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Later emotional and behavioral problems associated with sleep problems in toddlers: a longitudinal study
Børge Sivertsen1, Allison G Harvey2, Ted Reichborn-Kjennerud3
1Division of Mental Health, Norwegian Institute of Public Health, Bergen2Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway 3Department of Psychiatry, Helse Fonna HF, Haugesund, Norway.
Insights
Early childhood sleep problems, including short sleep duration and frequent nocturnal awakenings, predict later emotional and behavioral issues in preschool children. These findings highlight the importance of addressing sleep in early development.
Area of Science:
- Child Psychology
- Developmental Pediatrics
- Sleep Medicine
Background:
- Childhood sleep problems are associated with adverse health outcomes.
- Limited understanding exists regarding the temporal link between early sleep issues and later emotional/behavioral problems.
Purpose of the Study:
- To investigate the association between sleep problems in 18-month-old toddlers and concurrent/subsequent emotional and behavioral problems at age 5.
- To determine if sleep duration and nocturnal awakenings predict later behavioral outcomes.
Main Methods:
- Longitudinal population-based study using data from the Norwegian Mother and Child Cohort Study (N=32,662).
- Sleep assessed via mother-reported sleep duration and nocturnal awakenings at 18 months.
- Emotional and behavioral problems measured using the Child Behavior Checklist at 5 years, with risk ratios (RRs) calculated via negative binomial regression.
Main Results:
- Short sleep duration (≤10 hours) and frequent nocturnal awakenings (≥3 times) at 18 months significantly predicted emotional and behavioral problems at 5 years.
- Adjusted RRs for internalizing problems were 1.59 for short sleep and 1.57 for awakenings; for externalizing problems, RRs were 1.77 and 1.25, respectively.
- Associations remained significant after controlling for baseline emotional/behavioral problems and other covariates.
Conclusions:
- Early childhood sleep problems are significant predictors of later emotional and behavioral problems.
- Findings suggest that interventions targeting early childhood sleep may help prevent adverse developmental outcomes.
- Further intervention studies are warranted to confirm the efficacy of sleep programs in mitigating later problems.
Importance:
Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children.
Objective:
To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years.
Design, Setting, And Participants:
A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included.
Exposures:
Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings.
Main Outcomes And Measures:
Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percentile). Risk ratios (RRs) were calculated using negative binomial regression, controlling for emotional and behavioral problems at 18 months and other relevant covariates.
Results:
Short sleep duration (≤10 hours) in 556 children (1.7%) and frequent nocturnal awakenings (≥3 times) in 1033 children (3.2%) at 18 months significantly predicted both concurrent and later incidence of emotional and behavioral problems at 5 years. The longitudinal RRs were generally larger for internalizing problems, with adjusted RRs of 1.59 (95% CI, 1.23-2.08) for both short sleep duration and 1.57 (95% CI, 1.28-1.93) for nocturnal awakenings; RRs for externalizing problems were 1.77 (95% CI, 1.37-2.30) and 1.25 (95% CI, 1.00-1.58), respectively. Additional adjustment for emotional and behavioral problems at 18 months slightly reduced the strength of these associations, and all RRs remained significant in the fully adjusted models.
Conclusions And Relevance:
Early sleep problems predict later development of emotional and behavioral problems. Intervention studies are needed to examine whether sleep programs targeting early childhood may avert the onset of later adverse outcomes.
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