Health & wellness

Child in Mind

Sleep and childhood behavior: a complex relationship


Adapted from the Child in Mind blog at

A study published in the July/August issue of the Journal of Developmental and Behavioral Pediatrics showing a connection between hours of sleep and childhood behavior problems has received a lot of attention. Children who slept less than 9.4 hours had more impulsivity, anger, tantrums, and annoying behavior. The obvious conclusion: more sleep, better behavior.

If only it were that simple. What is correctly described as an “association” in the article is in fact two phenomena that have a common cause. Sleep problems are behavior problems. To know the cause, one must know the family story.

Sleep is a developmental phenomenon. In infancy a child learns “sleep associations.” The breast, a pacifier, a lovey, or even a parent’s hair may be what a child associates with falling asleep. Frequent night wakings, expected in the early weeks and months, can become a problem if that sleep association requires a parents’ physical presence. As the months wear on parents become severely sleep deprived, and often find that this pattern is not so easy to change. In toddlerhood, as a child begins to assert his independence, he may resist bedtime. Further complicating the picture is the fact that sleep represents a major separation. A child who handles the first day of preschool with grace may suddenly refuse to go to bed, or begin waking during the night.


Given the complexity of this process, there are many ways it can get derailed. If parents do not agree about teaching a child to sleep independently, a child in the bed can cause significant marital discord. When a parent is quick to lash out at a child, the child may become anxious. Sometimes this anxiety leads to “acting out” in the form of oppositional behavior. It seems illogical, but a 2-year-old may simply see that when he is “difficult” his parents are more engaged with him. Separation anxiety is common in these situations, and sleep is a major separation. Bedtime refusal and frequent night wakings are common in this setting. This leads to a vicious cycle as both parent and child become increasingly irritable.

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I feel for the parent who reads an article titled “More Sleep Might Help Tots’ Tantrums’’ and is unable to change the situation because the underlying cause is not addressed. This is where our culture of quick fixes can lead to feelings of inadequacy and guilt. The key to treating these problems is to give parents time to tell the full story. When parents feel understood, they are better positioned to explore the meaning of their child’s behavior.

Read more of this blog at