An IgE-mediated reaction was observed during oral food challenge testing in 6% of the patients. CONCLUSIONS: The manifestations of FPIAP appeared earlier in premature infants and later in infants using formula. The use of amino acid-based formula and having had diarrhea were associated with delayed tolerance.

Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID-19 pandemic.

OBJECTIVE: This study aimed to determine the differences in attitudes and views towards influenza and pneumococcal vaccines in parents of children with asthma during the COVID-19 pandemic. MATERIALS AND METHODS: Asthmatic children in the 6-18 age group who were admitted to the pediatric allergy clinic of our hospital between October 1, 2020 and February 31, 2021 were included in the study. The parents were given a questionnaire asking about their demographics and medical history. Their attitudes and thoughts towards these two vaccines, both before and during the pandemic, and their COVID-19 stories were questioned. RESULTS: A total of 78 patients diagnosed with asthma were included in this study. While the rate of influenza vaccination before the pandemic was 29.5%, the rate of those who received or wanted to receive influenza vaccine during the pandemic was 71.8% (p = 0.001). It was observed that the rate of influenza vaccination during the pandemic increased with the regular use of asthma medication, the presence of atopy, and a history of COVID-19 infection in the family/close environment. In total, 69.2% of the parents stated that their child's pneumococcal vaccination was incomplete or they were unaware of their child's vaccination status. CONCLUSION: This study demonstrated that there was an increase in the rate and willingness of parents of asthmatic children to have their children vaccinated against influenza during the COVID-19 pandemic. As for the pneumococcal vaccine, the majority of the parents did not have enough information or they were unaware of the vaccination status of their children.

Anaphylaxis and epinephrine autoinjector use in pediatric patients with cutaneous mastocytosis.

BACKGROUND/OBJECTIVES: Mastocytosis is a complex disorder presenting with a broad clinical spectrum. In this study, we aimed to evaluate the frequency of systemic symptoms, necessity of the usage of epinephrine autoinjectors (EAI), and factors affecting the use of EAI among pediatric patients with cutaneous mastocytosis (CM). METHODS: The study population was composed of 53 patients with CM. The clinical data were collected from the medical files. A questionnaire about the patient's anaphylaxis experiences and treatment attitudes toward EAI was performed. RESULTS: Thirty-three of 53 patients were male (62.3%), and the median age of the study participants was 80 months. Anaphylaxis was reported in two patients (3.7%). One of the patients had drug-induced anaphylaxis, and the other had venom-induced anaphylaxis. Three patients (5.6%) reported a personal history of EAI use due to systemic symptoms. Patients with higher serum tryptase level and cases of familial mastocytosis had more systemic symptoms (P = .012 and P = .010, respectively). The patient rate of compliance with EAI for prescription filling and carrying the EAI was 88.7% and 79.2% respectively. 41.5% of parents were hesitant to use EAI when necessary, although they were trained for the use of it by medical staff. CONCLUSIONS: The rate of anaphylaxis in patients with CM in the current study wassignificant and justifies prescribing EAI. Detailed education and counseling on EAI usage are needed to reduce parental hesitancy.

Is Oral Food Challenge as Safe Enough as It Seems?

BACKGROUND: Oral food challenges (OFCs) assist in the diagnosis of food allergies and are essential to determine whether an allergy has been outgrown. During the OFC, a medical procedure e introduces foods suspected to be allergenic orally in increasing doses. Mild skin reactions such as urticaria or rarely serious life-threatening reactions such as anaphylaxis may develop. OBJECTIVE: In this study, we aimed to retrospectively evaluate the clinical and laboratory characteristics of patients who experienced anaphylaxis during open OFCs in a tertiary care children's hospital. METHODS: Patients who underwent OFCs to confirm the presence of a food allergy or to assess tolerance status at the University of Health Sciences, Ankara, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Pediatric Allergy and Immunology Outpatient Clinic between 1 January 2013 and 1 February 2016, were included in the study. Patients' data were obtained retrospectively from electronic medical records and challenge chart reviews. RESULTS: A total of 623 OFCs were performed during the period studied. Nine patients (1.4%) between 13 and 67 months of age (mean age: 38.3 months) developed anaphylaxis during their OFC. CONCLUSION: OFCs should be performed in a hospital or outpatient office under medical supervision that is adequate for anaphylaxis intervention by an allergy specialist. Close observation of objective and subjective symptoms is essential during the challenge because there are no laboratory tests that can predict an anaphylactic diagnosis or the severity of the reaction.

A remarkable food allergy in children: cashew nut allergy.

OBJECTIVE: The prevalence of cashew nut allergy is increasing. Clinical reaction to cashew nuts may be severe, including anaphylaxis. In this study, we aimed to evaluate the frequency of cashew nut sensitivity in a group of children with food allergy and the clinical features and course of cashew nut allergy. MATERIAL AND METHODS: A retrospective chart review was performed on 516 children who presented with food allergy at a pediatric allergy department. Individuals sensitized to cashew nuts were examined. RESULTS: Cashew nut sensitization was detected in 17 (64.7% male; mean age of symptom onset, 14 months) of 516 patients with food allergy. Skin symptoms were the most frequent clinical presentation, followed by gastrointestinal symptoms. Overall, 29.4% of the patients presented with anaphylaxis. All anaphylactic reactions were developed after the first consumption of cashew nuts. Of the cashew nut-sensitized patients, 82.3% were diagnosed with moderate-to-severe atopic dermatitis, and all of them had multiple food allergies. During the follow-up, 90% of the patients who had cashew nut sensitization and co-existing food allergies to cow's milk and/or hen's egg developed tolerance to cow's milk and/or hen's egg, but none of the patients could tolerate cashew nut ingestion. CONCLUSION: Cashew nut is a potent allergen, causing severe allergic reactions that persist long term compared with other food allergies. Early onset of moderate-to-severe atopic dermatitis and multiple food allergies are remarkable co-existing conditions in children who have been diagnosed with cashew nut allergy. Pediatricians should be aware of this emerging food allergy.

Revaccination following suspected vaccine-triggered hypersensitivity reactions: experience of a tertiary care centre.

INTRODUCTION AND OBJECTIVES: Suspected hypersensitivity reactions (HRs) associated with vaccines are frequently reported, but confirmed cases of vaccine-triggered HRs are rare. Suspected HRs should be distinguished from actual HRs. The aims of this study are to identify the rate of actual vaccine-triggered hypersensitivity in patients who were referred to the paediatric allergy clinic due to a suspected HR and to explore the rate of revaccination in a real clinical setting. MATERIALS AND METHODS: A retrospective study was performed with a group of preschool children who were evaluated by skin and/or provocation tests (PTs) for the suspected HRs following vaccination. RESULTS: A total of 26 paediatric patients (61.5% male; median age 9 months) with a previous history of suspected vaccine-triggered HR were included. In this group, 69.2% and 38.5% of the patients had a pre-existing atopic disease and an immediate reaction (emerging <1 hour after vaccine administration), respectively. Skin rash was the most frequent clinical presentation (96.1%). Vaccine-triggered anaphylaxis was reported in six patients (23.1%). Measles-mumps-rubella was the most frequently suspected vaccine causing HRs. The skin test positivity with the suspected vaccine was 4%, whereas PTs revealed no reaction after reimmunisation in 76.9% (20/26) of the study participants tested. CONCLUSIONS: Most incidents of skin rashes after immunisation are not suggestive of actual HRs. The results in the current study showed that the majority of the patients presenting with suspected HRs tolerated revaccination, including those with a previous history of suspected anaphylaxis. Revaccination of these patients is safe with adequate precautions. It is absolutely essential to be equipped for the management of anaphylaxis.

Revaccination following suspected vaccine triggered hypersensitivity reactions: experience of a tertiary care centre

INTRODUCTION AND OBJECTIVES: Suspected hypersensitivity reactions (HRs) associated with vaccines are frequently reported, but confirmed cases of vaccine-triggered HRs are rare. Suspected HRs should be distinguished from actual HRs. The aims of this study are to identify the rate of actual vaccine-triggered hypersensitivity in patients who were referred to the pae­diatric allergy clinic due to a suspected HR and to explore the rate of revaccination in a real clinical setting. MATERIALS AND METHODS: A retrospective study was performed with a group of preschool chil­dren who were evaluated by skin and/or provocation tests (PTs) for the suspected HRs follow­ing vaccination. RESULTS: A total of 26 paediatric patients (61.5% male; median age 9 months) with a previous history of suspected vaccine-triggered HR were included. In this group, 69.2% and 38.5% of the patients had a pre-existing atopic disease and an immediate reaction (emerging < 1 hour after vaccine administration), respectively. Skin rash was the most frequent clinical presentation (96.1%). Vaccine-triggered anaphylaxis was reported in six patients (23.1%). Measles-mumps-rubella was the most frequently suspected vaccine causing HRs. The skin test positivity with the suspected vaccine was 4%, whereas PTs revealed no reaction after reimmunisation in 76.9% (20/26) of the study participants tested. CONCLUSIONS: Most incidents of skin rashes after immunisation are not suggestive of actual HRs. The results in the current study showed that the majority of the patients presenting with suspected HRs tolerated revaccination, including those with a previous history of suspected anaphylaxis. Revaccination of these patients is safe with adequate precautions. It is absolutely essential to be equipped for the management of anaphylaxis

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The peripheral blood inflammatory patterns in the control levels of asthma in children.

OBJECTIVE: Asthma is the most common chronic inflammatory disease of childhood, but there are no useful and easily accessible laboratory tests routinely used in the diagnosis and follow-up of this disease in children. Therefore, this study aimed to investigate the roles of white blood cell (WBC) count, platelet count, mean platelet volume (MPV), and eosinophil percentage as full blood count inflammatory markers in evaluating the control level and follow-up of asthma in the pediatric age group. METHODS: A retrospective review of patient records and files of 3,580 patients diagnosed with asthma at the University of Health Sciences in Ankara, Turkey was performed. Patients who met inclusion/exclusion criteria were divided into two groups based on the asthma control level: controlled and uncontrolled. Laboratory data were compared according to the asthma control levels, drug use status, and atopy status of the patients. RESULTS: A total of 348 patients between 4 and 18 years of age, who were followed-up with the diagnosis of asthma, were included in this study. A significant difference was found between the controlled and uncontrolled groups of asthma patients in terms of the eosinophil percentage (mean ± SD, respectively; 3.493 ± 2.24; 4.992 ± 3.43; p = .003). When patients were grouped according to their asthma control levels and atopy status, only the eosinophil percentages were different in the logistic regression analysis (odds ratio = 1.276, 95% confidence interval = 1.113-1.462). CONCLUSION: Our study showed that the percentage of eosinophils can be used as an asthma control parameter, but additional prospective studies would be desirable to confirm our results.

A More Comfortable Method of Skin Prick Testing in Children Ages 0-2 to Decrease Symptoms of Pain.

BACKGROUND: Skin prick testing (SPT) is the best initial diagnostic method for individuals of all ages who have potential allergies. AIM: We aimed to investigate if recent breastfeeding has any effect on reducing the pain of children before SPT. DESIGN: Prospective, randomized, single-blinded study. SETTINGS: Academic hospital specialized in pediatrics. PARTICIPANTS/SUBJECTS: Sixty-four out of seventy-five children requiring SPT within ages 0-2 were included. METHODS: All participants in this study were breastfed children, and that group assignment randomized them to the control group (n = 32) if children breastfed 30-90 min. prior to arriving for SPT, and study group of children (n = 32) who were also breastfed 30-90 minutes prior to arriving for SPT who were then breastfed again just prior to the beginning of the SPT. The FLACC pain scale was used to test the sensitivity of all children for pain before, during, and 15 minutes after the SPT. The effect of breastfeeding on the pain score and the duration of crying were compared among groups. RESULTS: Both groups were similar according to age, gender, and other socio-demographic characteristics (p > .05). The percentage of children that cried during SPT was significantly higher in the control group than the study group (p = .002). The FLACC pain scale values were significantly lower in the study group (p < .001). CONCLUSION: Recent breastfeeding before SPT is correlated with less crying by possibly reducing the perceived pain of children ages 0-2.

Interaction between childhood vocal fold nodules and allergic diseases.

OBJECTIVES: Vocal fold nodules (VFNs) are benign lesions at the junction of the anterior and middle third of the vocal folds. Although VFNs are often a result of vocal cord trauma due to vocal abuse, childhood allergic diseases, and medications may be a cause. We aimed to investigate the association of detected VFNs with allergic diseases in childhood patients with vocal abuse. METHODS: This is a prospective, cross-sectional, case-control study. Caucasian children in ages 3-12, who speak loud, vocal abuse confirmed with Turkish Children's voice handicap index-10 (TR-CVHI-10) above 9 were enrolled to the study. 33 children with VFN were included as the study group and age-matched 26 healthy children without VFN were included as the control group. Children questioned and tested for allergic diseases with Allergometric tests. RESULTS: Asthma was detected in 42.4% of the study group and absent in the control group. The history of inhaler or nasal steroid use was positive in 30.3% of the study group and 7.7% of the control group (p = 0.032). Dysphonia and the presence of allergic diseases were determined as independent risk factors for the study group (p = 0.001; 0.021, respectively). The median values of blood lymphocyte counts were significantly different among study and control groups (2900 µl vs 2335 µl, respectively; p = 0.04). CONCLUSION: Investigating allergic diseases, especially asthma, for success in the treatment of pediatric patients with VFNs is of utmost importance.

Sleep Patterns and Development of Children with Atopic Dermatitis.

INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory disease that begins in early childhood. Sleep problems have increased in children with AD. The aim of this study was to evaluate sleep patterns and the development of children with AD at an early age. METHODS: This is a cross-sectional study consisting of a total of 80 children aged 0-36 months with AD. Patients were evaluated by the Brief Infant Sleep Questionnaire and International Guide for Monitoring Child Development. RESULTS: The median age (IQR) of the patients was 6 (4.25-9) months, 63.7% of them were male and 50% of them had sleep problems. Male sex (OR: 3.78, p = 0.024, 95% CI, 0.083-0.837), patients with AD who were in the first 3 months after diagnosis (OR: 3.56; 95% CI, 1.220-10.43, p = 0.020), and moderate-severe AD (OR: 5.09; 95% CI, 1.649-15.748, p = 0.005) were determined as risk factors for sleep problems. In all, 12.5% of the patients needed support for one or more developmental areas (gross motor skills, expressive language and communication, receptive language, fine motor skills, relationship, and play). Developmental delay was higher in patients with sleep problems (p = 0.037). Multiple siblings (OR: 14.381; 95% CI, 1.557-132.871, p = 0.019) and the presence of sleep problems (OR: 8.011; 95% CI, 1.764-36.387, p = 0.024) were found to be risk factors for developmental delay. CONCLUSION: Boys with moderate-severe AD within the first 3 months of diagnosis were at increased risk for sleep problems. Children with AD who have multiple siblings and sleep problems should be evaluated for developmental delay and monitored closely.