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Infant sleep and child mental health: a longitudinal investigation
  1. Fallon Cook1,2,
  2. Laura J Conway1,2,
  3. Rebecca Giallo1,2,
  4. Deirdre Gartland1,2,
  5. Emma Sciberras1,2,3,
  6. Stephanie Brown1,4
  1. 1 Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3 School of Psychology, Deakin University, Melbourne, Victoria, Australia
  4. 4 Department of General Practice and Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Fallon Cook, Intergenerational Health, Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; fallon.cook{at}


Objective To determine whether infants with severe persistent sleep problems are at increased risk of (1) meeting diagnostic criteria for a psychiatric disorder (age 10 years), and (2) having elevated symptoms of mental health difficulties (ages 4 and 10 years), in comparison with infants with settled sleep.

Design and setting Prospective longitudinal community cohort study—the Maternal Health Study. Mothers completed questionnaires/interviews at 15 weeks' gestation; 3, 6, 9 and 12 months post partum; and when their child turned 4 and 10 years old. Measures included parental report of infant night waking and sleep problems and child mental health (Strengths and Difficulties Questionnaire; Spence Children’s Anxiety Scale; Development and Well-being Assessment).

Participants 1460 mother-infant dyads.

Results 283 (19.4%) infants had persistent severe sleep problems, 817 (56.0%) had moderate/fluctuating sleep problems and 360 (24.7%) infants were settled. Infants with persistent severe sleep problems were more likely to report emotional symptoms at age 4 (adjusted odds ratio (AOR)=2.70, 95% CI 1.21 to 6.05, p=0.02), and meet diagnostic criteria for an emotional disorder at age 10 (AOR=2.37, 95% CI 1.05 to 5.36, p=0.04). Infants with persistent severe sleep problems also had elevated symptoms of separation anxiety (AOR=2.44, 95% CI 1.35 to 4.41, p<0.01), fear of physical injury (AOR=2.14, 95% CI 1.09 to 4.18, p=0.03) and overall elevated anxiety (AOR=2.20, 95% CI 1.13 to 4.29, p=0.02) at age 10.

Conclusions Infants with persistent severe sleep problems during the first postnatal year have an increased risk of anxiety problems and emotional disorders at age 10.

  • child psychiatry
  • child psychology
  • epidemiology
  • sleep

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  • Contributors FC developed the paper proposal, carried out data analysis and wrote the manuscript. LJC contributed to development of the paper proposal and made edits to the manuscript. RG assisted with data analysis and made edits to the manuscript. DG contributed to the design and execution of the cohort study and made edits to the manuscript. ES contributed to the interpretation of the findings and made edits to the manuscript. SB conceptualised the cohort study, wrote the original study protocol and has overseen the conduct of the study since its inception. In addition, SB provided feedback on previous versions of the manuscript, and approved the final version.

  • Funding The Maternal Health Study was supported by project grants from the Australian National Health and Medical Research Council (NHMRC) (No 199222, No 433006 and No 491205) and Australian Rotary Health.

  • Competing interests FC and LJC hold life course postdoctoral fellowships supported by the Royal Children’s Hospital Research Foundation. RG holds a NHMRC career development fellowship (No 1123900). DG and LJC are supported by the NHMRC Safer Families Centre (No 1116690). ES is supported by an NHMRC career development fellowship (No 1110688) and a veski Inspiring women’s fellowship. SB holds a NHMRC senior research fellowship (No 1103976). Research at the Murdoch Children’s Research Institute is supported by the Victorian Government Operational Infrastructure Support Program.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for this study was granted by human research ethics committees at La Trobe University (2002/38), the Royal Women's Hospital (2002/23), the Royal Children’s Hospital (27056), Southern Health (2002-099B) and Angliss Hospital.

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

  • Data availability statement No data are available. Owing to conditions of ethics approval the Maternal Health Study data are not open access and cannot be released to other research groups. Further information about the Maternal Health Study can be obtained from the LifeCourse website ( Requests for collaboration can be sent to Professor Brown ( and will be considered by the investigative team.