"Babies who persistently struggle with sleep in their first year are THREE TIMES more likely to have anxiety by age four," reports the Mail Online.
A new Australian study has looked at nearly 1,500 mother-child pairs to see whether babies with persistent and severe sleep problems (waking 3 or more times a night on most nights) were more likely to show signs of mental health problems in later childhood.
They found these children, when aged 4 and 10, were more likely to have emotional problems such as anxiety about being away from parents, but not more likely to have hyperactivity or developmental disorders.
Because of the nature of the study, we do not know whether the sleep problems caused the anxiety, or were a sign that the baby was already anxious. That is, it may have been an inherent characteristic of the baby/child. It could also be that another factor, such as environmental, caused both problems.
The results of the study do not mean that all babies who have problems sleeping will develop anxiety or other problems. About 85% to 90% of children who had severe sleep problems as babies did not have emotional problems at age 4 or 10.
Where did the story come from?
The researchers who carried out the study were from Murdoch Children's Research Institute in Australia. The research was funded by the Australian National Health and Medical Research Council and Australian Rotary Health. The study was published in the peer-reviewed journal Archives of Disease in Childhood.
The report in the Mail Online may have caused unnecessary alarm. It reported only the relative risk figures – how likely children were to have a problem compared to a group of children who had no sleep problems as babies. It is not clear from the report that only around 1 in 7 children with sleep problems went on to have emotional problems.
What kind of research was this?
This was a cohort study. Cohort studies are good ways to look for patterns that link risk factors (such as sleep problems) with possible outcomes (such as mental health problems in later life). However, they cannot show that 1 directly causes another. Other unmeasured factors may be involved.
What did the research involve?
Researchers recruited 1,507 women pregnant with their 1st child. Each mother filled in questionnaires about their baby's sleep at 3, 6 and 12 months after their child's birth. They also answered questionnaires and structured interviews about their child's mental health when children were 4 and 10 years old.
Children were grouped into:
- settled sleep, with little problem sleeping at any measurement point
- moderate or fluctuating sleep problems (some sleep problems, or at only 1 point)
- severe and persistent sleep problems (waking 3 or more times a night on most nights at every point)
The questionnaires and interviews at age 4 and 10 included:
- the Strengths and Difficulties Questionnaire, which identifies emotional symptoms, behaviour problems, problems with other children and sociability (at age 4 and 10)
- the Spence Children's Anxiety Scale, which identifies children with symptoms of specific anxiety-related problems (at age 10 only)
- the Development and Well-Being Assessment interview, which assesses whether a child meets standard diagnostic criteria for an established mental health problem (at age 10 only)
Researchers compared the children who had settled sleep with those who had severe and persistent sleep problems, to see how likely each group was to have difficulties. They took account of factors including the mother's age, postnatal depression, socioeconomic status, weight of the baby at birth and the baby's sex.
What were the basic results?
The researchers had results from 1,460 mothers who filled in the sleep questionnaires.
They found 360 babies (24.7%) were 'settled' in their sleep, 817 (56%) had moderate or fluctuating sleep problems, and 283 (19.4%) had severe persistent sleep problems.
Results for children aged 4
The researchers found 9.4% of children who'd had persistent sleep problems as babies had symptoms of emotional problems, using the Strengths and Difficulties Questionnaire, compared with 4.1% of children with settled sleep. This meant they were 2.7 times more likely to have emotional problems at age 4 (adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 1.21 to 6.05) compared to children with settled sleep.
However, they were no more likely than children with settled sleep to have hyperactivity, conduct problems (behavioural problems), problems with other children or with sociability.
Results for children aged 10
15.1% of children who'd had severe persistent sleep problems as babies were diagnosed with emotional disorders using the Developmental and Well-Being Assessment scale. These children were 2.37 times more likely to have emotional disorders (aOR 2.37, 95%CI 1.05 to 5.36) on this scale than children with settled sleep (7.4%).
15.6% of children who had severe persistent sleep problems had overall raised anxiety symptoms on the Spence Children's Anxiety Scale compared with 7.5% of those with settled sleep. This made them 2.2 times more likely to have raised anxiety symptoms on this scale than children with settled sleep (aOR 2.20, 95% CI 1.13 to 4.29).
By the specific conditions measured on the Spence Children's Anxiety Scale:
- 21.5% showed signs of separation anxiety, which was 2.44 times more likely than those with settled sleep (aOR 2.44, 95% CI 1.35 to 4.41)
- 14.7% had fear of physical injury, which was 2.14 times more likely than those with settled sleep (aOR 2.14, 95% CI 1.09 to 4.18)
- they were no more likely to have obsessive compulsive disorder, social phobia, panic attacks or agoraphobia or general anxiety
How did the researchers interpret the results?
The researchers said: "Persistent disturbed sleep during infancy may be an early indication of a child's heightened susceptibility to later mental health difficulties – in particular, anxiety problems."
They added: "Infants with persistent severe sleep problems should be monitored for emerging mental health difficulties during childhood."
News that babies who do not sleep could have mental health problems in later childhood are likely to alarm parents struggling to deal with their children's sleep patterns. However, this research does not mean that sleepless babies will all grow up to be anxious children.
It is important to note that the majority of children who had severe and persistent problems with sleep as babies did not have emotional problems at age 4 or 10. The study showed problems were more common in children who'd had poor sleep as babies, not that these problems were inevitable.
The researchers compared mental health problems between children with severe sleep difficulties and the 25% of children who had settled sleep patterns. The majority of babies had moderate sleep problems, or sleep problems at certain points in their 1st year. Problems with getting babies to sleep are normal for most parents.
Because this is an observational study, we cannot tell whether sleep problems caused later difficulties, were a sign of underlying anxiety (or inherent characteristics/traits of the individual), or whether other factors were involved in both sleep and later emotional problems. Many things – from relationships within the family to problems at school or health issues – can affect a child's mental health.
If you are worried that your child is anxious or upset, find out about how to talk to children about their feelings.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Mail Online, 9 March 2020
Links to the science
Archives of Disease in Childhood. Published online 9 March 2020