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Review Article

Factors influencing the family management of children with atopic dermatitis: an integrative review

Sunyeob Choi1orcid researcher_id, Hyewon Shin2orcid researcher_id
Child Health Nursing Research 2025;31(4):187-197.
Published online: October 31, 2025
 

1Assistant Professor, College of Nursing, Dongguk University WISE, Gyeongju, Korea

2Associate Professor, College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author Hyewon Shin College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea Tel: +82-2-3277-3305 Fax: +82-2-3277-2850 E-mail: hyeshin@ewha.ac.kr
• Received: July 30, 2025   • Revised: August 26, 2025   • Accepted: September 3, 2025

© 2025 Korean Academy of Child Health Nursing.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial and No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted non-commercial use, distribution of the material without any modifications, and reproduction in any medium, provided the original works properly cited.

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  • Purpose
    Atopic dermatitis (AD) is prevalent among children and often requires family members to assume significant management responsibilities. Family management affects the child’s disease prognosis and health as well as the family’s functioning and overall quality of life. This integrative study aimed to identify the impact of AD on children and their families and examine child- and family-related factors that influence family management.
  • Methods
    Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), a systematic search was conducted across five electronic databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science, Research Information Sharing Service, and Korean Information Service System) for studies published between 2000 and May 2024. Studies were screened using predefined inclusion and exclusion criteria, and the Mixed Methods Appraisal Tool was used to evaluate methodological quality.
  • Results
    In total, 1,144 records were identified, and 14 studies met the inclusion criteria. The findings indicate that the impact of AD extends to both children, who experience psychological distress, sleep disturbances, impaired academic performance, and negative self-image, and families, who face treatment challenges, disrupted routines, and economic burden. Factors influencing family management were categorized into child-related factors (developmental stage and disease severity) and family-related factors (family burden, social support, coping strategies, and concerns regarding topical steroid use).
  • Conclusion
    Family management of pediatric AD is shaped by a complex interplay of child- and family-related factors. Therefore, interventions should be designed to strengthen coping resources, enhance social support, and reduce the management burden, promoting child well-being and family resilience.
  • Key words: Atopic dermatitis; Child; Disease management; Family; Review
Atopic dermatitis (AD), commonly known as atopic eczema, is a chronic inflammatory skin condition that affecting all age groups, including infants, children, and adults [1]. AD is characterized by severe pruritus and lichenification, in which both the epidermis and portions of the dermis thicken from persistent scratching [2]. Globally, approximately 20% of children are diagnosed with AD [2], with notable prevalence in infancy, preschool, and school-age years [3]. It often coincides with early immune development and greater exposure to external antigens [4].
AD challenges multiple aspects of a child’s development and functioning, affecting their physical, emotional, and social well-being [5]. Pruritus, the primary symptom of AD, causes sleep-related issues, such as poor sleep quality, frequent awakenings, and reduced sleep duration, which contribute to daytime fatigue, impaired cognition, and lower academic achievement [6]. Children with AD often experience anxiety, depression, and feelings of powerlessness, because of its chronic nature [7]. These findings emphasize the importance of family management in mitigating the broader effects of AD on a child’s life.
Given that most affected children are infants or young school-age, they depend on parents for treatment, daily care, and emotional regulation [3,8]. Therefore, family management, rather than child self-management, has become the central framework for addressing the multifaceted impact of AD in this population.
Managing AD requires a holistic approach that involves the family in daily treatment and broader lifestyle adjustments. Family involvement is crucial because AD affects not only the child’s physical symptoms, but also the family’s emotional and psychological well-being [9]. According to Knafl et al. [8], family management is the family’s recognition of the chronic disease and adherence to treatment, reducing stress and supporting long-term adaptation. Effective family management helps children cope by controlling symptoms, fostering adaptation, and improving quality of life [10].
The complex nature of managing AD, especially in infants and young children, places a considerable burden on families. Inadequate family management can exacerbate the child’s condition, resulting in greater emotional stress and healthcare costs [10]. An AD diagnosis often shifts in family dynamics, causing role overload, tension, and parental conflicts over the child’s management [11]. As families focus on managing their children’s symptoms, their attention to other aspects of family functioning may decline, further complicating relationships [12].
Addressing AD from a family-systems perspective is crucial, because it affects the child’s overall wellbeing and development; managing it requires families to adapt to medical, emotional, and environmental challenges.
Accordingly, this integrative study aimed to identify the impact of AD on children and their families, and to examine the child- and family-related factors influencing family management. This study seeks to provide a comprehensive understanding of how AD affects family dynamics and clarify the factors that facilitate or hinder effective family management by synthesizing the available literature.
Ethical statements: This literature review was exempt from Institutional Review Board approval.
1. Study Design
The results of this integrative study were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [13]. This study followed the interview review guidelines by Whittemore and Knafl [14], comprising: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis, and (5) presentation of findings.
2. Problem Identification
This integrative review aimed to (1) identify the impact of AD on children and their families and (2) examine the child- and family-related factors influencing family management.
3. Literature Review
We followed PRISMA guidelines to search for relevant literature [13]. The following five databases were used for the literature search: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Research Information Sharing Service (RISS), and Korean Studies Information Service (KISS). Data were collected from studies published between 2000 and May 2024. Search terms included (“pediatric” OR “child” OR “childhood”), (“parents” OR “family” OR “caregiver”), (“atopic dermatitis” OR “eczema”), and (“care” OR “management” OR “treatment”). The search was limited to articles published in English or Korean. Because AD management typically falls under family responsibility during early childhood and school years, the age range was restricted to under 12 years. Systematic and literature reviews, opinion pieces, editorials, conference proceedings, books, dissertations, and studies published in languages other than English and Korean were excluded. The first author conducted the search, which was reviewed for suitability by other researchers. The literature search process followed the PRISMA flow diagram [13]. In total of 1,144 studies were identified: PubMed (n=53), CINAHL (n=353), Web of Science (n=706), RISS (n=8), KISS (n=22), and a manual search (n=2). Two researchers independently screened the titles and abstracts of 599 articles to identify those addressing AD’s impact and family management. As a result, 14 studies were selected for final inclusion. Articles were excluded based on the following criteria: studies not related to AD (19 articles), studies not focused on children (15 articles), studies not addressing family management (eight articles), and studies specifically targeting adolescents (six articles). The final 14 studies are shown in Figure 1.
4. Data Evaluation
Quality assessment of the literature was conducted using the Mixed Methods Appraisal Tool (MMAT) [15]. The MMAT is a validated tool for assessing qualitative, quantitative non-randomized, quantitative descriptive, quantitative randomized controlled trials and mixed-methods studies [15,16]. The MMAT begins with two questions: “Is the research question clearly stated?” and “Do the collected data align with the research question?” Quality assessment items varied depending on the research method used.
Of the selected articles, eight were quantitative descriptive studies employing a cross-sectional design. Evaluation criteria included sampling strategy, sample representativeness, measurement validity, response bias, and statistical analysis. Two articles (A3 and A11) were quasi-experimental studies using non-randomized study designs. Three articles (A5, A10, and A12) were qualitative studies assessed with qualitative tools. One article (A8) used a mixed methods study evaluation tool. The inter-rater agreement was 98.9% with discrepancies in items related to between-group differences and statistical analysis. Discrepancies were resolved through researcher discussions.
After independently using the MMAT, two researchers scored items as 1 for “yes” and 0 for “no” or “cannot tell”. The researchers then discussed the quality assessment results. The results of the quality appraisal are presented in Table 1.
5. Data Analysis
The selected articles were summarized in terms of research design, participants, key variables, strengths, and limitations, as shown in Table 2.
This study revealed two major domains (Figure 2): (1) the impact of AD on children and families, which constitutes the foundation for understanding family management and (2) factors influencing family management of AD. Extracted data encompassed children’s developmental status, AD severity, family burden, social support, and coping strategies. These variables were analyzed to identify recurring patterns and key determinants of family management in families of children with AD.
1. Family Management of Children with AD
Family management in the context of AD involves recognizing the chronic nature of the condition and adhering to treatment plans to cope with associated stress [8,17].
AD, an allergic skin condition exacerbated by excessive immunoglobulin E response to antigens, often coexists with food allergies and necessitates dietary management [18]. Dust and pollen can worsen symptoms, prompting parents to control humidity, temperature, and ventilation. Comprehensive management of detergents, clothing, and other daily-life factors is essential [19].
Recent treatment guidelines for AD have emphasized the importance of family management [2]. Families often struggle with complex AD management [20], including skin moisturization, dietary control, outpatient visits, and associated psychological burdens [21]. Inadequate family management may require additional healthcare support, increasing economic burdens [10]. Stress caused by a child’s AD can create a vicious cycle, impairing family functioning and management [10,22].
2. Factors Affecting Family Management of Children with AD

1) Children-related factors

(1) Developmental status of children

The level of management required for chronic conditions, such as AD, varies according to the child’s developmental stage [23]. Younger children with AD require more time and effort to manage [24]. Families of preschool children with chronic conditions spend considerable time on management and experience difficulties in performing caregiving roles [11,25]. Recognizing symptoms in preschool children is difficult due to limited language and cognitive abilities [24].
As children develop, self-management abilities improve, reducing caregiving difficulties [26]. Family perceptions and coping abilities vary with the child’s developmental stage [25]. Families tend to perceive younger children as more vulnerable to diseases and emotional difficulties [27].

(2) Severity of AD

AD severity influence disease management, with families spending more time and resources as severity rises [28]. The degree to which families reorganize their daily lives is determined by the severity of their children’s chronic conditions [24]. Severe AD, with frequent allergy outbreaks, requires 1.4 to 1.7 times more management time than mild cases due to outpatient visits and medication needs [29]. The management requirements for clothing, environment, and food also increase with the severity of AD, resulting in management costs that are 2–3 times higher than those for mild cases [29,30].
Chronic condition severity also impacts family functioning, social support, and coping resources. Families face management difficulties due to uncertainties regarding treatment and psychological issues, increasing the need for more social support [31]. Severe AD significantly burdens family health management, reducing social and economic functioning [32].

2) Family-related factors

(1) Burden of family

A family experiences physical, psychological, social, and financial burdens when a child is diagnosed with a chronic condition [12,30]. The primary caregiver manages the child’s symptoms, dietary needs, and environmental factors, whereas other family members typically perform household duties to support the primary caregiver and often experience physical and mental challenges [12,30].
The emotional burden and challenges experienced by parents of children with chronic conditions can impair parental and child treatment adherence [22]. Additionally, this can lead to disappointment and frustration and reduce their confidence in managing the child’s illness, thereby negatively affecting disease management [22,28,31]. They face dilemmas related to balancing the child’s autonomy with disease management [33], creating an imbalance between the disease’s demands and the family’s capabilities, which negatively affects family management [34].
Additionally, parents face challenges resulting from the added role of disease management along with their existing parenting roles, leading to increased stress and difficulty [31]. As the family focuses on children with chronic conditions, marital cohesion may decrease, and interaction with other siblings may become challenging [35].

(2) Social support

Social support acts as a buffer against the negative effects of stress and enhances family flexibility, adaptability, problem-solving skills, and overall coping abilities during crises [36].
Families of children with chronic illnesses often experience social isolation, leave their jobs, and have limited interpersonal relationships when managing their children’s conditions [37]. Support from family and friends has been shown to alleviate emotional difficulties in families of children with chronic illnesses [38]. Information provision and emotional support from healthcare professionals enhance a family’s understanding of their child’s chronic condition, improving their ability to make treatment decisions [34,38]. Families receiving support from healthcare professionals tend to perceive a child’s prognosis optimistically, demonstrating higher levels of management skills and overall care [3]. However, social support is crucial for sustaining family care, particularly for long-term management, which requires extended support [32].

(3) Family’s coping mechanisms

The families of children with chronic illnesses adapt to challenges through coping mechanisms [32,39]. The coping abilities of families of children with chronic illnesses have been shown to contribute to the improvement of the children’s disease course and overall health status [40]. Coping skills alleviate difficulties experienced by families of children with chronic illnesses, enhance their ability to overcome challenges [30,32], help maintain balance while managing illnesses [30], and improve confidence in disease management, leading to higher levels of care [41].
In situations involving children with chronic illnesses, families with strong coping abilities are more likely to sustain their management efforts, positively influence their children’s prognoses [35], perceive their illness positively, and respond actively [41]. In the context of managing a child’s AD, the coping abilities of the family have a more significant impact than disease severity or challenges experienced by the family [32,42].

(4) Concerns about topical steroid use

Despite the effectiveness of basic skin care and topical corticosteroids (TCS) in managing mild-to-moderate AD in children, many parents struggle to adhere to the prescribed treatment plans [43]. The primary obstacle to consistent adherence is a pervasive fear of corticosteroids [20]. This fear is often rooted in misconceptions and misinformation regarding corticosteroids, such as the belief that they are addictive or can cause long-term side effects, like skin thinning [20]. Additionally, parents may be concerned about the possibility of systemic absorption and adverse effects on their child’s growth and development [20]. These concerns can lead to hesitation or outright refusal to use TCS as prescribed, even when they are the most effective treatment option [3,20].
This study highlights the multifaceted effects of AD on children and their families. AD affects the physical, emotional, and social well-being of children, thereby hindering their growth and development [2,44]. Children with AD often lack self-management skills, and responsibilities for medication, diet, and environmental management typically fall to their parents [9]. Families managing children with AD face significant challenges due to the complexity of dietary, environmental, and medication interventions [45], which can reduce treatment adherence, family confidence, and coping capacity.
Drawing upon this theoretical framework, this study aimed to identify the factors influencing family management among families with children with AD. The results indicate that both child- and family-related characteristics contribute to family management of AD. Among child-related attributes, developmental stage and disease severity were identified as influential factors. Younger children require more family time and effort for management, and families experience difficulties before establishing a stable socioeconomic foundation [24].
Family-related attributes influencing AD management, include family burden, perceived social support, coping strategies, and fear of steroid use. Meanwhile, AD diagnosis broadly impacts the entire family, causing physical, psychological, and social challenges. Daily challenges negatively affect treatment adherence reduce families’ confidence in managing the condition. Social support alleviates the emotional difficulties experienced by families, enhances problem-solving abilities, and positively contributes to disease management [38]. Family coping mechanisms foster positive responses, alleviating difficulties, enhance coping abilities, and support effective disease management [32]. Misconceptions about steroids and concerns regarding potential side effects lead to parental reluctance and consequently suboptimal treatment adherence [20,46].
Interventions targeting family support are essential to address these challenges. Counseling and education can enhance family resilience and coping skills, whereas support group meetings provide opportunities for interaction and experience sharing among families. Family-centered activities, such as AD camps, help alleviate psychological burdens and foster supportive networks. For example, the American Academy of Dermatology Association provides free camp programs for children with chronic skin conditions [47]. Programs such as rest assistance and after-school care can mitigate physical exhaustion associated with disease management. A multidisciplinary team of nurses, physicians, family specialists, and psychological counselors can provide guidance to promote family functioning and effective disease management. Broader initiatives, such as public campaigns, educational programs, and policy expansions, can further raise awareness about AD and create a more supportive environment for affected families.
This study has several limitations. As an integrative study, a quantitative meta-analysis to measure the magnitude of the impact of family management on children with AD was not possible. Therefore, future meta-analysis studies should quantify the effect of family management and identifying influencing factors through outcome evaluation. Second, all studies included in this study were cross-sectional. Longitudinal studies are needed to understand changes in family management and its influencing factors over time.
AD is a chronic condition that affects both children and their families. It involves recurring cycles of exacerbation and remission, and can progress to allergic rhinitis, asthma, and other related conditions, thereby necessitating ongoing management. Since AD is most prevalent in children, much of the responsibility for its management lies with the family. Thus, the influencing factors must be identified to enhance family management. The review results indicate that family management is influenced by children’s characteristics, including their developmental stage, severity and duration of the illness, and family-related factors, such as family functioning, resilience, social support, coping strategies, and concerns about topical steroid use. Therefore, interventions to enhance the family management of AD should consider child- and family-related attributes. Thus, these interventions may include counseling and education, family activities, strengthening social support, and the promotion of social awareness through campaigns and policy expansion.

Authors’ contribution

Conceptualization: SC, HS. Methodology: SC. Data collection: SC. Formal analysis: SC. Validation: SC, HS. Investigation: SC. Supervision: HS. Project administration: SC. Writing–original draft: SC. Writing–review and editing: SC, HS. Final approval of published version: SC, HS.

Conflict of interest

No existing or potential conflict of interest relevant to this article was reported.

Funding

No funding was received for this study.

Data availability

Please contact the corresponding author for data availability.

Acknowledgements

We used part of the first author’s doctoral thesis for this study.

Figure 1.
Flow diagram of literature review.
chnr-2025-027f1.jpg
Figure 2.
Summary of the review.
chnr-2025-027f2.jpg
Table 1.
Results of quality appraisal using Mixed Methods Appraisal Tool
Article no. 1. Qualitative studies 2. Non-randomized studies 3. Quantitative descriptive studies 4. Mixed method studies Total score
Q1.1 Q1.2 Q1.3 Q1.4 Q1.5 Q2.1 Q2.2 Q2.3 Q2.4 Q2.5 Q3.1 Q3.2 Q3.3 Q3.4 Q3.5 Q4.1 Q4.2 Q4.3 Q4.4 Q4.5
A1 Yes Yes Yes Yes Yes 5
A2 Yes Yes Yes Yes Yes 5
A3 Yes Yes Yes No Yes 4
A4 Yes Yes Yes Yes Yes 5
A5 Yes Yes Yes Yes Yes 5
A6 Yes Yes Yes Yes Yes 5
A7 Yes Yes Yes Yes Yes 5
A8 Yes Yes Yes Yes Yes 5
A9 Yes Yes Yes Yes Yes 5
A10 Yes Yes Yes Yes Yes 5
A11 Yes Yes Yes Can’t tell Yes 4
A12 Yes Yes Yes Yes Yes 5
A13 Yes Yes Yes Yes Yes 5
A14 Yes Yes Yes Yes Yes 5
Table 2.
Summary of selected studies
Article First author (year) Design Participant Aim Factors Strength/limitation
A1 Barbarot (2022) Cross-sectional study 7,465 Pairs of pediatric participants with AD and their parents or caregivers To evaluate the impact of AD on families of pediatric patient - Severity of AD S: Conducting the study across multiple countries
- Age of children L: No control group, participation in the study was limited to those with online access
- Geographic regions
A2 Barlkrishman (2003) Cross-sectional study 49 Parents of children (6 months–12 years old) with AD To assess how parent caregivers are affected by their child’s AD, and how certain parent caregiver characteristics and perceptions affect the family - Severity of AD S: Addresses an important aspect of AD by examining its impact on the family unit
- Financial concern about the child’s condition L: Small sample size, conducted the study in a single region
A3 Beattei (2006) Quasi-experimental study Parents of 203 infants (mean age 19.8 months) with AD attending pediatric dermatology To examine the impact of an initial consultation with a dermatology team on AD severity and QoL impairment from the parent’s perspective - Severity of AD S: The usefulness of these measures in routine clinical management of AD
L: No control group
A4 Im (2020) Cross-sectional study 146 Familes of atopic disease To propose clusters of family management styles in the Korean families of children with chronic atopic disease - Family functioning S: Provided strong evidence linking how families manage chronic atopic diseases in children and the overall functioning of the family unit.
- Social support L: Convenience sampling from a limited location
A5 Kim (2017) Qualitative study 9 Mothers of children with AD To understand the experience of family management style in mothers who have children with AD - Age of children S: In-depth exploration of the lived experiences
- Parental method of grandparents of children L: Conducted with mothers, the majority of children had mild AD
- Burden of management
A6 Kobusiewicz (2023) Cross-sectional study design 88 Mothers of children with AD and 57 mothers of children without AD as controls To compare strategies for coping with stress in mothers of children with and without AD, as well as to investigate the relationship between coping strategies of mothers of affected children and AD variables, stress intensity, and quality of life. - Severity of AD S: Have compare group
- Burden of family L: Only mothers were involved
- Perceived stress level
- Coping strategies
A7 Mitchell (2016) Cross-sectional study design 64 Parent-child dyads To examine relationships between child, parent, and family variables, parent-reported and directly observed child and parent behavior, parents’ self-efficacy with managing difficult child behavior, self-reported parenting strategies, and disease severity. - Severity of AD S: Conducted both children and parents
- Child behavior problem L: Small sample size
- Parent depression
- Parenting stress
- Parenting conflict
- Relationship satisfaction
A8 O'connor (2021) Mixed methods study 168 Parents of children with AD To assess the burden of treatment of AD on children and caregivers using mixed methods - Family coping S: Use of mixed methods, sampled from mild to severe, the adequate sample sizes in both methods
- Family burden L: Morbidities such as food allergy, airways disease, and neuropsychiatric disease was not explored
A9 Ricci (2007) Cross-sectional study Parents of 45 children aged 3–84 months with AD To determine the ways in which AD affects the lives of young Italian children and their families - Severity of AD S: Focusing on cultural relevance
L: Small sample size
A10 Santer (2012) Qualitative study 31 Caregivers carers of children aged ≤5 years with AD To explore parents’ and carers’ views of childhood eczema and its treatment - Worry about corticosteroid S: Despite its qualitative nature, the study involved a substantial number of participants.
- Confidence of management L: Lack of objective data
- Severity of AD
A11 Shin (2013) Quasi-experimental study 12 Families of children aged 5–11 years old diagnosed with AD To test the effect of family participated Healing Camps with the application of family life habit improvement on AD - Healing camps: education, tracking, counseling S: The first attempt at a long-term camp in Korea, regular check-ups were conducted.
L: The low attendance rate
A12 Sivyer (2022) Qualitative study 32 Studies and interviews with 30 parents/carers To develop an online behavioral intervention to help parents/carers manage and co-manage their child's AD - Incomplete knowledge and skills around managing AD S: Use of a theory-, evidence-, and person-based approach
- Concerns and doubts about the management L: Most of participants were mothers
A13 Son (2016) Cross-sectional study 109 Korean mothers caring for a child with AD To compare family management style according to severity in children with AD - Severity of AD S: Identifying family management according to severity of AD
L: Self-report questionnaire, conducted the study in a single region
A14 Son (2018) Cross-sectional study 168 Korean mothers caring for a child with atopic dermatitis under the age of 13 To identify the variables that affect family management of childhood AD and establish a prediction model based on Bandura’s self-efficacy theory - Management effort S: Theory-based research
- Self-efficacy L: Low reliability of measurement

AD, atopic dermatitis; S, strength; L, limitation; QoL, quality of life.

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      Factors influencing the family management of children with atopic dermatitis: an integrative review
      Child Health Nurs Res. 2025;31(4):187-197.   Published online October 31, 2025
      DOI: https://doi.org/10.4094/chnr.2025.027
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      Factors influencing the family management of children with atopic dermatitis: an integrative review
      Child Health Nurs Res. 2025;31(4):187-197.   Published online October 31, 2025
      DOI: https://doi.org/10.4094/chnr.2025.027
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      Factors influencing the family management of children with atopic dermatitis: an integrative review
      Image Image
      Figure 1. Flow diagram of literature review.
      Figure 2. Summary of the review.

      Figure 1.

      Figure 2.

      Factors influencing the family management of children with atopic dermatitis: an integrative review
      Article no. 1. Qualitative studies 2. Non-randomized studies 3. Quantitative descriptive studies 4. Mixed method studies Total score
      Q1.1 Q1.2 Q1.3 Q1.4 Q1.5 Q2.1 Q2.2 Q2.3 Q2.4 Q2.5 Q3.1 Q3.2 Q3.3 Q3.4 Q3.5 Q4.1 Q4.2 Q4.3 Q4.4 Q4.5
      A1 Yes Yes Yes Yes Yes 5
      A2 Yes Yes Yes Yes Yes 5
      A3 Yes Yes Yes No Yes 4
      A4 Yes Yes Yes Yes Yes 5
      A5 Yes Yes Yes Yes Yes 5
      A6 Yes Yes Yes Yes Yes 5
      A7 Yes Yes Yes Yes Yes 5
      A8 Yes Yes Yes Yes Yes 5
      A9 Yes Yes Yes Yes Yes 5
      A10 Yes Yes Yes Yes Yes 5
      A11 Yes Yes Yes Can’t tell Yes 4
      A12 Yes Yes Yes Yes Yes 5
      A13 Yes Yes Yes Yes Yes 5
      A14 Yes Yes Yes Yes Yes 5
      Article First author (year) Design Participant Aim Factors Strength/limitation
      A1 Barbarot (2022) Cross-sectional study 7,465 Pairs of pediatric participants with AD and their parents or caregivers To evaluate the impact of AD on families of pediatric patient - Severity of AD S: Conducting the study across multiple countries
      - Age of children L: No control group, participation in the study was limited to those with online access
      - Geographic regions
      A2 Barlkrishman (2003) Cross-sectional study 49 Parents of children (6 months–12 years old) with AD To assess how parent caregivers are affected by their child’s AD, and how certain parent caregiver characteristics and perceptions affect the family - Severity of AD S: Addresses an important aspect of AD by examining its impact on the family unit
      - Financial concern about the child’s condition L: Small sample size, conducted the study in a single region
      A3 Beattei (2006) Quasi-experimental study Parents of 203 infants (mean age 19.8 months) with AD attending pediatric dermatology To examine the impact of an initial consultation with a dermatology team on AD severity and QoL impairment from the parent’s perspective - Severity of AD S: The usefulness of these measures in routine clinical management of AD
      L: No control group
      A4 Im (2020) Cross-sectional study 146 Familes of atopic disease To propose clusters of family management styles in the Korean families of children with chronic atopic disease - Family functioning S: Provided strong evidence linking how families manage chronic atopic diseases in children and the overall functioning of the family unit.
      - Social support L: Convenience sampling from a limited location
      A5 Kim (2017) Qualitative study 9 Mothers of children with AD To understand the experience of family management style in mothers who have children with AD - Age of children S: In-depth exploration of the lived experiences
      - Parental method of grandparents of children L: Conducted with mothers, the majority of children had mild AD
      - Burden of management
      A6 Kobusiewicz (2023) Cross-sectional study design 88 Mothers of children with AD and 57 mothers of children without AD as controls To compare strategies for coping with stress in mothers of children with and without AD, as well as to investigate the relationship between coping strategies of mothers of affected children and AD variables, stress intensity, and quality of life. - Severity of AD S: Have compare group
      - Burden of family L: Only mothers were involved
      - Perceived stress level
      - Coping strategies
      A7 Mitchell (2016) Cross-sectional study design 64 Parent-child dyads To examine relationships between child, parent, and family variables, parent-reported and directly observed child and parent behavior, parents’ self-efficacy with managing difficult child behavior, self-reported parenting strategies, and disease severity. - Severity of AD S: Conducted both children and parents
      - Child behavior problem L: Small sample size
      - Parent depression
      - Parenting stress
      - Parenting conflict
      - Relationship satisfaction
      A8 O'connor (2021) Mixed methods study 168 Parents of children with AD To assess the burden of treatment of AD on children and caregivers using mixed methods - Family coping S: Use of mixed methods, sampled from mild to severe, the adequate sample sizes in both methods
      - Family burden L: Morbidities such as food allergy, airways disease, and neuropsychiatric disease was not explored
      A9 Ricci (2007) Cross-sectional study Parents of 45 children aged 3–84 months with AD To determine the ways in which AD affects the lives of young Italian children and their families - Severity of AD S: Focusing on cultural relevance
      L: Small sample size
      A10 Santer (2012) Qualitative study 31 Caregivers carers of children aged ≤5 years with AD To explore parents’ and carers’ views of childhood eczema and its treatment - Worry about corticosteroid S: Despite its qualitative nature, the study involved a substantial number of participants.
      - Confidence of management L: Lack of objective data
      - Severity of AD
      A11 Shin (2013) Quasi-experimental study 12 Families of children aged 5–11 years old diagnosed with AD To test the effect of family participated Healing Camps with the application of family life habit improvement on AD - Healing camps: education, tracking, counseling S: The first attempt at a long-term camp in Korea, regular check-ups were conducted.
      L: The low attendance rate
      A12 Sivyer (2022) Qualitative study 32 Studies and interviews with 30 parents/carers To develop an online behavioral intervention to help parents/carers manage and co-manage their child's AD - Incomplete knowledge and skills around managing AD S: Use of a theory-, evidence-, and person-based approach
      - Concerns and doubts about the management L: Most of participants were mothers
      A13 Son (2016) Cross-sectional study 109 Korean mothers caring for a child with AD To compare family management style according to severity in children with AD - Severity of AD S: Identifying family management according to severity of AD
      L: Self-report questionnaire, conducted the study in a single region
      A14 Son (2018) Cross-sectional study 168 Korean mothers caring for a child with atopic dermatitis under the age of 13 To identify the variables that affect family management of childhood AD and establish a prediction model based on Bandura’s self-efficacy theory - Management effort S: Theory-based research
      - Self-efficacy L: Low reliability of measurement
      Table 1. Results of quality appraisal using Mixed Methods Appraisal Tool

      Table 2. Summary of selected studies

      AD, atopic dermatitis; S, strength; L, limitation; QoL, quality of life.

      Table 1.

      Table 2.

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