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Updated: Dec 25, 2025
Psychophysiological Assessment of the Effectiveness of Emotion Regulation Strategies in Childhood
Published on: February 11, 2017
Parent-reported early sleep problems and internalising, externalising and dysregulation symptoms in toddlers
Isabel Morales-Muñoz1,2, Sakari Lemola3,4, Outi Saarenpää-Heikkilä5
1Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
Insights
Infant sleep problems like shorter duration and more night wakings predict emotional and behavioral issues in toddlers. Early identification and intervention for infant sleep disturbances may support healthy socio-emotional development.
Area of Science:
- Child development
- Pediatric sleep medicine
- Developmental psychology
Background:
- Sleep and socio-emotional development in children are linked, but the predictive role of infant sleep problems on later emotional and behavioral issues is unclear.
- This study investigates the association between early childhood sleep problems and the development of internalizing, externalizing, and dysregulation symptoms in toddlers.
Purpose of the Study:
- To examine the prospective associations between sleep problems in early childhood and internalizing, externalizing, and dysregulation symptoms in toddlers.
- To understand the impact of sleep duration, sleep-onset latency, night wakings, and daytime sleep proportion on toddler socio-emotional outcomes.
Main Methods:
- 1679 families were recruited during pregnancy, with 936 children participating at 24 months.
- Parent-reported sleep data (duration, onset latency, night wakings, daytime sleep, bedtime) were collected at 3, 8, 18, and 24 months using two sleep questionnaires.
- Emotional and behavioral problems (internalizing, externalizing, dysregulation) at 24 months were assessed using the Brief Infant-Toddler Social and Emotional Assessment.
Main Results:
- Short sleep duration at 3 and 8 months, frequent night wakings, and greater daytime sleep at 24 months were linked to internalizing symptoms.
- Shorter sleep duration, longer sleep-onset latency, more night wakings, earlier bedtime, and increased daytime sleep were associated with dysregulation symptoms.
- More night wakings and longer sleep-onset latency at 24 months correlated with externalizing problems.
Conclusions:
- Infant sleep problems, including shorter sleep duration and poorer sleep quality, prospectively predict emotional and behavioral symptoms in toddlers.
- These associations were most pronounced for internalizing and dysregulation symptoms, highlighting the critical role of early sleep in socio-emotional development.
- Early interventions targeting infant sleep disturbances may be beneficial for preventing or mitigating emotional and behavioral problems in toddlers.
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.
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