Infant cry-sleep linked to later behavior

U. WARWICK (UK) — Infants who have problems with persistent crying or with sleeping and/or feeding are far more likely to become children with significant behavioral problems, including ADHD.

Around 20 percent of all infants show symptoms of crying-sleep-feeding issues—known as regulatory problems—in their first year of life. Previous research has suggested these regulatory problems can have an adverse effect on behavioral or cognitive development later in childhood, but findings have been inconclusive.

Researchers from the University of Warwick in the U.K., University of Basel in Switzerland, and the University of Bochum in Germany carried out an analysis of 22 studies from 1987 to 2006 that had investigated this possible association. The studies included collectively 16,848 children, of which 1,935 children with regulatory problems were tested.

Of the 22 studies, 10 studies reported on consequences of excessive crying, four on sleeping problems, three on feeding problems, and five studies on multiple regulatory problems. The team’s full findings are reported in the journal Archives of Disease in Childhood.

Childhood behavioral problems were divided into four categories:

  • internalizing (anxiety, depression, or withdrawal),
  • externalizing (aggressive or destructive behavior, conduct problems, or temper tantrums),
  • attention deficit/hyperactivity (ADHD), and
  • general behavioral problems.

The researchers found that infants with previous regulatory problems were more likely to have behavioral problems as children than infants without regulatory problems. The most likely outcomes for children who had regulatory problems as an infant were externalizing problems and ADHD.

The more types of regulatory problems that an infant had (cumulative problems), the more likely this was to increase the risk of behavioral problems as a child.

The researchers note that concerns about their baby’s crying, sleeping, or feeding problems were a major reason for many parents seeking professional help. Clinically referred children often came from families with a range of risk factors such as obstetric, interactional, or psychosocial problems in addition to multiple regulatory problems.

Therefore, the accumulation of child symptoms and negative family characteristics was more predictive of behavioral problems than any particular combination of them.

In the study, the researchers conclude: “Our findings highlight the need for prospective follow-up studies of regulatory disturbed infants and require reliable assessments of crying, sleeping, or feeding problems.

“The evidence from this systematic review suggests that those with persisting regulatory problems in families with other problems may require early interventions to minimize or prevent the long-term consequences of infant regulatory problems.”

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