Mandatory Nap Times and Group Napping Patterns in Child Care: An Observational Study

Exploring the Relationship Between Age at Nap Cessation and Social-Emotional Functioning in Children

OBJECTIVE

The objective of this study was to examine variations in age at nap cessation and identify whether there is an association with social-emotional functioning (SEF) as measured by internalizing/externalizing behavior, child temperament, and social skills in a sample of early childhood education and care-attending children.

METHODS

The sample comprised 1117 children from the Australian Effectiveness Early Educational Experiences for Children longitudinal early childhood study. We used children's age at nap cessation as retrospectively recalled by caregivers in 2011 or 2013 when children were between ages 2 and 7 years. Each child's SEF was reported by a caregiver using the Strengths and Difficulties Questionnaire, the Short Temperament Scale for Children, and the Social Skills Inventory Scale. Associations between children's age of nap cessation and SEF were tested using linear regressions.

RESULTS

The children's age at nap cessation ranged from 6 months to 6 years. For each additional year of napping, children's total , conduct , externalizing , and peer behavior problems decreased by 0.39 (95% confidence interval [CI], -0.70 to -0.09), 0.11 (95% CI, -0.21 to -0.01), 0.11 (95% CI, -0.51 to -0.06), and 0.11 (95% CI, -0.20 to -0.02) units on the Strengths and Difficulties Questionnaire scale, respectively. No further significant associations were found.

CONCLUSION

This is the first study reporting the age range of nap cessation and its associations with social-emotional functioning. Our findings demonstrate earlier cessation ages in Australian children attending Early Childhood Education and Care programs than previously reported and a small association with externalizing and peer problems.

Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.

Regular, intermittent, and spontaneous: Patterns of preschool Children's nap behavior and their correlates

BACKGROUND

Daytime sleep during the preschool years (i.e., 1-5-years-old) is characterized by high inter-child variability in several components of nap behavior, including nap duration, nap timing, and the proportion of sleep during daytime. We used an empirical approach to examine variations amongst children in these aspects of napping and investigated correlates of these components of nap behavior.

METHODS

A large, nationally representative sample (N = 702) of Canadian parents completed an online survey, including a one-month retrospective report of their 1.5-5 year old's daytime and nighttime sleep behavior and other questionnaires. To understand patterns of children's nap behaviors we applied Latent Profile Analysis (LPA) to typical nap duration, typical timing of naps, frequency of naps, proportion of sleep during the daytime, and the proportion of naps which were spontaneous (i.e., child just fell asleep). Then, multinominal logistic regression was used to examine correlates of profile membership.

RESULTS

Four profiles of children emerged: (1) regular nappers; (2) intermittent nappers; (3) spontaneous nappers; and (4) non-nappers. After controlling for demographic variables (e.g., child age, sex, ethnicity) and known correlates of napping behaviors (e.g., birthweight, nighttime sleep duration), profile membership was related to parents' beliefs about napping, parents' own nap behaviors, family functioning, and child nighttime sleep problems in a multinominal logistic regression.

CONCLUSIONS

An empirical approach aided in understanding the inter-child variability in napping amongst preschool-age children. Parental beliefs about napping and the home environment were shown to be critical factors influencing this variability.

Sleep maturation influences cognitive development of preterm toddlers

Our recent study on full-term toddlers demonstrated that daytime nap properties affect the distribution ratio between nap and nighttime sleep duration in total sleep time but does not affect the overall total amount of daily sleep time. However, there is still no clear scientific consensus as to whether the ratio between naps and nighttime sleep or just daily total sleep duration itself is more important for healthy child development. In the current study, to gain an answer to this question, we examined the relationship between the sleep properties and the cognitive development of toddlers born prematurely using actigraphy and the Kyoto scale of psychological development (KSPD) test. 101 premature toddlers of approximately 1.5 years of age were recruited for the study. Actigraphy units were attached to their waist with an adjustable elastic belt for 7 consecutive days and a child sleep diary was completed by their parents. In the study, we found no significant correlation between either nap or nighttime sleep duration and cognitive development of the preterm toddlers. In contrast, we found that stable daily wake time was significantly associated with better cognitive development, suggesting that sleep regulation may contribute to the brain maturation of preterm toddlers.

Associations of diarised sleep onset time, period and duration with total and central adiposity in a biethnic sample of young children: the Born in Bradford observational cohort study

OBJECTIVES

To investigate associations of parent-reported sleep characteristics with adiposity levels in a biethnic sample of young children.

DESIGN

A cross-sectional observational study.

SETTING

The Born in Bradford 1000 study, UK.

PARTICIPANTS

Children aged approximately 18 months (n=209; 40.2% South Asian; 59.8% white) and 36 months (n=162; 40.7% South Asian; 59.3% white).

PRIMARY AND SECONDARY OUTCOME MEASURES

Children's body mass index (BMI) z-score, sum of two-skinfolds (triceps and subscapular) and waist circumference. Adjusted regression was used to quantify associations of sleep parameters with adiposity stratified by ethnicity and age group. The results are beta coefficients (95% CIs) and unless otherwise stated represent the difference in outcomes for every 1-hour difference in sleep parameters.

RESULTS

The average sleep onset time was markedly later in South Asian (21:26±68 min) than white children (19:41±48 min). Later sleep onset was associated with lower BMI z-score (-0.3 (-0.5 to -0.0)) and sum of two-skinfolds (-1.5 mm (-2.8 mm to -0.2 mm)) in white children aged 18 months and higher BMI z-score in South Asian children aged 36 months (0.3 (0.0-0.5)). Longer sleep duration on weekends than weekdays was associated with higher BMI z-score (0.4 (0.1-0.8)) and waist circumference (1.2 cm (0.3-2.2 cm)) in South Asian children aged 18 months, and later sleep onset on weekends than weekdays was associated with larger sum of two-skinfolds (1.7 mm (0.3-3.1 mm)) and waist circumference (1.8 cm (0.6-2.9 cm)). Going to sleep ≥20 min later on weekends than weekdays was associated with lower waist circumference in white children aged 18 months (-1.7 cm (-3.2 cm to -0.1 cm)).

CONCLUSIONS

Sleep timing is associated with total and central adiposity in young children but associations differ by age group and ethnicity. Sleep onset times and regular sleep schedules may be important for obesity prevention.

Correlates of naptime behaviors in preschool aged children

Purpose: Major changes in the timing, duration, and function of sleep occur during childhood. These changes include the transition from habitual napping to infrequent napping. This transition is likely to reflect, at least in part, neurocognitive development. This study sought to identify factors that discriminate between four groups of children with different teacher-reported responses to naptime in childcare: those who nap (nappers), sometimes nap (transitioners), do not nap (resters), and neither nap, nor lie still (problem nappers). Methods: Standardized observations of sleep and sleep behaviors, daytime behaviors across a number of domains, and direct neurocognitive assessment of 158 preschool aged children (aged 49-72 months; 54% male) attending childcare centers in Queensland (QLD), Australia, were adopted as part of a large longitudinal study of early childhood, the Effective Early Education Experiences (E4Kids) study. Discriminant function analysis was used to examine how age, parent education, nighttime sleep duration, cognitive functioning, behavior problems, and temperament differentiated the four groups. Results: Three discriminant functions were identified and defined as maturation (strong loadings of nighttime sleep duration, cognitive function, and age), socioeconomic status (parental education), and behavioral problems (externalizing behavior, temperament, and internalizing behavior). These functions accounted for 62.9%, 32.6%, and 4.5% of the between-groups variance, respectively. Children defined as nappers (n=44) had significantly shorter duration of nighttime sleep, were younger, and had lower cognitive functioning scores than did other groups. Problem nappers, (n=25) were more likely to have parents with lower levels of education than did transitioners (n=41). Standard behavior and temperament measures did not significantly differentiate the groups. Conclusion: The findings support an interaction between cognitive development, sleep behaviors, and the individual needs and circumstances of children. Further research in this area could make a strong contribution to theory and practice in early childhood education, and a strong contribution to understanding of children's development.

Mandatory Naptimes in Childcare do not Reduce Children's Cortisol Levels

The majority of preschool children (aged 3–5 years) no longer habitually nap, yet in childcare settings daily mandated naptimes in which children lie down without alternative activity remains a common practice. Mandated naptimes are associated with observed reductions in emotional climate and increased incidence of distress. While intended to be restful, mandatory naptimes may induce stress in those children unable to sleep. To examine this possibility, we applied a 2 (mandated/flexible practice) × 2 (nap/no-nap) design to test group difference in stress responses of children (N = 43, mean age 56.3 months). Salivary cortisol level was measured at 4 time-points (waking, pre-naptime, post-naptime, and bedtime) across two days at childcare. Overall our results show a significant decline in cortisol level from wake to pre-naptime and from post-naptime to bedtime. No significant change in cortisol level was observed from pre- to post- naptime. Significant group differences in cortisol patterns were observed. Notably, children under mandatory naptime conditions who did not nap showed no significant reduction in cortisol level from post-naptime to bedtime. While cortisol measurement suggests naptime is neither stressful nor restful for children in any group, implications for bedtime arousal are raised for those unable to sleep under conditions of mandated naptimes.

Daytime nap controls toddlers' nighttime sleep

Previous studies have demonstrated that afternoon naps can have a negative effect on subsequent nighttime sleep in children. These studies have mainly been based on sleep questionnaires completed by parents. To investigate the effect of napping on such aspects of sleep quality, we performed a study in which child activity and sleep levels were recorded using actigraphy. The parents were asked to attach actigraphy units to their child’s waist by an adjustable elastic belt and complete a sleep diary for 7 consecutive days. 50 healthy young toddlers of approximately 1.5 years of age were recruited. There was a significant negative correlation between nap duration and both nighttime sleep duration and sleep onset time, suggesting that long nap sleep induces short nighttime sleep duration and late sleep onset time. We also found a significant negative correlation between nap timing and nighttime sleep duration and also a significant positive correlation between nap timing and sleep onset time, suggesting that naps in the late afternoon also lead to short nighttime sleep duration and late sleep onset. Our findings suggest that duration-controlled naps starting early in the afternoon can induce a longer nighttime sleep in full-term infants of approximately 1.5 years of age.