Infant Regulatory Problems Increase Risk for Mental Health Difficulties in Childhood

Infants who have multiple moderate-to-severe regulatory problems have increased odds of experiencing mental health problems during childhood.

Infants who have multiple moderate-to-severe regulatory problems have more than 10 times the odds of experiencing mental health problems during childhood, and these problems worsen over time.

In a large, prospective, community-based Australian study published in Pediatrics, Fallon Cook, PhD, from the Murdoch Children’s Research Institute, Melbourne, Australia, and colleagues examined the profiles of infant regulatory behaviors and associated familial and child characteristics.

In the present study, the investigators included 1759 12-month-old infants who were of average birth weight, with 50% being male and 50% being firstborn infants. Participating mothers completed the Kessler 6 Psychological Distress Scale (K6), with scores ≥8 indicating significant psychological distress. Mothers reported the presence and severity of children’s sleep problems, excessive crying, temper tantrums, and mood swings. Participating mothers also noted whether their infants coughed, choked, or gagged on foods of various textures.

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When their children were aged 5 and 11 years, participating mothers completed the parent report version of the Strengths and Difficulties Questionnaire, a 25-item behavioral screen for children.

Researcher analysis identified 5 profiles that ranged from the most settled infants (36.8%) to those with mainly sleep problems (25.4%), isolated mild-to-moderate tantrums (21.3%), complex regulatory difficulties (13.2%), and complex and severe regulatory difficulties (3.4%). Compared with those infants who were most settled, infants in the moderately unsettled profile were at increased odds for having mental health difficulties at 11 years of age (odds ratio [OR], 2.85; P <.01), whereas those in the severely unsettled profile were at increased odds for those difficulties at age 5 years (OR, 9.35; P <.01) and age 11 years (OR, 10.37; P <.01).

Researchers found that infants from the moderately unsettled profile and tantrums profile were more likely to be firstborns, and suggested that first-time mothers may be more likely to report problematic infant behavior because of their lack of familiarity with normal infant behavior.

Researchers noted that the infant regulation items analyzed in this study may not accurately encompass all features of infant regulation, and that children did not complete diagnostic interviews for mental disorders. They called for replication of this work in future longitudinal studies and suggested that future research should investigate whether early intervention can improve outcomes for these children.


Cook F, Giallo R, Hiscock H, Mensah F, Sanchez K, Reilly S. Infant regulation and child mental health concerns: a longitudinal study. Pediatrics. 2019;143(3):e20180977.