Outcome correlates of parent-child bedsharing: an eighteen-year longitudinal study

Associations of preschool reactive bed-sharing with sociodemographic factors, sleep disturbance, and psychopathology

OBJECTIVE

To advance understanding of early childhood bed-sharing and its clinical significance, we examined reactive bed-sharing rates, sociodemographic correlates, persistence, and concurrent and longitudinal associations with sleep disturbances and psychopathology.

METHODS

Data from a representative cohort of 917 children (mean age 3.8 years) recruited from primary pediatric clinics in a Southeastern city for a preschool anxiety study were used. Sociodemographics and diagnostic classifications for sleep disturbances and psychopathology were obtained using the Preschool Age Psychiatric Assessment (PAPA), a structured diagnostic interview administered to caregivers. A subsample of 187 children was re-assessed approximately 24.7 months after the initial PAPA interview.

RESULTS

Reactive bed-sharing was reported by 38.4% of parents, 22.9% nightly and 15.5% weekly, and declined with age. At follow-up, 48.9% of nightly bed-sharers and 88.7% of weekly bed-sharers were no longer bed-sharing. Sociodemographics associated with nightly bed-sharing were Black and (combined) American Indian, Alaska Native and Asian race and ethnicity, low income and parent education less than high school. Concurrently, bed-sharing nightly was associated with separation anxiety and sleep terrors; bed-sharing weekly was associated with sleep terrors and difficulty staying asleep. No longitudinal associations were found between reactive bed-sharing and sleep disturbances or psychopathology after controlling for sociodemographics, baseline status of the outcome and time between interviews.

CONCLUSIONS

Reactive bed-sharing is relatively common among preschoolers, varies significantly by sociodemographic factors, declines during the preschool years and is more persistent among nightly than weekly bed-sharers. Reactive bed-sharing may be an indicator of sleep disturbances and/or anxiety but there is no evidence that bed-sharing is an antecedent or consequence of sleep disturbances or psychopathology.

The physical home environment and sleep: What matters most for sleep in early childhood

The physical home environment is thought to play a crucial role in facilitating healthy sleep in young children. However, relatively little is known about how various features of the physical home environment are associated with sleep in early childhood, and some of the recommendations clinicians make for improving child sleep environments are based on limited research evidence. The present study examined how observer and parent descriptions of the child's physical home environment were associated with child sleep, measured using actigraphy and parent's reports, across a year in early childhood. The study used a machine learning approach (elastic net regression) to specify which aspects of the physical home environment were most important for predicting five aspects of child sleep, sleep duration, sleep variability, sleep timing, sleep activity, and latency to fall asleep. The study included 546 toddlers (265 females) recruited at 30 months of age and reassessed at 36 and 42 months of age. Poorer quality physical home environments were associated with later sleep schedules, more variable sleep schedules, shorter sleep durations, and more parent-reported sleep problems in young children. The most important environmental predictors of sleep were room sharing with an adult, bed sharing, and quality of both the child's sleep space and the wider home environment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths

Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.

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

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

Reasons mothers bedshare: A review of its effects on infant behavior and development

Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the "review behind the review," highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers' decisions about infant sleep location influence infant behavior and development.

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.

Early Childhood Co-Sleeping Predicts Behavior Problems in Preadolescence: A Prospective Cohort Study

OBJECTIVE/BACKGROUND

Co-sleeping is common practice around the globe. The relationship between early childhood co-sleeping and adolescent behavior problems remains uncertain. We aim to identify whether early childhood co-sleeping can predict behavior problems in preadolescence.

PARTICIPANTS

A cohort of 1,656 Chinese preschool children were followed up in adolescence.

METHODS

Prospective cohort study design involving two waves of data collection from the China Jintan Cohort (1,656 children aged 3-5 years). Co-sleeping history was collected at 3-5-years-old via parent-reported questionnaire at wave I data collection. Behavior problems were measured twice in childhood and preadolescence, respectively. Adolescent behavior problems were measured by integrating data from self-report, parent-report and teacher-report using the Achenbach System of Empirically Based Assessment. Predictions were assessed using the general linear model with mixed effects on the inverse probability weight propensity-matched sample.

RESULTS

1,656 children comprising 55.6% boys aged 4.9 ± 0.6 were initially enrolled in the first wave of data collection. In the second wave of data collection, 1,274 children were 10.99 ± 0.74 (76.9%) aged 10-13 years were retained. Early childhood co-sleeping is significantly associated with increased behavior problems in childhood (Odds Ratio [OR] 1.22-2.06, ps<0.03) and preadolescence (OR 1.40-2.27, ps<0.02). Moreover, co-sleeping history significantly predicted multiscale increase in internal (OR 1.63-2.61, ps<0.02) and external behavior problems in adolescence.

CONCLUSIONS

Early childhood co-sleeping is associated with multiple behavioral problems reported by parents, teachers, and children themselves. Early childhood co-sleeping predicts preadolescent internalizing and externalizing behavior after controlling for baseline behavior problems.

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.

Bedsharing in Early Childhood: Frequency, Partner Characteristics, and Relations to Sleep

Bedsharing (sharing a bed with others during sleep) in early childhood (3-5 years old) is common across Western and non-Western societies alike. Though prior work indicates that bedsharing may relate to impairments in child sleep quantity or quality, the majority of studies conducted in young children are limited to parent-child bedsharing and rely almost exclusively on caregiver reports to measure child sleep. Here, the authors endeavored to gain further insights into the diversity of bedsharing practices among children in the United States, including how different bedsharing partners (caregivers, siblings) might impact actigraphy-derived measures of children's sleep. Using a sample of 631 children ages 2:9 to 5:11 years, we found that over 36% of children bedshared in some form overnight, with approximately 22% bedsharing habitually. In a subset of children for whom actigraphy measures were collected (n = 337), children who bedshared habitually (n = 80) had significantly shorter overnight sleep, later sleep and wake times, and longer naps than solitary sleepers (n = 257), even when controlling for socioeconomic status. Despite supplementing their shorter overnight sleep with longer naps, habitually bedsharing children had significantly shorter 24-hr sleep time than did solitary sleepers, though differences in sleep efficiency were nonsignificant for all sleep periods. Additionally, sleep efficiency, onset latency, and duration did not differ between children who habitually bedshared with siblings versus those who habitually bedshared with parents. The present results add to prior work examining family contextual correlates of sleep differences in early childhood and provide a more objective account of relations between bedsharing and child sleep.

Insomnia and poor sleep quality during peripartum: a family issue with potential long term consequences on mental health

BACKGROUND

Improving maternal's health is a worldwide priority. Sleep is a fundamental operating state of the central nervous system and it may be one of the most important psychophysiological processes for brain function and mental health. The study of maternal sleep problem including insomnia, however, implies deepening our understanding of family context. Family systems are dynamic and involve reciprocal interactions among members during day and night. So far, however, maternal and children's sleep has been rarely studied in a family perspective, and paternal sleep has often been neglected.

METHODS

The present work summarizes in a narrative review the state of the art of our current knowledge on the role of insomnia and poor quality of sleep for mental health in all family members in the peripartum period. The mother, the father, the child and the family interactive perspectives are considered.

RESULTS

Insomnia and poor sleep problems are frequent in all family members during peripartum. Poor sleep and insomnia symptoms are recognized as important risk factors for mental health in adults and children. Despite this alarming evidence, sleep is rarely assessed in clinical contexts.

CONCLUSIONS

Clinical implications include the utmost relevance of assessing sleep problems during pregnancy and early post-partum. Insomnia and poor sleep quality should be evaluated and treated in the clinical practice by using a "family perspective."

Nigerian sleep study found that children slept less and had more problems than children in other countries

AIM

We studied sleep patterns, sleep problems and associated socio-demographic factors among children aged one year to 12 years in Lagos, Nigeria.

METHODS

This prospective hospital-based study involved 432 children (55% males) who came for routine paediatric care at the Lagos State University Teaching Hospital. Information on socio-demographics, sleeping patterns and specific sleep disorders was obtained.

RESULTS

The mean age of the subjects was 5.4 ± 3.3 years. Night sleep duration decreased significantly with age from 9.6 ± 1.3 hours at one to four years to 8.7 ± 1.0 hours at nine years to 12 years (p < 0.001). There was no significant gender difference in bedtimes (p = 0.057), rise times (p = 0.095) and night sleep duration (p = 0.191). Most (70%) napped during the day, and 26% of these did so on a regular basis. The most common sleep problems were enuresis (42%), afraid of sleeping alone (38%), snoring (28%) and sleep talking (24%). There was no significant association between sleep duration (p > 0.05), sleep problems (p > 0.05) and socio-demographic characteristics. Comparisons with other studies showed that the children had shorter sleep duration than peers in other countries and regions and a higher prevalence of sleep disorders.

CONCLUSION

Children in Nigeria had shorter sleep duration and more sleep problems than children in other international studies.

A Multispecies Approach to Co-Sleeping : Integrating Human-Animal Co-Sleeping Practices into Our Understanding of Human Sleep

Human sleeping arrangements have evolved over time and differ across cultures. The majority of adults share their bed at one time or another with a partner or child, and many also sleep with pets. In fact, around half of dog and cat owners report sharing a bed or bedroom with their pet(s). However, interspecies co-sleeping has been trivialized in the literature relative to interpersonal or human-human co-sleeping, receiving little attention from an interdisciplinary psychological perspective. In this paper, we provide a historical outline of the "civilizing process" that has led to current sociocultural conceptions of sleep as an individual, private function crucial for the functioning of society and the health of individuals. We identify similar historical processes at work in the formation of contemporary constructions of socially normative sleeping arrangements for humans and animals. Importantly, since previous examinations of co-sleeping practices have anthropocentrically framed this topic, the result is an incomplete understanding of co-sleeping practices. By using dogs as an exemplar of human-animal co-sleeping, and comparing human-canine sleeping with adult-child co-sleeping, we determine that both forms of co-sleeping share common factors for establishment and maintenance, and often result in similar benefits and drawbacks. We propose that human-animal and adult-child co-sleeping should be approached as legitimate and socially relevant forms of co-sleeping, and we recommend that co-sleeping be approached broadly as a social practice involving relations with humans and other animals. Because our proposition is speculative and derived from canine-centric data, we recommend ongoing theoretical refinement grounded in empirical research addressing co-sleeping between humans and multiple animal species.

An evolutionary perspective on night terrors

Night terrors, also known as sleep terrors, are an early childhood parasomnia characterized by screams or cries, behavioral manifestations of extreme fear, difficulty waking and inconsolability upon awakening. The mechanism causing night terrors is unknown, and a consistently successful treatment has yet to be documented. Here, we argue that cultural practices have moved us away from an ultimate solution: cosleeping. Cosleeping is the norm for closely related primates and for humans in non-Western cultures. In recent years, however, cosleeping has been discouraged by the Western medical community. From an evolutionary perspective, cosleeping provides health and safety benefits for developing children. We discuss night terrors, and immediate and long-term health features, with respect to cosleeping, room-sharing and solitary sleeping. We suggest that cosleeping with children (≥1-year-old) may prevent night terrors and that, under certain circumstances, cosleeping with infants (≤11-months-old) is preferable to room-sharing, and both are preferable to solitary sleeping.

Differences in sleep problems between Japanese and Chinese preschoolers: a cross-cultural comparison within the Asian region

STUDY OBJECTIVES

Previous studies have performed cross-cultural comparisons of differences in childhood sleep problems between Asian and Western countries. However, whether such differences can be observed among Asian countries remains unclear. The present study aimed to investigate differences in the pattern of sleep problems between Japanese and Chinese preschoolers.

METHODS

Data were collected from one city in Japan and 10 cities in China. The present study recruited 438 Japanese and 1020 Chinese preschoolers aged four and five years. Sleep problems and patterns were assessed on the basis of parental reports using the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

Analysis of covariance revealed no significant difference in total CSHQ scores between Japanese and Chinese preschoolers, thus indicating that the total severity of sleep problems did not differ between the groups. Japanese preschoolers exhibited higher scores on the bedtime resistance subscale of the CSHQ than Chinese preschoolers. Conversely, Chinese preschoolers exhibited higher subscale scores for night wakings and sleep-disordered breathing. In addition, Japanese preschoolers exhibited earlier bedtimes and wake times and shorter total sleep times than Chinese preschoolers.

CONCLUSIONS

Our findings indicate that the patterns of sleep problems in preschoolers differ between Japan and China and that such differences may be due to differences in cosleeping practices, bedtime routines, and/or environmental conditions. Thus, investigators studying sleep in preschoolers should consider regional differences in the pattern of sleep problems, even among Asian countries.

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.

Mother-child bed-sharing trajectories and psychiatric disorders at the age of 6 years

BACKGROUND

Little is known about the effect of bed-sharing with the mother over the child mental health.

METHODS

Population-based birth cohort conducted in Pelotas, Brazil. Children were enrolled at birth (n=4231) and followed-up at 3 months and at 1, 2, 4, and 6 years of age. Bed-sharing was defined as "habitual sharing of the bed between the child and the mother, for sleeping, for part of the night or the whole night". Trajectories of bed sharing between 3 months and 6 years of age were calculated. Mental health was assessed at the age of 6 years using the Development and Well-Being Assessment instrument that generates psychiatric diagnosis according to ICD-10 and DSM-IV criteria. Odds ratios (OR) with 95% confidence intervals were obtained by multivariate logistic regression.

RESULTS

3583 children were analyzed. Four trajectories were identified: non bed-sharers (44.4%), early-only (36.2%), late-onset (12.0%), and persistent bed-sharers (7.4%). In the adjusted analyses persistent bed-sharers were at increased odds of presenting any psychiatric disorder (OR=1.7; 1.2-2.5) and internalizing problems (OR=2.1; 1.4-3.1), as compared to non bed-sharers. Among the early-only bed-sharers OR for any psychiatric disorder was 1.4 (1.1-1.8) and for internalizing problems 1.6 (1.2-2.1).

LIMITATIONS

Although the effect of bed-sharing was adjusted for several covariates including the family socio-economic status, maternal mental health and excessive crying, there was no information on maternal personal reasons for bed-sharing. Mothers that bed-share intentionally and those that bed-share in reaction to a child sleep problem may have a different interpretation of their children behavior that may bias the study results.

CONCLUSION

Bed-sharing is a common practice in our setting and is associated with impaired child mental health at the age of six years.

Prolonged rooming-in in infancy is associated with generalized anxiety disorder in the adolescent period

OBJECTIVE

This study aims to investigate whether anxiety disorders in adolescents have a link with the separation time of bed/bedroom sharing with parents. It also aims to raise awareness in society about the issue of minimizing anxiety disorders in childhood.

METHODS

A case-control study was conducted in Şevket Yılmaz Training and Research Hospital between June 2013 and May 2014. The participants included 51 adolescents who were diagnosed as generalized anxiety disorder (GAD) with no-comorbidity and 71 healthy adolescents as the control group, who were chosen randomly. Diagnosis of GAD was based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed) by child and adolescent psychiatry doctors. The Turkish version of the State-Trait Anxiety Inventory (STAI) was used for the control group. A special survey about demographics and bed-sharing statements was constructed for the purpose of the study. The groups were analyzed in terms of duration of co-sleeping (bed-sharing) and rooming-in (keeping the mother and the baby in same room) with parents during infancy and the development of anxiety disorders in later period.

RESULTS

Mean duration of rooming-in was significantly longer in the case group than in the control group (p=0.009). Similarly, mean duration of co-sleeping in the case group was longer than that of the control group. However, this difference was not statistically significant (p=0.529).

CONCLUSION

Sleeping in the same room with children for a long time may result in anxiety disorders in later period due to possible difficulties in bonding and/or less self-confidence.

Parent-child bed-sharing: The good, the bad, and the burden of evidence

The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - anthropology, psychology/psychiatry, and pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.

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.

Methodology and recruitment for a randomised controlled trial to evaluate the safety of wahakura for infant bedsharing

BACKGROUND

Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device.

METHODS/DESIGN

This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns.

DISCUSSION

Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide.

TRIALS REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010.

Maternal stress and psychological status and sleep in minority preschool children

OBJECTIVES

Minority women living in inner city environments may be at more risk for psychological distress. Maternal stress, anxiety, depression, and psychological trauma can influence the preschool child's behavior and may have a negative impact on the preschool child's sleep patterns. The purpose of the study was to: (a) examine objective and subjective preschool children sleep patterns and (b) explore the relationship between objective and subjective sleep patterns in preschool children and maternal psychological status.

DESIGN AND SAMPLE

A cross-sectional observational design was used. Descriptive analyses and correlations were conducted to examine the data. Twenty-one minority women were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children Program.

MEASURES

Preschool children wore wrist actigraphs, and their sleep efficiency, time in bed, and sleep periods were analyzed. Mothers completed measures on depression, anxiety, stress, and psychological trauma.

RESULTS

Mothers' self-report of their children's sleep habits indicated at risk scores for sleep problems. Life stress in the mothers was statistically significant and negatively related to preschool child's sleep duration. Mild to severe symptoms of depression and mild anxiety were reported and criteria for Post Traumatic Stress Disorder were found in 12 of the 21 mothers. The results of the study indicate that parent education on sleep and the minority preschool child should be part of community interventions and screening preschool parents for psychological distress should be considered with referrals for support services.

Risk factors for father-daughter incest: data from an anonymous computerized survey

Retrospective data from 2,034 female participants, provided anonymously using a computer-assisted self-interview, were used to identify risk factors for father-daughter incest (FDI). A total of 51 participants had reported having experienced FDI. The risk factors identified within the nuclear family by the multiple logistic regression analysis included the following: (a) Having parents whose relationship included verbal or physical fighting or brutality increased the likelihood of FDI by approximately 5 times; (b) families accepting father-daughter nudity as measured by a scale with values ranging from 0 to 4 increased the likelihood of FDI by approximately 2 times for each unit value increase of 1 above 0; (c) demonstrating maternal affection protected against FDI. The likelihood of being a victim of FDI was highest if the participant's mother never kissed or hugged her; it decreased by 0.44 for a 1-unit increase in affection and by 0.19 times for a 2-unit increase; and (d) being in homes headed by single-parent mothers or where divorce or death of the father had resulted in a man other than the biological father living in the home increased the risk of FDI by approximately 3.2 times. The results were consistent with the idea that FDI in many families was the cumulative result of a circular pattern of interactions, a finding that has implications for treatment of the perpetrator, the victim, and the families. The data also suggested it may be possible to design an information program for parents that will result in reducing the risk of FDI in families implementing the program's recommendations.

Sleep patterns of Japanese preschool children and their parents: implications for co-sleeping

AIM

The aim of this study was to investigate the direct relationship of sleep schedule and sleep quality variables between healthy preschool children and their parents, focusing on the influence of the difference in bedtime between each other.

METHODS

Forty-seven Japanese 5-year-old children and their primary parent were studied. The parents completed questionnaires including the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The children wore an actigraph for one week.

RESULTS

Although sleep patterns of children were generally independent of their parents, late sleep end time and bedtime of children were associated with parents' late sleep end time on weekends. For 87% of children and parents who shared a bedroom, sleep quality was negatively affected by a shorter difference in bedtimes between child and parent, but not by co-sleeping.

CONCLUSION

Sleep behaviours of parents can influence those of their children. For parents and children who share a bedroom, the timing of bedtime rather than co-sleeping may be a key factor in modulating sleep patterns. Trying to get children asleep and subsequently falling asleep at a similar time may disturb parents' sleep quality, which may subsequently affect that of their children.

Sleep patterns and sleep disturbances among Chinese school-aged children: prevalence and associated factors

OBJECTIVE

The study aimed to (1) characterize sleep patterns and sleep disturbances among Chinese school-aged children, (2) determine the prevalence of their short sleep duration and sleep disturbances based on clinical cutoffs, and (3) examine possible factors (socio-demographic factors and emotional/behavioral problems) that are associated with sleep disturbances.

METHODS

A large representative sample of 912 children aged 6-14years was recruited from Shenzhen, China. Their parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The mean bedtime was 9:45pm (SD=1h 11min), mean wake-up time was 7:03am (SD=31min), mean sleep duration was 9h 14min (SD=46min), and 23.8% of the children had sleep duration <9h. Overall, 69.3% of the children suffered from global sleep disturbances (CSHQ total score >41). Bedtime resistance (22.9%), sleep anxiety (22.1%), sleep duration (21%) and daytime sleepiness (20%) were the most prevalent sleep disturbances; followed by sleep disordered breathing (12.1%), parasomnias (9.4%), sleep onset delay (6.9%), and night waking (5.2%). The prevalence of specific sleep disturbances ranged from 3.2% (falling asleep while watching television) to 81.9% (awakening by others in the morning). Correlations between most domains of sleep disturbances and emotional/behavioral problems were statistically significant (p<0.05 or p<0.01). Hierarchical multiple regression analysis revealed that gender (β=0.10, p<0.01), school grade (β=-0.09, p<0.05), co-sleeping (β=0.25, p<0.01), emotional symptoms (β=0.24, p<0.01), conduct problems (β=0.09, p<0.05), and hyperactivity (β=0.17, p<0.01) accounted for significant variance in CSHQ total score.

CONCLUSIONS

Short sleep duration and sleep disturbances are prevalent among Chinese school-aged children. Sleep disturbances are associated with gender, school grade, co-sleeping, emotional symptoms, conduct problems, and hyperactivity.

Scientific consensus forum to review the evidence underpinning the recommendations of the Australian SIDS and Kids Safe Sleeping Health Promotion Programme--October 2010

This paper summarises a 1-day scientific consensus forum that reviewed the evidence underpinning the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. The focus was on each of the potentially modifiable risk factors for sudden unexpected deaths in infancy, including sudden infant death syndrome (SIDS) and fatal sleeping accidents. In particular infant sleeping position, covering of the face, exposure to cigarette smoke, room sharing, unsafe sleeping environments, bed sharing, immunisation, breastfeeding, pacifier use and Indigenous issues were discussed in depth. The participants recommended that future 'Reducing the Risk' campaign messages should focus on back to sleep, face uncovered, avoidance of cigarette smoke before and after birth, safe sleeping environment, room sharing and sleeping baby in own cot.

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.

The Ecology of Human Development: Evolving Models for Cultural Psychology

The Whiting model aimed to provide a blueprint for psychocultural research by generating testable hypotheses about the dynamic relationships of a culture with the psychology and behavior of its members. This analysis identifies reasons why the model was so effective at generating hypotheses borne out in empirical research, including its foundational insight that integrated nature and nurture, its reconceptualization of the significance of early environments, and its attention to biopsychocultural dynamics active in those environments. Implications and the evolution of the ecological paradigm are tracked through presentations of three current models (developmental niche, ecocultural theory, bioecocultural microniche) and discussion of their related empirical literatures. Findings from these literatures converge to demonstrate the power of a developmental, cultural, ecological framework for explaining within- and between-population variation in cultural psychology.

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.

Insomnias of childhood and adolescence

Childhood insomnias (CI) are a diverse group of sleep-related problems that present across the first 2 decades of life, ranging widely in severity. Little is understood about the origins of CI which are likely heterogeneous. Nevertheless, effective treatments for younger children have been shown to be efficacious. Defined within a development framework, this article reviews common correlates and causes of CI during the first two decades. A practical approach to the evaluation and treatment of insomnias among children and youth is presented.

Bed-sharing at 3 months and breast-feeding at 1 year in southern Brazil

OBJECTIVE

To investigate the association between bedsharing at age 3 months and breastfeeding (BF) at age 12 months.

STUDY DESIGN

Almost all children born in Pelotas, Brazil in 2004 (99.2%) were enrolled in a cohort study. At birth, age 3 months, and age 12 months, mothers were interviewed to gather information on sociodemographic, reproductive, BF, and bedsharing characteristics. Bedsharing was defined as habitual sharing of a bed between mother and child for the entire night or part of the night. The analysis was limited to children from single births who were breastfed at 3 months. Multivariate analyses were carried out using Poisson regression.

RESULTS

Of 4231 live births, 2889 were breastfed at age 3 months. The prevalence of BF at age 12 months was 59.2% in the children who bedshared at 3 months and 44% in those who did not (adjusted prevalence ratio [PR] for weaning= 0.75; 95% confidence interval [CI] = 0.69-0.81; P < .001). Among children who were exclusively breastfed at 3 months, 75.1% of those who also bedshared were still breastfed at age 12 months, versus 52.3% of those who did not bedshare (adjusted PR = 0.63; 95% CI = 0.53- 0.75; P < .001). The adjusted PR was 0.74 (95% CI = 0.60-0.90; P = .003) in children who were predominantly breastfed and 0.83 (95% CI = 0.76-0.90; P < .001) in those who were partially breastfed.

CONCLUSIONS

Bedsharing at 3 months protected against weaning up to age 12 months.

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.

Culture and the socialization of child cardiovascular regulation at school entry in the US

The measurement of cardiovascular functioning targets an important bridge between social conditions and differential well-being. Nevertheless, the biocultural, psychosocial processes that link human ecology to cardiovascular function in children remain inadequately characterized. Childrearing practices shaped by parents' cultural beliefs should moderate children's affective responses to daily experience, and hence their psychophysiology. The present study concerns interactions among family ecology, the normative social challenge of entry into kindergarten, and parasympathetic (vagal) cardiac regulation in US middle-class children (N = 30). Although parents believed children must be protected from overscheduling to reduce stress and improve socio-emotional adaptation, maternal rather than child schedules predicted parasympathetic regulation during a nonthreatening social engagement task following school entry. Children of busier married mothers, but less busy single mothers, showed the context-appropriate pattern of parasympathetic regulation, low respiratory sinus arrhythmia (RSA). These findings are expected if: maternal and family functioning, rather than the scheduling of the child's daily life, principally drive young children's cardiovascular responsiveness to a normative challenge; and busy schedules represent high family functioning with married mothers, but not under single-parent conditions wherein adult staffing is uniquely constrained. Family ecology is shaped by culture, and in turn shapes the development of children's cardiovascular responses. Appropriately fine-grained analysis of daily experience can illustrate how culturally driven parenting practices may have unintended consequences for child biological outcomes that vary by family structure.

Bed- and room-sharing in Chinese school-aged children: prevalence and association with sleep behaviors

OBJECTIVE

To survey the prevalence of bed- and room-sharing and assess associations with sleep/wake patterns, duration of sleep, and sleep problems among urban school-aged children in China.

METHODS

Students representing eight Chinese cities were studied during November and December, 2005. A total of 19,299 elementary-school children (49.7% boys and 50.3% girls with a mean age of 9.00 years) participated in the survey. A parent-administered questionnaire and the Chinese version of the Children's Sleep Habits Questionnaire were completed to quantify children's sleep arrangements and to characterize sleep behaviors.

RESULTS

Co-sleeping was a common practice, with a prevalence of 37.6% (routine bed-sharing: 23.0%; room-sharing: 14.6%) in Chinese school-aged children. Bed- and room-sharing did not show significant gender difference but gradually decreased with increasing age. Compared to room-sharing and sleeping alone, bed-sharing was correlated with later bedtimes, later awakening times, and a shorter duration of sleep. However, the small difference was unlikely to have clinical significance. Bed- and room-sharing tended to be associated with the increased probability of six types of sleep problems: bedtime resistance, sleep anxiety, night waking, parasomnia, sleep-disordered breathing, and daytime sleepiness. Compared to bed-sharing, room-sharing had a lower odds ratio. Among six sleep problems, bedtime resistance and sleep anxiety had the strongest association with bed-sharing.

CONCLUSIONS

Sleep problems were common in Chinese school-aged children. Co-sleeping was highly prevalent and may be potentially associated with negative effects on sleep hygiene and sleep quality, although the context of the co-sleeping must be taken into consideration.