Psychological Factors Implicated In Development Of Asthma

An eight-year prospective study of 150 children, published in the October 2001 issue of Pediatrics, indicates that parenting difficulties in the first year of a baby’s life increase the chances that the child will develop asthma. Children in the study whose parents coped poorly with the demands of parenting were more than twice as likely to develop asthma by the time they were 6 to 8 years old than were children whose parents did "okay." The report is the first to document psychological factors in the development of asthma.

"Asthma is a complex disease with many contributing factors," said Mary Klinnert, Ph.D., National Jewish pediatric psychologist and lead author of the study. "Many of the children in our study with well-adjusted, caring, effective parents still developed asthma. But our results do indicate that the psychological environment of the child may play a role in the development of asthma."

The researchers followed 150 children from before birth until they were 6 to 8 years old. The children were considered genetically at risk for asthma because all their mothers and some of their fathers had asthma. Ninety-three percent of the mothers were Caucasian, and most families were middle and upper middle class.

The researchers assessed parenting difficulties in a 60- to 90-minute semistructured interview with the mothers three weeks after the baby’s birth, well before the appearance of any asthma symptoms. The interview evaluated a variety of factors including a mother’s emotional state, the support she receives from family and friends, the parents’ care-giving knowledge and sensitivity to the child’s needs. Following the interview, parents were rated on a three-point Parenting Risk Scale, generally summarized as: 1) things are going okay; 2) there are potential problems that should be reassessed later; and 3) there are clear problems in the care and emotional environment of the child.

The researchers also documented respiratory infections, ear infections, and eczema during the first year, and serum IgE levels at six months. IgE, is an antibody associated with allergic reactions.

Forty of the children, 28% of the group, developed asthma by ages 6 to 8. Statistical analysis highlighted two main risk factors that were associated with asthma at age 6 to 8: serum IgE levels and parenting difficulties. An elevated IgE level at six months increased odds of developing asthma by 2.15 times. Parenting difficulties documented at three weeks increased odds of developing asthma by 2.07 times. "It is becoming increasingly clear that a child’s physical environment during the first months of life can promote the development of asthma. Our findings indicate that we should consider the emotional environment as well," said Klinnert. "Our results, however, should not be used to unfairly blame parents. Rather, they should reinforce the importance of providing support and education to new parents and their children."

Klinnert and her colleagues speculate that parenting difficulties may influence the development of asthma through a couple of mechanisms. A poorly coping parent may expose the infant to greater emotional stress, which may alter both immune and inflammatory responses. Both are implicated in asthma. Also, an adult coping well with parenthood may recognize medical problems and intervene earlier than a parent having difficulty, thereby reducing the severity or duration of the infant’s airway inflammation.

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