Family environment and preschoolers' sleep: the complementary role of both parents

European expert guidance on management of sleep onset insomnia and melatonin use in typically developing children

Sleeping problems are prevalent among children and adolescents, often leading to frequent consultations with pediatricians. While cognitive-behavioral therapy has shown effectiveness, especially in the short term, there is a lack of globally endorsed guidelines for the use of pharmaceuticals or over-the-counter remedies in managing sleep onset insomnia. An expert panel of pediatric sleep specialists and chronobiologists met in October 2023 to develop practical recommendations for pediatricians on the management of sleep onset insomnia in typically developing children. When sleep onset insomnia is present in otherwise healthy children, the management should follow a stepwise approach. Practical sleep hygiene indications and adaptive bedtime routine, followed by behavioral therapies, must be the first step. When these measures are not effective, low-dose melatonin, administered 30-60 min before bedtime, might be helpful in children over 2 years old. Melatonin use should be monitored by pediatricians to evaluate the efficacy as well as the presence of adverse effects.    Conclusion: Low-dose melatonin is a useful strategy for managing sleep onset insomnia in healthy children who have not improved or have responded insufficiently to sleep hygiene and behavioral interventions.

Development of the Parenting Behavior Checklist to Promote Preschoolers' Sleep (PCPP)

OBJECTIVES

To develop the Parenting Behavior Checklist to Promote Preschoolers' sleep (PCPP), quantify sleep-promoting parenting behaviors for children, and examine the scale's reliability and validity.

METHODS

The PCPP was developed based on the recommendations of the ABCs of SLEEPING for children's sleep, which is strongly supported by research evidence. Its validity and reliability were evaluated using data from 140 participants. Structural validity was estimated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency was evaluated by Cronbach's α. Hypothesis testing was evaluated by analyzing the correlations between each factor of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) and the PCPP.

RESULTS

Regarding structural validity, EFA was conducted because CFA showed a poor model fit. The PCPP comprised one factor and six items. The JSQ-P subfactors of insomnia or circadian rhythm sleep-wake disorders, undesirable morning symptoms and behaviors, and insufficient sleep were moderately negatively correlated with the PCPP; the subfactor of undesirable daytime behaviors related to sleep problems was weakly negatively correlated with the PCPP. Thus, the sleep-promoting parenting behaviors listed in the PCPP were associated with better sleep in children.

CONCLUSIONS

The PCPP showed sufficient reliability and validity. Future studies should use the scale to examine more effective interventions regarding sleep-promoting parental behaviors for children.

A Systematic Review and Meta-analysis: Paternal Anxiety and the Emotional and Behavioral Outcomes in Their Offspring

OBJECTIVE

Anxiety disorders are highly prevalent worldwide; however, the literature lacks a meta-analytic quantification of the risk posed by fathers' anxiety for offspring development. This systematic review and meta-analysis aimed to provide a comprehensive estimate of the magnitude of the association between paternal anxiety and emotional and behavioral problems of offspring.

METHOD

In February 2022, Web of Science, Ovid (Embase, MEDLINE, PsycINFO), Trip Database, and ProQuest were searched to identify all quantitative studies that measured anxiety in fathers and emotional and/or behavioral outcomes in offspring. No limits were set for offspring age, publication language, or publication year. Summary estimates were extracted from the primary studies. Meta-analytic random-effects 3-level models were used to calculate correlation coefficients. Quality was assessed using the Newcastle-Ottawa Scale. The study protocol was preregistered with PROSPERO (CRD42022311501) and adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines.

RESULTS

Of 11,746 records identified, 98 were included in the meta-analysis. Small but significant associations were found between paternal anxiety and offspring emotional and behavioral problems overall (r = 0.16, 95% CI [0.13, 0.19]) and behavioral (r = 0.19, 95% CI [0.13, 0.24]), emotional (r = 0.15, 95% CI [0.12, 0.18]), anxiety (r = 0.13, 95% CI [0.11, 0.16]), and depression (r = 0.13, 95% CI [0.03, 0.23]) problems. Some significant moderators were identified.

CONCLUSION

Paternal mental health is associated with offspring development, and the offspring of fathers with anxiety symptoms or disorders are at increased risk of negative emotional and behavioral outcomes, in line with the principles of multifinality and pleiotropy. The substantial heterogeneity among studies and the overrepresentation of White European American groups in this literature highlight the need for further research.

DIVERSITY & INCLUSION STATEMENT

While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Qualitative study of the association between psychosocial health and physical activity/sleep quality in toddlers

Physical activity and sleep are important factors of mental and physical health in children, with some reports indicating that their effects can persist into adulthood. However, there is limited research on the qualitative aspects of physical activity and sleep in preschool children, particularly in those aged < 3 years. Therefore, to elucidate the association between psychosocial health and physical activity/sleep in early childhood in terms of qualitative aspects, we conducted a retrospective cohort study in 2985 3-year-old children (37.2 ± 0.75 months) in Shanghai, China. An analysis using structural equation modeling indicated that current physical activity had a direct and moderate impact on current psychosocial health evaluated using the Strength and Difficulties Questionnaire. In particular, past physical activity had an indirect and mild effect on current psychosocial health via current physical activity in girls. However, regardless of sex, past sleep quality had slight impact on current psychosocial health, not only indirectly via current sleep quality, but also directly. These findings highlight the importance of considering the qualitative aspects of physical activity and sleep quality as significant factors influencing the current and future psychosocial health of children, even at a very early age (< 3 years).

Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis

Up to 50% of children and adolescents in the United States (U.S.) experience sleep problems. While existing research suggests that perceived stress in caregivers is associated with poorer sleep outcomes in children, research on this relationship is often limited to infant and early childhood populations; therefore, we investigated this association in school-age children and adolescents. We used cross-sectional caregiver-reported surveys and applied item response theory (IRT) followed by meta-analysis to assess the relationship between caregiver perceived stress and child sleep disturbance, and moderation of this relationship by child age and the presence of a child mental or physical health condition. We analyzed data from the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program, a collaboration of existing pediatric longitudinal cohort studies that collectively contribute a diverse and large sample size ideal for addressing questions related to children's health and consolidating results across population studies. Participants included caregivers of children ages 8 to 16 years from four ECHO cohorts. Caregiver perceived stress was measured using the Perceived Stress Scale (PSS), and child sleep disturbance was assessed using five sleep-related items from the School-Age version of the Child Behavior Checklist (CBCL). Increases in caregiver perceived stress and child mental or physical health condition were independently associated with greater sleep disturbance among children. The findings reinforce the importance of accounting for, and potentially intervening on, the broader family context and children's mental and physical health in the interest of improving sleep health.

Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers

OBJECTIVE

To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged.

METHODS

We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR).

RESULTS

An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors.

CONCLUSIONS

More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.

The association between family function and sleep disturbances of preschool children in rural areas of China: a cross-sectional study

This study aimed to explore the association between family function and sleep disturbances in preschool children in rural areas of China. Caregivers of preschool children completed sociodemographic questionnaires, the Children's Sleep Habits Questionnaire (CSHQ), the Self-rating Anxiety Scale (SAS) and the Family APGAR scale. Using sleep disturbances in children as the dependent variable, family function and other related factors as independent variables, binary logistic regression analyses were performed to examine associations between family function and sleep disturbances in children. A total of 3,636 caregivers of preschool children were enrolled in our study, and the prevalence of sleep disturbances among their preschool children was 89.4%. In our study, lower family function was associated with higher risk of sleep disturbances among preschool children. After adjusting for age (years), education level of mother, discipline attitudes of father and mother, only child status and caregivers' anxiety, the associations were statistically significant both in families of which caregivers of children are their parents or other relatives. (AOR for parents = 1.487, 95% CI:1.152-1.919, P = 0.002; AOR for other relatives = 1.963, 95% CI:1.302-2.958, P = 0.001). Our study results indicated that family function was associated with sleep disturbances in preschool children, and future high-quality cohort studies are needed to explore this topic in more detail.

Family environment characteristics and sleep duration in children: Maternal mental health as a mediator

BACKGROUND

Family environment is a key factor affecting children's health. However, little is known about whether and how the family environment affects sleep duration in children. This study investigated the effects of both physical and social characteristics of the family environment on sleep duration in children and determined whether these associations were mediated by maternal mental health.

METHODS

Data were obtained from the Taiwan Birth Cohort Study. A total of 19,400 children who completed 6-month, 18-month, 3-year, 5.5-year, and 8-year surveys were analyzed. The physical family environment characteristics were household crowding and housing quality. Family functioning was used as an indicator of family social environment. Multiple linear regression and path analysis were performed to test the hypotheses.

RESULTS

The children living in crowded households had shorter sleep durations (β = -0.03, p < .001). Superior housing quality and family functioning were associated with longer sleep durations (β = 0.04 and 0.02, respectively, ps < .01). The effects of housing quality and family functioning on sleep duration were mediated by maternal mental health.

CONCLUSIONS

Both physical and social characteristics of the family environment are critical to sleep duration in children. The effects of family environment characteristics on sleep duration in children are in part mediated by maternal mental health. Interventions to improve sleep during childhood by targeting the family environment may be more effective when maternal mental health is considered.

Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent-child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study

BACKGROUND

In early childhood sleep and regulatory problems, parental factors are often impaired but essential to overcoming them. This study aims to examine, in parents of young sleep-disturbed children, whether mothers' and fathers' sense of parenting competence were increased and dysfunctional parent-child interactions reduced with a parental sleep intervention, whether these changes were sustained over a 12-month follow-up period and if children's symptomatic parameters could be related factors.

METHODS

A total of 57 families with sleep-disturbed children aged 6 months to 4 years entered this single-arm pilot study. Each parent pair participated in six weekly individual face-to-face sessions of a multimodal cognitive-behavioral sleep intervention. The Parenting Sense of Competence Scale, Parental Stress Index Short Form, Child's Sleep Diary and Child's Questionnaire on Crying, Eating and Sleeping were obtained pre-, post-, 3, 6 and 12 months after the intervention.

RESULTS

Maternal sense of competence and dysfunctional mother-child interaction improved significantly up to 6 months after the intervention. Factors related to lower maternal competence were the child's more frequent nightly food intake and more crying due to defiance; factors related to dysfunctional mother-child interaction were more frequent crying episodes, more crying due to defiance and more eating difficulties; factors related to increased maternal competence were less duration of child's night waking, less bed-sharing and lower frequency of crying episodes; factors related to increased paternal competence were less child's nightly food intake and fewer episodes of unexplained and unsoothable crying; and factors related to improved father-child interaction were less frequent child's night waking and fewer unexplained and unsoothable crying episodes.

CONCLUSION

For parents of sleep-disturbed young children, an intervention that addresses the child's sleep could be promising to increase the parental sense of competence and reduce dysfunctional parent-child interactions, especially for mothers. Child symptomatic parameters may change, together with the parental sense of competence and parent-child interaction of both parents, after the intervention. Mothers with children with more severe symptomatology perceive their parenting competence as lower on average and their mother-child interaction as more dysfunctional. Future research with a larger sample and a randomized controlled design is needed.

TRIAL REGISTRATION

The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578; registration date: 21.03.2022).

Understanding family life during the COVID-19 shutdown

OBJECTIVE

Our study investigates how changes in family contexts were associated with child behaviors during Ohio's COVID-19 shutdown of early 2020.

BACKGROUND

The COVID-19 pandemic caused major economic and social changes for families. Rapid research was conducted to assess these changes and their potential impacts on child behaviors.

METHOD

Using a diverse sample of families with children aged birth to 9 years (N = 559), we describe key economic changes and parent-reported stressors experienced during Ohio's shutdown period. Then, we use regression models to examine how these family conditions were associated with child emotional distress and changes in sleep routines.

RESULTS

When parents experienced more total COVID-19 pandemic-related stressors, they also reported that their children exhibited more anxious and withdrawn, fearful, acting out, and COVID-19 pandemic-related behaviors (p < 0.01).

CONCLUSION

Families and children living at home in Ohio experienced significant stress during the shutdown. These findings can be used to inform future studies of the social and economic consequences of the COVID-19 pandemic for parents and children.

IMPLICATIONS

Families and children have experienced multiple stressors during the COVID-19 pandemic. Researchers and practitioners should continue to monitor and support families and children to mitigate potential lasting consequences.

Sleep disturbances and correlates among a sample of preschool children in rural China

This study aimed to explore the prevalence of sleep disturbances among preschool children in rural areas of China and identify the underlying associated factors. A cross-sectional study was conducted in rural areas of Anhui Province, China, from September 2019 to January 2020. The caregivers of children from 26 kindergartens completed the demographic questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), the Strengths and Difficulties Questionnaire (SDQ), the Self-rating Anxiety Scale (SAS), and the adapted Identification and Management of Feeding Difficulties (IMFeD) tool. One-way analysis of variance, independent-samples t-test, and hierarchical multiple linear regression were conducted to explore the potential influencing factors of sleep disturbances in preschool children. For the specific sleep disturbances based on each subscale of the CSHQ, bedtime resistance (54.9%) and sleep anxiety (47.9%) were the most common types of sleep disturbances, followed by daytime sleepiness (21.3%), sleep duration (20.8%), parasomnias (16.5%), sleep-onset delay (12.6%), night wakings (12.2%) and sleep-disordered breathing (10.3%). The ages of children, children's emotional/behavioral problems, children's feeding difficulties, inconsistent parenting attitudes of parents, poor parenting styles, non-parent caregivers, and caregiver anxiety contributed significantly to the CSHQ total score, accounting for approximately 27.1% (R2 = 0.271) of the variance. Our study indicates that the prevalence of sleep disturbances among preschool children in rural areas of China is quite high. Furthermore, the potential risk factors are complicated, including factors related to both children and their caregivers.

A Systematic Review on Attachment and Sleep at Preschool Age

Sleep is a biological process that impacts nearly every domain of a child's life. Sleep-wake regulation influences and it is highly influenced by developmental variables related to parent-child relationships, such as attachment. The main goal of the present systematic review is to analyze and integrate the findings of empirical studies investigating the relations between attachment and sleep in preschool age, a period marked by important developmental changes that challenge both attachment system and sleep-wake regulation. A database search was performed using a combination of relevant keywords, leading to the identification of 524 articles, with 19 manuscripts assessed for eligibility; finally, seven studies (2344 children) were included. Overall, the findings were not consistent, with some studies reporting significant associations between attachment security and sleep quality, as well as between attachment insecurity and sleep problems, whereas others did not find significant associations. The results are discussed in light of the available theoretical models and integrated in the context of measurement approaches to attachment and sleep heterogeneity, aiming to guide future research on the topic.

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families

OBJECTIVE

The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic.

METHODS

Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial.

RESULTS

While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep.

CONCLUSIONS

The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

[Pandémie COVID-19, sommeil et séquelles psychologiques: au nom du Réseau canadien du sommeil et des rythmes circadiens* et de la Société canadienne du sommeil*]

Les données recueillies lors de crises et tragédies passées prouvent que les problèmes de sommeil survenant durant ou peu de temps après un événement traumatique sont reliés à une probabilité accrue de développer des symptômes psychiatriques durables. Or la pandémie COVID-19 et ses conséquences à moyen et long-terme combinent plusieurs facteurs de risque pour le sommeil, tant pour les intervenants de la santé que la population générale. Notre relevé mensuel des publications scientifiques qui combinent COVID-19 et sommeil/insomnie entre janvier et juillet 2020 révèle un taux de croissance comparable pour les articles qui portent plus précisément sur la santé mentale mais aucune ne porte sur les résultats d’une intervention. Nous proposons qu’il faille agir rapidement sur les difficultés de sommeil en cette période de pandémie afin de protéger l’équilibre psychologique individuel à moyen et long terme, d’autant plus que les outils nécessaires à la prévention de l’insomnie, sa détection et son traitement sont à la portée de tous les professionnels de la santé mentale.

Quality of father-child relationships as a predictor of sleep developments during preschool years

Substantial developmental changes in sleep occur during the preschool period, but few studies have investigated the factors that forecast these developments. The aim of this study was to examine whether three aspects of father-child relationships in toddlerhood predicted individual differences in developmental patterns of change in five actigraphy-derived sleep variables during the preschool period (N = 67; sleep assessed yearly between 2 and 4 years). In a predominantly White and middle-to-higher income sample, paternal mind-mindedness and quality of father-child interactions were assessed during father-child free play at 18 months and fathers self-reported on their involvement in childrearing at age 2. Multilevel growth modeling revealed that children whose father made more mind-related comments during father-child interactions had a higher proportion of sleep taking place during nighttime as well as shorter daytime and total sleep duration at 2 years. This was, however, followed by a relative leveling off (i.e., less rapid change) of these sleep features between 2 and 4 years. Given previous studies documenting that nighttime sleep proportion increases while daytime and total sleep duration decrease during preschool years, the findings suggest that children who are exposed to more paternal mind-mindedness may reach more mature sleep patterns earlier in development.

Sleep disturbances in autism spectrum disorder without intellectual impairment: relationship with executive function and psychiatric symptoms

The autism spectrum disorder (ASD) is a neurodevelopmental condition, frequently accompanied by medical and psychiatric pathology. One of the most commonly found problems associated with ASD is sleep disturbances, which are estimated to affect approximately 80% of the people with ASD, not only during childhood but also in the adolescence and adult stages. Nevertheless, the relationship of these sleep difficulties with autism severity, as well as other associated impairments such as executive functioning and psychiatric disorders (eg, depression), has not yet been widely studied. The main objective of the present study was to explore the relationship between sleep disturbances, subjective measures of executive function, and psychiatric pathology in the ASD population. To reach that goal, a group of 89 participants with ASD (44 children/adolescents and 45 adults) was recruited and evaluated with self-reported measures of executive function performance and psychiatric pathology tests. Multivariate analysis showed a significant association between sleep disturbances and psychiatric symptoms in both ASD groups, with greater sleep disturbances predicting more severe psychiatric pathology. No significant association was found with executive function in any group. Limitations included a small sample size and lack of objective measures. Sleep problems seem to be associated with the severity of psychiatric pathology throughout the lifespan, increasing the chance of developing psychiatric symptoms when they were present. Improving sleep quality in ASD at all ages may result in preventing and/or decreasing psychiatric pathology in this population.

The contributory role of the family context in early childhood sleep health: A systematic review

Sleep-wake regulation is established during early childhood and contributes to life-long health. The family context is critical to the development of child sleep-wake regulation. The primary aim of this systematic review was to elucidate family-level constructs (outside of bedtime parenting) that contribute to early childhood (age 0-5 years) sleep health. We identified empirical research articles that investigate these relationships through systematically searching PubMed, Web of Science, and PsycINFO databases. The transactional model of sleep-wake regulation guided the selection of family-level search terms, including socioeconomic status (SES), family structure, household chaos, marital, co-parenting, and social relationships. Sleep search terms included sleep problems, duration, timing, and variability. We searched sleep and family terms in combination with infant, toddler, or preschool developmental age. Sixteen studies satisfied criteria for inclusion. Results indicated that the presence of household chaos and poor quality marital relationships were directly associated with early childhood sleep problems and variable sleep timing. Higher marital satisfaction and the presence of household routines were positively associated with sleep duration. Several, but not all, studies showed an association between lower SES and poor child sleep health. There were no significant direct associations for family structure and limited findings for the role of perceived social support and co-parenting relationship quality. Overall, operationalization and measurement of family and sleep constructs varied across studies, decreasing our ability to make comparisons and draw robust conclusions. Future research should identify modifiable family-level factors that can be targeted, in addition to bedtime parenting, to improve sleep-wake regulation development.

The Family Context of Toddler Sleep: Routines, Sleep Environment, and Emotional Security Induction in the Hour before Bedtime

Family processes during the pre-bedtime period likely have a crucial influence on toddler sleep, but relatively little previous research has focused on family process in this context. The current study examined several aspects of family process during the pre-bedtime period, including the use of bedtime routines, the qualities of the child's home sleep environment, and the promotion of child emotional security, in families of 30-month-old toddlers (N= 546; 265 female) who were part of a multi-site longitudinal study of toddler development. These characteristics were quantified using a combination of parent- and observer-reports and examined in association with child sleep using correlation and multiple regression. Child sleep was assessed using actigraphy to measure sleep duration, timing, variability, activity, and latency. Bedtime routines were examined using parents' daily records. Home sleep environment and emotional security induction were quantified based on observer ratings and in-home observation notes, respectively. All three measures of pre-bedtime context (i.e., bedtime routine inconsistency, poor quality sleep environments, and emotional security induction) were correlated with various aspects of child sleep (significant correlations:.11-.22). The most robust associations occurred between the pre-bedtime context measures and sleep timing (i.e., the timing of the child's sleep schedule) and variability (i.e., night to night variability in sleep timing and duration). Pre-bedtime variables, including bedtime routine consistency, home sleep environment quality, and positive emotional security induction, also mediated the association between family socioeconomic status and child sleep. Our findings underscore the value of considering family context when examining individual differences in child sleep.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

STUDY OBJECTIVES

To examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children.

METHODS

The current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015-2016 on 736 children aged 3-6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling.

RESULTS

An hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders.

CONCLUSIONS

Increased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

[Sleep disorders in babies and children]

Many children develop a characterized sleep disorder, sometimes with severe consequences. Behind the term "insomnia", there is a wide variety of disorders, causes and psychopathological contexts to which the clinician will have to adapt for optimal management, from babies to pre-adolescents.