Infant Sleep Issues Linked to Anxiety and Emotional Problems

Fallon Cook, PhD

While sleep troubles is common for infants, they also could foreshadow emotional and psychological issues later on in life.

A team, led by Fallon Cook, PhD, Department of Pediatrics at the University of Melbourne, determined whether infants with severe persistent sleep problems are at an increased risk of meeting the diagnostic criteria for a psychiatric disorder at age 10 or have elevated symptoms of mental health difficulties at ages 4 and 10.

In the prospective longitudinal community cohort study, dubbed the Maternal Health Study, mothers completed questionnaires and interviews at 15 weeks’ gestation, 3,6,9, and 12 months postpartum, as well as when their child turned 4 and 10 years old.

There was a total of 1460 mother-infant pairings from 6 public hospitals in Melbourne, Australia, beginning in April 2003. Participants were eligible if they were at least 18 years old, at 10-20 weeks’ gestation, and had sufficient English to complete the questionnaire and phone interviews.

Some of the measured included a parental report of the infant’s night waking and sleep problems and child mental health assessment completed through the Strengths and Difficulties Questionnaire, Spence Children’s Anxiety Scale and a development and well-being Assessment.

In the study, 283 infants (19.4%) infants had persistent severe sleep problems, 817 infants (56.0%) had moderate/fluctuating sleep problems, and 360 infants (24.7%) were settled.

Infants with persistent severe sleep problems are more likely to report an emotional disorder at age 10 (adjusted OR, 2.37; 95% CI, 1.05-5.36; P = 0.04).

These infants also had elevated symptoms of separation anxiety (AOR, 2.44; 95% CI, 1.35-4.41; P <0.01), fear of physical injury (AOR, 2.14; 95% CI, 1.09-4.18; P = 0.03), and overall elevated anxiety (AOR, 2.20; 95% CI, 1.13-4.29; P = 0.02) at age 10.

“Infants with persistent severe sleep problems during the first postnatal year have an increased risk of anxiety problems and emotional disorders at age 10,” the authors wrote.

Approximately 17% of all infants suffer from sleep difficulties, including frequent waking at night and trouble falling asleep with the aid of a parent. This can have a deleterious impact on parental mental health and family functioning. It is also associated with poorer mental health during early childhood.

However, it has been previously unclear whether these early mental health difficulties persist into middle childhood and whether specific psychiatric symptoms or diagnoses are likely to emerge in this group of children.

Evidence from a previous community-based cohort suggests that persistent sleep problems from 8 months of age is linked to increased emotional and behavioral problems at age 2. Similar findings were also found at a 3.5 years old in a small sample of children with persistent night waking and bedtime difficulties during the first postnatal year.

Despite evidence suggesting that poor sleep in infancy is associated with poorer mental health during childhood, little high-quality research has been previously completed exploring this association.

The study, “Infant sleep and child mental health: a longitudinal investigation,” was published online in the Archives of Disease in Childhood.