Early Childhood Nutrition and Development in Atopic Families from Northeastern Bulgaria

Abstract

Objectives: Early environmental factors have a significant impact on the development of atopic conditions in children. Breastfeeding has been highlighted for its role in enhancing both immune support and cognitive development. Early allergic conditions and maternal behaviors are linked to cognitive and neurodevelopmental challenges. Our study aims to compare children from atopic families focusing on early nutrition and the neuropsychological development of children, especially in the presence of an allergic predisposition. Materials and methods: The study included 120 children with a family history of allergies (55% boys). Children were divided into group A, children breastfed for at least two months, and group B, children breastfed for less than two months or fed with formula. The study measurements and outcomes included demographic and social data, medical data, the smoking status of the parents, breastfeeding and early feeding practices, and anthropometric measurements. The assessment of the neurological development was carried out with a validated Developmental Profile-3 questionnaire. Diagnosis of allergic conditions was carried out with the SCORAD (SCORing Atopic Dermatitis) questionnaire for assessing atopic dermatitis; the CoMiSS (Cow’s Milk-Related Allergy Symptom Score) questionnaire for potential cow’s milk protein allergy and Prick testing and elimination-provocation protocol were used to confirm allergic status in children with atopic conditions. Data were analyzed using Jamovi 2.2.2 software, with statistical significance set at p ≤ 0.05. Results: The age of the examined children was 13 ÷ 31 months, the age of the mothers was 21 ÷ 42 years, and that of the fathers was 22 ÷ 44 years. Educational levels among mothers were 68.35% (n = 54) with higher education in group A and 61.5% (n = 24) in group B, compared to fathers with rates of higher education of, respectively, 54.3% (n = 44) and 38.5% (n = 15). The average gestational age of the children was 38.8 ± 1.08 weeks, and the relative share of cesarean delivery—50.8% (n = 61)—was slightly higher than vaginal delivery. Anthropometric results (HAZ, WAZ, BMIAZ) did not show a statistically significant influence of the type of feeding (breastfeeding, standard formula, or hydrolyzed formula) on growth during the first two months after birth (p > 0.05). During the study period, a significant number of the children developed allergic conditions, which were more common in children from group A—43.2% (n = 35)—compared to group B—38.5% (n = 15). In the families included in the study, mothers smoked more often (53.3%; n = 64) than fathers (43.3%; n = 52), and 13.3% (n = 16) of the women smoked during pregnancy. Children’s neuropsychological development, assessed with the DP-3 questionnaire, according to the duration of breastfeeding, does not show statistically significant differences for the five functional areas (“Physical development”, “Adaptive behavior”, “Social-emotional” Development”, “Cognitive development “, and “Communication”) or the overall development of children from both groups. The neuropsychological development (DP-3) of the group A children showed correlations with the presence of atopic dermatitis, parents’ age, father’s level of education, mother’s smoking during pregnancy, number of cigarettes smoked by the mother per day, and cesarean delivery. Maternal smoking (number of cigarettes per day) had significant negative correlations with all areas of children’s neuropsychological development, which were most pronounced with physical (rho = −0.352; p = 0.001) and overall development (rho = −0.329; p= 0.003). Cesarean delivery moderately correlated with physical development (rho = 0.292; p = 0.008) and adaptive behavior (rho = −0.294; p = 0.008). In group B, neuropsychological development (DP-3) correlates most clearly with allergic conditions (allergy at two years of age and atopic dermatitis), as well as with maternal smoking during pregnancy, with a strong negative correlation with physical development (rho = −0.510; p = 0.001). Conclusions: Our study reinforces the link between early feeding practices, neuropsychological development, and allergic conditions, emphasizing the lasting effects they have on children’s neurological health. However, limitations such as the relatively small sample size and reliance on parental reporting may affect the generalizability of the findings. Future studies with larger cohorts and objective biomarkers for allergic conditions are needed to further validate these results.

1. Introduction

Early environmental factors play a crucial role in the development of atopic traits. Over recent decades, with the rise of Western lifestyles and urbanization, the prevalence of atopic conditions such as atopic dermatitis (AD), allergic rhinitis, asthma, and food allergies has significantly increased [1]. This rise has been particularly evident in children [2], with urban environments and unhealthy maternal lifestyles seemingly contributing to an increased risk of atopic diseases in offspring [3].

The hygiene hypothesis postulates that increased cleanliness and reduced exposure to microorganisms in early childhood disturb the intestinal microbiome, leading to abnormal immune responses. More recent research suggests that vitamin D deficiency exacerbates this issue by reducing immune tolerance and contributing to aberrant immune responses. The biologically active form of vitamin D, 1,25(OH)2D3, plays a key role in immune modulation by interacting with vitamin D receptors (VDRs) in immune cells and influencing gut microbiota composition [4].

Breastfeeding is widely recognized for its numerous benefits for infants and mothers, ranging from nutritional value to immune system support. Beyond these well-documented short-term advantages, researchers have explored the relationship between breastfeeding and cognitive development, with duration being a key factor [4,5,6]. Research has consistently shown a positive correlation between breastfeeding and improved cognitive outcomes in children, though the strength of the relationship can vary depending on breastfeeding duration [7]. Breastfeeding provides essential nutrients, such as long-chain polyunsaturated fatty acids (LCPUFAs), which are vital for brain development. LCPUFAs, specifically docosahexaenoic acid (DHA), have been shown to improve children’s cognitive performance [8,9,10]. These nutrients contribute to synaptogenesis and neurogenesis, which are crucial during the first years of life when the brain undergoes rapid development [9].

Beyond nutrition, breastfeeding fosters maternal–infant bonding, enhancing a child’s emotional and cognitive development. The act of breastfeeding involves skin-to-skin contact, eye contact, and other forms of interaction that contribute to social and emotional development, further promoting cognitive functions [11]. Cognitive development in childhood is positively influenced by the duration of breastfeeding [12]. Additionally, the allergic phenotype in early childhood can affect neurodevelopment. Early childhood allergic diseases have been identified as predictors of later neurodevelopmental outcomes [13,14], with atopic dermatitis during early childhood being associated with an increased risk of neurodevelopmental dysfunction, including both fine and gross motor skills [15].

Executive function, which includes cognitive skills like planning, inhibition, and attention, is particularly vulnerable to prenatal nicotine exposure. Research has shown that maternal smoking increases the risk of attention deficit hyperactivity disorder (ADHD) and other executive function impairments in children [16]. In a cohort study from 2015, children of mothers who smoked during pregnancy were found to have a 42% increased likelihood of developing ADHD, with significant deficits in attention regulation and impulse control [17].

Maternal smoking during pregnancy also has implications for quantitative reasoning and mathematics performance. Children exposed to prenatal tobacco smoke often demonstrate lower performance in math-related tasks, which can hinder academic achievement in school [18]. This is likely due to disruptions in the development of the parietal cortex, a brain region involved in numerical processing. Quantitative scores were significantly lower in children whose mothers smoked during pregnancy, reinforcing the link between prenatal nicotine exposure and cognitive impairments [19].

Neurodevelopment covers a wide range of areas, including motor coordination, cognitive skills, language development, and social–emotional functioning. Common neurodevelopmental assessment tests include a variety of scales and questionnaires such as the Bayley Scales of Infant and Toddler Development (Bayley-III), the Denver Developmental Screening Test (DDST), and the Wechsler Preschool and Elementary Intelligence Scale (WPPSI), Ages and Stages Questionnaires (ASQ) and Developmental Profile-3 Test (DP-3) [20]. Assessments can detect conditions such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and learning disabilities, allowing for personalized treatment plans that address the child’s specific needs.

Early childhood nutrition plays a pivotal role in shaping the developmental trajectory of individuals, particularly within atopic families where genetic predispositions to allergic diseases are prevalent [21]. The intricate interplay between genetic, epigenetic, and environmental factors significantly influences the manifestation of atopic conditions, necessitating a comprehensive understanding of these interactions to devise effective prevention and treatment strategies [22]. It has become clear that early exposure to food through the skin may trigger allergies, while tolerance develops in the gut, and the local microbiota can also affect how the immune system balances tolerance and allergies in the gut [23]. Early interventions can narrow the window of time in which children are not protected by tolerance [23].

Research Gaps and Future Directions

More region-specific studies are needed to assess how local diets and environmental factors influence atopic disease prevalence in Northeastern Bulgaria. There is a lack of longitudinal studies tracking dietary intake and health outcomes from infancy to adulthood, limiting causal insights. Further research should explore the intergenerational effects of nutritional interventions and the role of technology-driven solutions in improving dietary practices among atopic families. A deeper understanding of dietary and environmental factors affecting atopic families could lead to more effective prevention strategies and improved health outcomes.

2. Objective of the Study

The aim of our study is to compare children from atopic families who were breastfed for at least two months with those who were breastfed for less than two months. We will analyze demographic characteristics, the presence of diagnosed allergies at the time of the study, maternal habits (such as smoking), and the neuropsychological development (NPD) of the children. Examining these factors will enhance our understanding of the challenges associated with early nutrition and highlight the need for targeted interventions focusing on early nutrition and the neuropsychological development of children, especially in the presence of an allergic predisposition.

3. Methodology

3.1. Study Design and Setting

This prospective cohort study was conducted in Varna from 2017 to 2020, following approval from the Ethics Committee for Research at the Medical University “Prof. Dr. P. Stoyanov”—Varna (Protocols No. 60/23.02.2017 and No. 91/21.02.2020).

3.2. Participants and Recruitment

The study included 120 children with a family history of allergies, of which 66 were boys (55%). Based on breastfeeding duration and formula feeding, the children were divided into two groups:

Group A—children breastfed for at least two months;

Group B—children breastfed for less than two months or fed with formula.

Participants were invited for follow-up visits by phone, and their parents were interviewed to assess their eligibility for inclusion in the study. Parents signed an informed consent form after being informed about the study’s objectives, methods, and associated risks, ensuring the confidentiality of their personal information.

3.3. Eligibility Criteria

3.3.1. Inclusion Criteria

Healthy full-term infants with a birth weight above 2500 g;

Gestational age above 37 weeks;

Age between 0 and 4 days at the beginning of the study;

Family history of allergic diseases (mother, father, siblings);

Signed informed consent from parents/guardians for participation in the study;

Parental willingness to monitor the health status of the children.

3.3.2. Exclusion Criteria

Premature birth or immaturity;

Coexisting diseases at the start of the study;

Birth asphyxia;

Birth trauma;

Presence of congenital malformations;

Genetic diseases.

4. Study Measurements and Outcomes

4.1. Demographic and Social Data:

Parents completed a questionnaire regarding the socio-demographic characteristics of the family, including the child’s gender, age, ethnicity, place of residence (urban/rural), parents’ education and age, family size, and other factors.

4.1.1. Medical Data

Mode of delivery;

Gestational age and birth weight;

Past and current history of doctor-diagnosed allergies in the family, including types of allergies (allergic rhinoconjunctivitis, atopic dermatitis/eczema, urticaria, food allergy, asthma) through a standardized questionnaire.

4.1.2. Smoking Status

Father’s smoking status—number of cigarettes per day;

Mother’s smoking status—number of cigarettes per day and smoking during pregnancy.

4.1.3. Breastfeeding and Early Feeding Practices

Information on breastfeeding practices and early feeding up to the time of the study was collected through individual surveys when the children were between two and three years old.

4.1.4. Assessment of Neuropsychological Development

The neuropsychological development of the children was assessed using the validated DP-3 (Developmental Profile-3) questionnaire and compared with age-appropriate standards.

The DP-3 methodology, adapted for Bulgarian use, is designed to assess the development of children from birth to 12 years and 11 months.

Data provided by parents/caregivers covered five scales, the “Physical Development”, “Adaptive Behavior Scale”, “Social-Emotional Scale”, “Cognitive Scale”, and “Communication Scale”, with a varying number of questions (34 to 38).

The overall developmental index was calculated from the scores across the five key functional areas, with higher scores indicating better development.

4.2. Clinical Data

Diagnosis of allergic conditions in children by the end of the study:

The SCORAD (SCORing Atopic Dermatitis) questionnaire for assessing atopic dermatitis;

The CoMiSS (Cow’s Milk-Related Allergy Symptom Score) questionnaire for potential cow’s milk protein allergy;

A prick testing and elimination-provocation protocol for confirming allergic status in children with atopic conditions.

4.3. Nutritional Status Assessment

Anthropometric measurements, including height, weight, and head circumference were monitored at different ages (birth and two years), with Z-scores calculated based on WHO growth charts.

5. Data Management and Analysis

Data were securely collected, anonymized to ensure confidentiality, and managed electronically. To minimize potential measurement errors due to parental reporting, responses regarding smoking status, length of breastfeeding, and early feeding practices were cross-validated with medical records and follow-up interviews where possible. Analyses were conducted using appropriate statistical methods to compare the outcomes in children who were breastfed for at least two months versus those who were breastfed for less than two months or were formula-fed. Descriptive statistics were applied to summarize the demographic data. A Student’s t-test was used to compare the means between two independent samples, and chi-square tests were employed to analyze categorical variables. Correlation analysis was conducted to explore relationships and determine the strength of their influence. Additionally, potential confounding factors, such as regional differences in healthcare access, were considered during the analysis to ensure the robustness of the findings. Statistical analysis was performed using Jamovi 2.2.2 software, with statistical significance set at p ≤ 0.05.

6. Results

6.1. Socio-Demographic Profile of the Study Participants

The study examined 120 children at high risk of allergies and their parents. More than half of the children were male—66 (55%). The children’s ages ranged from 13 to 31 months, with a mean age of 24.01 ± 3.87 months. The distribution of children according to ethnicity revealed that the majority were of Bulgarian origin, 90.8% (n = 109), followed by Turkish (5.8%; n = 7), mixed ethnicity (2.5%; n = 3), and other origins (0.9%; n = 1).

The mothers of the children were aged between 21 and 42 years, with a mean age of 30.59 ± 4.53 years, while the fathers were aged between 22 and 44 years, with a mean age of 33.48 ± 4.62 years. The difference in the mothers’ mean age based on breastfeeding duration was negligible, with group A (30.7 years) having a slightly higher mean age compared to group B (30.4 years). About two-thirds of the mothers breastfed for more than two months (group A: n = 81; group B: n = 39).

The educational level of the parents indicated a higher level of education among the mothers, with 68.35% (n = 54) in group A and 61.5% (n = 24) in group B having higher education (Bachelor’s/Master’s degrees), compared to 54.3% (n = 44) and 38.5% (n = 15) of fathers, respectively.

The demographic characteristics of the participants, stratified by breastfeeding duration, are presented in

Table 1. Socio-demographic characteristics stratified by breastfeeding duration (group A: breastfed for at least two months; group B: breastfed for less than two months or formula-fed).

Category	Variable	Group A More than 2 Months (n = 81)	Group B Less than 2 Months (n = 39)
Demographics	Gender
	Male	41 (50.6%)	25 (64.1%)
	Female	40 (49.4%)	14 (35.9%)
	Mother’s Age (years)	30.7 (4.6)	30.4 (4.5)
	Father’s Age (years)	33.3 (4.6)	33.8 (4.8)
Parental Factors	Mother’s Education
	Till Secondary	25 (31.65%)	15 (38.5%)
	Bachelor/Master	54 (68.35%)	24 (61.5%)
	Father’s Education
	Till Secondary	36 (44.4%)	23 (59.0%)
	Bachelor/Master	44 (54.3%)	15 (38.5%)

.

The distribution of children by gender in group A was almost equal—50.6% male (n = 41) and 49.4% female (n = 40)—while in group B, the proportion of boys was higher at 64.1% (n = 25) compared to girls at 35.9% (n = 14) (Figure 1).

6.2. Medical Data and Smoking Status

The medical characteristics of the children at risk of allergies and the smoking status of their families are summarized in

Table 2. Medical data for children and smoking status of parents, stratified by breastfeeding duration (organized by category).

Category	Variable	Group A More than 2 Months (n = 81)	Group B Less than 2 Months (n = 39)	T-Value/Chi-square	df	p-Value
Health Indicators	Cesarean Section					0.104
	Yes	37 (45.7%)	24 (61.5%)
	No	44 (54.3%)	15 (38.5%)
	Birth Weight (grams)	3385.3 (±337.1)	3356.2 (±483.7)	0.383	118	0.702
	Child’s Age (months)	24.8 (3.6)	22.4 (3.9)	3.259	118	0.001
	Allergy at 2 Years			0.244	1	0.621
	Yes	35 (43.2%)	15 (38.5%)
	No	46 (56.8%)	24 (61.5%)
Nutritional Status	HAZ	0.43 (1.33)	0.51 (1.05)	−0.327	118	0.744
	WAZ	0.62 (0.99)	0.57 (0.85)	0.253	118	0.800
	BMIAZ	0.49 (1.34)	0.35 (1.35

. The mean gestational age of the children was 38.8 ± 1.08 weeks. The ratio between vaginal delivery and cesarean section in all examined children was almost equal, with the relative share of cesarean section—50.8% (n = 61)—being slightly higher. In the children in group B, cesarean section prevailed at 61.5% (n = 24), compared to group A—45.7% (n = 37).

The average birth weight of children in group A (3385.3 ± 337.1 g) was slightly higher than in group B (3356.2 ± 483.7 g), though the difference was not statistically significant (p > 0.05).

Throughout the study period, a significant number of the children developed allergic conditions, predominantly the children in group A, 43.2% (n = 35), compared to group B, 38.5% (n = 15).

The analysis of nutritional status, including deviations in anthropometric indices (HAZ, WAZ, BMIAZ) based on breastfeeding duration, showed no statistically significant impact of feeding type (breastfeeding, standard formula, or hydrolyzed formula) on growth during the first two months of the lactation period (p > 0.05).

The investigation into the smoking habits of families with children at a high risk of allergies revealed that mothers smoked more frequently (53.3%; n = 64) than fathers (43.3%; n = 52). During pregnancy, 13.3% of mothers (n = 16) smoked, with a higher prevalence among mothers of girls—14.8% (n = 8) compared to mothers of boys—12.1% (n = 8).

According to the results, parents in group A smoked fewer cigarettes per day (mothers: 2.3 ± 2.9 cigarettes/day; fathers: 5.5 ± 6.8 cigarettes/day) compared to those in group B (mothers: 3.8 ± 6.2 cigarettes/day; fathers: 8.4 ± 13.8 cigarettes/day), though the difference was not statistically significant (p > 0.05).

6.3. Developmental Outcomes (DP-3)

Based on breastfeeding duration, the results for the neuropsychological development of children, assessed using the DP-3 questionnaire, showed no statistically significant differences in the scores across the various functional areas (“Physical Development”, “Adaptive Behavior”, “Social-Emotional Development”, “Cognitive Development”, and “Communication”) or in the overall development of the children in the two groups.

Children in group B had higher scores in the overall developmental index and most assessed areas, except for “Cognitive Development” and “Adaptive Behavior”, which were higher in group A (p > 0.05) (

Table 3. Results of the DP-3 neuropsychological development assessment, stratified by breastfeeding duration (organized by category).

Category	Variable	Group A More than 2 Months (n = 81)	Group B Less than 2 Months (n = 39)	T-Value/Chi-square	df	p-Value
Developmental Outcomes	Physical Development (DP-3)	91.2 (15.6)	94.6 (14.3)	−1.134	118	0.259
	Social-Emotional Development (DP-3)	85.5 (16.1)	87.9 (16.9)	−0.742	118	0.459
	Cognitive Development (DP-3)	98.4 (13.2)	97.5 (12.8)	0.346	118	0.730
	Adaptive Behavior (DP-3)	96.7 (14.8)	96.2 (18.6)	0.173	118	0.863
	Communication (DP-3)	96.0 (17.8)	100.2 (20.0)	−1.160	118	0.248
	Overall Development (DP-3)	91.0 (16.9)	92.8 (17.5)	−0.540	118	0.590

).

The neuropsychological development (DP-3) of children in group A showed correlations with the presence of atopic dermatitis (adaptive behavior, social-emotional area), parental age (physical and cognitive areas), father’s education level (cognitive area), maternal smoking during pregnancy (overall development), the number of cigarettes smoked by the mother per day (physical, adaptive, social-emotional, cognitive, communication, and overall development), and cesarean-section delivery (physical, adaptive, and overall development). However, there were no significant correlations with the presence of food allergies or allergies at two years of age (

Table 4. Correlations between allergy, lifestyle factors, and development in children breastfed for more than two months (group A).

Correlation	Spearman’s rho	Physical Development	Adaptive Behavior	Social-Emotional	Cognitive Development	Communication	Overall Development
	p-Value
Food allergy 2 years Y/N	Spearman’s rho	−0.069	−0.129	−0.172	−0.105	0.010	−0.082
	p-value	0.540	0.251	0.126	0.353	0.927	0.468
Allergy at 2 years Y/N	Spearman’s rho	−0.038	−0.140	−0.002	0.074	0.044	0.013
	p-value	0.735	0.212	0.989	0.510	0.698	0.906
Atopic dermatitis	Spearman’s rho	−0.205	−0.250 *	−0.246 *	−0.179	−0.142	−0.206
	p-value	0.067	0.024	0.027	0.110	0.205	0.066
Mother’s age	Spearman’s rho	0.263 *	0.141	0.087	0.224 *	0.117	0.139
	p-value	0.018	0.208	0.438	0.044	0.300	0.216
Father’s age	Spearman’s rho	0.261 *	0.155	0.065	0.091	0.042	0.082
	p-value	0.019	0.167	0.562	0.417	0.712	0.468
Father’s education	Spearman’s rho	−0.079	−0.143	−0.134	−0.238 *	0.001	−0.056
	p-value	0.485	0.201	0.234	0.032	0.992	0.619
Smoking (mother) per day	Spearman’s rho	−0.352 **	−0.235 *	−0.234 *	−0.282 *	−0.250 *	−0.143
	p-value	0.001	0.034	0.035	0.011	0.025	0.204
Smoking during pregnancy	Spearman’s rho	−0.179	−0.129	−0.135	−0.266 *	−0.187	−0.329 **
	p-value	0.109	0.252	0.230	0.016	0.095	0.003
Cesarean section Y/N	Spearman’s rho	0.292 **	0.294 **	0.203	0.195	0.126	−0.244 *
	p-value	0.008	0.008	0.069	0.081	0.261	0.028

Note. * p < 0.05, ** p < 0.01

).

Maternal smoking (number of cigarettes per day) had significant negative correlations with all areas of children’s neuropsychological development, moderate correlations with physical development (rho = −0.352; p = 0.001) and overall development (rho = −0.329; p = 0.003), and weaker correlations with social–emotional development (rho = −0.234; p = 0.035), cognitive development (rho = −0.282; p = 0.011), adaptive behavior (rho = −0.235; p = 0.034), and communication (rho = −0.250; p = 0.025).

Cesarean-section delivery moderately correlated with two areas of neuropsychological development—physical (rho = 0.292; p = 0.008) and adaptive behavior (rho = −0.294; p = 0.008)—while the correlation with overall development was weak (rho = 0.246; p = 0.027).

The neuropsychological development of the children in group B showed correlations with the presence of allergy at two years of age (physical, social–emotional, communication, and overall development), the presence of atopic dermatitis (physical, social–emotional, cognitive, communication, and overall development), maternal smoking during pregnancy (physical, social–emotional, communication, and overall development), and the number of cigarettes smoked by the mother per day (adaptive, communication, and overall development), but not with the mode of delivery or demographic factors (

Table 5. Correlations between allergy, lifestyle factors, and development in children breastfed for less than 2 months (group B).

Correlation	Spearman’s rho	Physical Development	Adaptive Behavior	Social-Emotional	Cognitive Development	Communication	Overall Development
	p-Value
Food allergy 2 years Y/N	Spearman’s rho	−0.181	−0.103	−0.120	−0.077	−0.086	−0.098
	p-value	0.269	0.532	0.467	0.641	0.604	0.551
Allergy at 2 years Y/N	Spearman’s rho	−0.419 **	−0.228	−0.347 *	−0.279	−0.363 *	−0.342 *
	p-value	0.008	0.162	0.030	0.085	0.023	0.033
Atopic dermatitis (AD)	Spearman’s rho	−0.358 *	−0.185	−0.334 *	−0.351 *	−0.372 *	−0.368 *
	p-value	0.025	0.260	0.038	0.028	0.020	0.021
Mother’s age	Spearman’s rho	−0.007	0.137	0.006	0.040	−0.042	−0.011
	p-value	0.965	0.404	0.969	0.811	0.798	0.947
Father’s age	Spearman’s rho	0.116	0.060	0.156	0.074	−0.019	0.119
	p-value	0.482	0.716	0.344	0.653	0.908	0.469
Mother’s education	Spearman’s rho	0.076	0.141	−0.002	−0.094	0.024	0.007
	p-value	0.645	0.390	0.989	0.569	0.886	0.968
Father’s education	Spearman’s rho	0.043	0.073	−0.011	−0.052	0.017	0.038
	p-value	0.796	0.657	0.947	0.754	0.916	0.817
Smoking_ mother_ cigars/day	Spearman’s rho	−0.098	−0.386 *	−0.303	−0.310	−0.331 *	−0.318 *
	p-value	0.553	0.015	0.061	0.055	0.040	0.049
Smoking during pregnancy	Spearman’s rho	−0.510 ***	−0.268	−0.390 *	−0.247	−0.345 *	−0.398 *
	p-value	<0.001	0.099	0.014	0.130	0.032	0.012
Cesarean section Y/N	Spearman’s rho	0.208	0.221	0.192	0.169	0.077	0.190
	p-value	0.203	0.176	0.240	0.304	0.640	0.247

Note. * p < 0.05, ** p < 0.01, *** p < 0.001.

).

In group B, the most pronounced relationships with neuropsychological development were found for allergic conditions (allergy at two years of age or atopic dermatitis) and maternal smoking during pregnancy, with a strong negative correlation with physical development (rho = −0.510; p = 0.001).

7. Discussion

Our study reinforces the link between early feeding practices, neuropsychological development, and allergic conditions, emphasizing their lasting effects on children’s neurological health. Chronic immune responses and persistent inflammation are influenced by CD8+ T suppressor cells, which regulate immune homeostasis and help prevent autoimmunity. In atopic conditions, characterized by chronic immune activation, the impaired function of these suppressor cells contributes to prolonged inflammatory responses [24].

The analysis of the socio-demographic profile of the studied groups of children and parents, along with the characteristics of the early environment and early feeding, reveals significant correlations with the overall development and neuropsychological functioning of children from atopic families. Our results confirm the influence of higher parental age, higher education, cesarean-section delivery, and parental smoking (both during pregnancy and after the child’s birth) on children’s health and growth:

7.1. Smoking in the Family

Specific urban exposures in early life (nicotine, indoor air pollution, maternal stress) increase the risk of allergic sensitization [25]. Prenatal smoking and exposure to secondhand smoke are significant risk factors for impaired lung function and are mainly linked to asthma development in children [25,26]. Our findings show a lower rate of smoking (53.3%; n = 64) compared to a U.S. study where about 60% of infants were exposed to tobacco smoke [25]. However, our data report a higher prevalence of maternal smoking (53.3%) compared to paternal smoking (43.3%), contrary to other studies that report higher smoking rates among fathers [26,27].

7.2. Early Feeding, Parental Age, and Education

The average age of mothers in our study (30.59 years) was higher than the national average (28.7–28.9 years) during the study period (2017–2020) [28]. Socio-demographic factors, including maternal age and education, influence breastfeeding duration [29,30,31]. Our findings indicate a similar trend, with more educated mothers and fathers breastfeeding for longer periods (group A: 68.35% vs. 54.3%).

7.3. Early Feeding, Allergic Diseases, Growth, and Development

In recent decades, the prevalence of atopic diseases has increased globally, affecting 10–21% of the population [32]. We report a threefold higher incidence in our sample, with 41.7% of children diagnosed with allergies by age two. While breastfeeding is often considered protective against allergies [33,34], our study did not find such an association.

Breastfeeding duration is associated with better cognitive, motor, and language development [16,17,18]. We observed better cognitive development scores in children breastfed for longer periods (DP-3: 98.4 for group A vs. 97.5 for group B, p > 0.05).

7.4. Neuropsychological Development (DP-3) in Atopic Families

The children’s neurodevelopmental assessment was based on the widely used DP-3 instrument, which is used in the identification of potential delays or impairments and highlights areas that may need additional support or intervention.

One of our key findings is the strong negative correlation between maternal smoking (during pregnancy and daily cigarette consumption) and all areas of neuropsychological development in children with atopic predispositions. Children in group A showed moderate effects of smoking on physical and overall development. Children in group B had strong negative associations with smoking during pregnancy, especially on physical development.

Allergic conditions, such as atopic dermatitis and food allergies, were significantly correlated with neuropsychological development, supporting the hypothesis that early allergic diseases influence later neurodevelopment.

Lower motor skills have been identified in children with allergic diseases, as well as a link between food allergies and internalizing behavioral problems and socio-emotional manifestations [25]. A significant relationship between atopic dermatitis and delays in children’s mental and psychological development, along with behavioral and emotional disorders, has been found.

In children who were breastfed for less than 2 months, allergies and atopic dermatitis observed at 2 years of age are associated with all areas of neurodevelopmental functioning (NDF), except the adaptive domain. In children who were breastfed for more than 2 months, only atopic dermatitis shows a connection with NDF, and only in two areas—adaptive and socio-emotional—suggesting a potential protective effect of breastfeeding on neurodevelopment.

Cesarean-section delivery is a moderately influencing factor in the physical and adaptive domains, affecting the overall development of the children in group A. There are reports that cesarean-section delivery may have a negative effect on children’s cognitive development [35,36], which may be noticeable a few months after birth [37].

While the numerical results highlight statistically significant correlations, a deeper analysis of these findings suggests complex interactions between early-life exposures and neurodevelopmental trajectories. The negative impact of maternal smoking on all functional areas of neuropsychological development underscores the importance of prenatal and early postnatal environmental factors in shaping developmental outcomes. Additionally, the observed associations between cesarean-section delivery and physical as well as adaptive development may reflect differences in perinatal stress and early microbiome establishment. The stronger correlation of allergic conditions with neurodevelopmental outcomes in group B suggests that shorter breastfeeding duration and formula feeding might amplify the neuroimmune interactions affecting cognitive and socio-emotional development. Future research should explore these relationships with longitudinal models, accounting for confounding variables such as socioeconomic factors, dietary diversity, and genetic predisposition to allergic conditions.

7.4.1. Factors Related to Children’s Neuropsychological Development (NPD)

Table 6. Factors related to children’s neuropsychological development (NPD) in group A and group B.

NPD Areas (DP-3)	Group A (More than 2 Months)	Group B (Less than 2 Months)
Physical Development	Parents’ age	Allergy at 2 years
	Cesarean section	Atopic dermatitis
	Mother’s daily cigarette consumption	Maternal smoking during pregnancy
Adaptive Behavior	Cesarean section	Mother’s daily cigarette consumption
	Atopic dermatitis
	Mother’s daily cigarette consumption
Social-Emotional Development	Atopic dermatitis	Allergy at 2 years
	Mother’s daily cigarette consumption	Atopic dermatitis
Cognitive Development	Parents’ age	Atopic dermatitis
	Father’s education level
	Mother’s daily cigarette consumption
Communication	Mother’s daily cigarette consumption	Allergy at 2 years
		Atopic dermatitis
		Maternal smoking during pregnancy
Overall Development	Cesarean section	Allergy at 2 years
	Maternal smoking during pregnancy	Atopic dermatitis
	Mother’s daily cigarette consumption	Mother’s daily cigarette consumption

highlights key factors influencing neurodevelopment in children breastfed for more than two months (group A) and those breastfed for less than two months (group B). The findings suggest distinct developmental risks associated with feeding duration, allergic conditions, and parental factors.

7.4.2. Physical and Adaptive Development

In group A, parental age, cesarean section, and maternal smoking correlated with physical development, while cesarean section and atopic dermatitis impacted adaptive behavior. Cesarean birth may affect neurodevelopment through microbiome alterations while smoking negatively influences motor and adaptive skills.

For group B, allergy at two years, atopic dermatitis, and maternal smoking were key factors. Allergic conditions may disrupt physical and adaptive development via chronic inflammation and sleep disturbances, while prenatal nicotine exposure impairs self-regulation skills.

7.4.3. Social–Emotional and Cognitive Development

In group A, atopic dermatitis and maternal smoking negatively affected social–emotional skills, while parental age, father’s education, and maternal smoking influenced cognitive development. Higher parental education was protective while smoking exposure correlated with cognitive delays.

In group B, allergy at two years and atopic dermatitis strongly affected social–emotional outcomes, and atopic dermatitis was the sole predictor of cognitive scores, suggesting immune dysfunction’s role in neurodevelopment.

7.4.4. Communication and Overall Development

Maternal smoking was the primary factor affecting communication in group A, while in group B, allergy at two years, atopic dermatitis, and maternal smoking played a stronger role. Early allergic conditions may disrupt speech development due to immune and respiratory challenges.

Overall development in group A was impacted by cesarean-section delivery and maternal smoking, whereas in group B, allergy at two years and atopic dermatitis were the strongest factors, reinforcing the long-term neurodevelopmental impact of early allergic diseases.

8. Conclusions

Our study confirms the relationship between early feeding, neuropsychological development, and allergic status, highlighting the long-term impact of these factors on children’s neurological functioning. However, several limitations should be acknowledged. The study relied on parental reporting for key variables, which may introduce recall bias. Additionally, the relatively small sample size and lack of longitudinal follow-up limit the ability to establish causal relationships. Future research should incorporate objective biomarkers for allergic conditions, larger cohort studies, and extended follow-up to better understand the long-term neurodevelopmental impact of early-life exposures. Practical applications of our findings include strengthening public health policies on maternal smoking cessation, promoting breastfeeding education, and improving early allergy screening in high-risk infants. Further research should also explore the role of the microbiome and genetic predispositions in modulating neurodevelopment in children with atopic conditions.