Children's sleep patterns from 0 to 9 years: Australian population longitudinal study

Shorter night-time sleep duration and later sleep timing from infancy to adolescence

BACKGROUND

Here, we (a) examined the trajectories of night-time sleep duration, bedtime and midpoint of night-time sleep (MPS) from infancy to adolescence, and (b) explored perinatal risk factors for persistent poor sleep health.

METHODS

This study used data from 12,962 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Parent or self-reported night-time sleep duration, bedtime and wake-up time were collected from questionnaires at 6, 18 and 30 months, and at 3.5, 4-5, 5-6, 6-7, 9, 11 and 15-16 years. Child's sex, birth weight, gestational age, health and temperament, together with mother's family adversity index (FAI), age at birth, prenatal socioeconomic status and postnatal anxiety and depression, were included as risk factors for persistent poor sleep health. Latent class growth analyses were applied first to detect trajectories of night-time sleep duration, bedtime and MPS, and we then applied logistic regressions for the longitudinal associations between risk factors and persistent poor sleep health domains.

RESULTS

We obtained four trajectories for each of the three sleep domains. In particular, we identified a trajectory characterized by persistent shorter sleep, a trajectory of persistent later bedtime and a trajectory of persistent later MPS. Two risk factors were associated with the three poor sleep health domains: higher FAI with increased risk of persistent shorter sleep (OR = 1.20, 95% CI = 1.11-1.30, p < .001), persistent later bedtime (OR = 1.28, 95% CI = 1.19-1.39, p < .001) and persistent later MPS (OR = 1.30, 95% CI = 1.22-1.38, p < .001); and higher maternal socioeconomic status with reduced risk of persistent shorter sleep (OR = 0.99, 95% CI = 0.98-1.00, p = .048), persistent later bedtime (OR = 0.98, 95% CI = 0.97-0.99, p < .001) and persistent later MPS (OR = 0.99, 95% CI = 0.98-0.99, p < .001).

CONCLUSIONS

We detected trajectories of persistent poor sleep health (i.e. shorter sleep duration, later bedtime and later MPS) from infancy to adolescence, and specific perinatal risk factors linked to persistent poor sleep health domains.

Effects of Ball Combination Exercise Combined with cTBS Intervention on Sleep Problems in Children with Autism

Sleep problems significantly affect the quality of life of autism spectrum disorder (ASD) children. This study aimed to evaluate the effects of a 12-week ball combination exercise, continuous theta burst stimulation (cTBS) stimulation, and combined intervention on sleep problems in children with ASD. Forty-five ASD children were divided into three intervention groups (ball combination exercise(n = 12), cTBS stimulation(n = 10), combined (n = 12) and a control group (n = 11). The intervention groups underwent intervention, while the control group maintained daily activities. The effects were assessed using the Children's Sleep Habits Questionnaire (CSHQ) scale. The results revealed that after 12 weeks of intervention, three programs reduced sleep problems in children with ASD. The post-test scores of the cTBS group (p = 0.002) and the combined group (p < 0.001) were significantly lower than the baseline scores on the CSHQ scale. The exercise group (p = 0.002) and the combined group (p < 0.001) showed significant improvement in sleep anxiety, while there was no statistically significant difference in the effectiveness of the three interventions for sleep-onset delay. The combined group outperformed the single intervention groups in the CSHQ score and sleep anxiety sub-dimensions. The combined intervention group showed slightly superior performance in sleep onset latency, however, there was no significant difference. Three interventions alleviated sleep issues in ASD children, with the combined method proving more effective. This study validates non-pharmacologic and combined approaches for ASD sleep problems. Future research should delve deeper into the mechanisms of these interventions in ASD children's sleep improvement.

Association between adherence to 24-h movement guidelines and sociodemographic factors among Malaysian preschoolers: Findings from SEANUTS II Malaysia

BACKGROUND

Adhering to 24-h movement guidelines (24-hMG) have health benefits for young children; yet research on Malaysian preschoolers' movement behaviors is limited. This study investigates the association between adherence to 24-hMG and sociodemographic factors of Malaysian preschoolers.

METHODS

Data from 939 preschoolers aged 3-6 years (mean age = 4.83 ± 0.04 years, 53.7% boys) from the Second South East Asian Nutrition Surveys (SEANUTS II) Malaysia study was analyzed. Socio-demography, physical activity, sedentary behaviors, and sleep were parent-reported via questionnaire. Associations between adherence of 24-hMG and sociodemographic factors were analyzed using complex samples logistic regression.

RESULTS

Only 12.1% of preschoolers adhered to the overall 24-hMG, and 67.1%, 54.7%, and 42.7% of preschoolers adhered to physical activity, sleep, and sedentary behavior guidelines, respectively; while 6.8% did not meet any guidelines. Compared to 3-4-year olds, preschoolers aged 5-6 years had higher odds of adhering to physical activity guidelines, sedentary behavior guidelines, and overall 24-hMG, but lower odds of adhering to sleep guidelines. Chinese and Indian preschoolers were more likely to adhere to sedentary behavior guidelines than Malay preschoolers; however, Chinese preschoolers had lower odds of adhering to physical activity guidelines. Paternal tertiary education was associated with a higher likelihood of adherence to sleep guidelines.

CONCLUSION

Our findings suggest that adherence to 24-hMG among Malaysian preschoolers is associated with age, ethnicity, and paternal education level. This underscores the importance of targeted interventions and health awareness program to promote healthy movement behaviors, particularly among children under 5, ethnic minorities, and educationally disadvantaged families.

When they just don't sleep: differential impacts of reduced child sleep on depression, anxiety, and stress among caregivers of children with and without neurogenetic syndromes

Introduction

Children with neurogenetic syndromes commonly experience significant and pervasive sleep disturbances, however, associations with caregiver mental health remains unclear. Previous studies have linked sleep disturbances with increased caregiver depression in typically developing populations, and heightened caregiver stress among neurogenetic populations. The present study expands on findings by exploring the longitudinal association between child sleep duration and caregiver mental health (depression, anxiety, stress) throughout development (infancy to school-aged children) in dyads with and without a child affected by a neurogenetic syndrome.

Methods

Participants were drawn from the Purdue Early Phenotype Study, including 193 caregivers (Age: M = 34.40 years, SD = 4.53) of children with neurogenetic syndromes (Age: M = 40.91 months, SD =20.72) and typically developing children (n = 55; Age: M = 36.71 months, SD = 20.68). Children in the neurogenetic group were diagnosed with Angelman (n = 49), Prader Willi (n = 30), Williams (n = 51), and Fragile X (n = 8) syndromes. Caregivers completed assessments every six months up to child age three, and annual assessments thereafter. Child sleep duration was measured using the Brief Infant Sleep Questionnaire, and caregiver internalizing symptoms were assessed using the Depression, Anxiety, Stress Scale. Multilevel models were conducted to examine caregiver depression, anxiety, and stress in relation to child sleep duration at both between- and within-person levels, with child age as a moderator.

Results

Results indicated a between-person effect of child sleep duration on caregiver depression (i.e., differences between families) and a within-person effect on caregiver stress (i.e., change over time) in the full, combined sample. These effects were not maintained when examined separately in neurogenetic and typically developing groups, except for a between-person effect on caregiver stress in the typically developing cohort. Moderating effects of child age were significant for depression and stress only in the typically developing cohort.

Discussion

In summary, persistent child sleep disruptions were linked to exacerbated caregiver depression across the sample, while acute child sleep disruptions exacerbate caregiver stress within dyads over time. These findings emphasize the importance of addressing child sleep to enhance caregiver wellbeing and has potential relevance for a wide range of neurogenetic syndromes.

Polysomnography in infants with clinical suspicion of sleep-related breathing disorders

STUDY OBJECTIVES

Limited data exist concerning the indications, parameters, utility of daytime polysomnography, and treatment of infants with suspected sleep-related breathing disorders.

METHODS

We retrospectively reviewed all polysomnography undertaken in a quaternary pediatric hospital for term infants up to 6 months of age between January 2017 and December 2019. Outcomes were evaluated, including a comparison among diagnostic groups.

RESULTS

Of 161 infants (58% male), 77 (48%) were ≤ 2 months old, and 103 (61%) were referred for either craniofacial abnormalities or an airway malformation. Daytime (n = 100) vs nighttime (n = 61) studies showed no differences in sleep architecture or treatment rates. Apnea-hypopnea index was > 10 events/h in 137 (85%) and was similar across different diagnostic groups, and 97 (78%) were prescribed noninvasive ventilation, with a mean treatment duration of 13.4 ± 9 months. Of the infants who were commenced on noninvasive ventilation 75% did not require it beyond 24 months.

CONCLUSIONS

Polysomnographic sleep parameters and the number of treatments prescribed were equivalent whether the polysomnography was performed during daytime or nighttime. Treatment with noninvasive ventilation was required in the short term for most infants with sleep-related breathing disorders, regardless of the indication for referral.

CITATION

Singh J, Yeoh E, Castro C, Uy C, Waters K. Polysomnography in infants with clinical suspicion of sleep-related breathing disorders. J Clin Sleep Med. 2022;18(12):2803-2812.

The multidimensionality of sleep in population‐based samples: a narrative review

The identification of optimal sleep duration recommendations for the general population has long been an important goal on the public health agenda, as both short and long sleep duration have been linked to unfavourable health outcomes. Yet, sleep is more than duration alone and can be described across multiple domains, such as timing, regularity, satisfaction, alertness, and efficiency. We reviewed observational population‐based studies that examined differences in age, sex, and origin across multiple dimensions of sleep. Reviewed literature suggests an increasing prevalence of insomnia symptoms, shorter and less deep sleep in old age. Overall, women report poorer sleep quality than men despite objective measures revealing shorter and more fragmented sleep in men. Minorities generally have poorer quantity and quality of sleep, but multi‐ethnic studies have reported mixed results regarding the subjective experience of sleep. In sum, effects of age, sex and origin differ across sleep dimensions, thereby suggesting that the multidimensionality of sleep and how these different aspects interact should be studied across individuals. Studies should include both self‐reported measures and objective assessments in diverse population‐based samples, as both aspects are important to understand sleep health in the general population. Data‐driven descriptions could provide researchers and clinicians with insights into how well individuals are sleeping and offer concrete targets for promotion of sleep health across the population.

Sleep Patterns and Myopia Among School-Aged Children in Singapore

Purpose

To evaluate the associations of sleep factors with myopia, spherical equivalent (SE), and axial length (AL) in elementary school-aged children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort.

Methods

This cross-sectional study included multi-ethnic children who participated in the GUSTO prospective birth cohort and were delivered in two major tertiary hospitals in Singapore (2009–2010). Sleep factors and myopia outcomes were assessed at the 8- and 9-year study visits, respectively. Parent-reported sleep quality was assessed with the Children's Sleep Habits Questionnaire (CSHQ) total scores. Additionally, each child's sleep duration, timing (bedtime; waketime), and the consistency of sleep duration or timing (i.e., the difference between weekends and weekdays) were parent-reported. Outcomes included cycloplegic SE, myopia (SE ≤ −0.5 D) and AL. Eye measurements from both eyes were included in the analyses. Multivariable linear or logistic regression with Generalized Estimating Equations were used to account for the correlation between paired eyes and confounders in the associations of sleep factors at age 8 and myopia at age 9.

Results

A total of 572 multi-ethnic children (49.5% boys; 56.1% Chinese) aged 9 years were included in the analyses. Overall, 37.3% of eyes were myopic. Children reported a mean total CSHQ score of 46 [standard deviation (SD) = 6]. The mean duration of sleep was 9.2 (SD = 1.0) hours per day (h/day), with 59.9% of children reporting sufficient sleep (≥9 h/day) based on guidelines recommended by the National Sleep Foundation, USA. The mean bedtime and wake time were 22:00 (SD = 00:53) and 07:08 (SD = 00:55), respectively. In multivariable regression models, total CSHQ scores, the duration of sleep, bedtime and wake time were not significantly associated with myopia, SE, or AL (p ≥ 0.05 for all), adjusting for gender, ethnicity, time outdoors, near-work, parental myopia, maternal education levels (and additionally the child's height when the outcome was AL). Similarly, the consistency of both the duration and timing of sleep (across weekends and weekdays) were not significantly associated with myopia, SE, or AL (p ≥ 0.05 for all).

Conclusion

In this cross-sectional study, sleep quality, duration, timing, and the consistency of specific sleep factors were not independently associated with myopia, SE, or AL among elementary school-aged children in Singapore. Large longitudinal studies are warranted to corroborate these results.

Sleep in Individuals with ADHD: Prevalence, Impacts, Causes, and Treatments

Sleep problems are common in children and adolescents with ADHD. This chapter covers the basics of sleep and the prevalence and types of sleep problems experienced by children and adolescents with ADHD. The impacts of sleep problems on the day-to-day lives of children with ADHD and their families are covered including impacts on child daily functioning and cognition, as well as family well-being. There is no one cause of sleep problems in children with ADHD with both biological and environmental factors implicated. There are a small number of randomized controlled trials that support the efficacy of treating sleep problems in children with ADHD using behavioral strategies. A small number of studies also have found improvements in sleep onset delay in children with ADHD following treatment with melatonin. Little is known about how to best support adolescents and adults with ADHD with sleep, although a small emerging literature largely in adults with ADHD suggests that bright light therapies could potentially be helpful given the extent of circadian involvement in the sleep problems experienced by individuals with ADHD. This chapter ends with consideration of future research directions largely related to approaches to supporting individuals with ADHD and sleep difficulties.

Study protocol for Healthy Conversations @ Playgroup: a multi-site cluster randomized controlled trial of an intervention to promote healthy lifestyle behaviours in young children attending community playgroups

BACKGROUND

Early childhood is a critical window for preventing obesity and chronic disease. Yet, 1 in 4 Australian children aged 5 years and under are affected by overweight or obesity; and significant proportions of children under 5 years fail to meet guidelines for diet quality, physical activity (PA), screen time, and sleep. Consequently, effective interventions to promote healthy lifestyle behaviors and prevent obesity during early childhood are needed. Community playgroups provide an opportunity for parents, carers, and children to meet in a safe and relaxed environment to play and share information. The structure, low cost and reach of playgroups provide a unique platform to engage parents in a scalable program to promote healthful lifestyle behaviors and prevent childhood obesity. However, the evidence base for the effectiveness of health promotion programs delivered in community playgroup settings is limited and lacking credible evidence from rigorously conducted randomized controlled trials.

METHODS

The Healthy Conversations @ Playgroup randomized controlled trial (RCT) aims to address the underlying behavioral risk factors for obesity by helping parents take effective steps to improve their child's dietary, PA, screen time, and sleep behaviors. The intervention program comprises 10 "healthy conversations" led by a trained peer facilitator, designed to increase parents' behavioral capability and self-efficacy to implement autonomy-supportive parenting practices. The program will be delivered biweekly during regularly scheduled playgroup sessions over 10-weeks. Effectiveness will be tested in a 2-arm cluster RCT involving 60 community playgroups in three states across Australia. After baseline assessments, participating playgroups will be randomly allocated to either intervention or wait-list control conditions. Primary outcomes (vegetable intake, discretionary foods, daily PA, screen time, sleep duration, and body mass index [BMI] z-score) will be assessed at baseline, immediately post-intervention (10-weeks; T2) and 6-months post-intervention (T3). Outcomes will be assessed for differential change at T2 and T3.

DISCUSSION

The Healthy Conversations @ Playgroup trial will rigorously evaluate a novel peer-led intervention program to promote healthful lifestyle behaviors and prevent obesity in children and families attending community playgroups. If effective, the program could be immediately scaled-up and delivered in community playgroups across Australia.

TRIAL REGISTRATION

Trial registered 22nd January 2021 with the Australian and New Zealand Clinical Trials Registry ( ACTRN12621000055808 ).

Longitudinal changes in sleep patterns and circadian rhythm metrics in preschool-age children from Northern Mexico

OBJECTIVES

To assess changes in sleep parameters and circadian rhythm metrics measured by actigraphy in preschool-aged children.

DESIGN

Longitudinal analysis over 1 year.

PARTICIPANTS

Ninety-four children living in Tijuana and Ensenada, Mexico.

MEASUREMENTS

Children wore accelerometers on the right hip for one continuous week at baseline and 1-year follow-up. Parents recorded child bedtime, waketime, and naps in sleep diaries. We used cosinor and nonparametric approaches to calculate circadian rhythm metrics.

RESULTS

At baseline, children had a mean age of 4.2 years, and 51.1% were girls. In multivariable models adjusted for age, gender, BMI category, parental education, household income and city, at follow-up children had significantly earlier waketimes (β = -7.99 minutes, p < .001) compared to baseline. Children also had lower sleep onset latency (β = -2.32 minutes, p = .057), and longer nighttime sleep (β = 9.38 minutes, p = .079), but these changes were not significant at the α < 0.05 level. We found significant increases in log relative amplitude (β = 0.017, p = .009), and decreases in log midline estimated statistic of rhythm (β = -0.084, p = .017) and log of the least active 5-hour period (β = -0.057, p = .010). When we adjusted for co-sleeping, we found significant decreases in the number of nighttime awakenings (β = -1.29, p = .011) but otherwise similar results. There were no other changes in sleep parameters or circadian rhythm metrics.

CONCLUSIONS

Mean increases in nighttime sleep and earlier wake times over one year were concomitant with decreases in overall activity levels and increases in circadian rhythm robustness. Co-sleeping was a predictor of sleep disturbances. This study provides longitudinal evidence regarding changes in sleep and circadian metrics in a sample of children from an under-researched sociodemographic group during an important, early life period.

Bedtimes, Bedtime Routines, and Children's Sleep across the First Two Years of Life

STUDY OBJECTIVES

The first objective of this study was to determine whether establishing bedtime routines in the first year of life predicts better sleep outcomes (i.e., longer sleep duration, less nighttime waking, earlier bedtime, shorter sleep latency, fewer sleep problems) across the first two years of life. The second objective was to determine whether specific adaptive bedtime activities (e.g., book reading) were associated with sleep outcomes. The third objective was to describe changes in adaptive bedtime activities (hug/kiss caregiver, say goodnight to family) across the first two years of life.

METHODS

Parents of 468 children from the STRONG Kids 2 birth cohort were surveyed about bedtime and bedtime routines, their child's sleep duration, nighttime waking, sleep latency and sleep problems at 3, 12, 18, and 24 months of age.

RESULTS

Cross-lagged panel models revealed partial evidence for reciprocal associations between bedtime routine consistency and adaptive bedtime activities and better sleep outcomes over time. Specifically, more bedtime routine consistency predicted less nighttime waking and sleep problems, and more bedtime adaptive activities predicted longer sleep duration and fewer sleep problems.

DISCUSSION

The findings are discussed from a developmental perspective to highlight how consistency of bedtime routines established as early as three months of age may affect sleep outcomes and that the adaptive activities associated with these routines may increase in frequency over the first two years of life.

The contribution of good sleep to working memory in preschool: A matter of sleep quality or duration?

Good sleep is essential for efficient cognitive performance. The present research examined the link between sleep and working memory (WM) during early childhood, a period of major advances in neurodevelopment. The sample included 80 healthy children, 40 3-year-olds and 40 4-year-olds, attending childcare settings. The children were individually tested using WM tasks; parents completed sleep questionnaires. On a group level, WM improved with age. Process model analysis demonstrated the effect of age on WM (P=0.001) and indicated an age-specific involvement of sleep quality (P=0.01). Whereas sleep duration was not associated with WM, at 4years of age, sleep disturbance with physical symptoms (e.g., breathing, motor) was associated with poor WM performance. Among 3-year-old girls, fear-related sleep disruption was associated with better WM performance. Together, the results suggest that the association between sleep and WM is dependent on: (a) specific aspects of sleep, (b) age, and (c) gender. More research is essential for unraveling the underlying neuro-maturational processes and mechanisms.

Late bedtime and body mass index gain in indigenous Australian children in the longitudinal study of indigenous children

AIM

To explore sleep patterns in indigenous Australian children and assess the role of sleep timing in longitudinal changes in body mass index (BMI).

METHODS

Latent profile analysis was conducted with the Australian Longitudinal Study of Indigenous Children (LSIC) cohort data (wave 5), to determine distinct patterns of bed and wake timing, taking account of weekday sleep duration, weekday and weekend bedtimes, and weekday wake times. Multilevel models with a random intercept were used to investigate the role of baseline sleep pattern in predicting longitudinal changes in BMI.

RESULTS

Baseline data for 1258 children (50.7% males), mean age 6.32 ± 1.52 years, indicated the presence of five classes of sleep patterns: early/long sleepers (4.5%), normative sleepers (25.5%), late sleepers (49.9%), consistent late sleepers (11.1%) and early risers (9%). Late sleeping was significantly associated with longitudinal gains in BMI. Compared with early sleepers, consistent late sleepers experienced 1.03 unit gain in BMI at follow-up (95% CI: 0.001-2.05, P = .05).

CONCLUSION

This study underscores the importance of looking beyond sleep duration and highlights the positive outcomes of early bedtimes in children. As sleep timing is modifiable, this offers the opportunity for improvement in sleep and protecting against future weight gain in indigenous children.

Sleep across early childhood: implications for internalizing and externalizing problems, socioemotional skills, and cognitive and academic abilities in preschool

BACKGROUND

Sleep is thought to be important for behavioral and cognitive development. However, much of the prior research on sleep's role in behavioral/cognitive development has relied upon self-report measures and cross-sectional designs.

METHODS

The current study examined how early childhood sleep, measured actigraphically, was developmentally associated with child functioning at 54 months. Emphasis was on functioning at preschool, a crucial setting for the emergence of psychopathology. Participants included 119 children assessed longitudinally at 30, 36, 42, and 54 months. We examined correlations between child sleep and adjustment across three domains: behavioral adjustment (i.e., internalizing and externalizing problems), socioemotional skills, and academic/cognitive abilities. We further probed consistent associations with growth curve modeling.

RESULTS

Internalizing problems were associated with sleep variability, and cognitive and academic abilities were associated with sleep timing. Growth curve analysis suggested that children with more variable sleep at 30 months had higher teacher-reported internalizing problems in preschool and that children with later sleep timing at 30 months had poorer cognitive and academic skills at 54 months. However, changes in sleep from 30 to 54 months were not associated with any of the domains of adjustment.

CONCLUSIONS

Findings indicate that objectively measured sleep variability and late sleep timing in toddlerhood are associated with higher levels of internalizing problems and poorer academic/cognitive abilities in preschool.

Variations in longitudinal sleep duration trajectories from infancy to early childhood

OBJECTIVE

This study investigates variations in night, day, and total sleep trajectories across infancy and childhood in Asian children.

PARTICIPANTS

Participants consisted of a subset of 901 children, within the Growing Up in Singapore Towards healthy Outcomes cohort, which recruited 1247 pregnant women between June 2009 and September 2010.

DESIGN

We used a novel conditional probabilistic trajectory model: a probabilistic model for mixture distribution, allowing different trajectory curves and model variances among groups to cluster longitudinal observations. Longitudinal sleep duration data for the trajectory analyses were collected from caregiver-reported questionnaires at 3, 6, 9, 12, 18, 24, and 54 months.

RESULTS

We found 3 patterns of night sleep trajectories (n = 356): long consistent (31%), moderate consistent (41%), and short variable (28%); and 4 patterns of day sleep trajectories (n = 347): long variable (21%), long consistent (20%), moderate consistent (34%), and short consistent (25%). We also identified 4 patterns of total sleep trajectories (n = 345): long variable (19%), long consistent (26%), moderate consistent (28%), and short variable (27%). Short, moderate, and long trajectories differed significantly in duration. Children with consistent trajectories also displayed sleep patterns that were significantly more representative of typical developmental sleep patterns than children with variable trajectories.

CONCLUSIONS

This is the first study to describe multiple sleep trajectories in Singaporean children and identify between-individual variability within the trajectory groups. Compared to predominantly Caucasian samples, night/total sleep trajectories were generally shorter, while day sleep trajectories were longer. Future studies should investigate how these variations are linked to different developmental outcomes.

Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Sleep disordered breathing (SDB) in neonates and implications for its long-term impact

Sleep-disordered breathing (SDB) is a significant cause of morbidity in neonates and young infants. SDB occurs more commonly in preterm infants and in neonates with underlying syndromes. Recent evidence shows that infants with obstructive sleep apnoea (OSA) or SDB have greater health care resource utilization, including longer hospital stay. Management of SDB includes non-invasive ventilation or surgical interventions tailored to the patient. Screening high risk newborns should allow for early diagnosis and timely therapeutic intervention for this population. However, the thresholds for diagnosing SDB and for guiding and implementing treatment in neonates remain unclear. A collective effort is required to standardize the practice worldwide. This article will discuss neonatal sleep physiology and characteristics of neonatal sleep, with an emphasis on the epidemiology and diagnosis of SDB in neonates and its implications for long term outcomes.

Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective

Although the influence of sleep on epilepsy has long been recognized, this relationship has yet to be fully exploited to benefit patients. The past decade has seen significant advances in understanding paediatric sleep, providing a framework by which to properly evaluate the sleep of children with epilepsy, which itself has been subject to increasing scrutiny. The role of sleep in learning and the potential for interictal discharges to disrupt sleep-related memory consolidation provide a novel perspective for understanding the association of childhood epilepsy with a high rate of intellectual disability. In this review, I outline the evolution of sleep duration, architecture, and homeostasis across childhood, relating this to the development of cognitive functions. I describe how these may be disrupted or preserved in children with epilepsy; in particular, collating data from polysomnography. Finally, I explore how sleep may, in the future, be modulated to improve cognitive outcome in these patients. WHAT THIS PAPER ADDS: Children with epilepsy have less rapid eye movement sleep than controls, but this improves with seizure cessation. Deep or slow-wave sleep is highly conserved in children with epilepsy. Sleep homeostasis may be disrupted either at a local or global level by the presence of interictal epileptiform discharges.

Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children

Background

Excessive engagement with digital screens is harmful to children’s health. However, new evidence suggests that exposure at moderate levels may not be harmful and may even provide benefit. Therefore, our objective was to determine if there are curvilinear relationships between different types of screen time and a diverse set of outcomes, including health and education.

Methods

We address our objective using a repeated measures design. Children (N = 4013), initially aged 10–11 were assessed every 2 years between 2010 and 2014. Children’s screen time behavior was measured using time-use diaries, and categorized into five types: social, passive, interactive, educational, or other. We used measures of children’s physical health, health-related quality of life, socio-emotional outcomes, and school achievement. The analysis plan was pre-registered. Models were adjusted for gender, socio-economic status, ethnicity, number of siblings, and housing factors.

Results

There were linear associations between total screen time and all outcomes, such that more screen time was associated with worse outcomes. However, there was variability when examined by screen time type. Passive screen time (e.g., TV) was associated with worse outcomes, educational screen time (e.g., computer for homework) was associated with positive educational outcomes and had no negative relations with other outcomes. Interactive screen time (e.g., video games) had positive associations with educational outcomes but negative associations with other outcomes. In all instances, these significant associations were small or very small, with standardised effects < 0.07. We found little evidence of curvilinear relationships.

Conclusions

The small effects of screen time on children’s outcomes appear to be moderated by the type of screen time. Policy makers, educators, and parents should consider the type of screen time when considering the benefits and harms of use.

Mothers' postpartum sleep disturbance is associated with the ability to sustain sensitivity toward infants

BACKGROUND/OBJECTIVE

Infancy is a period of rapid development when the quality of caregiving behavior may be particularly consequential for children's long-term functioning. During this critical period for caregiving behavior, parents experience changes in their sleep that may affect their ability to provide sensitive care. The current study investigated the association of mothers' sleep disturbance with both levels and trajectories of maternal sensitivity during interactions with their infants.

METHODS

At 18 weeks postpartum, mothers and their infants were observed during a home-based 10-minute "free play" interaction. Mothers' nighttime sleep was objectively measured using actigraphy and subjectively measured using sleep diaries. Maternal sensitivity was coded in two-minute intervals in order to characterize changes in sensitivity across the free play interaction. We used exploratory factor analysis to reduce the dimensionality of the objective and subjective measures of mothers' sleep, identifying a subjective sleep disturbance and an objective sleep continuity factor.

RESULTS

Using multi-level modeling, we found that mothers with poorer objective sleep continuity evidenced decreasing sensitivity toward their infants across the interaction. Mothers' self-reports of sleep disturbance were not associated with maternal sensitivity.

CONCLUSIONS

Although future research is necessary to identify the mechanisms that may explain the observed association between poor sleep continuity and the inability to sustain sensitivity toward infants, mothers' postpartum sleep continuity may be one factor to consider when designing interventions to improve the quality of caregiving.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov, NCT01846585.

Sleep and Behavior Problems in Children With Epilepsy

We designed a cross-sectional study to examine the association between sleep and behavior problems in toddlers and preschool-age children with epilepsy. We found that 71 (78.9%) children slept less than 10 hours in a 24-hour period according to the actigraphy, with 75 (83.3%) children waking for more than an hour during nocturnal sleep. Twenty-five (27.8%) children usually or sometimes had an inconsistent bedtime, and 24 (26.7%) did not sleep the same amount each day. Twenty-nine (32.2%) and 18 (20.0%) children had an internalizing and externalizing problem in clinical range, respectively. Sleep anxiety was significantly (p < .01) associated with increased internalizing and externalizing problems, even after the relevant epilepsy variables were controlled for. Findings from our study suggest that screening of sleep and behavior problems should be part of routine epilepsy care to identify children with problematic sleep and unrecognized sleep disorders and those at risk of behavioral dysfunction.

Prevalence of night sleep duration, sleep quality and sleep hygiene practices among children attending childcare services in New South Wales, Australia

AIM

To describe parent-reported child: (i) sleep duration; (ii) sleep quality; (iii) sleep hygiene practices; and (iv) the proportion of children meeting sleep duration recommendations.

METHODS

A convenience sample of parents of Australian pre-school-aged children (3-5 years) were surveyed from the Hunter New England region of New South Wales. The cross-sectional survey was conducted via computer-assisted telephone interview. The survey assessed parent and child demographic characteristics and parent-reported child sleep duration, quality and sleep hygiene practices.

RESULTS

A total of 488 eligible parents or guardians took part in the study. Parents reported that children slept an average of 11.03 h per night. Approximately 96% of children met daily sleep duration recommendations from sleep guidelines for their age group. The majority of parents reported that their child had 'good' sleep quality (86.89%). Almost 40% reported that their child woke at least once a night. Sleep hygiene practices were relatively well established; however, a small proportion of parents indicated that they had no rules surrounding bedtime (13.52%) or television use before bed (14.52%).

CONCLUSIONS

The current study describes the sleep duration, quality and sleep hygiene practices of a sample of pre-school-aged children in New South Wales, Australia. Future research using objective measures of sleep duration and hygiene, as well as assessing a broader spectrum of sleep hygiene practices, is needed.

Cerebrospinal fluid flow increases from newborn to adult stages

Solute transport through the brain is of major importance for the clearance of toxic molecules and metabolites, and it plays key roles in the pathophysiology of the central nervous system. This solute transport notably depends on the cerebrospinal fluid (CSF) flow, which circulates in the subarachnoid spaces, the ventricles and the perivascular spaces. We hypothesized that the CSF flow may be different in the perinatal period compared to the adult period. Using in vivo magnetic resonance imaging (MRI) and near-infrared fluorescence imaging (NIRF), we assessed the dynamic of the CSF flow in rodents at different ages. By injecting a contrast agent into the CSF, we first used MRI to demonstrate that CSF flow gradually increases with age, with the adult pattern observed at P90. This observation was confirmed by NIRF, which revealed an increased CSF flow in P90 rats when compared with P4 rats not only at the surface of the brain but also deep in the brain structures. Lastly, we evaluated the exit routes of the CSF from the brain. We demonstrated that indocyanine green injected directly into the striatum spread throughout the parenchyma in adult rats, whereas it stayed at the injection point in P4 rats. Moreover, the ability of CSF to exit through the nasal mucosa was increased in the adult rodents. Our results provide evidence that the perinatal brain has nonoptimal CSF flow and exit and, thus, may have impaired clean-up capacity. © 2018 Wiley Periodicals, Inc. Develop Neurobiol, 2018.

Discrepancies in maternal reports of infant sleep vs. actigraphy by mode of feeding

OBJECTIVES

Many studies of infant sleep rely solely on parentally-reported data, assuming that parents accurately report their infant's sleep parameters. The objective of this paper is to examine whether night-time sleep parameters of exclusively breastfed or exclusively formula-fed infants differ, and whether correspondence between parental reports and objective measures varies by feeding type.

METHODS

Mother-infant dyads intending to breastfeed or formula-feed exclusively for 18 weeks were recruited. Mothers were multiparas and primiparas, aged between 18 and 45 years. Infants were full-term, normal birthweight singletons. Maternal report and actigraphic data on infant sleep were collected fortnightly, from four to 18 weeks postpartum. Data were analysed cross-sectionally using t-tests and GLM analysis to control for interaction between feed-type and sleep location.

RESULTS

Actigraphy-assessed infant sleep parameters did not vary by feed-type but parentally reported sleep parameters did. Maternal report and actigraphy data diverged at 10 weeks postpartum and discrepancies were associated with infant feeding type. Compared to actigraphy, maternal reports by formula-feeding mothers (controlling for infant sleep location) over-estimated infant's Total Sleep Time (TST) at 10 weeks and Longest Sleep Period (LSP) at 10, 12 and 18 weeks.

CONCLUSIONS

These results raise questions about the outcomes of previous infant sleep studies where accuracy of parentally-reported infant sleep data is assumed. That parental reports of infant sleep vary by feeding type is particularly important for reconsidering previous studies of infant sleep development and intervention studies designed to influence sleep outcomes, especially where feed-type was heterogeneous, but was not considered as an independent variable.

Infant sleep and the influence of a pacifier

BACKGROUND

Divergent opinions are found in the literature regarding the use of a pacifier. During the longitudinal follow-up of children, health professionals must take a position on this issue and offer clear information regarding the pros and cons of pacifier use so that parents/caregivers can feel comfortable enough to make their own decision.

AIM

Evaluate the beneficial effects of pacifier use on the sleep quality of infants.

DESIGN

A cross-sectional study was conducted at public day care centres in the city of Recife, Brazil. Interviews were held with 157 mothers of infants aged five to 13 months. Data were collected on the mother's and child's profiles. Child's sleep quality was determined using the Brief Infant Sleep Questionnaire.

RESULTS

The results demonstrated no statistically significant differences between the group that used a pacifier and the group that did not use a pacifier with regard to sleep variables of the child.

CONCLUSIONS

When deciding whether or not to permit pacifier use, the infant's sleep quality should not be considered a critical factor.

Sleep Patterns in Chinese Preschool Children: A Population-Based Study

STUDY OBJECTIVES

This study aimed to (1) provide data on normal sleep patterns in Chinese preschool children, (2) identify cross-cultural differences of sleep patterns among children from China and other countries, (3) estimate the prevalence of sleep duration not meeting the optimal amount, and (4) characterize delayed weekend sleep pattern.

METHODS

A population-based sample of 1,610 children aged 3-6 years was recruited from 10 cities across China. Parents completed questions about their child's sleep patterns adapted from the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

The mean bedtime was 9:31 PM, wake time was 7:27 AM, nighttime sleep duration was 9 hours 30 minutes, daytime sleep duration was 1 hour 31 minutes, and total sleep duration was 11 hours 2 minutes. The children had a shorter nighttime sleep duration but longer daytime naps, resulting in no differences in total sleep duration compared with counterparts predominantly in the west. Of the children, 85.3% met the recommended amount of sleep of 10 to 13 hours, and 10.8% slept fewer than 10 hours. The prevalence of sleep less than 10 hours was higher in older children and children from eastern China. Children went to bed and woke up more than 30 minutes later on weekends than weekdays, accounting for 40.1% and 50%, respectively. Children in western China showed longer delay than children in eastern China (P < .05).

CONCLUSIONS

Age- and region-specific variability of sleep patterns are reported as well as insufficient sleep and delayed weekend sleep pattern in Chinese preschool children. The cross-cultural difference of sleep patterns was in temporal placement rather than sleep duration.

Association between short sleep duration and body mass index in Australian Indigenous children

AIM

Associations between short sleep duration and obesity and the relationship between obesity and chronic illness are well documented. Obese children are likely to become obese adults. To date, there is a paucity of information regarding sleep duration and quality for Indigenous Australian people. It may be that poor-quality, short sleep is contributing to the gap in health outcomes for Indigenous people compared with non-Indigenous adults and children. This study sought to investigate the possibility that poor sleep quality may be contributing to health outcomes for Indigenous children by exploring associations between sleep duration and body mass index (BMI).

METHODS

Participants included 1253 children aged 7-12 years in Wave 7 of the national Longitudinal Study of Indigenous Children survey. Interviewers asked primary carers about children's sleep times. BMI was derived from measurements of children made by researchers.

RESULTS

Regardless of age, relative socio-economic disadvantage and level of remoteness, unhealthy weight was associated with less sleep duration than healthy weight for Indigenous children.

CONCLUSION

The relationship between short sleep duration and BMI in Indigenous children has important implications for their future health outcomes. Both overweight conditions and short sleep are established modifiable risk factors for metabolic dysfunction and other chronic illnesses prominent in the Indigenous population. It is important to consider strategies to optimise both for Indigenous children in an attempt to help 'close the gap' in health outcomes and life expectancy between Indigenous and non-Indigenous people.

Agreement Between Actigraphy and Diary-Recorded Measures of Sleep in Children With Epilepsy

PURPOSE

To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings.

DESIGN

Cross-sectional study.

METHODS

Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends.

FINDINGS

Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent.

CONCLUSIONS

Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary.

CLINICAL RELEVANCE

Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.

A different rhythm of life: sleep patterns in the first 4 years of life and associated sociodemographic characteristics in a large Brazilian birth cohort

Objective

Sleep is an important marker of healthy development and has been associated with emotional, behavioral, and cognitive development. There is limited longitudinal data on children's sleep with only a few reports from low- and middle-income countries (LMICs). We investigate sleep parameters and associated sociodemographic characteristics in a population-based longitudinal study in Pelotas, Brazil.

Methods

Data from the Pelotas 2004 Birth Cohort were used (N = 3842). Infant sleep was collected through maternal report at 3, 12, 24, and 48 months: sleep duration, bed and wake time, nighttime awakenings, co-sleeping and sleep disturbances (24 and 48 months).

Results

Compared to children in high-income countries (HICs), children in Brazil showed a substantial shift in rhythms with later bed and wake times by approximately 2 hours. These remain stable throughout the first 4 years of life. This population also shows high levels of co-sleeping which remain stable throughout (49.0–52.2%). Later bedtime was associated with higher maternal education and family income. Higher rates of co-sleeping were seen in families with lower income and maternal education and for children who were breastfed. All other sleep parameters were broadly similar to data previously reported from HICs.

Conclusion

The shift in biological rhythms in this representative community sample of children in Brazil challenges our understanding of optimal sleep routine and recommendations.

•

Biological rhythms are shifted with later bedtime by approximately 2 h (22.18 hours).

•

Later bedtime is associated with higher maternal education and family income.

•

High levels of co-sleeping are prevalent until 4 years of age (49% at 3 months to 52% at 4 years).

•

Co-sleeping was more prevalent in families with lower income and maternal education.

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

Policy provision for naps is typical in child care settings, but there is variability in the practices employed. One practice that might modify children's early sleep patterns is the allocation of a mandatory nap time in which all children are required to lie on their beds without alternate activity permitted. There is currently limited evidence of the effects of such practices on children's napping patterns. This study examined the association between duration of mandatory nap times and group-level napping patterns in child care settings. Observations were undertaken in a community sample of 113 preschool rooms with a scheduled nap time (N = 2,114 children). Results showed that 83.5% of child care settings implemented a mandatory nap time (range = 15-145 min) while 14.2% provided alternate activities for children throughout the nap time period. Overall, 31% of children napped during nap times. Compared to rooms with ≤ 30 min of mandatory nap time, rooms with 31-60 min and > 60 min of mandatory nap time had a two-and-a-half and fourfold increase, respectively, in the proportion of children napping. Nap onset latency did not significantly differ across groups. Among preschool children, exposure to longer mandatory nap times in child care may increase incidence of napping.

Diet and nutrients in the modulation of infant sleep: A review of the literature

OBJECTIVES

The establishment of organized sleep patterns is an important developmental process during infancy. Little is known about the role of nutrition in sleep maturation. This review focuses on exploring the link between infant sleep and nutrition with the aim to provide an overview of existing literature on the impact of diet and specific nutrients on sleep modulation in infants.

METHODS

An exploratory literature search was performed on the topic in Medline, Scopus and Cochrane Library databases, with a focus on publications in English.

RESULTS

Both the type of nutrients consumed and the timing at which they were consumed, relative to sleeping time, have been reported to influence infant sleep. Some nutrients have been shown to naturally fluctuate in maternal breast milk with circadian rhythm, and nutrients such as tryptophan, nucleotides, essential fatty acids and Omega-3 long-chain fatty acids have been suggested to impact infant sleep.

DISCUSSION

In summary, little is known about the nutritional impact on infant sleep and sleep maturation, particularly with regard to specific nutrients. While nutrients like tryptophan and nucleotides seem to impact sleep at the level of brain activity, some fatty acids may affect sleep as a result of their role in supporting the maturity of the central nervous system. In our view, the existing literature indicates that the link between nutrition and infant sleep may be a promising concept to support this crucial phase of early development.

The Objective Measurement of Brace-Use Adherence in the Treatment of Idiopathic Clubfoot

BACKGROUND

A successful outcome for the treatment of idiopathic clubfoot is believed to require adequate adherence to brace use. Previous studies have relied on parental reporting of brace application. We used temperature sensors to determine the adherence to the bracing protocol, the accuracy of parent-reported use, and differences in adherence between patients who experienced relapse of deformity and those who did not.

METHODS

Using wireless sensors attached to brace sandals, we monitored brace wear over a 3-month period in this cross-sectional study involving 48 patients in 4 age-based groups: 6 to 12 months (Group 1), >1 to 2 years (Group 2), >2 to 3 years (Group 3), and >3 to 4 years (Group 4). Parents were blinded to the purpose of the sensors. The mean number of hours of daily brace use as measured by the sensors was compared with the physician-recommended hours and parent-reported hours of brace use.

RESULTS

Sensors were retrieved from 44 of 48 patients. Overall, the median brace use recorded by the sensors was 62% (range, 5% to 125%) of that recommended by the physician, and 77% (range, 6% to 213%) of that reported by the parents. For Groups 1 to 3, the difference between the physician-recommended and measured number of hours of daily brace use was significant (p ≤ 0.002), and the difference between the parent-reported and measured number of hours of daily brace use was also significant (p ≤ 0.013). Eight (18%) of the 44 patients who completed the study experienced relapse during the period of monitoring; most importantly, the mean number of hours of brace wear for these patients, 5 hours per day (median, 4; and standard deviation [SD], 3 hours per day) was significantly lower than the 8 hours per day for those who did not experience relapse (median, 9; and SD, 5 hours per day) (p = 0.045).

CONCLUSIONS

The present study objectively quantified the number of daily hours of post-corrective brace wear for patients with clubfoot in varying age groups and provides an estimate of the number of hours required to avoid relapse.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective assessment of sleep status and its correlates in hospitalized children with cancer: Exploratory study

BACKGROUND

Children with cancer are known to have sleep problems. Although hospitalization and psychosocial factors are considered to be the factors affecting children's sleep, few studies have confirmed these effects. The aims of this study were to describe the sleep status of hospitalized children with cancer and to explore the correlates.

METHODS

The sleep status of 11 hospitalized children (aged 2-12 years) with cancer was measured using actigraph and sleep diary during hospitalization and a short home stay. Possible correlates were assessed using a questionnaire.

RESULTS

The participants had significantly longer sleep onset latency, earlier bedtime, and poorer self-evaluated sleep quality during hospitalization than the short home stay. They had shorter total sleep time, longer wake time after sleep onset, and less sleep efficiency at home, compared with healthy historical controls. Children's age, symptoms, hospitalization period, Cognitive Fatigue, Procedural Anxiety, Treatment Anxiety, Social Anxiety, and Separation Anxiety, as well as caregiver anxiety, Receptive and Focused Attitude, and Regimented Attitude were significantly correlated with sleep variables.

CONCLUSIONS

Hospitalization decreased self-evaluated sleep quality, and difficulty falling asleep. The sleep of the participants at home was disturbed compared with that of healthy children. Hospitalization, patient characteristics, disease-related, and some psychosocial factors were associated with sleep variables. Medical professionals should develop a favorable environment for falling asleep in hospital for individual children. Children with cancer in the early period of hospitalization need increased care to facilitate good sleep.

Sleep timing and child and parent outcomes in Australian 4-9-year-olds: a cross-sectional and longitudinal study

OBJECTIVES

The aim of this study is to use national Australian time-diary data to examine both (1) cross-sectionally and (2) longitudinally whether being late versus early to sleep or wake is associated with poorer child behavior, quality of life, learning, cognition and weight status, and parental mental health.

METHODS

DESIGN/SETTING

Data from the first three waves of the Longitudinal Study of Australian Children were taken.

PARTICIPANTS

A national representative sample of 4983 4-5-year-olds, recruited in 2004 from the Australian Medicare database and followed up biennially, was taken; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave.

MEASURES

EXPOSURE

Parents completed 24-h child time-use diaries for one week and one weekend day at each wave. Using median splits, sleep timing was categorized into early-to-sleep/early-to-wake (EE), early-to-sleep/late-to-wake (EL), late-to-sleep/early-to-wake (LE), and late-to-sleep/late-to-wake (LL) at each wave.

OUTCOMES

The outcomes included parent-reported child behavior, health-related quality of life, maternal/paternal mental health, teacher-reported child language, literacy, mathematical thinking, and approach to learning. The study assessed child body mass index and girth.

RESULTS

(1) Using EE as the comparator, linear regression analyses revealed that being late-to-sleep was associated with poorer child quality of life from 6 to 9 years and maternal mental health at 6-7 years. There was inconsistent or no evidence for associations between sleep timing and all other outcomes. (2) Using the count of the number of times (waves) at which a child was categorized as late-to-sleep (range 0-3), longitudinal analyses demonstrated that there was a cumulative effect of late-to-sleep profiles on poorer child and maternal outcomes at the child age of 8-9 years.

CONCLUSIONS

Examined cross-sectionally, sleep timing is a driver of children's quality of life and maternal depression. Examined longitudinally, there appears to be cumulative and adverse relationships between late-to-sleep profiles and poorer child and maternal outcomes at the child age of 8-9 years. Understanding how other parameters - such as scheduling consistency, sleep efficiency and hygiene - are also related to child and parent outcomes will help health professionals better target sleep management advice to families.