Normal sleep development in infants: findings from two large birth cohorts

Shorter night-time sleep duration and later sleep timing from infancy to adolescence

BACKGROUND

Here, we (a) examined the trajectories of night-time sleep duration, bedtime and midpoint of night-time sleep (MPS) from infancy to adolescence, and (b) explored perinatal risk factors for persistent poor sleep health.

METHODS

This study used data from 12,962 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Parent or self-reported night-time sleep duration, bedtime and wake-up time were collected from questionnaires at 6, 18 and 30 months, and at 3.5, 4-5, 5-6, 6-7, 9, 11 and 15-16 years. Child's sex, birth weight, gestational age, health and temperament, together with mother's family adversity index (FAI), age at birth, prenatal socioeconomic status and postnatal anxiety and depression, were included as risk factors for persistent poor sleep health. Latent class growth analyses were applied first to detect trajectories of night-time sleep duration, bedtime and MPS, and we then applied logistic regressions for the longitudinal associations between risk factors and persistent poor sleep health domains.

RESULTS

We obtained four trajectories for each of the three sleep domains. In particular, we identified a trajectory characterized by persistent shorter sleep, a trajectory of persistent later bedtime and a trajectory of persistent later MPS. Two risk factors were associated with the three poor sleep health domains: higher FAI with increased risk of persistent shorter sleep (OR = 1.20, 95% CI = 1.11-1.30, p < .001), persistent later bedtime (OR = 1.28, 95% CI = 1.19-1.39, p < .001) and persistent later MPS (OR = 1.30, 95% CI = 1.22-1.38, p < .001); and higher maternal socioeconomic status with reduced risk of persistent shorter sleep (OR = 0.99, 95% CI = 0.98-1.00, p = .048), persistent later bedtime (OR = 0.98, 95% CI = 0.97-0.99, p < .001) and persistent later MPS (OR = 0.99, 95% CI = 0.98-0.99, p < .001).

CONCLUSIONS

We detected trajectories of persistent poor sleep health (i.e. shorter sleep duration, later bedtime and later MPS) from infancy to adolescence, and specific perinatal risk factors linked to persistent poor sleep health domains.

Exclusive breastfeeding mitigates the association between prenatal maternal pandemic-related stress and children sleep problems at 24 months of age

Infant sleep quality is increasingly regarded as an important factor for children long-term functioning and adaptation. The early roots of sleep disturbances are still poorly understood and likely involve a complex interplay between prenatal and postnatal factors. This study investigated whether exclusive breastfeeding during the first 6 months moderated the association between maternal prenatal pandemic-related stress (PRS) and sleep problems in 24-months children born during the COVID-19 pandemic. We also explored the potential contribution of maternal postnatal anxiety in these relations. Seventy-eight infants (50% males) and their mothers provided complete data from birth to 24 months. Between 12 and 48 h from birth, maternal PRS during pregnancy was retrospectively reported as well as maternal anxiety and exclusive breastfeeding. Maternal anxiety and exclusive breastfeeding were also reported at 3 and 6 months after childbirth. Children sleep disturbances were reported at 24 months. Bayesian analyses revealed that maternal PRS was positively associated with sleep problems in children who were not exclusively breastfed from birth to 6 months. Findings add to the growing literature on the lasting impact of early pre- and postnatal experiences on child well-being and development.

Intrafamilial associations of sleep multitrajectory groups between ages of 3 and 60 months in the SEPAGES cohort

OBJECTIVES

We investigated intrafamilial sleep evolution by identifying children's sleep multitrajectory groups between 3- and 60-month of age and their association with parental sleep multitrajectory groups.

METHODS

We included 180 children from the SEPAGES cohort (Grenoble, France) whose parents belonged to previously identified sleep multitrajectory groups, through group-based multitrajectory modeling, between 3 and 36months postpartum, using nighttime (NSD) and weekend daytime (DSD) sleep durations and subjective sleep loss, comprising "No," "Subjective," and "Global" sleep problems groups. Child sleep information (NSD, DSD, subjective sleep loss, night waking, and sleep onset difficulties) was collected by parental questionnaires at 3-, 12-, 36-, and 60-month. We identified sleep multitrajectory groups using group-based multitrajectory modeling in children and examined their associations with parental sleep multitrajectory groups using multinomial logistic regressions.

RESULTS

We identified three sleep multitrajectory groups in children: the "No/few" group (29.4%) had moderate NSD, long DSD, low subjective sleep loss/night waking/sleep onset difficulties prevalence, the "Moderate" group (60.0%) had long NSD and moderate DSD, and medium subjective sleep loss/night waking/sleep onset difficulties prevalence, and the "Global" group (10.6%) had the shortest NSD and DSD, and the highest subjective sleep loss/night waking/sleep onset difficulties prevalence. After adjusting for covariates, mothers in the "Global" group were more likely to have children in the same group, and mothers in "Subjective" and "Global" groups were less likely to have children in the "Moderate" group than in the "No/few" group. No association was identified with paternal or couple sleep multitrajectory groups.

CONCLUSIONS

The observed associations between parent-child sleep multitrajectory groups suggest greater maternal sensitivity to or involvement in the child's sleep than the fathers. Early preventive sleep actions could improve sleep in children and mothers.

Maternal depressive symptoms and mother-infant cosleeping (including room sharing and bedsharing): a systematic review

STUDY OBJECTIVES

Maternal depressive symptoms (MDS) affect most women during the first year postpartum. Mothers provide most of the nighttime care for infants, so studying the relationship between MDS and infant sleep location (ISL) is highly relevant to understanding maternal mental health over the first year of life and beyond. Infant sleep is studied by anthropologists, health care providers, and psychologists, with very little communication across disciplines. This review aimed to determine whether there is a predictive relationship between MDS and ISL.

METHODS

This systematic review searched 6 databases with terms related to maternal mood and ISL. Final analysis included 14 published studies, analyzed with narrative synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies directly compared ISL and MDS.

RESULTS

Five studies showed no relationship between ISL and MDS, and 1 study found bedsharing reduced MDS. Five studies found cosleeping was related to higher MDS although directionality is mixed or missing, and 3 studies found an association at some ages or for some populations only. Examining studies according to type of infant sleep assessment, study design, age of infant, or breastfeeding status failed to detect consistent patterns.

CONCLUSIONS

A variety of study designs, types and definitions of variable measures, sample recruitment, and study outcomes prevent detection of a consistent relationship between MDS and ISL. We explore reasons for the elusive nature of a relationship and make recommendations for future research in MDS and ISL, including crossdisciplinary collaborations.

CITATION

Barry ES, D'Souza L. Maternal depressive symptoms and mother-infant cosleeping (including room sharing and bedsharing): a systematic review. J Clin Sleep Med. 2024;20(9):1517-1533.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study

PURPOSE

Previous studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time.

METHODS

Data for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings.

RESULTS

2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05-3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45-0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05-1.44 -ꭓ2 6.25, p = 0.012).

CONCLUSIONS

The current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

New parents' sleep, movement, health, and well-being across the postpartum period

OBJECTIVE

The aim of this study was to examine changes and the bi-directional relationship in sleep and movement, and health and well-being among new parents and differences by sex.

METHODS

This secondary data analysis included both conditions from a randomized control trial to improve new parents'physical activity [PA] and recruited couples. Parents (n = 181, 117 couples represented 31.5 ± 4.4 years, 51.3% women, 83.3% White) completed questionnaires on regular overnight sleep duration, PA, mental health (perceived stress), physical health (physical quality of life [PQoL]), and well-being (life satisfaction) at 2-, 4-, 6-, and 8-month postpartum. Random-intercept cross-lagged panel models were stratified by sex to examine changes in sleep and PA with health and well-being across time.

RESULTS

Sleep and stress were interrelated at different times for fathers (2 months), and mothers (8 months). Sleep and PQoL improved across time, with mothers reporting less sleep than fathers at 4 and 6 months. PQoL at 4 months was related to MVPA at 6-months. Life satisfaction and PA at 2 months was related to PA at 4 months.

CONCLUSION

Mothers and fathers experienced different sleep and stress trajectories. Mental health improved postpartum with early connections to PA. Supporting the 24-hour movement behavior cycle and mental health across the parenthood transition may benefit couples.

Role of Inflammation in Short Sleep Duration Across Childhood and Psychosis in Young Adulthood

Importance

Short sleep duration over a prolonged period in childhood could have a detrimental impact on long-term mental health, including the development of psychosis. Further, potential underlying mechanisms of these associations remain unknown.

Objective

To examine the association between persistent shorter nighttime sleep duration throughout childhood with psychotic experiences (PEs) and/or psychotic disorder (PD) at age 24 years and whether inflammatory markers (C-reactive protein [CRP] and interleukin 6 [IL-6]) potentially mediate any association.

Design, Setting, and Participants

This cohort study used data from the Avon Longitudinal Study of Parents and Children. Data analysis was conducted from January 30 to August 1, 2023.

Exposures

Nighttime sleep duration was collected at 6, 18, and 30 months and at 3.5, 4 to 5, 5 to 6, and 6 to 7 years.

Main Outcomes and Measures

PEs and PD were assessed at age 24 years from the Psychosislike Symptoms Interview. CRP level at ages 9 and 15 years and IL-6 level at 9 years were used as mediators. Latent class growth analyses (LCGAs) were applied to detect trajectories of nighttime sleep duration, and logistic regressions were applied for the longitudinal associations between trajectories of nighttime sleep duration and psychotic outcomes at 24 years. Path analyses were applied to test CRP and IL-6 as potential mediators.

Results

Data were available on 12 394 children (6254 female [50.5%]) for the LCGA and on 3962 young adults (2429 female [61.3%]) for the logistic regression and path analyses. The LCGA identified a group of individuals with persistent shorter nighttime sleep duration across childhood. These individuals were more likely to develop PD (odds ratio [OR], 2.50; 95% CI, 1.51-4.15; P < .001) and PEs (OR, 3.64; 95% CI, 2.23-5.95; P < .001) at age 24 years. Increased levels of IL-6 at 9 years, but not CRP at 9 or 15 years, partially mediated the associations between persistent shorter sleep duration and PD (bias-corrected estimate = 0.003; 95% CI, 0.002-0.005; P = .007) and PEs (bias-corrected estimate = 0.002; 95% CI, 0-0.003; P = .03) in young adulthood.

Conclusions and Relevance

Findings of this cohort study highlight the necessity of addressing short sleep duration in children, as persistence of this sleep problem was associated with subsequent psychosis. This study also provides preliminary evidence for future targeted interventions in children addressing both sleep and inflammatory responses.

The influence of infant sleep problems and sleep training on maternal subjective well-being

Background

Disturbed sleep during infancy and early childhood can have a detrimental effect on parental sleep and consequently parental well-being. However, there is a paucity of research on how perceived child sleep problems and behavioural sleep interventions as treatment influence maternal subjective well-being.

Aim

This study aimed to explore the incidence of subjective well-being in mothers of children with sleep problems and whether implementing two behavioural sleep interventions changed their well-being.

Setting

The research was conducted in a community setting, with parents voluntarily approaching a sleep consultancy based in South Africa.

Method

Using data from 119 mothers voluntarily approaching a sleep consultancy in South Africa, a pre-test-post-test design was employed to investigate changes in life satisfaction, affect, couple satisfaction, perceived stress and depression approximately 3 weeks after implementation of a sleep intervention.

Results

Results indicate that mothers of children with sleep problems experienced moderate to high life satisfaction and positive affect although the presence of moderate negative affect, couple satisfaction and stress and mild depression suggest possible decreased subjective well-being.

Conclusion

Findings suggest implementation of graduated extinction and extinction with parental presence sleep interventions may improve life satisfaction, affect, stress and depression but not couple satisfaction in the short-term.

Contribution

This study contributes towards understanding the effect of sleep loss on the subjective well-being of mothers and provides preliminary evidence regarding the benefits of two sleep interventions for improving maternal subjective well-being.

Parents' perceptions of care quality at child health centres: A cross-sectional study from Sweden

AIM

To examine parents' perceptions of care quality at child health centres. Specific objectives were to examine parents' perceptions of the care received and the subjective importance of such care. Furthermore, to examine the relationship between parents' sociodemographic characteristics and the perceptions of care quality.

DESIGN

A cross-sectional study.

METHODS

A random sample of parents of children born in Sweden in 2021 participated. Data were collected by the QPP-CHC questionnaire and analysed using descriptive and analytical statistics.

RESULTS

The response rate was 19.4%. The targeted sample size of 210 participants was reached as 584 parents responded to the questionnaire. Parents' overall ratings of care quality at child health centres indicated optimal quality with mean values >3. However, various potential improvements areas were identified as needing additional information. These included dental care (m = 2.82), allergy prevention (m = 2.25), breastfeeding (m = 2.97), sleep (m = 2.83), the child's behaviour (m = 2.47) and the child's crying (m = 2.47). Also, parents rated suboptimal quality regarding that the care was based on healthcare routines rather than parental preferences and needs (m = 2.86). Parents born outside of the Nordic countries rated higher care quality than those born in the Nordic countries, as well as parents with a non-academic education.

CONCLUSION

Parents want information based on their preferences and needs. Parent's perceptions of areas for improvement are new and important knowledge for registered nurses at child health centres.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings indicate that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres is an important component of quality work and might lead to improvements in the care quality at child health centres.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting.

IMPLICATIONS FOR POLICY AND PRACTICE

The findings of this study suggests that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres provides important knowledge which can guide further development of care quality at child health centres. The findings indicate that a family-centred approach that integrates relational and routine-oriented nursing can be a way to ensure that the care is based on parents' preferences and needs. No patient or public contribution.

Parental experiences of subjective well-being in the context of infant sleep problems

OBJECTIVE

This study explored parental experiences of subjective well-being in the context of infant sleep problems.

BACKGROUND

Although quantitative research has highlighted the deleterious impact of infant sleep problems for parental well-being broadly, little is known about subjective experiences of well-being specifically.

METHOD

This retrospective qualitative study formed part of a larger multiphase project. Ten parents who approached a sleep consultancy for assistance with infant sleep problems participated in the study. Data was collected through in-depth interviews and results were analysed thematically.

RESULTS

Two key themes were identified: (1) the negative influences of insufficient sleep on parental subjective well-being, and (2) the indirect influence of infant sleep problems on parental subjective well-being. Participants highlighted the direct influence of insufficient sleep on their life satisfaction, affect and mood. Further, through its impact on infant well-being and behaviour, and the loss of free time, infant sleep problems indirectly negatively influenced parental subjective well-being. As a result, life satisfaction and affect was deleteriously influenced.

CONCLUSION

Parental subjective well-being may be deleteriously influenced by infant sleep problems, both directly through insufficient sleep and indirectly through the impact of infant sleep problems.

Sleep characteristics and changes in sleep patterns among infants in Bhaktapur, Nepal

OBJECTIVE

Sleep undergoes major changes during the first year of life, but the characteristics of sleep among infants in low and middle-income countries are not well documented. This study describes sleep characteristics and changes in sleep patterns in infants at 6 and 12months of age from Bhaktapur, Nepal.

METHODS

This was a community-based longitudinal study comprising 735 infants. Sleep characteristics were obtained by interview with the mother using the Brief Infant Sleep Questionnaires. The stability of sleep duration and night awakenings were estimated by logistic regression analysis.

RESULTS

Cosleeping in the parent's bed at 6 and 12months of age was almost universal (>97%). At 6months of age, 254 (35%) and at 12months of age, 341 (46%) infants had a total 24-hour sleep duration <12 hours. Night awakenings >3 times per night were common (65%) both at 6 and 12months of age. Infants with frequent nightly awakenings at 6months had increased odds of frequent nightly awakenings at 12months (OR=2.2; 95% CI: 1.6, 2.9). Very few (<3%) mothers reported sleep problems in their infants at 6 and 12months of age.

CONCLUSIONS

Cosleeping was almost universal among Nepalese infants, and very few of the mothers reported sleep problems in their infants. Infants at 6 and 12months had similar patterns for both sleep duration and nocturnal awakenings. For infants, there were increased odds of having similar sleep duration and nocturnal awakening at 6 and 12months.

Maternal Reports of Preterm and Sick Term Infants' Settling, Sleeping and Feeding in the 9 Months after Discharge from Neonatal Nursery: An Observational Study

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU.

Child sleep problems, maternal sleep and self-efficacy: Sleep's complicated role in maternal depression

Depression, poor sleep duration and low self-efficacy are common in mothers of children with sleep problems. However, research rarely extends beyond the postpartum period. This study investigated the multifaceted relationship between child sleep and maternal depression in early motherhood. A confidential survey assessed child sleep problems, maternal sleep duration, parental self-efficacy and depressive symptoms in 477 Australian mothers of children aged 3 months to 5 years. We found no relationship between child age and maternal depression, supporting our decision to look beyond postpartum depression. Robust bootstrapped mediation modelling tested the hypothesis that both maternal sleep duration and parental self-efficacy would mediate child sleep problems as predictors of maternal depression. After controlling for child age, results showed a significant parallel mediation effect, demonstrating that maternal sleep duration and parental self-efficacy both mediate the relationship between child sleep problems on maternal depression. While the total effect of child sleep problems on maternal depression was statistically significant, after partialling out the effects of other variables, child sleep problems no longer predicted maternal depression. Akaike information criterion analyses supported the full model, with both mediators explaining meaningful variance in maternal depression. This study expands our knowledge beyond the postpartum period, and divulges the disparate effects of sleep deprivation and parental self-efficacy on the relationship between child sleep and depression in early motherhood. Maternal sleep duration and self-efficacy are modifiable risk factors of maternal depression, indicating possible efficacious treatments. Parental self-efficacy stands out as a direction for clinical practice and further psychobiological study.

Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process

Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.

Sleep problems during early and late infancy: Diverse impacts on child development trajectories across multiple domains

OBJECTIVE

Child developmental rate holds predictive value for early-stage developmental trajectories, yet few studies explored how sleep problems during different infancy stages impact this rate. This study aims to investigate the correlation between sleep problems and child developmental trajectories.

METHODS

This study utilized a prospective national cohort of 5006 children in Taiwan. The developmental inventories covering motor, cognitive, language, and socioemotional domains were collected through questionnaire-based in-person home interviews conducted at 3, 12, 24, and 36 months. Sleep problems data, encompassing bedtime regularity, sleep duration, and sleep quality, were collected at 3 and 12 months. Child developmental rate was assessed by analyzing the slope of developmental ability estimates over a period of time.

RESULTS

Bedtime regularity and high-quality sleep at 3 and 12 months were found to be significantly associated with intercepts across all domains (estimate = -0.196∼0.233, p < 0.033). Children with high-quality sleep at 3 months showed enhanced developmental slopes in socioemotional domains (estimate = 0.032, p < 0.001). Atypical sleep duration at 3 and 12 months had differential detrimental association with child development in various domains (estimate = -0.108∼-0.016, p < 0.048).

CONCLUSION

The relationship between sleep problems and child development exhibited variability based on the timing of exposure to these issues. Early exposure to low-quality sleep was significantly related to developmental functions and socioemotional developmental rate, potentially leading to increased developmental disparities as children age. Inadequate sleep duration in late infancy and excessive sleep duration in early infancy were both negatively associated with child development trajectories. Policymakers can use these findings to design targeted sleep programs for optimal child development.

Early childhood multiple or persistent regulatory problems and diurnal salivary cortisol in young adulthood

BACKGROUND

Early childhood multiple or persistent regulatory problems (RPs; crying, sleeping, or feeding problems) have been associated with a risk of behavioural problems in young adulthood. It has been suggested that this may be due to the possible influence of early RPs on the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. However, associations between early RPs and HPA-axis activity in young adulthood remain unexplored. Thus, the aim of the current study was to investigate whether early childhood multiple or persistent RPs are associated with diurnal salivary cortisol in young adulthood.

METHODS

At the ages of 5, 20 and 56 months, RPs of 308 children from the Arvo Ylppö Longitudinal Study were assessed via standardized parental interviews and neurological assessments. Multiple RPs were defined as two or three RPs at the age of 5 months and persistent RPs as at least one RP at 5, 20 and 56 months. At the mean age of 25.4 years (SD= 0.6), the participants donated saliva samples for cortisol at awakening, 15 and 30 min thereafter, 10:30 am, at noon, 5:30 pm, and at bedtime during one day. We used mixed model regressions, and generalized linear models for testing the associations, controlling for important covariates.

RESULTS

Of the 308 children, 61 (19.8%) had multiple or persistent RPs in early childhood: 38 had multiple, and 27 had persistent RPs. Persistent RPs were associated with significantly higher cortisol peak and output in the waking period, and cortisol awakening response. On the other hand, multiple RPs were not associated with salivary cortisol.

CONCLUSION

Children displaying persistent RPs throughout early childhood show, over two decades later, increased HPA axis activity in response to awakening stress. This may be one physiological mechanism linking early childhood RPs to adulthood behavioural outcomes.

Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers

AIM

To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes.

DESIGN

Qualitative study using semi-structured interviews.

METHODS

Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis.

RESULTS

Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent-clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term.

CONCLUSION

This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent-nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period.

IMPACT

The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.

Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period

OBJECTIVE

This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9-20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics.

METHODS

Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).

RESULTS

The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001).

CONCLUSIONS

Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.

Infant sleep interventions with sleep measurements using actigraphy: A systematic review

AIM

This review investigated the outcomes and methodological quality of infant sleep intervention studies utilizing actigraphy.

BACKGROUND

Parents need appropriate support for infant sleep from nurses. There are few methodological reports of actigraphy in infant sleep intervention studies that objectively measure infant sleep in a natural setting.

DESIGN

This was a systematic review study.

DATA SOURCES

Ovid MEDLINE, Embase, Cochrane, CINAHL and PsycINFO were searched from database establishment to 30 December 2021.

REVIEW METHODS

This systematic review utilized the Cochrane Collaboration review guidelines.

RESULTS

Eleven sleep intervention studies were reviewed. Three used extinction-based behavioural interventions, and eight included parental education programs. The infant sleep interventions positively affected the sleep outcomes of both infants and parents. Fairly consistent effects were found on infants' number of awakenings and sleep onset latency. However, parental psychosocial outcomes were inconsistent. All studies reported device placement, the algorithm for analysis, the use of a sleep diary and number of days/nights, but external movements affecting infants' sleep records were insufficiently reported. Only two studies had a low risk of bias.

CONCLUSIONS

The infant sleep interventions had positive effects on both infants and their parents. Comprehensive methodological considerations are required for more standardized assessments using actigraphy for infant sleep evaluation.

Maternal depression and anxiety symptoms across pregnancy and the postnatal period: Modest associations between depression symptoms and infant sleep outcomes

Maternal depression and anxiety symptoms are common across the perinatal period and are associated with a raised risk for adverse child outcomes. While substantial evidence exists for child outcomes such as behaviour, language and cognition, infant sleep has been less studied. In this longitudinal study, we examined the association between maternal symptoms of depression and anxiety and mother-reported infant sleep at 6 and 12 months. Across the four infant sleep outcomes, total sleep time, sleep onset latency, number of awakenings and a maternal perception variable, we found modest effects for concomitant depression symptoms. There were almost no additional effects for anxiety symptoms beyond that already accounted for by depression. Using trajectory modelling of maternal symptoms at five time points, we found more robust effects for maternal groups with postnatally emerging symptoms over prenatally present symptoms across all four sleep outcomes. Our strongest finding was that mothers with postnatal depression symptoms were more likely to perceive their infant's sleep as problematic compared with all other mothers. Where we found effects on duration-based infant sleep outcomes overall, these were small and clearest for depressive symptoms over anxiety symptoms. For both nighttime awakenings and perception of sleep as a problem, effects were apparent only for mothers in the postnatal symptom groups, and not for prenatal symptoms, at both infant ages six and 12 months. Our sample was a relatively high-socioeconomic group with low symptoms overall, and findings may not generalize to more vulnerable populations.

Parental Discontent with Infant Sleep During the First Two Years of Life

BACKGROUND

Problematic sleep in infants can have a high impact on families. We examined parental discontent with infant sleep in the first six months of life and parent-perceived problematic sleep during the second year of life.

METHODS

We used Sarphati Cohort data of 1471 children. During periodic youth health care visits in the first six months of life, professionals registered parental discontent with infant sleep. In the second year of life, parents filled out the Brief Infant Sleep Questionnaire (BISQ), from which we defined parent-perceived problematic sleep and BISQ-defined problematic sleep. We examined the association of parental discontent with infant sleep during the first six months with both BISQ-derived outcomes up to age two, using multivariable logistic regression analysis.

RESULTS

26% of parents were discontented with infant sleep during the first six months of life. During the second year of life, 27% of the parents perceived their child's sleep as problematic, and 9% of the infants had BISQ-defined problematic sleep. Early parental discontent with infant sleep was associated with parent-perceived problematic sleep [adjusted OR 2.50 (95% CI 1.91-3.28)], and BISQ-defined problematic sleep [adjusted OR 1.88 (1.11-3.17)].

CONCLUSIONS

Early registered parental discontent with infant sleep was a predictor of parent-perceived problematic sleep in early toddlerhood. Registering parental discontent during infancy might enable professionals to identify a group of infants at risk for later problematic sleep. We recommend screening and parental support for sleep difficulties in an early stage.

Sleep and Women's Mental Health

Women have increased risks for both sleep disturbances and disorders and for mental health issues throughout their lives, starting in adolescence. Women have a higher prevalence of insomnia disorder and restless legs syndrome (RLS) versus men, and obstructive sleep apnea (OSA) is more likely as women age. Hormonal transitions are important to consider in women's sleep. For women, insomnia, OSA, and RLS are predictive of depression, and insomnia and sleep-disordered breathing are predictive of Alzheimer disease. These findings underscore the importance of assessment, treatment, and future research examining sleep and mental health in women, given their unique and increased vulnerability.

Association between iron deficiency anemia and sleep duration in the first year of life

OBJECTIVE

The aim of this study was to investigate the association between iron deficiency anemia and sleep duration in the first year of life.

METHODS

A total of 123 infants were investigated, with sleep being evaluated at 3, 6, and 12 months of age and anemia at birth and 6 months. The cutoff points for anemia and short sleep duration were hemoglobin <11 g/dL (at birth and/or 6 months) and <10 h (at 3, 6, and 12 months), respectively. The comparison of the average sleep time between infants with and without anemia was performed using the Student's t-test, and logistic regression models were also used to verify differences in the sleep duration (short/not short) between the groups. Linear regression analyses were conducted to determine the association between sleep duration and hemoglobin values. The analyses were adjusted for potential confounders.

RESULTS

Children with anemia were more likely to be short sleepers [odds ratio (95% confidence interval (CI)): 4.02 (1.02-15.76); p≤0.05], and for each unit increase in hemoglobin values, the sleep duration increased by 16.2 min [β (95%CI): 0.27 (0.00-0.55); p≤0.05), regardless of family income, maternal schooling, gender, and body mass index at birth.

CONCLUSIONS

Our results suggest that iron deficiency anemia is associated with short sleep duration in the first year of life and indicate the need for longitudinal investigations, with longer follow-up, to verify the impact of anemia on sleep duration at subsequent ages.

Genetic background to attention deficit and hyperactivity disorder and attention deficit and hyperactivity disorder symptoms at the age of 5 years: the role of sleep duration

STUDY OBJECTIVES

We studied the associations between polygenic risk score (PRS) for attention deficit and hyperactivity disorder (ADHD) and (1) ADHD symptoms in 5-year-old children, (2) sleep duration throughout childhood, and (3) the interaction between PRS for ADHD and short sleep duration relative to ADHD symptoms at 5 years.

METHODS

This study is based on the population-based CHILD-SLEEP birth cohort (N = 1420 children). PRS was used to quantitate the genetic risk for ADHD. Parent-reported ADHD symptoms at 5 years were obtained from 714 children, using the Strengths and Difficulties Questionnaire (SDQ) and the Five-to-Fifteen (FTF). Our primary outcomes were SDQ-hyperactivity and FTF-ADHD total scores. Parent-reported sleep duration was measured at 3, 8, 18, 24 months, and 5 years in the whole sample and actigraphy-based sleep duration at 2 and 24 months in a subsample.

RESULTS

PRS for ADHD associated with SDQ-hyperactivity (β = 0.214, p = .012) and FTF-ADHD total (β = 0.639, p = .011), and FTF-inattention and hyperactivity subscale scores (β = 0.315, p = .017 and β = 0.324, p = .030), but not with sleep duration at any time point. Significant interactions were found between high PRS for ADHD and parent-reported short sleep throughout childhood in FTF-ADHD total score (F = 4.28, p = .039) and FTF-inattention subscale (F = 4.66, p = .031). We did not find any significant interaction between high PRS for ADHD and actigraphy-based short sleep.

CONCLUSIONS

Parent-reported short sleep moderates the association between genetic risk of ADHD and ADHD symptoms in early childhood in the general population, so that children with short sleep, in combination with high genetic risk for ADHD, could be at highest risk for ADHD symptoms.

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study

BACKGROUND

Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations.

METHODS

Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years.

RESULTS

Less regular sleep routines (OR = 0.51, 95% CI = 0.28-0.93, p = .029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56-0.89, p = .004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06-1.52, p = .009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, -0.002; p = .005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p = .003).

CONCLUSIONS

Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.

Loss of sleep when it is needed most - Consequences of persistent developmental sleep disruption: A scoping review of rodent models

Sleep is an essential component of development. Developmental sleep disruption (DSD) impacts brain maturation and has been associated with significant consequences on socio-emotional development. In humans, poor sleep during infancy and adolescence affects neurodevelopmental outcomes and may be a risk factor for the development of autism spectrum disorder (ASD) or other neuropsychiatric illness. Given the wide-reaching and enduring consequences of DSD, identifying underlying mechanisms is critical to best inform interventions with translational capacity. In rodents, studies have identified some mechanisms and neural circuits by which DSD causes later social, emotional, sensorimotor, and cognitive changes. However, these studies spanned methodological differences, including different developmental timepoints for both sleep disruption and testing, different DSD paradigms, and even different rodent species. In this scoping review on DSD in rodents, we synthesize these various studies into a cohesive framework to identify common neural mechanisms underlying DSD-induced dysfunction in brain and behavior. Ultimately, this review serves the goal to inform the generation of novel translational interventions for human developmental disorders featuring sleep disruption.

Associations between demographic and parental factors and infant sleep characteristics

Although sleep problems are highly prevalent in infants, the intrinsic and extrinsic factors that influence sleep consolidation and regulation in this age group are not well understood. This study aimed to examine the cross-sectional associations of demographic and parental factors with infant sleep characteristics. Participants were 97 Canadian mother-infant dyads primarily from Edmonton, Alberta. Demographic factors (e.g., infant age), parenting practices (e.g., sleep position, sleep initiation methods), and infants sleep characteristics (e.g., the frequency of nighttime awakenings) were assessed using the Brief Infant Sleep Questionnaire. Maternal sleep characteristics (e.g., nighttime sleep duration) were assessed using Actigraph accelerometers. Infant age (mean = 4.24 ± 2.90) was associated with most infant sleep characteristics. In multiple regression models for infant nighttime sleep duration, after removing influential observations, a negative association for side (vs. prone) sleep position was, respectively, observed. In multiple regression models for the frequency of nighttime awakenings in infants, positive associations for infants falling asleep while feeding (vs. in bed alone) and side (vs. prone) sleep position were consistently observed after removing influential observations. Lower nighttime sleep efficiency (B =  - 0.08, 95%CI: - 0.13, - 0.02) and longer nighttime wake after sleep onset (B = 1.03, 95%CI: 0.41, 1.65) in mothers were associated with more frequent nighttime awakenings in infants. After removing influential observations, more frequent nighttime awakenings (B = 0.35; 95%CI: 0.09, 0.61) and longer total sleep duration (B = 0.33, 95%CI: 0.11, 0.55) in mothers were also associated with more frequent nighttime awakenings in infants. Sleep initiation methods with less parental involvement, and more continuous and efficient maternal nighttime sleep, tended to be associated with less interrupted infant sleep.

Effect of combined procedural pain interventions during neonatal intensive care on sleep, cognitive development, and internalizing behavior: a follow-up analysis of a randomized controlled trial

ABSTRACT

Repeated procedural pain can cause preterm infants to spend excessive time awake at the cost of sleep and can have a detrimental impact on later cognitive and behavioral development. What's more, poor sleep may be correlated with worse cognitive development and more internalizing behaviors in infants and toddlers. In a randomized controlled trial (RCT), we found that combined procedural pain interventions (sucrose, massage, music, nonnutritive sucking, and gentle human touch) during neonatal intensive care could improve preterm infants' early neurobehavioral development. Here, we followed up the participants who were enrolled in the RCT to evaluate the effect of combined pain interventions on later sleep, cognitive development, and internalizing behavior and to determine whether sleep may moderate the effect of combined pain interventions on the cognitive development and internalizing behavior. Total sleep time and night awakenings at 3, 6, and 12 months old; the cognitive development (adaptability, gross motor, fine motor, language, and personal-social domains) at 12 and 24 months old measured by the Chinese version of Gesell Development Scale; and the internalizing behavior at 24 months old measured by the Chinese version of Child Behavior Checklist were assessed. Our findings showed the potential benefits of combined pain interventions during neonatal intensive care for preterm infant's later sleep, motor and language development, and internalizing behavior, and the effect of combined pain interventions on motor development and internalizing behavior might be moderated by the mean total sleep duration and night awakenings at 3, 6, and 12 months old.

Sensory processing and sleep characteristics in preterm infants in the early period of life

OBJECTIVE

The present study aimed to investigate the following: (i) differences in sensory processing and sleep characteristics between preterm infants born at < 32 weeks', vs. those born at ≥ 32 weeks' gestation; (ii) differences in sleep characteristics between preterm infants with typical vs. atypical sensory processing; and (iii) relationship between sensory processing and sleep characteristics in preterm infants at 3 months of age.

METHODS

A total of 189 preterm infants, 54 born at < 32 weeks' gestation (26 females; mean gestational age [standard deviation (SD)], 30.1 [1.7] weeks), and 135 born at ≥ 32 weeks' gestation (78 females; mean gestational age [SD], 34.9 [0.9] weeks) were included in the present study. Sleep characteristics were evaluated using the Brief Infant Sleep Questionnaire, and sensory processing was assessed using the Infant Sensory Profile-2.

RESULTS

There were no significant differences in sensory processing (P > 0.05) or sleep characteristics (P > 0.05) between the preterm groups; however, more infants snored in the <32 weeks' gestation group (P = 0.035). Preterm infants with atypical sensory processing showed lower nighttime (P = 0.027) and total sleep durations (P = 0.032), and higher rates of nocturnal wakefulness (P = 0.038) and snoring (P = 0.001) than preterm infants with typical sensory processing. A significant relationship, therefore, was observed between sensory processing and sleep characteristics (P < 0.05).

CONCLUSIONS

Sensory processing patterns may play an important role in understanding sleep problems in preterm infants. The early detection of sleep problems and sensory processing difficulties are necessary for early intervention.

The Architecture of Early Childhood Sleep Over the First Two Years

INTRODUCTION

The architecture and function of sleep during infancy and early childhood has not been fully described in the scientific literature. The impact of early sleep disruption on cognitive and physical development is also under-studied. The aim of this review was to investigate early childhood sleep development over the first two years and its association with neurodevelopment.

METHODS

This review was conducted according to the 2009 PRISMA guidelines. Four databases (OVID Medline, Pubmed, CINAHL, and Web of Science) were searched according to predefined search terms.

RESULTS

Ninety-three studies with approximately 90,000 subjects from demographically diverse backgrounds were included in this review. Sleep is the predominant state at birth. There is an increase in NREM and a decrease in REM sleep during the first two years. Changes in sleep architecture occur in tandem with development. There are more studies exploring sleep and early infancy compared to mid and late infancy and early childhood.

DISCUSSION

Sleep is critical for memory, learning, and socio-emotional development. Future longitudinal studies in infants and young children should focus on sleep architecture at each month of life to establish the emergence of key characteristics, especially from 7-24 months of age, during periods of rapid neurodevelopmental progress.

Season is related to the slow wave and sigma activity of infants and toddlers

OBJECTIVE/BACKGROUND

Slow wave activity (SWA) and sigma frequency activity (SFA) are hallmarks of NREM sleep EEG and important indicators of neural plasticity, development of the central nervous system, and cognition. However, little is known about the factors that modulate these sleep EEG activities, especially in small children.

PATIENTS/METHODS

We analyzed the power spectral densities of SWA (1-4 Hz) and SFA range (10-15 Hz) from six EEG derivations of 56 infants (8 months) and 60 toddlers (24 months) during their all-night sleep and during the first and the last half of night sleep. The spectral values were compared between the four seasons.

RESULTS

In the spring group of infants, compared with the darker seasons, SFA was lower in the centro-occipital EEG derivations during both halves of the night. The SWA findings of the infants were restricted to the last half of the night (SWA2) and frontally, where SWA2 was higher during winter than spring. The toddlers presented less frontal SWA2 during winter compared with autumn. Both age groups showed a reduction in both SWA and SFA towards the last half of the night.

CONCLUSIONS

The sleep EEG spectral power densities are more often associated with seasons in infants' SFA range. The results might stem from seasonally changing light exposure, but the exact mechanism warrants further study. Moreover, contrary to the adult-like increment of SFA, the SFA at both ages was lower at the last part of the night sleep. This suggests different regulation of spindle activity in infants and toddlers.

Effect of illuminated musical mobile on sleep quality of children hospitalized in pediatric emergency departments

PURPOSE

The aim of this study is to evaluate the effect of an illuminated musical mobile on the sleep quality of children hospitalized in a pediatric emergency department.

DESIGN AND METHODS

In this randomized controlled study, 124 children presenting to a pediatric emergency department who met the inclusion criteria were included in the study. Patients were randomized into two equal groups. In the intervention group, an illuminated musical mobile was used to help facilitate sleep. In the control group, routine sleep routines were continued. Groups were compared according to sleep quality as evaluated by mothers' observations. Evaluation was performed twice (before intervention - 1st day of hospitalization and on the intervention day - 2nd day of hospitalization).

RESULTS

Average age of children was 1.86 ± 0.78 years. On the intervention day, nighttime sleep duration was longer in the intervention group (p < .0001). Also, the frequency of spontaneous awakening (p < .0001), time to fall asleep after spontaneous awakening (p < .0001) and sleep time problems (p < .0001) were less in the intervention group. CONCLUSıONS: An illuminated musical mobile was used for the first time in the pediatric emergency department and was found to be effective in improving the sleep quality of hospitalized children aged between 1 and 3 years.

PRACTICE IMPLICATIONS

During hospitalization, children's sleep quality can be increased by using methods and objects suitable for the child's developmental level.

Breastfeeding and Maternal Perceptions of Infant Sleep, Settle and Cry Patterns in the First 9 Months

This study evaluated relationships between maternal perceptions of infant sleep, settling and crying patterns and breastfeeding. A prospective observational study of 91 mothers of healthy, term infants was conducted with follow ups over 9 months after discharge from a Western Australian maternity hospital. Feeding information, sleep, settle and cry behaviours, maternal bother at infant behaviours and confidence were measured using the Sleep and Settle Questionnaire. Breastfeeding confidence was measured using the Breastfeeding Self-Efficacy Scale-Short Form. Questionnaires were administered at 2 and 6 weeks, 3, 6 and 9 months. Linear mixed models were used to assess associations between maternal bother, feeding method and infant characteristics. The feeding method was not associated with maternal bother, and cessation of breastfeeding did not result in a change in bother scores (p = 0.34). Duration of infant crying in the day, evening and night, frequency of night waking and duration of settling to sleep in the day were associated with increased bother scores. Higher breastfeeding self-efficacy and maternal confidence were associated with lower bother scores (both p < 0.01). Maternal bother is associated with infant behaviours that require parental input, but not breastfeeding status. Resources that address parental expectations regarding infant sleep while providing strategies to support maternal wellbeing and breastfeeding are needed.

A single-arm pilot study: can a parental sleep intervention for sleep-disturbed young children in individual settings improve children's sleep, crying, eating, and parental distress in mothers and fathers?

Background

Early sleep problems co-occur with crying, eating problems, and parental distress. This study investigates the impact of a parent-focused intervention to improve child sleep with the following aims: (1) To assess the impact on child sleep (sleep onset latency, frequency and duration of nighttime awakenings, frequency of bed-sharing, and nighttime food intake, total nighttime sleep duration, and sleep efficiency), child crying (frequency of crying episodes, of unexplained and unsoothable crying and of crying out of defiance), child eating difficulties, and parental distress of mothers and fathers. (2) To assess the maintenance of any changes in these areas longitudinally, at 3-month, 6-month, and 12-month follow-ups. (3) To explore at the within-subjects level, how children’s sleep, crying, eating, and parental distress changed together across all study measurement points.

Methods

In this single-arm pilot study, the parents of 60 children participated in six individual sessions of a parent-focused multimodal age-adjusted cognitive-behavioral intervention to improve child sleep. Parents of 39 children (46% girls, age in months M = 22.41, SD = 12.43) completed pre- and at least one measure after the intervention. Sleep diary, questionnaire for crying, feeding, sleeping, and parental stress index (short-form) were assessed pre, post, three, six, and 12 months after the intervention.

Results

Significantly, sleep (decreased sleep onset latency, frequency, duration of nighttime awakenings, bed-sharing, nighttime food intake; increased total nighttime sleep duration, sleep efficiency), crying (reduced frequency of crying episodes, unexplained and unsoothable crying), and parental distress (reduced) changed, which remained partially stable over follow-up. The frequency of crying episodes decreased with fewer nighttime awakenings; morning crying with increased nighttime feeding; unexplained and unsoothable crying with higher sleep efficiency; crying due to defiance with more nighttime awakenings, sleep efficiency, and bed-sharing. Eating problems decreased with shorter night awakenings and time; maternal distress with fewer nighttime awakenings, paternal with less child’s nighttime feeding, unexplained and unsoothable crying, and time.

Conclusions

A parental sleep intervention for sleep-disturbed young children could be promising to reduce children’s sleep problems, crying, eating problems and parental distress. Future studies should consider more personal contact during the follow-up to reduce the drop-out rate and a randomized-controlled design.

Trial registration

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

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03631-5.

Infant sleep as a topic in healthcare guidance of parents, prenatally and the first 6 months after birth: a scoping review

Background

This scoping review focuses on infant sleep-related factors and themes that are relevant when health practitioners provide preventive health services to expectant and new parents.

Methods

A systematic literature search in CINAHL, PubMed, and PsycINFO, published in 2010 or later, identified 1661 records. The search was further narrowed to focus on sleep in healthy term-born infants until the second half of the first year of life. A blinded review by both authors covered 136 papers, of which 43 papers were reviewed in the full text. Finally, 38 articles were included in the data extraction.

Results

The analysis process showed that the selected studies formed three main information categories: 11 studies thematised safe infant sleep issues, 10 studies described design and findings from sleep-related intervention studies, and 17 studies focused on different parent-child interactive aspects that may influence the quality and duration of infant sleep in the first six months of life.

The main finding is that knowledge about early infant sleep is very complex, and includes both child, parent, and environmental factors. Several studies have shown that the concepts and factors related to safe infant sleep also influence the development of healthy infant sleep patterns. Thus, these aspects are interwoven with each other and should be addressed together in communication with parents.

Conclusions

Health practitioners with different professional backgrounds need to search for an agreement on when and how different aspects of sleep-related knowledge should be communicated to new and expectant parents to enable the design of national follow-up programs. Parents want coherent and personalized services regarding infant sleep issues that may allow them to choose sleeping arrangements, routines, and behaviors that fit in with their sociocultural attitudes and traditions. Many different sources and formats may be used to empower parents regarding infant sleep issues. Studies have described the use of group or individual meetings, videos, and written materials. The key issue is the importance of consistent and seamless knowledge-based services.

Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample

Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.

Development of circadian rest-activity rhythms during the first year of life in a racially diverse cohort

STUDY OBJECTIVES

To describe the development of circadian rest-activity rhythms (CRARs) during infancy in a racially diverse cohort.

METHODS

We studied 414 infants from the Nurture birth cohort (51.2% female, 65.2% Black) who wore actigraphs on their left ankles for 4 days and nights at 3, 6, 9, and 12 months. We quantified CRARs using cosinor and non-parametric circadian rhythm analysis, and investigated change in CRARs over time, comparing 6, 9, and 12 months to CRARs at 3 months. We adjusted for baseline and time-varying covariates and used function-on-scalar regression (FOSR) to identify the specific times of day at which activity changes occurred.

RESULTS

Across the first year, daily mean and peak activity levels and day-to-day activity level regularity increased, and activity level fragmentation and nighttime activity decreased. Only at 9 months, compared to at 3 months, did timing of peak activity levels and the most active periods shift later, while timing of least active periods shifted earlier. FOSR analyses showed that mean activity levels decreased during nighttime hours and increased during daytime hours, with the most pronounced changes at 9 months.

CONCLUSIONS

Among racially diverse infants, CRARs became more robust, stable, and less fragmented over time. Findings suggest the greatest change from 3-month CRARs occurs at 9 months, which may be a key period of CRAR development. This and future research will contribute to our understanding of normative infant CRAR development in diverse populations and enable us to identify infants who may benefit from intervention.

Using complexity science to understand the role of co-sleeping (bedsharing) in mother-infant co-regulatory processes

Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a "complex adaptive system" (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.

The Use of Caregivers’ Smartphones to Assist Infants’ Circadian Sleep–Wake Cycles

Parents and caregivers lack knowledge regarding young children’s sleep routines due to an absence of general guidelines about sleep development, and this knowledge gap has been associated with infants’ sleep problems. Approximately 30% of infants develop sleep problems, including difficulty with falling asleep and night-waking. In this study, we sought to develop a new indicator of regularity in infants’ circadian sleep–wake patterns. Our participants were healthy Japanese mothers and their infants ( n = 172 infants; Mage = 4.9, SD = 3.5 months). Mothers used their smartphones to record the time when their infants fell asleep and woke up in their natural home environments over 7 days. We conducted least-squares spectrum analysis, a time-series analysis often used in chronobiology, to calculate the percentage variance (PVA) of the best-fitted cosine waves with a 24-hr periodicity in the infants’ sleep records. We found that the PVA of the 24-hr cycles in the infants’ sleep records were significantly correlated with the infants’ age in months ( r = 0.554, p < 0.001), variations in their waking-up ( r = −0.316, p < 0.001) and falling asleep times ( r = −0.430, p < 0.001), and sleep duration ( r = −0.343, p < 0.001). Apart from these normative data, which are of potential comparative use by other investigators, we showed in this study that PVA data can be collected by infants’ parents and caretakers through smartphones to provide parents an indicator of the regularity of an infant’s 24-hr periodicity.

Kindliche Verhaltensauffälligkeiten im ersten Lebensjahr und mütterliche Belastung in der Zeit der COVID-19-Pandemie

Zusammenfassung. Theoretischer Hintergrund: Die COVID-19-Pandemie stellte in vielen Bereichen eine Belastung für Familien dar, insbesondere durch die einschneidenden Beschränkungen zu Beginn. Fragestellung: Wie wirkte sich dies auf die Belastung von Müttern mit Kindern im ersten Lebensjahr und auf die kindliche Verhaltensregulation aus? Methode: In einer Online-Befragung schätzten 577 Mütter das Schrei-‍, Schlaf- und Fütter-/Essverhalten ihrer Kinder ( M = 7.3; 0 – 12 Mon., SD = 3.25) und ihre eigene Belastung ein, zudem Stresserleben, depressive Symptomatik, Partnerschaftszufriedenheit und Bonding. Ergebnisse: Schlafprobleme traten bei 21.7 %, schwer tröstbares und häufiges Schreien bei 12.3 % und exzessives Schreien bei 1.6 % der Kinder auf. Mindestens jede fünfte Mutter fühlte sich durch Schreien oder Schlafprobleme belastet. Mehr Stress, beeinträchtigtes Bonding und weniger Partnerschaftszufriedenheit erklärten 17 – 21 % der Varianz der mütterlichen Belastung durch Schrei- und Schlafverhalten. In der Zeit der stärksten Beschränkungen zeigte sich signifikant mehr Belastung in der Gruppe von Müttern, die von vermehrtem Schreien und verlängerter Einschlaflatenz berichteten, sowie mit mindestens einem weiteren Kind im Haushalt (MANOVA). Diskussion und Schlussfolgerung: Pandemiebedingt belastend für Mütter im ersten Jahr scheinen eingeschränkter Zugang zum Versorgungssystem, die Betreuung von mehr als einem Kind sowie das Alter des Kindes zu sein, während eine gute Beziehung zum Kind (Bonding) und/oder zum Partner (Partnerschaftszufriedenheit) abmildernd wirken.

Demographic Correlates of Movement Behaviors in Infants: A Longitudinal Study

BACKGROUND

Demographic correlates of movement behaviors in infants are unclear. This study examined the longitudinal associations between demographic correlates and movement behaviors in infants.

METHODS

Participants were 411 parents of infants from the Early Movers project in Edmonton, Canada. Movement behaviors, infant and parental age, and nonparental care time were assessed using a parental questionnaire at 2, 4, and 6 months of age. Other infant and parental demographic variables were assessed at 2 months of age. Linear and generalized linear mixed models were conducted.

RESULTS

Infant age was associated with all movement behaviors except for restrained time. White infants and those with older parents had less tummy time but increased odds of having reading time. Infants of the most educated parents also had lower tummy time. Higher parental education and more siblings were associated with no screen time and longer infant sleep time. Infants with immigrant parent(s) were less likely to have reading time. No associations were found for infant sex, time spent in nonparental care, and parental marital status.

CONCLUSION

Since no single demographic group demonstrated healthy patterns for all movement behaviors, promotion of a healthy balance of movement behaviors may be needed universally for all infants.

Sleep problems and infant motor and cognitive development across the first two years of life: The Beijing Longitudinal Study

The present study examined bidirectional effects between sleep problems (nocturnal awakenings and insufficient nocturnal sleep) and infant development (gross motor, fine motor, and cognition) in a sample of 182 infants (89 girls) and their parents living in Beijing (China). Using 3 waves of longitudinal data (at 6 months, 1 year, and 2 years of age), this study (a) explored the differences in sleep patterns and developmental outcomes between infants in the current sample and infants from other cultures; and primarily examined (b) whether nocturnal awakenings and insufficient nocturnal sleep prospectively predicted infant development; (c) or whether infant development predicted sleep problems. Mothers reported their children's sleep problems, and infant development was assessed with Bayley III. Sleep patterns of Beijing infants were slightly different from those from Finland and Singapore, and most scores on Bayley III in this Beijing sample were higher than those in Danish, Dutch and Sri Lankan samples. Sleep problems and developmental measures were stable across the 3 times of assessments, but cross-lagged associations were limited in number and strength. High scores on the Bayley at 6 months predicted less nocturnal awakenings at 1 year of age. Insufficient nocturnal sleep at 1 year predicted poor fine motor development at 2 years. Thus, findings suggest some bidirectional associations between infant development and sleep problems and further highlight the need to understand these relations within specific cultural contexts.

Association of transportation noise with sleep during the first year of life: A longitudinal study

STUDY OBJECTIVES

During infancy, adequate sleep is crucial for physical and neurocognitive development. In adults and children, night-time noise exposure is associated with sleep disturbances. However, whether and to what extent infants' sleep is affected, is unknown. Thus, this study investigated the relationship between nocturnal transportation noise and actimetry-derived habitual sleep behavior across the first year of life.

METHODS

In 144 healthy infants (63 girls), nocturnal (23:00-7:00) transportation noise (i.e., road, railway, and aircraft) was modelled at the infants' individual places of residence. Using actimetry, we recorded movement patterns for 11 days in a longitudinal design at 3, 6, and 12 months of age and derived the recently proposed core sleep composites of night-time sleep duration, activity, and variability. Using linear mixed-effects models, we determined associations between noise exposure and sleep composites. Sex, gestational age, parents' highest educational level, infants' age, and the existence of siblings served as control variables.

RESULTS

In models without interactions, night-time transportation noise was unrelated to sleep composites across the first year of life (p > .16). Exploratory analyses of an interaction between noise and the existence of siblings yielded an association between night-time transportation noise and sleep duration in infants without siblings only (p = .004).

CONCLUSION

In our study, sleep in infants during the first year of life was relatively robust against external perturbation by night-time transportation noise. However, particularly in children without siblings increasing night-time transportation noise reduced sleep duration. This suggests that the habitual noise environment may modulate individual susceptibility to adverse effects of noise on sleep.

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families

BACKGROUND

Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study.

OBJECTIVE

To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents.

METHODS

To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age.

RESULTS

Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls.

CONCLUSIONS

The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.

Signaled night awakening and its association with social information processing and socio-emotional development across the first two years

STUDY OBJECTIVES

Night awakening is common in infancy, and some infants continue to have signaled night awakenings throughout early childhood. However, the influence of signaled night awakening on children's social development is less explored. In the present study, longitudinal associations between signaled night awakening, social information processing, and socio-emotional development were measured within the CHILD-SLEEP birth cohort in two groups formed based on parent-reported night awakenings.

METHODS

At 8 months, there were 77 infants in the waking group (≥3 awakenings) and 69 infants in the nonwaking group (≤1 awakening). At 8 and 24 months, social information processing was measured as children's attention to neutral and emotional faces, and at 24 months, parent-reported socio-emotional behavior was measured with the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire.

RESULTS

The two groups showed different patterns of attention to emotional faces. The waking group had a more pronounced attentional bias to fearful versus happy faces, whereas in the nonwaking group, attention to fearful and happy faces did not differ. In addition, at 24 months, the waking group had more dysregulation problems and lower social competence than the nonwaking group, but no clear differences in internalizing or externalizing problems were found.

CONCLUSIONS

Our results contribute to the literature by showing that during the first 2 years of life, signaled night awakening is associated with social information processing and socio-emotional behavior.

EEG sleep macrostructure and sleep spindles in early infancy

Study Objectives

Sleep features in infancy are potential biomarkers for brain maturation but poorly characterized. We describe normative values for sleep macrostructure and sleep spindles at 4–5 months of age.

Methods

Healthy term infants were recruited at birth and had daytime sleep electroencephalograms (EEGs) at 4–5 months. Sleep staging was performed and five features were analyzed. Sleep spindles were annotated and seven quantitative features were extracted. Features were analyzed across sex, recording time (am/pm), infant age, and from first to second sleep cycles.

Results

We analyzed sleep recordings from 91 infants, 41% females. Median (interquartile range [IQR]) macrostructure results: sleep duration 49.0 (37.8–72.0) min (n = 77); first sleep cycle duration 42.8 (37.0–51.4) min; rapid eye movement (REM) percentage 17.4 (9.5–27.7)% (n = 68); latency to REM 36.0 (30.5–41.1) min (n = 66). First cycle median (IQR) values for spindle features: number 241.0 (193.0–286.5), density 6.6 (5.7–8.0) spindles/min (n = 77); mean frequency 13.0 (12.8–13.3) Hz, mean duration 2.9 (2.6–3.6) s, spectral power 7.8 (4.7–11.4) µV², brain symmetry index 0.20 (0.16–0.29), synchrony 59.5 (53.2–63.8)% (n = 91). In males, spindle spectral power (µV²) was 24.5% lower (p = .032) and brain symmetry index 24.2% higher than females (p = .011) when controlling for gestational and postnatal age and timing of the nap. We found no other significant associations between studied sleep features and sex, recording time (am/pm), or age. Spectral power decreased (p < .001) on the second cycle.

Conclusion

This normative data may be useful for comparison with future studies of sleep dysfunction and atypical neurodevelopment in infancy.

Clinical Trial Registration: BABY SMART (Study of Massage Therapy, Sleep And neurodevelopMenT) (BabySMART)

URL: https://clinicaltrials.gov/ct2/show/results/NCT03381027?view=results.

ClinicalTrials.gov Identifier: NCT03381027

A longitudinal study of the links between maternal and infant nocturnal wakefulness

STUDY OBJECTIVES

To examine the longitudinal links between maternal and infant nocturnal wakefulness by employing a trajectory-based approach, and to assess whether the strength of these links differs as a function of sleep assessment method (actigraphy vs. self-report) and sleeping arrangements.

METHODS

Maternal and infant nocturnal wakefulness were assessed with actigraphy and sleep diaries at home for 5 nights, at 3 (N = 191), 6 (N = 178), 12 (N = 155), and 18 (N = 135) months postpartum. Outcome measures included the number of night-wakings (NW) and the length of nocturnal wakefulness (WASO).

RESULTS

Strong associations between maternal and infant nocturnal wakefulness (controlling for nighttime breastfeeding) were found for NW and WASO. Trajectory analyses demonstrated that the strength of these relations decreased linearly from 3 to 18 months. Furthermore, the findings showed that the links between maternal and infant NW and WASO were stronger for maternal reports than for actigraphy. No consistent differences were found in the strength of the relations between maternal and infant NW and WASO as a function of sleeping arrangements (ie, room-sharing vs. solitary-sleeping families).

CONCLUSIONS

The results suggest that infant and maternal sleep are strongly intertwined, especially during the first 6 months. The decline in the synchronization between maternal and infant nocturnal wakefulness through infant development may be attributed to the growing ability of infants to self-soothe during the night. The findings emphasize the need to study sleep within a family context.