Infant Temperament, Parental Depression and Sleep in Healthy Children and Children Born with Congenital Anomalies

Benedetta Ragni, Teresa Grimaldi Capitello, Simonetta Gentile, Francisco Pons, Simona De Stasio


Poor sleep quality represents a concern commonly reported by parents during the first year of life and is longitudinally related to problems with children's cognitive, emotional, and behavioural development. According to research, several intrinsic and extrinsic factors intervene in helping or hindering sleep quality during early childhood. In particular, the relationship between parental mental health, infants’ temperament, their at-risk health conditions, and sleep quality has not been investigated yet, especially in the Italian population. 100 Italian heterosexual couples, with infants aged from 8 to 12 months were involved in this study and completed self-report questionnaires: the Brief Infant Sleep Questionnaire (BISQ), the Italian Temperament Questionnaires (QUIT - version 0-12 months), the Edinburgh Postnatal Depression Scale (EPDS). 58 couples had healthy children and were recruited from kindergartens located in Rome, Italy. 42 couples had children born with congenital anomalies requiring surgery at birth and were recruited at Bambino Gesù Children's Hospital, Rome, Italy. Results highlighted similar sleep outcomes between clinical and healthy children. Furthermore, they showed that children’s insomnia symptoms resulted associated with children’s temperamental negative emotionality, parental postpartum depression symptoms, and constant bedtime routines in both groups. In conclusion, this study can raise awareness and enhance understanding of risk and protective factors for infants’ sleep, among families, education practitioners, healthcare providers, and the general public.


Sleep; Bedtime routines; Temperament; Postpartum depression; Congenital anomalies.

Full Text:



Aite, L., Bevilacqua, F., Zaccara, A., La Sala, E., Gentile, S., & Bagolan, P. (2016). Seeing their children in pain: Symptoms of posttraumatic stress disorder in mothers of children with an anomaly requiring surgery at birth. American Journal of Perinatology, 33(08), 770–775.

American Academy of Sleep Medicine (2014). International Classification of Sleep Disorders–Third Edition (ICSD-3). American Academy of Sleep Medicine.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Axia, G. (2002). QUIT-Questionari Italiani del Temperamento. Erikson.

Bacaro, V., Chiabudini, M., Buonanno, C., Bartolo, P. De, Riemann, D., Mancini, F., & Baglioni, C. (2021). Sleep characteristics in Italian children during home confinement. Clinical Neuropsychiatry, 18(1), 13–27.

Bertelle, V., Sevestre, A., Nagahapitiye, M. C., & Sizun, J. (2007). Sleep in the Neonatal Intensive Care Unit. Journal of Perinatal & Neonatal Nursing, 21(2), 140–148.

Camerota, M., Propper, C. B., & Teti, D. M. (2019). Intrinsic and extrinsic factors predicting infant sleep: Moving beyond main effects. Developmental Review, 53(July), 100871.

Cook, F., Giallo, R., Petrovic, Z., Coe, A., Seymour, M., Cann, W., & Hiscock, H. (2017). Depression and anger in fathers of unsettled infants: A community cohort study. Journal of Paediatrics and Child Health, 53(2), 131–135.

Cortesi, F., Giannotti, F., & Ottaviano, S. (1999). Sleep problems and daytime behavior in childhood idiopathic epilepsy. Epilepsia, 40(11), 1557-1565.

Cox, J. Holden, J. Sagovsky, R. (1987). Detection of Postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782-786.

De Stasio, S., Boldrini, F., Ragni, B., Bevilacqua, F., Bucci, S., Giampaolo, R., Messina, V., & Gentile, S. (2019). Sleep Quality, Emotion Regulation and Parenting Stress in Children with Congenital Heart Disease. Mediterranean Journal of Clinical Psychology, 7(3), 1-20.

De Stasio, S., Coletti, M. F., Boldrini, F., Bevilacqua, F., Dotta, A., & Gentile, S. (2018). Parenting stress in mothers of infants with congenital heart disease and of preterm infants at one year of age. Clinical Neuropsychiatry, 15(1), 3-11.

El-Sheikh, M., Buckhalt, J. A., Cummings, E. M., & Keller, P. (2007). Sleep disruptions and emotional insecurity are pathways of risk for children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48(1), 88–96.

El‐Sheikh, M., & Sadeh, A. (2015). I. Sleep and development: Introduction to the monograph. Monographs of the Society for Research in Child Development, 80(1), 1-14.

Gath, E. G., and Hayes, K. (2006). Bounds for the largest Mahalanobis distance. Linear Algebra and its Applications, 419, 93–106.

Gellerstedt, L., Medin, J., & Karlsson, M. R. (2014). Patients’ experiences of sleep in hospital: a qualitative interview study. Journal of Research in Nursing, 19(3), 176-188.

George, D., and Mallery, P. (2003). SPSS for Windows Step by Step: Answers to Selected Exercises. Allyn & Bacon.

Hair, J.F., Black,W.C., Bambin, B.J., & Anderson, R.E. (2010). Multivariate Data Analysis: A Global Perspective (7th ed.). Pearson.

Hamid, C. H., Holland, A. J. A., & Martin, H. C. O. (2007). Long-term outcome of anorectal malformations: The patient perspective. Pediatric Surgery International, 23(2), 97–102.

Hu, L.T., & Bentler, P.M (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55.

IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.

Johnson, C., & Mindell, J. A. (2011). Family-Based Interventions for Sleep Problems of Infants and Children. In Sleep and Development: Familial and Socio-Cultural Considerations. Oxford University Press.

Kaley, F., Reid, V., & Flynn, E. (2012). Investigating the biographic, social and temperamental correlates of young infants’ sleeping, crying and feeding routines. Infant Behavior and Development, 35(3), 596–605.

Kim, B. R., & Teti, D. M. (2014). Maternal emotional availability during infant bedtime: an ecological framework. Journal of Family Psychology, 28 (1), 1-11.

Kim, H., Zhou, E. S., Chevalier, L., Lun, P., Davidson, R. D., Pariseau, E. M., & Long, K. A. (2020). Parental Behaviors, Emotions at Bedtime, and Sleep Disturbances in Children with Cancer. Journal of Pediatric Psychology, 45(5), 550–560.

Lee, S., Narendran, G., Tomfohr‐Madsen, L., & Schulte, F. (2017). A systematic review of sleep in hospitalized pediatric cancer patients. Psychooncology, 26(8), 1059-1069.

Little, R. J. A. (1992). Regression with missing X’s: a review. Journal of the American Statistical Association, 87, 1227–1237.

Lupini, F., Leichman, E. S., Lee, C., & Mindell, J. A. (2021). Sleep patterns, problems, and ecology in young children born preterm and full-term and their mothers. Sleep Medicine, 81, 443–450.

Matthey, S., Barnett, B., Kavanagh, D. J., & Howie, P. (2001). Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 64(2–3), 175–184.

McCarthy, M. C., Bastiani, J., & Williams, L. K. (2016). Are parenting behaviors associated with child sleep problems during treatment for acute lymphoblastic leukemia?. Cancer Medicine, 5(7), 1473-1480.

McCusker, C. G., Doherty, N. N., Molloy, B., Rooney, N., Mulholland, C., Sands, A., Craig, B., Stewart, M., & Casey, F. (2012). A randomized controlled trial of interventions to promote adjustment in children with congenital heart disease entering school and their families. Journal of Pediatric Psychology, 37(10), 1089–1103.

McDaniel, B. T., & Teti, D. M. (2012). Coparenting quality during the first three months after birth: The role of infant sleep quality. Journal of Family Psychology, 26(6), 886–895.

Meltzer, L. J., Wainer, A., Engstrom, E., Pepa, L., & Mindell, J. A. (2021). Seeing the whole elephant: A scoping review of behavioral treatments for pediatric insomnia. Sleep Medicine Reviews, 56, 101410.

Meltzer, L. J., Williamson, A. A., & Mindell, J. A. (2021). Pediatric sleep health: It matters, and so does how we define it. Sleep Medicine Reviews, 57, 101425, 1-12.

Mindell, J. A., Telofski, L. S., Wiegand, B., & Kurtz, E. S. (2009). A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep, 32(5), 599–606.

Mindell, J.A., & Williamson, A. A. (2017). Benefits of a bedtime routine in young children: Sleep, development, and beyond. Sleep Medicine Reviews, 40, 93-108.

Morales-Muñoz, I., Partonen, T., Saarenpää-Heikkilä, O., Kylliäinen, A., Pölkki, P., Porkka-Heiskanen, T., Paunio, T., & Paavonen, E. J. (2019). The role of parental circadian preference in the onset of sleep difficulties in early childhood. Sleep Medicine, 54, 223–230.

Morrell, J., & Cortina-Borja, M. (2002). The Developmental Change in Strategies Parents Employ to Settle Young Children to Sleep, and their Relationship to Infant Sleeping Problems, as Assessed by a New Questionnaire: The Parental Interactive Bedtime Behaviour Scale. Infant and Child Development, 11(1), 17–41.

Morrell, J., & Steele, H. (2003). The role of attachment security, temperament, maternal perception, and care-giving behavior in persistent infant sleeping problems. Infant Mental Health Journal, 24(5), 447–468.

Mulkey, S. B., Yap, V. L., Bai, S., Ramakrishnaiah, R. H., Glasier, C. M., Bornemeier, R. A., Schmitz, M. L., & Bhutta, A. T. (2015). Amplitude-Integrated EEG in Newborns With Critical Congenital Heart Disease Predicts Preoperative Brain Magnetic Resonance Imaging Findings. Pediatric Neurology, 52(6), 599–605.

Muthén, L. K., & Muthén, B. (1998-2017). Mplus User’s Guide. Muthén & Muthén.

Netsi, E., van IJzendoorn, M., Bakermans-Kranenburg, M., Wulff, K., Jansen, P., Jaddoe, V., Verhulst, F., Tiemeier, H., & Ramchandani, P. (2016). Does infant reactivity moderate the association between antenatal maternal depression and infant sleep? Journal of Developmental & Behavioral Pediatrics, 36(6), 440–449.

Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659–668.

Ragni, B., De Stasio, S., Barni, D., Gentile, S., & Giampaolo, R. (2019). Parental Mental Health, Fathers’ Involvement and Bedtime Resistance in Infants. Italian Journal of Pediatrics, 45(1), 1–10.

Ragni, B., Stasio, S. De, & Barni, D. (2020). Fathers and sleep: a systematic literature review of bidirectional links between paternal factors and children’s sleep in the first three years of life.Clinical Neuropsychitry, 17(6), 349–360.

Sadeh, A., & Anders, T. (1993). Infant sleep problems: Origins, assessment, interventions. Infant Mental Health Journal, 14(1), 17–34.<17::AID-IMHJ2280140103>3.0.CO;2-Q

Sadeh, A., Mindell, J. A., Luedtke, K., & Wiegand, B. (2009). Sleep and sleep ecology in the first 3 years: A web-based study. Journal of Sleep Research, 18(1), 60–73.

Sadeh, A., Mindell, J., & Rivera, L. (2011). “My child has a sleep problem”: A cross-cultural comparison of parental definitions. Sleep Medicine, 12(5), 478–482.

Sadeh, A., Tikotzky, L., & Scher, A. (2010). Parenting and infant sleep. Sleep Medicine Reviews, 14(2), 89–96.

Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures. Methods of Psychological Research, 8, 23–74.

Sheridan, A., Murray, L., Cooper, P. J., Evangeli, M., Byram, V., & Halligan, S. L. (2013). A longitudinal study of child sleep in high and low risk families: Relationship to early maternal settling strategies and child psychological functioning. Sleep Medicine, 14(3), 266–273.

Sorondo, B. M., & Reeb-Sutherland, B. C. (2015). Associations between infant temperament, maternal stress, and infants’ sleep across the first year of life. Infant Behavior and Development, 39, 131–135.

Spence, K., Swinsburg, D., Griggs, J., & Johnston, L. (2011). Infant well‐being following neonatal cardiac surgery. Journal of Clinical Nursing, 20(17‐18), 2623–2632.

Spruyt, K., Aitken, R., So, K., Charlton, M., Adamson, T., & Horne, R. (2008). Relationship between sleep/wake patterns, temperament and overall development in term infants over the first year of life. Early Human Development, 84(5), 289–296.

Teti, D. M., & Crosby, B. (2012). Maternal Depressive Symptoms, Dysfunctional Cognitions, and Infant Night Waking: The Role of Maternal Nighttime Behavior. Child Development, 83(3), 939–953.

Teti, D. M., Crosby, B., McDaniel, B. T., Shimizu, M., & Whitesell, C. J. (2015). X. marital and emotional adjustment in mothers and infant sleep arrangements during the first six months. Monographs of the Society for Research in Child Development, 80(1), 160-176.

Teti, D. M., Shimizu, M., Crosby, B., & Kim, B. (2016). Sleep Arrangements, Parent – Infant Sleep During the First Year, and Family Functioning. Developmental Psychology, 52(8), 1169–1181.

Tikotzky, L. (2017). Parenting and sleep in early childhood. Current Opinion in Psychology, 15, 118-124.

Touchette, E., Cote, S. M., Petit, D., Liu, X., Boivin, M., Falissard, B., Tremblay, R. E., & Montplaisir, J. Y. (2009). Short Nighttime Sleep-Duration and Hyperactivity Trajectories in Early Childhood. Pediatrics, 124(5), e985–e993.

Troxel, W. M., Trentacosta, C. J., Forbes, E. E., & Campbell, S. B. (2013). Negative emotionality moderates associations among attachment, toddler sleep, and later problem behaviors. Journal of Family Psychology, 27(1), 127–136.

Weissbluth, M. (2015). Healthy sleep habits, happy child: A step-by-step program for a good night’s sleep. Ballantine Books.

Williamson, A. A., & Mindell, J. A. (2020). Cumulative socio-demographic risk factors and sleep outcomes in early childhood. Sleep, 43(3), 1–13.

Williamson, A. A., Mindell, J. A., Hiscock, H., & Quach, J. (2019). Sleep Problem Trajectories and Cumulative Socio-Ecological Risks: Birth to School-Age. Journal of Pediatrics, 215, 229-237.e4.

Yau, S., Pickering, R. M., Gringras, P., Elphick, H., Evans, H. J., Farquhar, M., Martin, J., Joyce, A., Reynolds, J., Kingshott, R. N., Mindell, J. A., & Hill, C. M. (2019). Sleep in infants and toddlers with Down syndrome compared to typically developing peers: looking beyond snoring. Sleep Medicine, 63, 88-97.



  • There are currently no refbacks.