'Unsettled' Infants More Likely to Develop Mental-Health Problems

February 11, 2019

By Will Boggs MD

NEW YORK—"Unsettled" infants - those with sleep problems, excessive crying, temper tantrums, and the like - have much higher odds of developing mental health concerns, compared with more settled infants, researchers from Australia report.

"Mental-health disorders are the leading cause of child disability worldwide," said Dr. Fallon Cook from Murdoch Children's Research Institute, Royal Children's Hospital, in Parkville.

"Our findings provide compelling evidence that for some, the pathway toward poorer mental health begins very early," she told Reuters Health by email. "By identifying infants at risk for poorer mental health during childhood, we have a powerful opportunity to develop early interventions that might prevent mental health difficulties from emerging."

Infant behavioral dysregulation affects 15% to 30% of infants and results in increased help-seeking behavior and cost to the healthcare system, Dr. Cook and colleagues note in Pediatrics, online February 8. While comorbid infant regulatory problems have been linked to behavioral and mental-health concerns during childhood, it remains unclear exactly which infants are at greatest risk, they add.

The team used data from the Early Language in Victoria Study to evaluate the profiles of infant regulatory behaviors and their association with mental-health difficulties once children reached 5 and 11 years of age.

The researchers identified five regulatory-behavior profiles in the 1,759 12-month-old infants included in the study: settled (those with few problems, 36.8%); tantrums (mostly mild, isolated temper tantrums, 21.3%); sleep problems (mild-to-moderate sleep problems, 25.4%); moderately unsettled (mild to moderate sleep problems, mild crying problems, mild-to-moderate tantrums and mild to moderate mood swings, 13.2%); and severely unsettled (worse sleep and crying problems, tantrums and mood swings, along with more difficult temperament and feeding problems, 3.4%).

All four profiles of regulatory problems were associated with greater total behavioral difficulties at 5 years of age, and all but the tantrums profile were associated with greater total behavioral difficulties at 11 years of age.

In adjusted analyses, children in the tantrums profile had 3.79-fold higher odds (P<0.01) of scoring in the clinical (abnormal) range on the parent-report version of the Strengths and Difficulties Questionnaire (SDQ) and children in the severely unsettled profile had 9.35-fold higher odds (P<0.01) of scoring in the clinical range at 5 years of age.

By age 11 years, the moderately unsettled profile was associated with 2.85-fold higher odds (P<0.01) of scoring in the clinical range, while the severely unsettled profile was associated with 10.37-fold higher odds (P<0.01) of scoring in the clinical range on the SDQ.

Mothers of infants in the severely unsettled profile, moderately unsettled profile, and tantrums profile were slightly younger than those who had infants in the settled profile.

Mothers of infants in the severely unsettled profile were less likely to be born in Australia, more likely to be of non-English-speaking background (NESB), less likely to have completed secondary school and more likely to live in areas of socioeconomic disadvantage.

Mothers of infants in the moderately unsettled profile were also more likely to report being NESB and to live in areas of greater socioeconomic disadvantage.

"Physicians should routinely enquire about the extent and severity of regulation problems - including problems with sleeping, crying, feeding, mood swings, and tantrums - when the infant is 1 year of age," Dr. Cook said. "When multiple moderate-to-severe problems are present, targeted intervention for these problems and referral to appropriate support services should be considered."

"Parents should not be alarmed by these findings," she said. "Most parents will experience one or two mild to moderate difficulties with their infant's behavior, and this is normal and expected. It is the combination of multiple moderate-to-severe problems with sleeping, crying, feeding, mood swings, and tantrums at 12 months of age that indicates increased risk for later difficulties. Concerned parents should seek advice and support from their health care provider."

Dr. Cook added, "Stemming from these findings, we are developing a brief screening instrument that clinicians can use to rapidly identify infants at risk for later mental health difficulties."

SOURCE: https://bit.ly/2TDbDh5

Pediatrics 2019.

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