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

Sources of attitudes towards parent-child co-sleeping and their effects: A systematic scoping review

Parent-child co-sleeping is a common practice in many cultures, although in Western countries, families who engage in parent-child co-sleeping can encounter attitudes about co-sleeping that feel critical from the people around them, as it is not commonly accepted and often stigmatized. This systematic scoping review examined and synthesized the available literature on the attitudes about parent-child co-sleeping that people encounter, their origins, and their effect on parents' own attitudes and behaviors. A total of 9796 abstracts were screened, and 33 studies were included. While the scope of the literature on this topic was narrow, this review demonstrated that parents/caregivers mostly encounter encouraging attitudes about co-sleeping from their extended family members and within their culture and discouraging attitudes from healthcare professionals. Findings suggest that encouraging attitudes enhance the likelihood of parents engaging and continuing with co-sleeping behavior, while discouraging attitudes can lead to the avoidance of parents discussing sleep with their healthcare professionals and can cause conflicts with other family members, including partners. Based on these findings, we conclude that further research is needed in several areas related to co-sleeping in Western culture, most specifically in how external attitudes influence the decision to co-sleep, as well as other behaviors and cognitions such as engagement with healthcare professionals, family satisfaction, parental self-efficacy, and overall mental health.

Analysis, evaluation, and reformulation of social cognitive theory: Toward parent-child shared management in sleep health

THEORETICAL PRINCIPLES

Social Cognitive Theory (SCT) is a middle-range theory with triadic determinism between behavioral, environmental, and personal. SCT has been a guiding framework in health promotion research as it helps understand people's behaviors.

PHENOMENA ADDRESSED

Behavioral Insomnia of Childhood (BIC) is highly prevalent, affecting up to 45% of typically developing children and 80% of children with special healthcare needs. BIC leads to sleep deficiency, disrupted physical and psychological health, poor school performance, behavioral dysfunction, and negatively affects parental and family functioning. Using Fawcett's framework, we analyzed and evaluated SCT in a pediatric sleep context and propose a reformulation of SCT to better inform sleep research.

RESEARCH LINKAGES

SCT is individually focused and does not account for interdependence within relationships. Pediatric sleep interventions have limited long-term effects and sustainability without considering the parent-child dyadic interdependency. We advance the argument that the parent-child shared management (PCSM) perspective is beneficial for understanding pediatric sleep health. PCSM is a concept that reflects the shared responsibility and interdependence that parent and child have for managing child health. It assumes that with parents' ongoing support, children's responsibility for their health management increases over time, along with developmental progression and health-related experiences. We propose reformulating SCT by integrating PCSM in the pediatric sleep context: SCT with Shared Management (SCT-SM). The proposed SCT-SM accounts for parent-child interdependence and role transition. Shared management interventions that engage parents and children in active roles in managing sleep have potential sustainable effects in improving sleep and quality of life. (250).

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.

Factors associated with sleep disorders among adolescent students in rural areas of China

Background

This study aimed to determine sleep patterns and the prevalence and association factors of sleep disorders in a regionally representative sample in Mo Jiang, China.

Methods

A total of 2,346 (participation rate 93.5%) Grade 7 students (aged 13-14 years) from 10 middle schools, including 1,213 (51.7%) boys and 1,133 (48.3%) girls, participated in the study. All the participants were invited to complete questionnaires that acquired information on sleep patterns, academic performance, academic stress, and sociodemographic factors. Sleep disorders were assessed using the Chinese version of the Children's Sleep Habits Questionnaire. Logistic regression models were used to investigate factors associated with sleep disorders.

Results

The prevalence of sleep disorders among rural adolescents was 76.4%, which is higher than that among urban adolescents. Compared with previous findings in urban areas, our results indicate that sleep loss is much more severe in rural adolescents. Sleep disorders were positively associated with factors, such as watching TV [odds ratio (OR) = 1.22, p = 0.001], academic performance (OR = 1.80, p < 0.001), and academic stress (OR = 1.38, p = 0.04). In addition, girls were more likely to suffer from sleep disorders than boys (OR = 1.36, p = 0.01).

Conclusion

Insufficient sleep and sleep disorders have become common health problems in rural Chinese adolescents.

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).

A Longitudinal Study of the Effects of Bed-Sharing Experience in Infancy on Sleep Outcomes at 2 Years Old

OBJECTIVE

To assess the effects of bed-sharing experiences in infancy on sleep patterns and sleep problems at 2 years of age.

STUDY DESIGN

A total of 1564 children from an ongoing Shanghai Maternal-Child Pairs Cohort were included. Bed-sharing experiences were collected when children were 2, 6, and 24 months old via caregiver-completed questionnaires (whether caregivers shared a bed with children during the night), and children's bed-sharing experiences were classified as follows: no bed-sharing, early-only bed-sharing, late-onset bed-sharing, and persistent bed-sharing. Sleep outcomes at month 24 were assessed using the Brief Infant Sleep Questionnaire. Sleep patterns and problems were compared among the 4 types of bed-sharing experiences.

RESULTS

Of the 1564 infants, 10.10% had no bed-sharing, 18.35% had early-only, 27.94% had late-onset, and 43.61% had persistent bed-sharing. Compared with children with no bed-sharing, children with late-onset and persistent bed-sharing had shorter nighttime sleep durations and longer daytime sleep durations (P < .05) and were more likely to snore (aOR 1.87 [95% CI 1.25-2.79]; aOR 1.68 [95% CI 1.14-2.47]) and have sleep onset difficulty (aOR 2.06 [95% CI 1.37-3.09]; aOR 2.07 [95% CI 1.41-3.05]). However, caregivers of infants in the late-onset and persistent bed-sharing groups perceived less problematic sleep (aOR 0.38 [95% CI 0.26-0.56] and aOR 0.40 [95% CI 0.28-0.58]).

CONCLUSIONS

Bed-sharing is a common experience among Chinese children. Although bed-sharing may reduce caregivers' perception of children's problematic sleep, late-onset or persistent bed-sharing in infancy is associated with sleep problems at 2 years of age.

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.

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.

Maternal lack of sleep in the first two years after childbirth: Perceived impacts and help-seeking behaviors

Most evidence-based sleep interventions (e.g., graduated extinction of nighttime crying) are in opposition to many parents' values. This warrants taking a step back and asking the parents about their main concerns regarding their baby's sleep and the type of help they would be likely to use. This study aimed to describe and identify, among mothers of a 0- to 24-month-old child, the perceived impact of lack of sleep, sleep-related help-seeking behaviors as well as the most concerning aspects of the child's sleep, and preferred sleep intervention modalities. Another objective was to identify the factors associated with a negative impact of postpartum sleep, concerns for the child's sleep, and interest in sleep interventions. Canadian mothers (N = 932) were recruited by email snowball sampling and through Facebook to complete an online questionnaire designed for the purposes of the study. Most mothers reported a negative impact of postpartum sleep on their romantic relationship (79.4%) and quality of life (76.7%). Low parental self-efficacy (PSE) about managing the child's sleep was the best predictor of a negative impact of lack of sleep and sleep-related concerns, above and beyond any other child's or mother's characteristics. The preferred intervention modalities were reliable websites and online courses on child sleep, with a greater interest in home visits among mothers who need help the most (low self-efficacy, high concerns). Interventions should aim at increasing PSE about the child's sleep in both parents and include home visits for those who need it the most.

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.

The impact of pediatric atopic dermatitis on families: A review

BACKGROUND

Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well-documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance.

OBJECTIVE

This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD.

METHODS

A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD.

RESULTS

Caring for children affected by AD can be an extremely time-consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement.

CONCLUSIONS

Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.