Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 836-842 (doi:10.1542/peds.2005-0775)

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Prevalence, Stability, and Outcomes of Cry-Fuss and Sleep Problems in the First 2 Years of Life: Prospective Community-Based Study

Melissa Wake, MD^a,b,c, Elise Morton-Allen, BBSc^a,c, Zeffie Poulakis, DPsych^a,c, Harriet Hiscock, MD^a,b,c, Susan Gallagher, MLitt^a,c, and Frank Oberklaid, MD^a,b,c

^a Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia
^b Department of Paediatrics, University of Melbourne, Melbourne, Australia
^c Murdoch Childrens Research Institute, Melbourne, Australia

OBJECTIVE. To report the prevalence and stability of cry-fuss problems during the first 4 months of life and sleep problems from 2 to 24 months and relationships between the persistence of cry-fuss and sleep problems and outcomes at 24 months.

METHODS. The study was a prospective cohort study in maternal and child health centers in 3 local government areas in Melbourne, Australia. A total of 483 first-born infants were monitored prospectively from 2 weeks through 2, 4, 8, 12, 18, and 24 months. Child behavior, maternal depression, parenting stress, and marital quality were assessed. Predictor variables were parent reports of moderate or greater cry-fuss problems (2 and 4 months) and sleep problems (8, 12, 18, and 24 months) and parent-reported, 24-hour, sleep/cry-fuss diaries (2, 4, and 12 months).

RESULTS. The response rate was 68% (483 of 710 infants); the attrition rate was <6%. The prevalence of cry-fuss problems decreased from 19.1% at 2 months to 12.8% at 4 months, with 5.6% of mothers reporting cry-fuss problems at both ages. Prevalence rates of sleep problems were 21.2%, 16.2%, 10.0%, and 12.1% at 8, 12, 18, and 24 months, respectively; 6.4% had a problem at 3 of these ages. In multivariate analyses, cry-fuss/sleep problems at 3 previous time points (but not 1 or 2 time points) contributed significantly to depression (2.8% of variance), total behavior (1.4% of variance), and total stress (4.6% of variance) scores. Repeated problems had a greater impact than a concurrent sleep problem on depression and stress scores, whereas the reverse was true for behavior scores.

CONCLUSIONS. Most cry-fuss and sleep problems in the first 2 years of life are transient. Persistent, rather than transient, problems contribute to maternal depression, parenting stress, and subsequent child behavior problems.

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Key Words: sleep • cry-fuss • child behavior • maternal depression • outcomes

Abbreviations: LGA—local government area • PEAS—Parent Education and Support • EPDS—Edinburgh Postnatal Depression Scale • CBCL—Child Behavior Checklist • PSI—Parenting Stress Index • DAS—Dyadic Adjustment Scale

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Accepted Jul 15, 2005.

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