Impaired Sleep Duration, Quality in Infancy Associated With Behavioral Health Issues in Children

Toddlers with reported diminished sleep duration and quality during infancy had a greater likelihood of emotional and behavioral problems, with associations proving strongest for internalizing and dysregulation symptoms, according to study findings published in BMJ Paediatrics Open.

Although the correlation between sleep issues and socioemotional development in children has been well accepted, investigators highlight that no research has examined the potential predictive role of these problems during infancy. “More studies are required regarding sleep quality and dysregulation, especially in early stages of life, and how sleep predicts outcomes and, in turn, could help us understand potential mechanisms and discover new windows for intervention,” said the study authors.

Previous studies have provided evidence of the potential predictive role of impaired sleep in infancy with later issues of internalizing and externalizing symptoms in childhood, but the study authors note that these studies failed to delineate which sleep problems in infancy and early childhood were associated with these issues. They aimed to uncover potential associations of early sleep problems at 3, 8, 18, and 24 months with the development of internalizing, externalizing, and dysregulation symptoms at 24 months in a large birth cohort of children (N = 936) from 1679 families. The study examined parent-reported sleep duration, sleep-onset latency, night wakings, proportion of daytime sleep, and bedtime, derived from 2 sleep questionnaires within the CHILD-SLEEP birth cohort from Finland.

Results from these 2 questionnaires were then compared with a separate questionnaire, Brief Infant-Toddler Social and Emotional Assessment, that examined externalizing, internalizing, and dysregulation problems, which was completed by 950 parents at the child’s age of 24 months.

In the study findings, researchers show that infants who experienced shorter sleep duration at months 8, 18, and 24; took longer to fall asleep; and experienced frequent night wakings at all time points were likely to have problems regulating their behaviour and emotions at the age of 24 months, leading to disrupting emotions and behaviours, such as temper tantrums. Additionally, more frequent night wakings was linked with internalizing symptoms at 3, 8, 18, and 24 months, and with externalizing problems at 3 and 24 months.

Lead study author Isabel Morales-Muñoz noted the importance of sleep quality early in life as its relationship to self-regulation, the ability to control our behavior, is potentially intertwined based on the study findings.

"Scientists think there are links in the central nervous system between sleep-wake behaviour and our emotions, and so it's possible these links have a biological basis," said Morales-Muñoz. "Environmental factors, such as sleeping practices in the family, parental reactions to crying, and parental stress also play an important part in a child's sleep and socioemotional development."

She highlighted that while more research is warranted to examine sleep quality and socioemotional development, early interventions in infancy can prove vital in reducing the risk of emotional and behavioral problems later in childhood.

Reference

Morales-Muñoz I, Lemola S, Saarenpää-Heikkilä O, et al. Parent-reported early sleep problems and internalising, externalising and dysregulation symptoms in toddlers [published online March 10, 2020]. BMJ Paediatr Open. doi: 10.1136/bmjpo-2019-000622.