Cosleeping in young Korean children

Responses of Early Childhood Educators to Children's Interpersonal Sexual Behaviors

There is a considerable amount of evidence in the literature that children engage in a wide range of sexual behaviors before puberty. How early childhood educators (ECEs) respond to children's interpersonal sexual behaviors (ISBs) is especially important during the early childhood stage not only due to their roles as educators, but also protector due to their legal obligation to report suspected cases of child sexual abuse. Considering the pivotal responsibilities ECEs have in addressing ISBs, it becomes imperative to gain a comprehensive understanding of the experiences they encounter in managing such behaviors. Surprisingly, the current body of research provides limited insights into how ECEs respond to children's ISBs. To address this gap, the present study aims to explore these topics by conducting a qualitative investigation to examine the experiences of Taiwanese ECEs who encountered ISBs among children and how they responded to these behaviors. Four themes emerged from an analysis of the stories shared by 36 ECEs: (1) being silent versus supporting children's healthy sexuality development, (2) protect yourself versus respect others, (3) punishments versus exploring strategies to address children's ISBs and (4) insensitivity to boundaries and bodily autonomy. This study provides guidelines for understanding the experiences of Taiwanese ECEs who encounter children's ISBs and contributes to the training needs of ECEs about children's sexuality development.

Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample.

Methods

This cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ).

Results

Children with autism had significantly more sleep problems than non-autistic children [t _(226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t ₍₁₆₅₎ = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t ₍₁₆₅₎ = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ.

Conclusion

In summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.

Effects of Frequent Smartphone Use on Sleep Problems in Children under 7 Years of Age in Korea: A 4-Year Longitudinal Study

The use of electronic screen devices has a negative effect on sleep. The purpose of this study is to longitudinally examine the effects of various screen use on sleep problems in children under 7 years of age. A total of 314 caregivers of children aged 4−7 years from three cities in Korea were recruited and responded to a self-administered questionnaire from 2017 to 2020. As a result of the analysis of the mixed model designed as a two-leveled structure, the use frequency of smartphones significantly predicted children’s sleep problems (β = 0.328, p < 0.001) compared to that of TV, PC, and tablet PC. In addition, the frequency of smartphone screen use showed a weak but significant correlation with bedtime resistance (r = 0.067, p = 0.009), sleep duration (r = 0.089, p <0.001), nighttime awakening (r = 0.066, p = 0.010), and daytime sleepiness (r = 0.102, p < 0.001). The results of this study suggest that screen time education in Korea should focus on smartphones above all else.

Mother-Adolescent Discrepancies in Reporting Sleep Disturbances: Effects of Diagnosis and Mother's Occupation

BACKGROUND

Sleep disturbances are common in children and adolescents. However, they are rarely diagnosed and treated because parents, who often report the symptoms, may fail to notice the problems. Factors that can affect parent-child discrepancy include child's diagnosis, parent's occupation, and child's sex. The current study retrospectively analyzed the effect of these factors on parent-child discrepancies of sleep disturbance scores.

METHODS

Data for sleep-related items in Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) from 2014 to 2020 August in South Korea were collected from psychiatric outpatient clinics at Konkuk University Medical Center and Soonchunhyang University Hospital.

RESULTS

A three-way analysis of variance revealed main effect of diagnosis type and interaction between diagnosis type and mother's occupation. Discrepancies were greater for mood and anxiety disorders compared to conduct-related disorder. Interaction effect revealed greater discrepancies in mood disorders for reports completed by working mothers compared to homemaker mothers.

CONCLUSION

The results of this study emphasize the need to explore with caution the self-reported sleep disturbances in adolescents, especially in those with mood disorders. The results also suggest that mother's occupation should be taken into account when evaluating sleep reports of parents and adolescents.

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

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

Napping alone in the snow and cuddling with mommy at night: An exploratory, qualitative study of Norwegian beliefs on infant sleep

This study addresses Norwegian infants' sleeping places during the day and night. In the first part we asked the general public to indicate where they think infants should sleep by placing stickers on a depiction of different sleeping places. This revealed that infants were expected to predominantly sleep outside in a stroller during the day and either bedshare, room share or sleep independently from their parents at night. Interviews with Norwegian mothers confirmed these patterns and revealed that mothers emphasized the benefits of fresh air and being out in nature. They expressed valuing independence, though their opinions on how this could be achieved diverged, some proposing independent, other co-sleeping. Other outcomes of sleeping arrangements were rarely mentioned. Some, particularly mothers whose children bedshared or had different sleeping places from one night to the other or throughout the night, emphasized the infants' right to choose how to sleep. None of the mothers endorsed letting infants cry themselves to sleep but many mentioned the importance of the child feeling secure. We argue that the seemingly contradictory sleeping patterns is in line with cultural values for independence, social cohesion and a love of nature.

Association of sleep disturbances and craniofacial characteristics in children with class ii malocclusion: An evaluative study

Background

Behaviour problems, poor academic performance and failure to thrive are some of the potential sequelae of sleep problems in children. Hence, there is a need to evaluate the prevalence of sleep problems and significant associations in children with skeletal class II malocclusion with mandibular retrognathism.

Aims

This study aimed to determine associations if any between sleep practices and problems and craniofacial characteristics in children with skeletal class II malocclusion with mandibular deficiency.

Settings and Design

A cross-sectional study was conducted among a group of children with skeletal class II malocclusion with mandibular retrognathism.

Materials and Methods

Fifty children aged 8-14 years with skeletal class II with mandibular retrognathism and who required myofunctional therapy were selected. A validated sleep questionnaire assessed the sleep practices and problems. A detailed clinical examination including tonsils and evaluation for mouth breathing was performed. A lateral cephalogram recorded specific linear, angular variables as well as upper and lower pharyngeal airway space.

Statistical Analysis

Descriptive statistics, frequency, and percentages were calculated, and the Chi-square test was used.

Results

All children reported at least one sleep problem, with snoring reported by 76% of the children. Forty-two percent of the children showed a decreased upper airway, whereas 80% showed a decreased lower airway. Significant associations were seen between SN-MP and noisy breathing, upper airway, and snoring with a P value of 0.017. We also found significant associations between upper and lower airway and sleep positions with a P value of 0.021 and 0.005, respectively.

Conclusion

All the children exhibited at least one sleep problem. There was a strong association of certain sleep practices and sleep problems with cephalometric variables.

The effects of bed sharing on sleep: From partners to pets

BACKGROUND

Bed sharing is common practice across the global population. However, the vast majority of research on bed sharing has focused solely on mother-infant bed sharing.

METHODS

Here, we provide a holistic review of research on bed sharing. Articles investigating the relationship between bed sharing and sleep were identified in 4 dyad categories: (1) parent and child, (2) couples, (3) siblings, and (4) pet owners and pets. Of interest was whether sleep-promoting factors such as psychological comfort were generalizable across bed-sharing dyads; alternatively, sleep-demoting factors such as movement or heat may be commonalities.

RESULTS

We found that, across dyad types, in general, subjective reports of sleep quality were better when bed sharing despite generally worse objective measures of sleep.

CONCLUSIONS

Understanding bed sharing is important to treating sleep disturbances, given the prevalence of shared beds. This scoping review points to critical gaps in our understanding of bed sharing that motivate future research.

Levels and correlates of physical activity and screen time among early years children (2-5 years): Cross-cultural comparisons between Canadian and South Korean data

BACKGROUND

Cross-cultural research can provide insight into whether levels and correlates of movement behaviours among early years children vary across different cultural contexts. This study (1) compared children's physical activity (PA) and screen time (ST) and parental and environmental correlates of PA and ST between samples of Canadian and South Korean (Korean thereafter) early years children (2-5 years) and (2) investigated parental and environmental correlates of PA and ST and whether country moderates the relationships.

METHODS

Cross-sectional data from 121 Canadian children (3.4 years; 49.6% girls) and 101 Korean children (3.4 years; 54.9% girls) who participated in the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) study were used. Demographic information, children's PA, ST, PA- or ST-specific parental cognitions and behaviours, and home and neighbourhood environments were measured using a proxy-reported questionnaire. Two-tailed independent samples T test or Mann Whitney U test, chi-square tests, linear regression and moderation analyses were performed.

RESULTS

Canadian children spent more time in non-organized PA compared to Korean children (111 vs. 63 min/day), whereas time spent in organized PA was higher in Korean children than Canadian children (25 vs. 9 min/day). Canadian children had more ST than Korean children (159 vs. 110 min/day). Similarly, Canadian parents reported higher screen (142 vs. 116 min/day) and sitting time (317 vs. 286 min/day) than Korean parents. Though children's behaviours, as well as parental cognitions and behaviours, varied between the two samples, similar correlates of children's PA and ST were observed. The relationship between presence of electronics in children's bedrooms and children's ST was moderated by country, with Canadian children showing a stronger relationship than Korean children.

CONCLUSIONS

Supporting parents to adopt cognitions and behaviours that are conducive to healthy PA and ST patterns of their own and their early years children may be important for both Canada and Korea.

A Systematic Review on Cross-Cultural Comparative Studies of Sleep in Young Populations: The Roles of Cultural Factors

Recent studies have shown that sleep is influenced and shaped by cultural factors, including cultural values, beliefs and practices. However, a systematic understanding of how cultural factors in countries may influence sleep duration and sleep disturbances is still lacking. Therefore, we focused on a comparison of sleep duration and disturbances in young populations between countries. We report cross-cultural differences between the child, parent and environmental factors, and their association with sleep duration and disturbances. The review is based on literature searches of seven databases published until December 2020. Studies were included if they investigated sleep duration and disturbances of individuals up to 18 years across at least two or more countries. The results of this review have shown that sleep duration and disturbances vary between countries and regions and certain factors (e.g., bedtime routines, sleeping arrangement, physical activity and psychological functioning) have been associated with sleep duration or disturbances. This review also demonstrates that certain factors which were associated with sleep duration or disturbances in one country, were not shown in other countries, suggesting a need for recommendations for age-related sleep duration and sleep interventions to consider cultural differences that influence sleep duration or disturbances in individual countries or regions.

Cosleeping, sleep disturbances, children's behavioral problems, and parenting self-efficacy among Korean American families

The purpose of this study was to compare sleep disturbances of children and their mothers, children's behavioral problems, and parenting self-efficacy between Korean American families who coslept and those who did not cosleep. Forty-eight mothers of children between 3 and 8 years of age completed the following surveys: Children's Sleep Habits Questionnaire, Pediatric Symptom Checklist, Pittsburgh Sleep Quality Index, Parenting Self-Efficacy Questionnaire, and Acculturation Rating Scale for Mexican Americans II. Overall, 48% (n = 23) of families coslept, and families with younger children coslept more than families with older children (x2=12.48,p<.05). When the families were divided into non-cosleeping (i.e., rarely) and cosleeping (i.e., sometimes and usually) groups, 100% of the cosleeping children had sleep disturbances compared to 56% of the non-cosleeping children (x2=8.67,p<.01). For mothers, 28% (n = 7) of the non-cosleeping mothers reported sleep disturbances, compared to 52% (n = 12) of the cosleeping mothers (x2=2.93,p=.08). Children's behavioral problems were not different between the two groups (F = 1.78, p = NS). Cosleeping mothers reported lower parenting self-efficacy than non-cosleeping mothers (F = 6.26, p < .05). When providing care to Korean American families with young children, their cosleeping, sleep disturbances, and parenting self-efficacy need to be addressed.

Bed-sharing and related factors in early adolescents

OBJECTIVE

To investigate the prevalence of bed-sharing and examine correlates of bed-sharing habits in early adolescents.

METHODS

Participants were 1452 early adolescents from 10 primary schools in Shanghai, China. Children's health status and past history, family environment and parents' attitude towards bed-sharing, and children's sleep arrangements were surveyed. Sleep was assessed by the Children's Sleep Habit Questionnaire. Tanner stage was determined by the endocrinologist.

RESULTS

The median of age was 10.83 years (range: 9.42-12.92; 95% confidence interval [CI]: 10.79-10.83) and boys accounted for 51.17%. The prevalence of bed-sharing was 16.8%. Positive parental attitude toward bed-sharing (OR: 9.87; 95% CI: 6.57-14.83), asthma (OR: 2.15; 95% CI: 1.16-3.98), smaller residential space (OR: 1.90; 95% CI: 1.17-3.09), extended family (OR: 1.59; 95% CI: 1.16-2.18), and being physically less mature (OR: 2.39; 95% CI: 1.16-4.91) increased the likelihood of bed-sharing. Bed-sharers were more likely to have bedtime resistance (OR: 12.20; 95% CI: 8.59-17.33), sleep anxiety (OR: 3.76; 95% CI: 2.74-5.15), and poor sleep quality (OR: 3.21; 95% CI: 2.28-4.81) compared to non-bed-sharers. Furthermore, bed-sharing was associated with daytime sleepiness (OR: 1.53; 95% CI: 1.10-2.13) but not with sleep duration.

CONCLUSIONS

Bed-sharing is highly prevalent among Chinese early adolescents and is significantly related to sleep quality. Parental positive attitude toward bed-sharing was the most determining factor.

Sleep Habits and Sleep Problems in Healthy Preschoolers

OBJECTIVES

To describe the sleep patterns and problems in children aged between 12 and 36 mo of age.

METHODS

This cross sectional survey was collected over a span of 1 y in Advanced Pediatric Centre, PGIMER, Chandigarh and crèches of Chandigarh. Children in the age group of 12 to 36 mo were included in study. Children with chronic illness, developmental delay, seizure disorder and lack of consent were excluded. A total of 368 children were enrolled. Main outcome measures were sleep duration over 1 to 3 y of life; sleep behavior at onset, during and waking of sleep and parent reported sleep problems and their predictors.

RESULTS

The average duration of sleep was 12.5 h (S.D = 1.9). The mean total sleep duration and mean day time sleep duration decreased, while mean night time sleep increased as the age advanced from 12 to 36 mo. Following were the frequency of sleep habits seen in the index study; bed time routine was seen only in 68(18.5 %), a regular bed time ritual was seen in 281(76.4 %), 329(89.4 %) children frequently required 0-20 min time to fall asleep, 11(3 %) parents used sleep inducing drugs. Night waking (1 to 3 times a night) was seen in 297(80.7 %) and its frequency declined with age. Parent reported sleep problems were seen in 12.8 % (47/368). Lack of co-sleeping and night waking were considered as strongest predictors of parent reported sleep problems.

CONCLUSIONS

Toddlers' sleep duration, night waking behavior, and day time naps decrease as the age progress while night time sleep duration increases with age. Lack of co-sleeping and night waking are considered as strongest predictors of parent reported sleep problems.

The relation among sleep duration, homework burden, and sleep hygiene in chinese school-aged children

Insufficient sleep in school-aged children is common in modern society, with homework burden being a potential risk factor. The aim of this article is to explore the effect of sleep hygiene on the association between homework and sleep duration. Children filled out the Chinese version of the Adolescent Sleep Hygiene Scale, and parents filled out a sociodemographic questionnaire. The final sample included 363 boys and 371 girls with a mean age of 10.82 ± 0.38 years. Children with more homework went to bed later and slept less. Better sleep hygiene was associated with earlier bedtimes and longer sleep duration. Findings suggest that homework burden had a larger effect on sleep duration than sleep hygiene. Fifth-grade children in Shanghai have an excessive homework burden, which overwrites the benefit of sleep hygiene on sleep duration.

Mother-child bed-sharing in toddlerhood and cognitive and behavioral outcomes

OBJECTIVE

We examined the predictors and consequences of mother-child bed-sharing at 1, 2, and 3 years of age in a racially/ethnically and geographically diverse sample of low-income families across the United States.

METHODS

We analyzed data from 944 low-income families who had children assessed at 1, 2, 3, and 5 years of age.

RESULTS

Mothers who were Hispanic and black were more likely to bed-share with children at ages 1, 2, and 3 years than other mothers. Maternal negative regard also predicted bed-sharing. Bed-sharing at ages 1 to 3 years was bivariately associated with poorer behavior and cognition at age 5 years. However, these associations lost significance when child and mother characteristics were controlled.

CONCLUSION

There seem to be no negative associations between bed-sharing in toddlerhood and children's behavior and cognition at age 5 years.

Bed sharing among mother-infant pairs in Klang district, Peninsular Malaysia and its relationship to breast-feeding

OBJECTIVE

The aim of the study was to determine the prevalence of mother-infant bed sharing in Klang district, Peninsular Malaysia and to identify factors associated with bed sharing.

METHOD

This was a cross-sectional study involving 682 mother-infant pairs with infants up to 6 months attending government clinics in Klang district, Peninsular Malaysia. Data were collected by face-to-face interview using a pretested structured questionnaire for a 4-month period in 2006. Data regarding maternal, paternal, obstetric, infant, occupancy, breast-feeding characteristics, and bed-sharing practice were collected. Data on bed sharing were based on practice in the past 1-month period. Bed sharing was defined as an infant sharing a bed with mother, and infant must be within arms reach from the mother, whereas a bed was defined as either a sleeping mattress placed on a bed frame or placed on the floor. The prevalence of bed sharing was estimated. Relationship and magnitude of association between independent factors and bed sharing were examined using odds ratio and 95% confidence interval. Logistic regression analysis was used to control for confounding factors.

RESULTS

The prevalence of bed sharing among mothers with infants aged between 1 and 6 months was 73.5% (95% confidence interval: 70.0-76.7). In multivariate analysis, urban/rural differences, mothers' ethnicity, occupation, family income, husbands' support on bed sharing, number of children younger than 12 years staying in the house, and breast-feeding were associated with bed sharing.

CONCLUSIONS

These factors need to be considered in analyzing the overall risks and benefits of bed sharing, paying attention to breastfeeding practices.

Family and cultural influences on sleep development

Sleep is a biopsychosocial process that is influenced by the complex interaction of biologic rhythms, including sleep homeostatic mechanisms, chronobiologic factors, parenting, and temperament. However, family structure, culturally specific values, and beliefs are all elements that impact the ecology of a child's sleep. Dramatic demographic changes in many countries have been witnessed in recent years, which have resulted in health professionals and pediatricians being confronted with families of widely differing cultural origins. Attitudes and beliefs on infant sleeping strongly influence whether or not infant sleep behavior is perceived as problematic. Thus, it is advantageous to explore a child's sleep behavior in a multicultural setting. Cultural comparisons are of intrinsic value because they allow not only a better understanding of sleep in different contexts but also an evaluation of the eventual benefits and consequences of different cultural sleep practices. This article provides an overview of some specific sleep-related behaviors and practices highly influenced by different cultural contexts.

Factors associated with bed and room sharing in Chinese school-aged children

BACKGROUND AND OBJECTIVES

Co-sleeping (bed or room sharing) has potential implications for children's development. Previous studies showed that co-sleeping was more prevalent in non-Western countries than in Western countries, which demonstrated that co-sleeping was marked with ethnic and socio-cultural background characteristics. The purpose of this study was to survey the prevalence of bed and room sharing and to examine related factors among school-aged children in an Asian country - China.

METHODS

A cross-sectional questionnaire survey was conducted in 10 districts of Shanghai, China from November to December 2005. A total of 4108 elementary school children, 49.2% boys and 50.8% girls with a mean age of 8.79 years, participated. Parent-administered questionnaires were used to collect information about children's sleeping arrangements and socio-demographic characteristics.

RESULTS

The prevalence of routine bed sharing, room sharing and sleeping alone in Chinese school-aged children was 21.0%, 19.1% and 47.7%, respectively. Bed and room sharing didn't show significant gender difference but gradually decreased with increasing age. Multivariate logistic regression identified those factors associated with bed and room sharing: younger age, large family, children without their own bedroom and parents' approval of a co-sleeping arrangement.

CONCLUSION

Co-sleeping arrangement was a common practice in Chinese school-aged children. Associated factors were characterized by intrinsic socio-cultural values and socio-economic status in China.

Factors associated with bed sharing and sleep position in Thai neonates

BACKGROUND

Sleep in a supine position and in a bed separate from but proximate to adults is recommended, in several Western countries, to prevent Sudden Infant Death Syndrome (SIDS). Cultural differences and a lower rate of SIDS in Asian populations may affect concern with this problem and thus infant sleeping arrangements. Objective To study bed sharing and sleep position in Thai neonates and the relationship to infant and maternal characteristics.

METHODS

A cross-sectional survey based on interviews with parents of infants aged 21 days old, was conducted under the Prospective Cohort Study of Thai Children.

RESULTS

Of the total sample, 2236/3692 (60.6%) infants shared a bed with their parents. Sixty per cent of the parents placed their infants to sleep in a supine position, 32.2% on their side and 4.9% in a prone position. Bed sharing was associated with older maternal age, higher education, Muslim mother, and with work status of professional career or unemployed. Placing the infants to sleep in a prone position was associated with infant birth weight of greater than 2500 g, older maternal age, higher education, Buddhist mother, mother with professional career and middle-class household economic status.

CONCLUSIONS

Infant bed sharing is a common practice in the Thai culture, as in other Asian countries. The prone sleep position is less common than in Western populations. The main factor associated with both bed sharing and putting infants to sleep in the prone position was a higher maternal socioeconomic status (SES), in contrast to previous studies in some Western countries in which both practices were associated with low maternal SES. Cultural differences may play an important role in these different findings.

Cosleeping versus solitary sleeping in children with bedtime problems: child emotional problems and parental distress

This study investigated sleep, behavioral and emotional problems, and parental relationships and psychological distress in a group of school-aged children with bedtime problems and persistent cosleeping, compared to solitary sleepers and controls. Participants were 148 school-aged children with bedtime problems (44 cosleepers, 104 solitary sleepers) and 228 healthy peers. Results suggested that cosleepers have a significantly later bedtime, shorter nighttime sleep duration, higher Children's Sleep Habits Questionnaire (CSHQ) bedtime resistance and sleep anxiety scores, and more behavioral and emotional problems compared to other groups. Parents of cosleepers have a significantly higher level of psychological and couple distress. A past history of sleep problems, couple and maternal distress, CSHQ bedtime resistance, sleep anxiety, and night wakings subscale scores, and nighttime fears were significantly predictive of cosleeping. Thus, when cosleeping is present, the child's emotional adjustment, family relationships, and parental psychological problems should be investigated.

Maternal-Infant Bedsharing: Risk Factors for Bedsharing in a Population-Based Survey of New Mothers and Implications for SIDS Risk Reduction

OBJECTIVES

Maternal-infant bedsharing is a common but controversial practice. Little has been published about who bedshares in the United States. This information would be useful to inform public policy, to guide clinical practice and to help focus research. The objective was to explore the prevalence and determinants of bedsharing in Oregon.

METHODS

Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a population-based random sample of women after a live birth. Women were asked if they shared a bed with their infant "always," "almost always," "sometimes" or "never."

RESULTS

1867 women completed the survey in 1998-99 (73.5% weighted response rate). Of the respondents, 20.5% reported bedsharing always, 14.7% almost always, 41.4% sometimes, and 23.4% never. In multivariable logistic regression, Hispanics (adjusted odds ratio [ORa] 1.69, 95% Confidence Interval [CI] 1.17-2.43), blacks (ORa 3.11, 95% CI 2.03-4.76) and Asians/Pacific Islanders (ORa 2.14, 95% CI 1.51-3.03), women who breastfed more than 4 weeks (ORa 2.65, 95% CI 1.72-4.08), had annual family incomes less than $30,000 (ORa 2.44, 95% CI 1.44-4.15), or were single (ORa 1.55, 95% CI 1.03-2.35) were more likely to bedshare frequently (always or almost always). Among Hispanic and black women, bedsharing did not vary significantly by income level. Bedsharing black, American Indian/Alaska Native and white infants were much more likely to be exposed to smoking mothers than Hispanic or Asian/Pacific Islander infants (p < .0001).

CONCLUSIONS

Bedsharing is common in Oregon. The women most likely to bedshare are non-white, single, breastfeeding and low-income. Non-economic factors are also important, particularly among blacks and Hispanics. Campaigns to decrease bedsharing by providing cribs may have limited effectiveness if mothers are bedsharing because of cultural norms.

A Clinical Report of Adverse Health Effects Due to Bed Sharing in Two Children with Spinal Cord Injury and Traumatic Brain Injury

This paper explores the possibility that bed sharing may carry particular risks for children with special healthcare needs (CSHCN). Two cases of CSHCN who may have sustained adverse health effects from bed sharing are described. These two case reports indicate that CSHCN may be particularly susceptible to risks associated with bed sharing. Healthcare providers for CSHCN may need to inquire about patients' sleeping arrangements and, when bed sharing is acknowledged, provide counseling regarding the potential risks and benefits. They may need to monitor more closely for adverse events when bed sharing is a factor and should consider reporting health problems that may have occurred in concurrence with bed sharing.

Children's sleep: an interplay between culture and biology

Pediatricians provide a major source of knowledge for parents about children's behavior and development, although their advice is largely based on their own cultural values and beliefs in interaction with their personal and clinical experience. This review presents cross-cultural aspects of children's sleep behavior in industrialized and complex modern societies and provides a basis for understanding dimensions and mechanisms of cultural differences. We submit that it is the interaction between culture and biology that establishes behavioral and developmental norms and expectations regarding normal and problematic children's sleep. Pediatricians need to recognize the cultural environment in which children live and be knowledgeable about how cultural beliefs and values of both families and physicians interact with the needs and biological characteristics of individual children.

Sleep patterns and sleep problems among schoolchildren in the United States and China

OBJECTIVES

Sleep patterns and sleep problems in children are not only influenced by a large number of biological and psychologic factors but also by cultural and social factors. Little is known about similarities and differences in sleep patterns and sleep problems among children across countries. We attempted to compare sleep patterns and sleep problems among schoolchildren from 2 countries with distinctive cultural contexts: the United States and China.

METHODS

The data come from 2 cross-sectional surveys in 3 elementary schools of Jinan City, People's Republic of China, and 3 elementary schools from a suburban school district in southeastern New England, United States. The Chinese sample consisted of 517 elementary school children (grades 1 to 5), and the US sample consisted of 494 elementary school children (grades kindergarten through 4). We used the Children's Sleep Habits Questionnaire (CSHQ) to assess children's sleep patterns and sleep problems as reported by parents. Parents of the Chinese sample completed a Chinese version of the CSHQ.

RESULTS

For children in both the US and Chinese samples, reported bedtime was delayed and sleep duration decreased with increasing age. Compared with the US children (grades 1-4), Chinese children went to bed approximately half an hour later (9:02 vs 8:27 pm) and woke up half an hour earlier (6:28 vs 6:55 am), resulting in an average sleep duration that was 1 hour less (9.25 vs 10.15 hours). Chinese children were rated significantly higher than the US children on almost all CSHQ scales, indicating more sleep problems in Chinese children. Common sleep problems observed for all children were difficulty falling asleep, having a fear of sleeping in the dark, sleep talking, restless sleep, teeth grinding during sleep, and daytime sleepiness. Shorter daily sleep duration was associated with difficulty falling asleep, struggling at bedtime, and trouble sleeping away for the US children, and with going to bed at different times and having a fear of sleeping alone for Chinese children. Short sleep duration was a main predictor of daytime sleepiness for Chinese children, whereas restless sleep and snoring predicted daytime sleepiness for the US children.

CONCLUSIONS

As reported by parents, children in China went to bed later and woke up earlier and their sleep duration was 1 hour shorter than the US children. Chinese children were reported to have more sleep problems than their US counterparts. Daytime sleepiness was determined by sleep duration only for those who slept insufficiently. Unique school schedules and sleep practices may contribute to the differences in the sleep patterns and sleep problems of children from the United States and China.

Interaction Between Feeding Method and Co‐Sleeping on Maternal‐Newborn Sleep

BACKGROUND

Previous studies have demonstrated that breastfed newborns spend more time awake than bottle-fed newborns, breastfeeding mothers have more fragmented sleep than bottle-feeding mothers, and mother-newborn sleeping arrangements may affect the sleep/wake pattern of mother-newborn pairs.

OBJECTIVE

To address the unsolved question of whether there is an interaction between type of feeding and sleeping arrangements that affects postpartum sleep during the 4th postpartum week.

DESIGN

Correlational, two-way design using feeding method and location of newborn at night as independent variables, and sleep patterns as the dependent variables.

SETTING

Patient's home during 4th week after giving birth.

PATIENTS/PARTICIPANTS

First-time mothers and their newborns (n = 33).

MAIN OUTCOME MEASURES

Amount of total sleep, amount of night sleep, number of night awakenings, and number of sleep periods in 24 hours using a modified version of the self-report sleep instrument by Barnard and Eyres.

RESULTS

Breastfed newborns had less total sleep per day than bottle-fed newborns, and breastfeeding mothers had more sleep periods in 24 hours than bottle-feeding mothers. Breastfeeding mothers slept more than bottle-feeding mothers when co-sleeping, but bottle-feeding mothers' sleep was unaffected by location of newborn. Average total sleep for 4-week-old newborns was about 14 hours daily.

CONCLUSIONS

More sleep was obtained when breastfeeding mothers slept with the newborn. Methods or devices that allow breastfeeding mothers and newborns to sleep next to each other in complete safety need to be developed.

Cosleeping and sleep behavior in Italian school-aged children

The prevalence and predictors of cosleeping were investigated in 901 healthy school-aged children. Parent reports on the Children's Sleep Habits Questionnaire and Child Behavior Checklist were used to assess children's sleep and behavioral problems. Regular, long-lasting cosleeping was present in 5% of our sample. Cosleepers rated higher on the Children's Sleep Habits Questionnaire total score and Bedtime Resistance, Sleep Anxiety, Nightwakings, and Parasomnias subscales than solitary sleepers. No significant behavioral problems were found in cosleepers. Regression results showed that low socioeconomic status, one parent who is a shiftworker, one-parent families, one parent who coslept as a child, prolonged breastfeeding, and previous and current sleep problems significantly predicted cosleeping. The high incidence of parents reporting having coslept as a child also suggested a lifestyle choice. Thus, cosleeping seems to reflect a parent's way to cope with sleep problems, and the long persistence of this practice may be related to the lifestyle of families.

Troubles du sommeil et rituels d’endormissement chez le jeune enfant dans une perspective transculturelle

Intercultural studies induced many controversies in the characteristics associated with sleep problems.

OBJECTIVES

The aim of this study was three fold: (1) to compare sleep problem frequency in two culturally different populations; (2) to analyze if some particular bedtime routines ("co-sleeping", "distal" or "proximal" parent-infant interaction) are associated to trouble; (3) to show influence of the cultural context to trouble.

POPULATION

This study examines bedtime routines in French infants aged 12 to 24 months in maternal and infant's protect center (PMI) in Lyon and la Réunion island, for a sleep - cross cultural approach. Three hundred infants were enrolled in the survey.

RESULTS

We showed prominent sleep problems in la Réunion's group (35%) in comparison with the group in Lyon (17%) (P <0.005). Regression analysis allowed to draw relations between several factors and the sleep problems. Hence, proximal bedtime routines and interactions (CR =0.530, P =0.05), "co-sleeping" (CR =0.989, P =0.005) and parental presence at bedtime until infant falls asleep (CR =0.595, P =0.04) are significantly associated with sleep problems. These attitudes are more frequent in la Réunion's group.

CONCLUSION

Our study confirms literature data and asks question about cultural meaning for these inadequate behaviors in relation to mother-infant separation distress. Acculturation notion is called forth in la Réunion's group.

Sleep wars: research and opinion

This article discusses the controversies and often conflicting advice available to the general pediatric practitioner regarding sleep complaints in children and adolescents. Consideration is given to preferences, such as parent-child co-sleeping, cross-cultural issues in patient interviewing and treatment planning, and the public policy issue of adolescent sleepiness and later high school start times. The authors draw on evidence-based knowledge and clinical expertise to offer a framework for considering sleep-related chief complaints along with guidelines for routine practice.