You are here

Article Text

Article menu

Download PDFPDF

XML
Child Psychiatry
Original research
Parent-reported early sleep problems and internalising, externalising and dysregulation symptoms in toddlers
  1. Isabel Morales-Muñoz1,2,
  2. Sakari Lemola3,4,
  3. Outi Saarenpää-Heikkilä5,
  4. Anneli Kylliäinen6,
  5. Pirjo Pölkki7,
  6. Tiina Paunio1,8,
  7. Matthew R Broome2,
  8. E. Juulia Paavonen1,9
  1. 1 Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
  2. 2 Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
  3. 3 Department of Psychology, Bielefeld University, Bielefeld, Germany
  4. 4 Department of Psychology, University of Warwick, Coventry, United Kingdom
  5. 5 Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
  6. 6 Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
  7. 7 Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
  8. 8 Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  9. 9 Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  1. Correspondence to Dr Isabel Morales-Muñoz; isabel.morales{at}thl.fi

Abstract

Background The concurrence of sleep and socio-emotional development in children is well accepted. However, the predictive role of sleep problems in infancy and the development of emotional and behavioural problems later in childhood remain still unclear. Therefore, in this study we examined the associations between sleep problems in early childhood and internalising, externalising and dysregulation symptoms in toddlers.

Methods 1679 families entered the study during pregnancy and 936 children participated at 24 months. Parent-reported sleep duration, sleep-onset latency, night wakings, proportion of daytime sleep and bedtime at 3, 8, 18 and 24 months were assessed with two sleep questionnaires. Externalising, internalising and dysregulation problems at 24 months were examined with the Brief Infant-Toddler Social and Emotional Assessment.

Results Short sleep duration at 3 and 8 months, more night wakings at 3, 8, 18 and 24 months and greater proportion of daytime sleep at 24 months were associated with internalising symptoms. Shorter sleep duration at 8, 18 and 24 months and longer sleep-onset latency and more night wakings at all time points, in addition to earlier bedtime at 8 months and greater proportion of daytime sleep at 24 months, were related to dysregulation. Finally, more night wakings at 3 and 24 months, and longer sleep-onset latency at 24 months were associated with externalising problems.

Conclusion Shorter sleep and poorer sleep quality in infancy were prospectively related to emotional and behavioural symptoms in toddlers, and these associations were strongest for internalising and dysregulation symptoms. This study contributes to the recent research on the role of early sleep problems in socio-emotional development, suggesting that shorter sleep duration, longer sleep-onset latency and higher waking frequency are related to internalising, externalising and dysregulation symptoms in toddlers, and thus it might be beneficial to provide early interventions for those infants reporting these sleep problems.

  • sleep
  • epidemiology
  • child psychiatry
  • data collection
  • neurodevelopment
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjpo-2019-000622

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors IMM designed the study, drafted the initial manuscript, conducted data analysis and reviewed and revised the manuscript. SL assisted with data analysis and reviewed and revised the manuscript. OS-H, AK, PP and TP conceptualised and designed the study, designed the data collection instruments, coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content. MB conceptualised the study and critically reviewed the manuscript for important intellectual content. JP conceptualised and designed the study, designed the data collection instruments, coordinated and supervised data collection and data analysis and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This project was funded by The Academy of Finland (#134880, #253346, #308588, #277557, #315035, and #326631), the Signe and Ane Gyllenberg Foundation, the Yrjö Jahnsson Foundation, the Foundation for Pediatric Research, the Finnish Cultural Foundation, the Competitive Research Financing of the Expert Responsibility area of Tampere University Hospital, the Arvo ja Lea Ylppö Foundation, and Doctors’ Association in Tampere.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the local hospital district ethical committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.