Benefits of a bedtime routine in young children: Sleep, development, and beyond

Translation and validation of the Thai Version of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P)

PURPOSE

This study aimed to translate and validate the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) into a Thai version and to evaluate factors associated with sleep problems in preschoolers.

METHODS

The cross-cultural adaptation of JSQ-P into Thai version of JSQ-P (TH-JSQ-P) was performed including forward translation, reconciliation, backward translation, and final approval by the original creator. Children aged 2-6 years from community and clinical settings were enrolled. The TH-JSQ-P was completed by parents of preschool children twice within 10-14 days to assess its reliability and validity. Six validity tests including face validity, content validity, structural validity, construct validity, criterion validity and predictive validity were assessed. Demographic data, Epworth sleepiness scale (ESS), medical and behavior problems, and socioeconomic status were collected for analysis.

RESULTS

A total of 2613 participants completed the TH-JSQ-P, with 1207 completing it twice to assess test-retest reliability. The TH-JSQ-P had good internal consistency reliability and test-retest ability with Cronbach's alpha value of 0.898 and intraclass correlation coefficient of 0.814. The content validity was acceptable. The ESS had correlation with sleep problems in almost all subscales except for sleep habit.

CONCLUSIONS

The TH-JSQ-P is a valid and reliable instrument for evaluating sleep problems in preschool children in Thailand. It has the potential to be extensively utilized to screen for sleep problems, thereby enabling healthcare professionals to identify them early and implement prompt management.

Sleepless nights, troubled futures: The association between insufficient sleep and child flourishing

OBJECTIVE

To examine associations between sleep and flourishing among children ages 0-5 years in the United States and whether these differ by age, developmental needs, and family resilience.

STUDY DESIGN AND METHODS

Cross-sectional data from the 2020-2021 National Survey of Children's Health (N = 31,095) were used with survey-weighted logistic regression to explore associations between insufficient sleep (defined as not meeting age-recommended daily sleep guidelines: 12-16 h for 4- to 12-month-olds, 11-14 h for 1- to 2-year-olds, and 10-13 h for 3- to 5-year-olds) and flourishing (using four markers combined and categorized into two groups). Tests of effect measure modification (EMM) were performed on the multiplicative and additive scales.

RESULTS

Weak but notable evidence was found that children with insufficient sleep had decreased odds of flourishing (aOR = 0.76; 95 % CI: 0.60, 1.00). No evidence of EMM by child age or family resilience was found. However, the sleep-flourishing association differed significantly by children's developmental needs, suggesting that the combined effect of sleep and developmental needs impact flourishing more than either factor alone.

CONCLUSIONS

Approximately 38 % of children ages 0-5 years in the United States are estimated to have insufficient sleep. This study provides evidence that insufficient sleep is associated with decreased flourishing among children with special health care needs (CSHCN).

FUTURE IMPLICATIONS

Increasing sleep interventions among children under five is warranted among children with special health care needs. The association between sleep and flourishing within specific CSHCN categories, including emotional, behavioral, or developmental (EBD) criteria, should be explored to optimize sleep policies.

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.

Association between Sleep and Language Development in Children with Congenital Zika Syndrome

AIM

Congenital Zika Virus Syndrome (CZS) presents notable hurdles to neurodevelopment, with language development emerging as a crucial aspect. This study investigates sleep patterns and language skills in children with CZS, aiming to explore the potential synchronization of sleep development with their neurodevelopment.

METHOD

We studied cross-sectionally 135 children with CZS aged 0 to 48 months, investigating sleep using the BISQ Questionnaire. Language development was assessed using the Early Language Milestone Scale, while motor development and cognitive and social ability were assessed using the Bayley Scales of Infant and Young Child Development 3rd edition. We also studied longitudinally a cohort of 16 children (initially aged 0 to 12 months) whom we followed for four years, assessing at one-year intervals.

RESULTS

Sleep disturbances and language deficits were highly frequent in this population. In the 0-12 months group, a late bedtime and frequent nighttime awakenings were associated with poorer auditory expressive skills. At 13-24 months, nighttime awakenings were associated with poorer auditory expressive skills, while among 25-36-month-olds decreased auditory receptive skills were associated with longer sleep onset latency and reduced nighttime sleep duration.

CONCLUSION

The brain alterations caused by Zika virus infection affect both sleep disturbances and delays in language development. It is possible that sleep disturbance may be a mediating factor in the pathway between CZS and delayed language development, as the three analyzed language skills showed a correlation with sleep parameters.

Hypertensive disorders of pregnancy, neonatal outcomes and offspring developmental delay in Japan: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

INTRODUCTION

Developmental delay at an early age indicates the probability of continued problems after school age. Hypertensive disorders of pregnancy (HDP) are associated with developmental delays in offspring, with inconsistent outcomes. Neonatal outcomes vary according to HDP exposure and are relevant to development in later years. Here we aimed to clarify the relationship between HDP and developmental delay in offspring and whether neonatal outcomes mediate this association.

MATERIAL AND METHODS

We used data from 5934 mother-child pairs from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a prospective cohort study conducted in Japan between July 2013 and March 2017. The Ages and Stages Questionnaires, third edition, at 24 and 42 months of age, measured developmental delay in five areas. We performed multivariate quasi-Poisson regression and causal mediation analysis by neonatal outcomes.

RESULTS

At 24 months of age, compared to offspring born from normotensive mothers, offspring born from HDP-affected mothers were more likely to experience developmental delay (risk ratio [RR] 1.29, 95% confidence interval [CI]: 1.09-1.52) in the areas of communication (RR 1.21, 95% CI: 1.00-1.45) and personal-social (RR 1.15, 95% CI: 1.03-1.28). This association was mediated by neonatal outcomes: preterm birth, neonatal asphyxia, NICU admission, and neonatal small head circumference. No association was observed between HDP and developmental delay at 42 months of age.

CONCLUSIONS

Exposure to HDP during fetal life is associated with offspring developmental delay. This association is partly mediated by neonatal outcomes.

The role of arts therapies in mitigating Sleep Initiation and Maintenance Disorders: a systematic review

Introduction

Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi.

Methods

Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity.

Results

Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes.

Discussion

The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits.

Systematic review registration

PROSPERO, ID: CRD42024506393.

Exploring an objective measure of overactivity in children with rare genetic syndromes

BACKGROUND

Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates.

METHODS

A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes.

RESULTS

M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex.

DISCUSSION

These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.

Evaluation of a daily facial massage on perceived sleep quality and well-being: A pilot study

OBJECTIVE

Sleep disorders are widespread and constitute a major public health risk. The present study thus aims to investigate the effect of a facial cosmetic self-massage daily routine on women's sleep and well-being.

METHODS

The present pilot study was conducted on 62 middle-aged women declaring daily tiredness and sleep troubles. We examined the effect of a regular facial cosmetic self-massage routine on sleep patterns, daytime sleepiness, and well-being over the course of 2 months.

RESULTS

After 1 and 2 months, our results show improved sleep quality (Pittsburgh Sleep Quality Index, PSQI - -20.2% after 2 months), reduced daytime sleepiness (Epworth Sleepiness Scale, ESS, -31.2% after 2 months), and increased well-being measures. The number of participants with abnormal sleep (PSQI >5) decreased over the course of the experiment as well, from 71.9% to 49.2% at the end of the 2 months [odds ratio 95% CI for decrease: 0.38 (0.18-0.81)]. Similarly, the number of participants with excessive daytime sleepiness (>10 on the ESS) decreased over the course of the study from 44.3% to 21% after 1 month [95% CI: 0.33 (0.15-0.73)] and to 16.1% after 2 months [95% CI: 0.24 (0.10-0.56)].

CONCLUSIONS

These results suggest that a facial cosmetic self-massage routine may improve sleep patterns and is likely to be a useful addition to a standard sleep hygiene routine.

Treatment for behavioral insomnia in young children with neurotypical development under 6 years of age: A systematic review

This literature review examines all treatments for behavioral insomnia in children under 6 years of age to determine which treatments have empirically demonstrated efficacy. Following PRISMA guidelines, three databases were investigated (Pubmed, Cochrane and Psychinfo) to select randomized controlled trials (RCTs) which assess treatments for behavioral insomnia in children under 6 years of age, all with neurotypical development. A total of 908 articles met the search criteria. 21 articles were selected and analyzed in their entirety for a total of 2363 children (ranging from 2 months to 6 years of age). Based on these studies, treatment of behavioral insomnia in young children under 6 years of age is primarily based on behavioral therapy. There is no evidence that pharmacological treatments are effective in the long term for neurotypical children. This review highlights the lack of RCTs in this field: new RCTs should be carried out among young children to refine and optimize the therapeutic approach and to address the risk of therapeutic abuse through the use of non-scientifically validated methods.

Trauma Informed Best Practices and Resiliency

Children who experience fleeing from their home countries, whether with family members or unaccompanied, almost certainly experience trauma. The response of caring systems should remain grounded in the known principles of trauma-informed care, an understanding of best practices based on evidence-based and informed interventions and the developmental process. In addition, care providers should be working to maximize the safety of the environment in which they are interacting with children and youth and considering the style, approach, and content of interaction to balance the purpose of any interaction with the safety and security needs of each child or youth.

Sleep duration trajectories and cognition in early childhood: A systematic review

Sleep is dynamic in childhood and studies have shown the relationship between sleep and cognition in children. As the human brain is the most plastic during childhood, the study of longitudinal sleep patterns and neurocognition is an important research area. We aimed to systematically review studies that investigated sleep duration trajectories and cognition in typically-developing children. We searched four databases for articles published between 2003 to October 2023. We included observation studies of children with sleep duration trajectories as a predictor and outcomes related to cognition, memory, language, developmental milestones, intelligence or executive function. We excluded studies where children had atypical development or completed the sleep and neurocognitive assessments after six and 12 years of age respectively. Out of 752 articles identified, 511 were screened and 23 full texts were assessed. The selected studies included three single trajectory and four multiple group trajectories studies. We found associations between both types of trajectories and cognitive development. Overall, children with longer sleep trajectories or more mature sleep pattern with rapid decrease in sleep duration, had better performance scores in developmental assessment tools, and intelligence tests. Findings for language and executive functioning were mixed, whereby some studies found associations and others did not.

Annual Research Review: The power of predictability - patterns of signals in early life shape neurodevelopment and mental health trajectories

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant impacts of patterns of signals on child development. We begin with an overview of the existing unpredictability literature, which has focused primarily on longer patterns of unpredictability (e.g. years, months, and days). We then describe our work testing the impact of patterns of parental signals on a moment-to-moment timescale, providing evidence that patterns of these signals during sensitive windows of development influence neurocircuit formation across species and thus may be an evolutionarily conserved process that shapes the developing brain. Next, attention is drawn to emerging themes which provide a framework for future directions of research including the evaluation of functions, such as effortful control, that may be particularly vulnerable to unpredictability, sensitive periods, sex differences, cross-cultural investigations, addressing causality, and unpredictability as a pathway by which other forms of ELA impact development. Finally, we provide suggestions for prevention and intervention, including the introduction of a screening instrument for the identification of children exposed to unpredictable experiences.

A comparison of perceived barriers to optimal child sleep among families with low and high income

OBJECTIVE

Families with low-income experience suboptimal sleep compared to families with higher-income. Unique drivers likely contribute to these disparities, along with factors that universally impede sleep patterns, despite income level. To inform intervention tailoring, this mixed-methods study gathered parent's perceptions about child sleep challenges to identify similarities/differences in families with lower-income and higher-income.

METHODS

Parents who experienced difficulties with their child (ages 2-4years) sleep were categorized as lower income (n = 15; $30,000 ± 17,845/year) or higher income (n = 15; $142,400 ± 61,373/year). Parents completed a survey and semistructured interview to explore barriers and facilitators for child sleep. Two coders independently evaluated transcripts for lower-income and higher-income groups using inductive analyses. Constant-comparison methods generated themes and characterized similarities/differences by income group.

RESULTS

Groups were similar in themes related to diverse bedtime routines, nighttime struggles with child sleep, parent strategies to reduce night wakings, parent effort to provide a sleep-promoting environment, and presence of electronic rules. Groups differed in themes related to factors influencing routine setting (eg, lower income: external factors influencing routines; higher income: personal attributes for structure), parent appraisal of child sleep (eg, higher income: ambivalence; lower income: mostly negative appraisal), nap timing and duration (eg, lower income: longer naps), and strategy utilization and pursuit of resources (eg, higher income: more parents tried various strategies and accessed online/print resources).

CONCLUSIONS

Parents experienced many similar barriers to child sleep, with a few distinct differences by income group. These findings can inform future intervention components for all families, as well as customized components to address the unique needs of families across income levels.

Sleep Problems in Autism Spectrum Disorder

Sleep problems are common in children with autism spectrum disorder (ASD), with 40% to 80% prevalence. Common disorders include insomnia, parasomnias, and circadian rhythm sleep-wake disorders. These problems have a multifactorial etiology and can both exacerbate and be exacerbated by core ASD symptoms. Sleep problems also impact the health and quality of life of both patients and their caregivers. All children with autism should be regularly screened for sleep problems and evaluated for co-occurring medical contributors. Behavioral interventions with caregiver training remain first-line treatment for sleep disorders in both neurotypical and neurodiverse youth.

Substituting Book Reading for Screen Time Benefits Preschoolers' Sleep Health: Results from the Ulm SPATZ Health Study

Purpose

Healthy sleep is essential for the physical, cognitive, and social development of children. Several studies have reported the increase in digital media use in preschool children and its association with impaired sleep. However, there is relatively little evidence on the effects of book reading as a potentially safe alternative. The objective of this study, therefore, was to investigate whether sleep in children could benefit from book reading, and whether the negative effects of media use on sleep can be mitigated by substituting book reading for screen time.

Participants and Methods

We used longitudinal data from three consecutive waves of the SPATZ Health study, including children at the ages of 4 (n=581), 5 (n=508), and 6 (n=426) years. All data were collected by self-administered questionnaires. Parent-reported child sleep was assessed by the Children's Sleep Habits Questionnaire.

Results

Across the three waves, screen-based media use increased and was associated with lower sleep quality. In contrast, the time spent with book reading decreased; however, book reading appeared to be beneficial for children's sleep. Substitution models revealed that the theoretical substitution of an equal amount of book reading for 50% of the time spent with screen-based media benefits several domains of preschoolers' sleep health, including parasomnias, sleep anxiety, daytime sleepiness, and sleep onset delay.

Conclusion

Besides implications for population-wide and individual prevention, book reading may also be incorporated as a useful intervention to improve sleep quality in children who are already affected by sleep problems. Given that book reading is perceived as a safe alternative, the presented evidence may suffice to support recommendations in this direction.

Hypnosis with depressed children and teens: Building skills, creating connection

Depression in children and teens has been on the rise for several years. Recent increases in anxiety and loneliness, both contributors to the development of depression, are putting more young people at risk for chronic and comorbid mental health struggles. The use of hypnosis with depressed children offers the opportunity to target the identified skills depressed and anxious children need and is a modality clinicians should embrace. This article describes how to create hypnotic interventions focusing on improved emotional and cognitive management, better sleep, and the ability to make positive social connections. Such interventions serve to not only build the resources depressed children need for recovery, but also support a paradigm shift toward prevention in children and families.

Common Childhood Sleep Problems and Disorders

BACKGROUND

Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children.

OBJECTIVE

To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents.

METHODS

A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled.

RESULTS

Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized.

CONCLUSION

Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

Sociodemographic, temporal and bedtime routine correlates of sleep timing and duration in South Asian and white children: A Born in Bradford study

Objective

The study aimed to examine sociodemographic, temporal and bedtime routine correlates of parent-reported sleep duration and timing in a biethnic sample of 18 month and 36 month old children from a disadvantaged location.

Methods

Between October 2010 and September 2012, parents completed a bespoke three day sleep diary when their child was approximately 18 months (n = 276) and 36 months of age (n = 262) (45.1% South Asian; 54.9% white). Parents reported their child's overnight sleep duration (h/day), the time their child fell asleep, their wake time and their child's bedtime and napping routines. Data were available at both time points for 135 children.

Results

In line with previous literature, South Asian children had shorter overnight sleep duration and later sleep and wake times than white children. In both ethnic groups, children slept and woke up later on weekends, and children went to bed earlier and slept longer in winter. In white children only, napping duration was associated with overnight sleep period. No significant associations were found between napping frequency and overnight sleep duration. Based on parent-reported data, children who consistently adhered to regular bedtimes and had set times for sleeping tended to go to sleep earlier, wake earlier and have longer overnight sleep.

Conclusions

The data showed parent-reported variation in sleep patterns between two ethnic groups within a single geographical and deprived area. It is important that researchers, clinicians and early years workers are considerate of cultural norms in sleep practices.

Common Issues for General Practitioners in the Medical Management of Child and Adolescent Psychiatric Care

With a limited number of child and adolescent psychiatrists available to see youth patients, many common psychiatric problems in youth are managed by other providers. Clinical pearls from experts in child and adolescent psychiatry can help general practitioners with this management. Some common issues are discussed here for which practical guidance is offered, ranging from approaches to assessment and how to start and titrate medications for the treatment of attention deficit hyperactivity disorder, depression, and sleep problems.

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.

Investigation of Factors Influencing Sleep Status in Beijing Children Aged 3 to 14 Years

OBJECTIVE

To investigate the current status of children's sleep in Beijing and analyze the factors that influence it.

MATERIALS AND METHODS

Using multi-stage stratified cluster random sampling, a total of 11 420 children aged 3 to 14 years in 7 districts of Beijing were included in this study. The Pediatric Sleep Questionnaire (PSQ) was used to investigate and analyze various factors influencing sleep.

RESULTS

The mean PSQ score of the children surveyed was 3.60 ± 2.69 points. The proportion of children with a score above 7 was 8.87%. Multi-level model analysis showed that the younger children had higher PSQ scores than older and that the boys had higher PSQ scores than the girls.

CONCLUSIONS

The sleep quality of children in Beijing is not optimistic. The PSQ score of preschool children is higher than school age children. It is recommended that parents pay attention to their children's sleep status and try to remove influencing factors.

Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation

BACKGROUND

Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality.

OBJECTIVE

This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps' general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB).

METHODS

Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps.

RESULTS

Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change.

CONCLUSIONS

Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals.

Nocturnal selective pressures on the evolution of human musicality as a missing piece of the adaptationist puzzle

Human musicality exhibits the necessary hallmarks for biological adaptations. Evolutionary explanations focus on recurrent adaptive problems that human musicality possibly solved in ancestral environments, such as mate selection and competition, social bonding/cohesion and social grooming, perceptual and motor skill development, conflict reduction, safe time-passing, transgenerational communication, mood regulation and synchronization, and credible signaling of coalition and territorial/predator defense. Although not mutually exclusive, these different hypotheses are still not conceptually integrated nor clearly derived from independent principles. I propose The Nocturnal Evolution of Human Musicality and Performativity Theory in which the night-time is the missing piece of the adaptationist puzzle of human musicality and performing arts. The expansion of nocturnal activities throughout human evolution, which is tied to tree-to-ground sleep transition and habitual use of fire, might help (i) explain the evolution of musicality from independent principles, (ii) explain various seemingly unrelated music features and functions, and (iii) integrate many ancestral adaptive values proposed. The expansion into the nocturnal niche posed recurrent ancestral adaptive challenges/opportunities: lack of luminosity, regrouping to cook before sleep, imminent dangerousness, low temperatures, peak tiredness, and concealment of identity. These crucial night-time features might have selected evening-oriented individuals who were prone to acoustic communication, more alert and imaginative, gregarious, risk-taking and novelty-seeking, prone to anxiety modulation, hedonistic, promiscuous, and disinhibited. Those night-time selected dispositions may have converged and enhanced protomusicality into human musicality by facilitating it to assume many survival- and reproduction-enhancing roles (social cohesion and coordination, signaling of coalitions, territorial defense, antipredatorial defense, knowledge transference, safe passage of time, children lullabies, and sexual selection) that are correspondent to the co-occurring night-time adaptive challenges/opportunities. The nocturnal dynamic may help explain musical features (sound, loudness, repetitiveness, call and response, song, elaboration/virtuosity, and duetting/chorusing). Across vertebrates, acoustic communication mostly occurs in nocturnal species. The eveningness chronotype is common among musicians and composers. Adolescents, who are the most evening-oriented humans, enjoy more music. Contemporary tribal nocturnal activities around the campfire involve eating, singing/dancing, storytelling, and rituals. I discuss the nocturnal integration of musicality's many roles and conclude that musicality is probably a multifunctional mental adaptation that evolved along with the night-time adaptive landscape.

Nocturnal sleep duration trajectories in early childhood and school performance at age 10 years

Sleep plays a fundamental role in brain development and resultant functions. The aim was to verify whether nocturnal sleep duration during early childhood has long-term associations with academic achievement at age 10 years. The present study is part of the Quebec Longitudinal Study of Child Development, a representative cohort of infants born in 1997-1998 in the province of Quebec, Canada. Children with known neurological conditions were excluded from this cohort. Four trajectories of parent-reported nocturnal sleep duration at ages 2.5, 3, 4, 5 and 6 years were determined using a SAS procedure named PROC TRAJ. Sleep duration at age 10 years was also reported. Teachers provided data on academic performance when the children were age 10 years. These data were available for 910 children (430 boys, 480 girls; 96.6% Caucasians). Univariate and multivariable logistic regressions were performed using SPSS. Children who slept less than 8 hr per night at 2.5 years but normalized later on (Traj1) had three-five times the odds of having grades below the class average in reading, writing, mathematics and science compared with children who slept sufficiently (Traj3-4: 10-11 hr per night). Children who slept about 9 hr per night throughout childhood (Traj2) had two-three times the odds of being below the class average in mathematics and science. Sleep duration at age 10 years was not correlated with the academic performance. These results point to the presence of a very important early period during which sufficient sleep is needed to fine-tune the functions necessary for academic achievement later on.

Disparities in Sleep-Disordered Breathing: Upstream Risk Factors, Mechanisms, and Implications

Sleep-disordered breathing (SDB) refers to a spectrum of disorders ranging from habitual snoring without frank episodes of obstructed breathing or desaturation during sleep to obstructive sleep apnea, where apneas and hypopneas repetitively occur with resultant intermittent hypoxia, arousal, and sleep disruption. Disparities in SDB reflect its overall high prevalence in children and adults from racially and ethnically minoritized or low socioeconomic status backgrounds coupled with high rates of underdiagnosis and suboptimal treatment.

The Relationship Between Maternal and Infant Sleep Duration Across the First Two Years

OBJECTIVES

The first objective of this study was to determine how mother-infant sleep duration is related across the first 2 years of life. The second objective was to determine whether these relationships change across the first 2 years of life. The third objective was to understand demographic and health predictors of the relationship between maternal and child sleep.

METHODS

Parents of 464 infants from the STRONG Kids 2 study reported their own and infants' nocturnal sleep duration and other health information (i.e., breastfeeding) at 3, 12, 18, and 24 months postpartum.

RESULTS

Latent transition models revealed 2 mother-infant sleep profiles exist at 3 to 24 months. The low maternal sleep ( LMS ) pattern was characterized by lower maternal sleep duration than the recommended amount and lower infant sleep duration. The average maternal sleep ( AMS ) pattern was characterized by average maternal sleep duration meeting the recommended standard and average infant sleep duration. Approximately half of the mothers who started in the LMS profile transitioned to the AMS profile after 12 months postpartum. The sleep profiles stabilized after 12 months postpartum with limited transitions across 12 to 24 months. More infant-signaled nighttime wakings, later bedtimes, more infant sleep problems, and more exclusive breastfeeding were predictors of being in the LMS profile.

CONCLUSION

Mother-infant sleep profiles stabilized after age 12 months, and mother-infant sleep profiles are driven by infant sleep quality during the night. The findings suggest the need to establish a healthy sleep routine for mothers and infants in the first year of life to promote longer-term sleep hygiene.

Treating sleep problems in young children: A randomised controlled trial of a group-based, parent-focused behavioural sleep intervention

This study tested the efficacy of a 5 × 1.5 h/session, group-based, parent-focused, behavioural intervention (BI) targeting sleep problems in preschool children. Parents were randomised to either the BI (N = 62) or care as usual (CAU; N = 66) conditions. Outcomes included sleep, anxiety, behavioural problems, internalising and externalising symptoms, transition to school and academic achievement. Assessments were conducted at pre- and post-BI intervention (in the year prior to formal schooling), and then at follow-ups 1 and 2 in the first year of formal schooling. Relative to the CAU, the BI condition demonstrated significantly greater improvements in sleep, anxiety, behaviour problems and internalising and externalising symptoms from pre-to post-intervention. Improvements in sleep, anxiety, and internalising symptoms were maintained, while behaviour and externalising symptoms were further improved upon at school follow-up 2. For the BI group, improvements in sleep at post-intervention were found to mediate improvements in anxiety, internalising, and externalising symptoms, but not behaviour problems, at school follow-ups 1 and 2. There were no significant effects of condition on school transition or academic outcome measures. The results suggest that the BI is effective for sleep, anxiety, behaviour, internalising and externalising symptoms, but not for school transition or academic outcomes. ANZCTR NUMBER: ACTRN12618001161213.

Habituation, Adaptation and Prediction Processes in Neurodevelopmental Disorders: A Comprehensive Review

Habituation, the simplest form of learning preserved across species and evolution, is characterized by a response decrease as a stimulus is repeated. This adaptive function has been shown to be altered in some psychiatric and neurodevelopmental disorders such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) or schizophrenia. At the brain level, habituation is characterized by a decrease in neural activity as a stimulation is repeated, referred to as neural adaptation. This phenomenon influences the ability to make predictions and to detect change, two processes altered in some neurodevelopmental and psychiatric disorders. In this comprehensive review, the objectives are to characterize habituation, neural adaptation, and prediction throughout typical development and in neurodevelopmental disorders; and to evaluate their implication in symptomatology, specifically in sensitivity to change or need for sameness. A summary of the different approaches to investigate adaptation will be proposed, in which we report the contribution of animal studies as well as electrophysiological studies in humans to understanding of underlying neuronal mechanisms.

School-Based Sleep Education Program for Children: A Cluster Randomized Controlled Trial

Insufficient sleep contributes negatively to child developmental processes and neurocognitive abilities, which argues the need for implementing interventions to promote sleep health in children. In this study, we evaluated the effectiveness of a multimodal and multilevel school-based sleep education program in primary school children using a cluster randomized controlled design. Twelve schools were randomly assigned to either the sleep education or nonactive control groups. The sleep education group included a town hall seminar, small class teaching, leaflets, brochures, and a painting competition for children. Parents and teachers were invited to participate in a one-off sleep health workshop. Parental/caregiver-reported questionnaires were collected at baseline and 1-month follow-up. A total of 3769 children were included in the final analysis. There were no significant improvements observed in the sleep-wake patterns, daytime functioning, and insomnia symptoms between the two groups at follow-up, whereas the intervention group had significantly improved parental sleep knowledge than the controls (paternal: adjusted mean difference: 0.95 [95% confidence interval (CI): 0.18 to 1.71]; maternal: adjusted mean difference: 0.87 [95% CI: 0.17 to 1.57]). In addition, children receiving the intervention had a lower persistence rate of excessive beverage intake (adjusted odds ratio: 0.49 [95% CI: 0.33 to 0.73]), and experienced greater reductions in conduct problems (adjusted mean difference: 0.12 [95% CI: 0.01 to 0.24]) compared with the controls at 1-month of follow-up. Moreover, a marginally significant reduction for emotional problems in the intervention group was also observed (adjusted mean difference: 0.16 [95% CI: -0.00 to 0.32]). These findings demonstrated that school-based sleep education was effective in enhancing parental sleep knowledge and improving behavioral outcomes in children, but not sufficient in altering the children's sleep-wake patterns and sleep problems.

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.

What daily factors affect the sleep habits of Japanese toddlers?

STUDY OBJECTIVES

Good sleep, especially during early childhood, is important for development. In Japan, the mean nocturnal sleep duration of toddlers is < 10 hours, and even if toddlers slept for > 11 hours/day, as recommended by the National Sleep Foundation, some of them showed late bedtime and late wake-up time or took long naps. Therefore, we provisionally assumed the minimal sleep conditions for Japanese toddlers, named Nenne-criteria, such as bedtime before 10:00 pm, nocturnal sleep duration of ≥ 9 hours, and < 1 average time of awakening after sleep onset, and investigated the important factors for good sleep.

METHODS

We analyzed cross-sectional data from online surveys describing the sleep-related behaviors of 2,124 toddlers and their caregivers. We compared the daily schedules that affect sleep between the Nenne-criteria-meet group and the not-meet group.

RESULTS

The Nenne-criteria-meet group showed better daytime behaviors than the not-meet group. Structural equation modeling on daily schedules revealed that, to increase sleep pressure at the appropriate time, it is important to restrict media viewing, play outdoors in the morning, have an early nap ending time, avoid hyperarousal-inducing behaviors before bedtime, maintain daily schedules regularly, and decrease social jetlag.

CONCLUSIONS

The Nenne-criteria are useful for screening Japanese toddlers who require intervention for sleep hygiene. To improve toddlers' sleep, it is important not only to guide the ideal bedtime but also to provide tips for improving daily schedules and to avoid suboptimal sleep-related behaviors.

CITATION

Murata E, Yoshizaki A, Fujisawa TX, Tachibana M, Taniike M, Mohri I. What daily factors affect the sleep habits of Japanese toddlers? J Clin Sleep Med. 2023;19(6):1089-1101.

Beyond Polysomnography: Clinical Assessment of Pediatric Sleep Health and Sleep Problems

This chapter reviews the Peds B-SATED model of pediatric sleep health and common pediatric sleep problems. Aspects of pediatric sleep health and sleep problems are considered across development, from infants through adolescents. Finally, information about clinical screening in both primary and specialty care is discussed, and subjective sleep questionnaires are reviewed.

Nurturing the Literacy Lives of Boys of Color During COVID-19

When school buildings closed suddenly due to the COVID-19 pandemic, educators relied on families more than ever to mediate their children's learning. This yearlong case study details the narratives of 14 Black and Latinx families as they negotiated literacy practices with their teenage sons during remote schooling. This study finds that families bolstered their sons' literacies through dimensions of family literacy care, a notion developed by the author to describe the material, emotional, embodied, and digital mentoring exchanged between caregivers and boys around literacy practices at home. Entangled in these narratives are the complex ways that families enacted their roles as caregivers and teachers during the pandemic, and in turn, how boys acquiesced to and resisted their parents' attempts at family literacy care. These findings texture and advance the field of family literacy scholarship to understand better the varied ways boys orient toward (and away from) texts in their family context.

The efficacy of massage as a nightly bedtime routine on infant sleep condition and mother sleep quality: A randomized controlled trial

BACKGROUND AND PURPOSE

Infants' sleep disorders and parents' insufficient sleep are common problems in the infant care. The current study was conducted to assess the effectiveness of infant massage on infants' night-time sleep condition and mothers' sleep quality.

PROCEDURES

140 infants were randomly put into two different groups, experimental group with fifteen-minute bedtime messages for two weeks and the control group with normal infant routine care. The Brief Infant Sleep Questionnaire, a personal information submission form, and Pittsburgh Sleep Quality Index for the mothers were the tools used to gather data in this study.

RESULTS

Infants in experimental group showed meaningful differences in variables such as, sleep latency (P <  0001, eta = 0.099), number of night waking (P = 0.03, eta = 0.027) and longest continuous sleep period (P = 0.03, eta = 0.026). As for other variables no meaningful differences were observed. There wasn't meaningful difference in the mother's overall night-time sleep quality between the two groups (P = 0.184, eta = 0.012) except for the duration of the mother's night-time sleep (P = 0.028, eta = 0.026) and the reduction of maternal sleep disorder (P = 0.020 eta = 0.029).

CONCLUSION

The findings indicated that infants' bedtime massages would improve some of the sleep markers of mothers and infants, and therefore, can be suggested as a practical, harmless, and cost-free method to improve sleep.

Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study

BACKGROUND

Exposure to environmental risk factors increases the negative impact maltreatment has on children's development. Sleep ecology (i.e., sleep hygiene and home sleeping conditions) can be one of these factors. Poor sleep hygiene and suboptimal home sleeping conditions can alter sleep characteristics, which in turn, may lead to behavior problems (BPs), highly prevalent in maltreated preschoolers.

OBJECTIVES

Describe sleep ecology in maltreated preschoolers and explore associations between their sleep ecology, objective sleep characteristics and BPs.

METHOD

Parents (n = 22) completed the Children's Sleep Hygiene Scale (CSHS), and a sleep environment questionnaire to document sleep ecology. Children wore an actigraph to record objective sleep characteristics. Parents completed the Behavioral Assessment Scale for Children (BASC-2) to assess children's BPs. Descriptive and correlational analyses were performed.

RESULTS

Most of the parents (90.5 %) reported adequate sleep hygiene. However, 20 parents (95.2 %) reported suboptimal home sleeping conditions. Better physiological and overall sleep hygiene were related to earlier sleep onset. Better emotional sleep hygiene was associated with shorter nighttime awakenings and better sleep efficiency. Later sleep onset was associated with lower anxiety, and longer 24-hour sleep duration with higher somatization. Better physiological sleep hygiene was associated with less depression, and better emotional sleep hygiene with less hyperactivity.

CONCLUSION

This study showed that sleep hygiene could be associated with maltreated preschoolers' sleep characteristics and BPs, and that their home sleeping conditions may be of concern. Associations between sleep ecology, objective sleep characteristics and BPs deserve to be better understood, and further explored.

Development and Psychometric Properties of the Sleep Parenting Scale for Infants

Although infants' sleep behaviors are shaped by their interactions with parents at bedtime, few tools exist to capture parents' sleep parenting practices. This study developed a Sleep Parenting Scale for Infants (SPS-I) and aimed to (1) explore and validate its factorial structure, (2) examine its measurement invariance across mothers and fathers, and (3) investigate its reliability and concurrent and convergent validity. SPS-I was developed via a combination of items modified from existing scales and the development of novel items. Participants included 188 mothers and 152 mother-father dyads resulting in 340 mothers and 152 fathers; about half were non-Hispanic white. Mothers and fathers completed a 14-item SPS-I for their 12-month-old infant. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore and validate SPS-I's underlying structure. Multigroup CFA was used to examine measurement invariance across mothers and fathers. Reliability was examined using Cronbach's alpha. Concurrent validity was assessed using linear regressions examining associations between SPS-I factors and parent-reported infants nighttime sleep duration. Convergent validity was assessed using paired-sample t-tests to test whether the SPS-I subscale scores were similar between mothers and fathers in the same household. EFA and CFA confirmed a 3-factor, 12-item model: sleep routines, sleep autonomy, and screen media in the sleep environment. SPS-I was invariant across mothers and fathers and was reliable. Concurrent and convergent validity were established. SPS-I has good psychometric properties, supporting its use for characterizing sleep routines, sleep autonomy, and screen media in the sleep environment by mothers and fathers.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002799 .

Sleep Disturbances and Mental Well-Being of Preschool Children during the COVID-19 Pandemic in Mexico

COVID-19 pandemic confinement caused changes in families and children's routines worldwide. Studies conducted at the beginning of the pandemic have examined the harmful effects of these changes on mental health, including sleep disturbances. As sleep is essential for optimal childhood development, this study was designed to determine preschool-aged (3-6 years old) children's sleep parameters and mental well-being during the COVID-19 pandemic in Mexico. Using a cross-sectional design, a survey was applied to parents of preschool children, inquiring about their children's confinement status, routine changes, and electronics use. The parents responded to the Children's Sleep Habits Questionnaire and the Strengths and Difficulties Questionnaire to assess children's sleep and mental well-being. To provide objective sleep data, the children wore wrist actigraphy for seven days. Fifty-one participants completed the assessment. The children's mean age was 5.2 years, and the prevalence of sleep disturbances was 68.6%. The use of electronic tablets in the bedroom near bedtime and symptoms of mental health deterioration (i.e., emotional distress and behavioral difficulties) were associated with sleep disturbances and their severity. The COVID-19 pandemic's confinement-related routine changes greatly impacted preschool children's sleep and well-being. We recommend establishing age-tailored interventions to manage children at higher risk.

Associations between chronotype, sleep quality, maternal mental health, and child development in mother-infant dyads

OBJECTIVE/BACKGROUND

Studies on circadian rhythms throughout development and their physiological and behavioral impacts at early stages are still scarce. Previous studies have shown that mother-infant interactions are important for both sleep and child development. In this cross-sectional study we investigated whether infants' chronotype, sleep and development were associated with their respective mothers' chronotype, sleep, mental health and socioeconomic status.

PATIENTS/METHODS

the following were used to evaluate mothers: the Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Self-Reporting Questionnaire 20 (SRQ-20). To assess the infants' characteristics, the following were used: the 19th question from the Morningness-Eveningness Questionnaire (MEQ), infant nocturnal midpoint of sleep (iMSF), Brief Infant Sleep Questionnaire (BISQ) and Ages and Stages Questionnaire-3 (ASQ3). Socioeconomic aspects were assessed using the Brazilian Economic Class Criterion of the Brazilian Association of Research Companies (ABEP).

RESULTS

A hundred and eight mother-infant dyads participated in the study. Sleep disorders were observed in 38 (35%) infants and atypical development (ASQ3) in 35 (32%). The infants' sleep phases were partially explained by the mother's chronotype. Infants' sleep duration was negatively correlated with sleep latency, which was higher in the group with atypical development. Mothers of infants with sleep disorders or discordant chronotypes (32%) had higher Pittsburgh scores (worse sleep quality) and higher SRQ-20 scores (screen for Common Mental Disorders).

CONCLUSIONS

We found evidence for the contribution of sleep quality and chronotypes to mothers' mental health and infant development. However, further studies are needed to confirm the influence of sleep and circadian phenotypes in the early stages.

Questionnaire survey on sleep habits of 3-year-old children in Asahikawa City: Comparison between 2005 and 2020

BACKGROUND

Good sleep is essential for children's healthy growth. In 2005, we conducted a questionnaire survey on children's sleep habits and their background, targeting parents who attended health checkups for their 3-year-old children in Asahikawa City, Hokkaido. In 2020, we performed a secondary survey, including additional questions regarding media usage. We analyzed changes in children's sleep environment by comparing the results of both surveys.

METHODS

Children from 500 families (n = 420; 219 males, 201 females; mean age, 3.6 years) who underwent 3.5-year-old health checkups (per the changed schedule in 2015) in Asahikawa City from July 2020 to November 2020 and their parents who had completely answered the questionnaire were included.

RESULTS

The proportion of children who used childcare support system such as nursery schools or kindergarten increased from 30% in the previous survey to 95% in the present survey. The mean nocturnal sleep duration of children was 9.33 h in the present survey, 0.77 h shorter than that in the previous survey; similar to the previous survey results, it was significantly short (8.71 h) in children who went to bed after 10 PM. Moreover, it was significantly short in children who watched television for more than two hours or used media within two hours before going to bed or if parents used smartphones or watched motion pictures for >30 min/day. The rate of consulting pediatricians regarding sleep problems decreased from 3% to 2.4%.

CONCLUSION

Parents' lifestyles greatly influenced children's sleep habits in 2020. Pediatricians should actively participate in managing children's sleep problems.

Association of Breastfeeding Practices During the First 3 Months with Infant Sleep Trajectories: A Prospective Cohort Study

BACKGROUND

Breastfeeding has numerous effects on maternal and child health. The effect of breastfeeding on infant sleep remains inconclusive.

OBJECTIVES

We aimed to examine whether full breastfeeding (FBF) during the first 3 mo is associated with longitudinal infant sleep trajectories in their first 2 y of life.

METHODS

The study was embedded in the Tongji Maternal and Child Health Cohort study. Information on infant feeding practices was collected at 3 mo of age, and maternal/child pairs were assigned to the FBF or the non-FBF group (including partially breastfeeding and exclusive formula feeding) on the basis of feeding practices during the first 3 mo of life. Sleep data of infants were obtained at 3, 6, 12, and 24 mo. Total, night, and day sleep trajectories across 3 to 24 mo were estimated with group-based models. Each sleep trajectory was differentiated on the basis of sleep duration at 3 mo (long/moderate/short) and the interval from 6 to 24 mo (moderate/short). Multinomial logistic regression was used to investigate the association of breastfeeding practices with infant sleep trajectories.

RESULTS

Among the 4056 infants studied, 2558 (63.1%) received FBF for 3 mo. When compared with FBF infants, non-FBF infants had shorter sleep duration at 3, 6, and 12 mo (P < 0.01). Non-FBF infants were more likely to experience Moderate-Short (OR: 1.31; 95% CI: 1.06, 1.61) and Short-Short (OR: 1.56; 95% CI: 1.12, 2.16) total sleep trajectories and more likely to experience Moderate-Short (OR: 1.84; 95% CI: 1.22, 2.77), and Short-Moderate (OR: 1.40; 95% CI: 1.06, 1.85) night sleep trajectories than FBF infants.

CONCLUSIONS

Full breastfeeding for ≥3 mo were positively associated with longer infant sleep duration. Infants fully breastfed were more likely to experience better sleep trajectories characterized by longer duration in their first 2 y of life. Full breastfeeding may benefit infants through healthy sleep.

Insomnia in Infancy, Childhood, and Adolescence

Insomnia is the most prevalent sleep disorder in youth, tends to persist over time, and is associated with a myriad of adverse outcomes. This paper synthesizes the current evidence regarding the phenomenology, prevalence, assessment, consequences, cause, and treatment of pediatric insomnia, highlighting areas that warrant further research and addressing the unique characteristics of this disorder in infants, children, and adolescents.

School-Age Child Routines: Adaptation and Validation Studies of the Portuguese Version of the Child Routines Questionnaire

Child routines have been recognized as positive contributors to children's development. However, in Portugal there is still a lack of instruments available to assess school-age child routines. The purpose of this study was to present the translation, adaptation, and validation studies of the Portuguese version of the Child Routines Questionnaire (CRQ), a parent self-report measure developed to assess school-age child routines. A total of 460 parents of children aged between 6 and 12 years-old participated in the study. Two studies were conducted to define the CRQ-PT factor structure. In Study 1 (n = 204 children from 6 to 12 years-old), findings from the exploratory factor analysis provided evidence for a four-factor structure (for 32 items), which explained 43.53% of the total variance. In Study 2 (n = 256 children from 6 to 9 years-old), results from confirmatory factor analysis showed good model fit indices (CFI = 0.84, RMSEA = 0.06). The total scale of the CRQ-PT (α = 0.89) and its subscales showed good internal consistency. Further evidence of construct validity was shown by weak to moderate correlations with measures of parental sense of competence and family mealtime routines. Relevant contributions of the study are underscored, namely the availability and usefulness of a reliable and valid assessment tool to evaluate the routines of Portuguese school-age children for clinical practice and research purposes.

Barriers to Optimal Child Sleep among Families with Low Income: A Mixed-Methods Study to Inform Intervention Development

This study gathered formative data on barriers to optimal child sleep to inform the development of a sleep intervention for parents of preschool-aged children in low-income households. Parents (n = 15, age: 34 ± 8 years, household income: $30,000 ± 17,845/year) reporting difficulties with their child's sleep participated in this study. Mixed methods included an online survey and semi-structured phone interview. Items assessed barriers/facilitators to optimal child sleep and intervention preferences. Interview transcripts were coded using inductive analyses and constant-comparison methods to generate themes. Derived themes were then mapped onto the Theoretical Domains Framework to contextualize barriers and inform future intervention strategies. Themes that emerged included: stimulating bedtime activities, child behavior challenges, variability in children's structure, parent work responsibilities, sleep-hindering environment, and parent's emotional capacity. Parent's intervention preferences included virtual delivery (preferred by 60% of parents) to reduce barriers and provide flexibility. Mixed preferences were observed for the group (47%) vs. individual (53%) intervention sessions. Parents felt motivated to try new intervention strategies given current frustrations, the potential for tangible results, and knowing others were in a similar situation. Future work will map perceived barriers to behavior change strategies using the Behavior Change Wheel framework to develop a parenting sleep intervention.

Sleep changes in Taiwanese first graders before and after school closure during the COVID-19 pandemic

PURPOSE

The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN AND METHODS

This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first-graders before and after school closure. Paired t-test and the general linear model were applied to data analysis.

RESULTS

Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (p = .029) and less delayed sleep-wake patterns in their children.

PRACTICAL IMPLICATION

Sleep is an indicator that reflects children's behavioral changes in response to the COVID-19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement.

Sleep patterns in childhood: a longitudinal assessment from the Generation XXI birth cohort

OBJECTIVE

To describe sleep-wake patterns in young children, based on sleep characteristics in early infancy and preschool ages, identifying their main sociodemographic characteristics, and to assess the association between different sleep characteristics at both ages.

METHOD

We included 1092 children from the Generation XXI birth cohort, evaluated at six months and four years of age, by face-to-face interviews. Sleep patterns were constructed through latent class analysis and structured equation modeling, including data on wake-up time and bedtime, afternoon naps, locale of nighttime sleep and night awakenings. To estimate the association between sociodemographic characteristics and sleep patterns, odds ratios and 95% confidence intervals were computed using logistic regression.

RESULTS

Two sleep patterns were identified through latent class analysis: pattern 1 was characterized by earlier bedtime and wake-up times, while pattern 2 was defined by later times. When compared with pattern 1, pattern 2 was more frequent among children whose mothers had changed from partnered to not partnered until preschool age and those who did not stay at the kindergarten, and was less common among those with siblings. Through structured equation modeling, an aggregating factor was identified at preschool age, which was mainly correlated with bedtime and wake-up time. A positive association between sleep characteristics evaluated in early infancy and in preschool ages was observed.

CONCLUSIONS

Sleep patterns and circadian sleep preferences seem to be developed early in life, which highlight the importance of promoting an adequate sleep hygiene from infancy, assuming its impact on sleep quality during the life course.

Sleep Patterns and School Readiness of Pre-Kindergarteners from Racially and Ethnically Diverse, Low-Income Backgrounds

OBJECTIVE

To explore patterns in parent-reported child sleep health and to investigate connections between such patterns and school readiness for newly enrolled prekindergarten (PreK) attendees from racially and ethnically diverse, low-income backgrounds.

STUDY DESIGN

In a secondary analysis from a larger multiple-cohort longitudinal observational study of prekindergartners in low-income families, parental reports of sleep health for 351 children (mean age, 52.8 ± 3.5 months) during the first month of PreK were analyzed. Children also had completed direct assessments measuring language, literacy, mathematics, and executive functioning, and teachers rated children's social-emotional-behavioral competencies and approaches to learning at PreK entry. We performed latent class analyses to identify patterns in sleep health and used regression models to examine concurrent associations between child sleep health patterns and school readiness competencies across 6 domains: language, literacy, mathematics, executive functioning, social-emotional-behavioral, and approaches to learning.

RESULTS

Two classes emerged reflecting more and less desirable patterns of sleep health. Children classified in the earlier, longer, consistent sleep health class (87% of children) experienced earlier bedtimes, longer night-time sleep durations, more consistent sleep routines, less caffeine consumption ≤3 hours before bedtime, and scored higher on a direct assessment of expressive vocabulary and on teacher-reported measures of social-emotional-behavioral competencies and learning approaches than their peers in the later, shorter, inconsistent sleep health class (13% of children).

CONCLUSIONS

Consistent sleep routines and more optimal sleep health may serve as a protective mechanism for the language development, social-emotional-behavioral regulation, and approaches to learning of PreK from racially and ethnically diverse, low-income backgrounds. Clinician-parent discussions regarding optimal sleep health may provide key opportunities for targeted education that promotes school readiness skill development.

Night Sleep and Parental Bedtime Practices in Low-Risk Preterm and Full-Term Late Talkers

Night sleep and parental bedtime practices have rarely been investigated in late talkers. This study aimed to explore: night sleep, parental bedtime practices, and their associations in late talkers as well as individual, socio-demographic, and socio-relational factors affecting them. Parents of 47 30-month-old late talkers, born low-risk preterm (n = 24) or full-term (n = 23), with an expressive vocabulary size ≤10th percentile measured by the MacArthur-Bates Communicative Development Inventory Words and Sentences, and normal cognitive abilities measured by the Bayley Scales, completed the Infant Sleep Questionnaire, the Parental Interactive Bedtime Behaviour Scale, and the Parenting Stress Index Short Form. Results showed slight settling difficulties, night wakings, and frequent co-sleeping in late talkers. Encouraging autonomy practices were frequently used by parents, rather than active physical comforting ones. Recurrent settling difficulties were reported by parents who often applied encouraging autonomy practices, whereas greater night waking problems and frequent co-sleeping were reported by parents who often left their child crying. Low-risk preterm birth and mother's parenting stress predicted total sleep difficulties and night wakings; first-born, high maternal education level and mother's parenting stress predicted settling difficulties; mother's parenting stress was the only predictor for co-sleeping and leaving to cry. These findings have relevant implications for improving late talkers' night sleep and their parents' bedtime practices.

Relations between bedtime parenting behaviors and temperament across 14 cultures

Objectives

The present study examined parental sleep-supporting practices during toddlerhood in relation to temperament across 14 cultures. We hypothesized that passive sleep-supporting techniques (e.g., talking, cuddling), but not active techniques (e.g., walking, doing an activity together), would be associated with less challenging temperament profiles: higher Surgency (SUR) and Effortful Control (EC) and lower Negative Emotionality (NE), with fine-grained dimensions exhibiting relationships consistent with their overarching factors (e.g., parallel passive sleep-supporting approach effects for dimensions of NE).

Methods

Caregivers (N = 841) across 14 cultures (M = 61 families per site) reported toddler (between 17 and 40 months of age; 52% male) temperament and sleep-supporting activities. Utilizing linear multilevel regression models and group-mean centering procedures, we assessed the role of between- and within-cultural variance in sleep-supporting practices in relation to temperament.

Results

Both within-and between-culture differences in passive sleep-supporting techniques were associated with temperament attributes, (e.g., lower NE at the between-culture level; higher within-culture EC). For active techniques only within-culture effects were significant (e.g., demonstrating a positive association with NE). Adding sleep-supporting behaviors to the regression models accounted for significantly more between-culture temperament variance than child age and gender alone.

Conclusion

Hypotheses were largely supported. Findings suggest parental sleep practices could be potential targets for interventions to mitigate risk posed by challenging temperament profiles (e.g., reducing active techniques that are associated with greater distress proneness and NE).

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.