It is a classic chicken or egg conundrum: across the many cross-sectional studies in the literature reporting significant associations between childhood sleep problems and emotional/behavioral problems, some consider sleep the exposure and behavior the outcome in their statistics and tables1,2 and some examine behavior problems as the predictor and sleep problems as the outcome.3 Although a cross-sectional study cannot demonstrate the causal sequence, many parents point out that it sometimes seems to flow in both directions, setting up a feedback whirlpool of despair. Inadequate sleep seems to beget tired meltdowns, which in turn delay sleep onset, potentially setting the child up for even more behavior problems the next day. Longitudinal research to date supports this idea that the effects are bidirectional.4 A variety of potential mediators are plausible, ranging from neuroendocrine pathways5 to the effect early childhood sleep problems have on parents’ sleep and mood.6
Garrison MM. The Feedback Whirlpool of Early Childhood Sleep and Behavior Problems. JAMA Pediatr. 2015;169(6):525–526. doi:10.1001/jamapediatrics.2015.0356
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