Atopic eczema is a chronic skin disorder that is most common in early childhood, an important stage in the child's social and emotional development. The psychiatric adjustment and mother-child attachment in 30 preschool children with severe atopic eczema was compared with 20 matched controls. Patients with eczema had a significant increase in behaviour symptoms, 7/30 (23%) v 1/20 (5%); with significant excess of dependency/clinginess, 15/30 (50%) v 2/20 (10%); fearfulness, 12/30 (40%) v 2/20 (10%); and sleep difficulty, 19/30 (63%) v 9/20 (45%), but there was no significant difference between the two groups in the security of attachments, 25/29 (86%) v 14/20 (70%). Significantly fewer mothers of children with atopic eczema were in outside employment, 8/29 (27%) v 13/20 (65%), or felt supported socially, 10/29 (34%) v 13/20 (65%). Significantly more of them, 9/30 (30%) v 1/20 (5%), felt particularly stressed in relation to their parenting and less efficient in their disciplining of the affected child. In spite of this and at variance with earlier reports in the literature, they did not display negative attitudes towards their child. On the contrary mothers had a positive empathic attitude towards the child, 7/14 (50%) v 2/16 (12%). Child behaviour problems, 7/14 (50%) v 2/16 (12%), and maternal distress, 12/14 (85%) v 5/16 (31%), were significantly more common in the more severely affected children. Minor behaviour problems and parenting distress are important features of severe atopic eczema in early childhood but atopic eczema does not lead to insecurity of the mother-child attachment.