Perinatal Complications Linked to Social Anxiety, Inhibition in Children

The relationship between perinatal complications and social anxiety may be mediated by children's behavioral inhibition.

Children who experience perinatal complications are more likely to experience behavioral inhibition (BI) and social anxiety compared with their counterparts who did not experience complications, according to study data published in Infant and Child Development.

As part of a larger laboratory study on temperament, attention, and anxiety, investigators screened 702 children age 9 to 12 years for BI per parental report on the Behavioral Inhibition Questionnaire (BIQ). Investigators defined BI as “temperament characterized by a tendency to exhibit a fearful disposition and withdrawal in unfamiliar contexts and situations.” The present analysis included only children with BI whose parents answered questions about perinatal complications. Children who met BIQ cut-off scores (≥119 total score or ≥60 social novelty subscale) were identified as behaviorally inhibited. Cutoff scores were based on existing literature. Screened families were asked 2 yes/no questions regarding perinatal complications and given the opportunity to describe such complications. The Computerized Diagnostic Interview Schedule for Children was administered separately to primary caregivers and child participants to capture social anxiety.

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The final cohort comprised 149 children of mean (SD) age 9.97 (1.00) years, of whom 37 (24.8%) had experienced perinatal complications. The most common complications were breech birth (16.2%), neonatal intensive care unit admission (16.2%), cardiopulmonary distress (16.2%), maternal distress during or after pregnancy/labor (16.2%), unplanned Cesarean section (13.5%), gastrointestinal complications (8.1%), and perinatal surgery (8.1%). Children experiencing perinatal complications were higher in BI and had greater parent-reported social anxiety (both P <.001). However, the same relationship was not observed between perinatal complications and child-reported social anxiety. The indirect effect of perinatal complications on social anxiety through BI was significant.

The study did not account for the possible influence of the postnatal environment on child social anxiety symptoms, and the self-reported nature of the study data.

These data suggest that the relationship between perinatal complications and social anxiety may be mediated by fearful temperament (ie, BI). Longitudinal analyses are necessary to examine the long-term impact of BI on social anxiety.


Suarez GL, Morales S, Metcalf K, Pérez‐Edgar KE. Perinatal complications are associated with social anxiety: indirect effects through temperament [published online March 19, 2019]. Infant Child Dev. doi:10.1002/icd.2130