Blog Post 40-Parental Anxiety, Depression, and Cognitive Biases (2 of 4)

Healthy Sleep Habits, Happy Child
by Marc Weissbluth, M.D.

A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you.

Parental Anxiety, Depression, and Cognitive Biases


When children are not sleeping well, the cause might be the father, the mother, the baby or any combination.  Even if the root cause or trigger might occur within the father, or the mother, or the baby, as time passes, interactive effects develop between all three.  In order to help solve sleep problems, without judgement, it is important to consider all possible causes (Blog Posts 17 and 18).

Parents may have symptoms of anxiety or depression or habitual thoughts and beliefs that might, or might not, contribute to or cause sleep difficulties in their child.  This topic is confusing because some studies look only at the father’s role and others look only at the mother’s role.  Some research suggests that a colicky baby might trigger these symptoms in the parents.  Interactions between each parent and the baby are important.  Therefore, it is difficult to make firm conclusions about the direction of effect.  Blog Posts 39-42 share studies that describe how parent’s issues might contribute to or cause sleep difficulties in their child.


Some fathers (Blog Posts 39), perhaps those with certain cognitive biases, experience parenthood with symptoms of agitation, frustration, irritability anxiety, depression, or risky alcohol use.  Other fathers are abusive, angry, absent, alcoholic, or addicted.  However, in studies that focus on mothers’ mental health around pregnancy and parenthood, fathers are often not studied, thus producing an incomplete picture of mothers’ mental health.  Mothers’ mental health status might, or might not, be strongly influenced by fathers’ mental health status.  Therefore, it is incorrect to conclude from the following discussion that the mother’s mental health status is the direct or only cause of the behaviors and problems discussed.

Dr. Liat Tikotzky studied maternal sleep-related cognitions (habitual thoughts and beliefs) and used a rating instrument describing 14 hypothetical case descriptions of infants who have difficulty falling asleep and staying asleep.  Mothers were asked to rate on a 6-point scale (from highly agree to highly disagree) their agreement with assertions in 2 categories:

  1. Distress (assertions that represent parental belief that infants experience distress or anxiety upon awakening and parents should therefore directly help or soothe them at night).
  2. Limits (assertions that emphasize the importance of limiting involvement at night and focus on encouraging infants to learn self-soothing without or with minimal parental assistance).

She also performed assessments of parental soothing patterns at bedtime and during the night, using a scale from low involvement to high involvement:

  1. In crib, by himself or herself, without caregiver’s help.
  2. In crib with parent’s passive presence (without talking, touching, etc.)
  3. In crib with brief parental help for less than 2 minutes.
  4. In crib with parental extended help
  5. While nursing, feeding, drinking or outside the crib with caregiver’s active help
  6. Falling asleep in parent’s bed

Objective sleep measures were obtained on the infants at 1, 6, and 12 months. Her results showed that “maternal cognitions related to concerns about the infants’ distress at night [were] associated with more disturbed sleep, as reflected by a higher number of objective and subjective night wakings, while maternal cognitions emphasizing the importance of limiting parental involvement were associated with more consolidated sleep.” Further, “maternal prenatal cognitions that are shaped even before the infant is born predicted the quality of the infant’s sleep at later stages.” Similarly, “mothers who put more emphasis on the infant’s distress reported later greater parental involvement in soothing their infant to sleep at the age of 6 and 12 months.”

“These findings support the hypothesis that parental soothing methods are not solely dependent on infant’s characteristics. It appears that mothers bring their own perceptions into the interaction and those cognitions seem to shape their behavior toward the infant around bedtime.”

Just to be absolutely clear, “It would be wrong to conclude from these findings that parents should abstain from approaching their infant at night in order to facilitate good sleep patterns. Undoubtedly during the first months of life, infants need their parents for comfort and regulation, while gradually these functions shift from the caregiver to the infant Parents emphasizing the importance of limiting parental involvement at night did not devaluate or disregard the interpretations underlying the need to soothe the infant. Moreover, in their actual soothing behavior, those parents who endorsed the limits interpretation were responsive to their infants and offered help although less intensively than parents who emphasized the distress interpretations and who relied more on active soothing.”

(To be continued.)


• Studies show that children are not harmed (Blog Post 24) when extinction or graduated extinction is used. Blog Post 25.



• Seek professional help if your child is not sleeping well and you suspect parental anxiety or depression might be present. Blog Posts 39.

• Accept the fact that your friends and relatives may not be aware of why a healthy brain depends on healthy sleep. Blog Post 38.

• Ignore myths such as sleep regressions or that teething or growth spurts disrupt sleep or that late bedtimes are fine because your young child is an “owl”. Blog Posts 36 and 37

• Focus on timing: The time when drowsy signs (Blog Post 9) begin to appear is the time when you start your soothing to sleep. Blog Posts 2835.

• It may be difficult to begin or choose a sleep solution. Blog Posts 23 and 26.  A Community Sleep Consultant may be helpful. Blog Post 27.

• No television or digital electronic devices in child’s bedroom (Blog Post 21), if possible. Blog Post 22.

• Some babies sleep better than other babies. Develop coping strategies to reduce stress if your baby has extreme fussiness or crying.  Plan to encourage self-soothing skills at 2 to 4 months of age. Blog Post 20.

•  ‘No Cry’ sleep solutions (‘Fading’ and ‘Check and Console’) may solve sleep problems. Blog Post 19

•  Communicate with each other and coordinate nighttime parenting practices.  Consider delaying your response to nondistress sounds your baby makes at night by 5-10 seconds, especially after 3 months of age.  Blog Post 18.

•  Encourage partner to help care for baby daytime and nighttime.  Be emotionally available at bedtime.  Seek help if your child is not sleeping well and there are symptoms of anxiety or depression for yourself or partner.  Blog Post 17.

•  Encourage self-soothing; the earlier the better.  Consider leaving the room after putting your child down to sleep. Provide opportunity for naps based on drowsy signs.  Encourage partner to help care for the baby daytime and nighttime. Blog Post 16,.

•  Plan for healthy sleep by focusing on sleep quality, not just sleep quantity. Provide opportunities for naps. Blog Post 15

•  Make a sleep plan that you are comfortable with; be flexible and tolerant.  Blog Post 14.

·  Become more aware of the difference between how you feel when well-rested versus mildly sleepy. Blog Post 13.

·  Try to maintain a regular sleep schedule.  Blog Post 12.

·  Try to not respond immediately to every quiet sound your baby makes at night.  Blog Post 11.  

·  Practice soothing to sleep and bedtime routines, every night, if possible. Blog Post 10.

·  Watch for drowsy signs. Blog Post 9.

·  Respect your child’s natural sleep rhythms.  Blog Post 8.

·  Encourage an early or earlier bedtime (even a slightly earlier bedtime may produce better sleep.  Blog Post 6) especially at 6 weeks.  Blog Post 7.

∙ Recognize that a healthy brain requires healthy sleep. Blog Posts 1, 2, 3, 4, 5, and 38.

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