Toddler Bedtime Routines and Associations With Nighttime Sleep Duration and Maternal and Household Factors

Trajectories of Housing Insecurity From Infancy to Adolescence and Adolescent Health Outcomes

BACKGROUND AND OBJECTIVES

Housing insecurity is associated with adverse effects on child growth and development cross-sectionally; less is known about its cumulative, long-term effects. This study describes longitudinal experiences of housing insecurity during childhood from infancy (age 1 year) to adolescence (age 15 years) and examines their associations with adolescent health outcomes.

METHODS

Using data from the Future of Families and Child Wellbeing Study, we created a composite measure of housing insecurity using 5 indicators (eg, skipping a rent or mortgage payment, eviction) for participants at ages 1, 3, 5, 9, and 15 years. We used group-based trajectory modeling to identify distinct patterns of housing insecurity, sociodemographic predictors of these patterns, and how these patterns relate to adolescent health outcomes.

RESULTS

We identified 3 trajectories of housing insecurity from infancy to adolescence: secure, moderately insecure, and highly insecure. Adolescents who experienced moderately and highly insecure housing had decreased odds of excellent health (adjusted odds ratio, 0.81; 95% confidence interval [CI], 0.69-0.95; adjusted odds ratio, 0.67; 95% CI, 0.50-0.92, respectively) and more depressive symptoms (adjusted incidence rate ratio, 1.05; 95% CI, 1.02-1.08; 1.13; 95% CI, 1.08-1.19, respectively) than adolescents with secure housing. Adolescents who experienced highly insecure housing reported significantly higher anxiety symptoms (adjusted incidence rate ratio, 1.05; 95% CI, 1.003-1.113).

CONCLUSIONS

Housing insecurity starting in infancy was associated with poorer adolescent health outcomes. These longitudinal patterns emphasize the need for novel screening mechanisms to identify housing insecurity when it emerges, as well as policies to prevent housing insecurity and its associated health outcomes.

The sleep problems in individuals with Rett syndrome and their caregivers

LAY ABSTRACT

Sleep problems are common and impactful among individuals with Rett syndrome (RTT) and their caregivers. We examined the sleep patterns of 29 RTT patients and their primary caregivers using various assessment tools. The study found that a majority of the patients experienced sleep disturbances, with younger patients showing more sleep difficulties. Caregivers also reported poor sleep quality. The findings emphasize the need to address sleep problems in RTT management, as improving sleep quality can positively impact the well-being of individuals with RTT and their caregivers.

Mental health and lifestyle behavior changes during COVID-19 among families living in poverty: A descriptive phenomenological study

PROBLEM

Families living in poverty may be particularly vulnerable to the deleterious effects of the coronavirus disease (COVID-19). The current study focuses on caregivers of preschoolers aged 3-5 years old who lived in poverty to explore how COVID-19 affected mental health and lifestyle behaviors and what coping strategies were helpful for dealing with challenges induced by COVID-19.

METHODS

A qualitative study was conducted using individual semi-structured interviews with 17 caregivers.

FINDINGS

Both caregivers and preschoolers experienced high levels of stress, anxiety, and depression and reported unhealthy eating habits and excessive screen time. Physical activity increased in preschoolers, but declined among caregivers during COVID-19. Caregivers' coping strategies included taking short walks, seeking professional and social support, and praying; avoidant caregiver coping strategies including eating when stressed and increased screen time.

CONCLUSIONS

Future interventions are warranted to empower caregivers who live in poverty with the skills needed to maintain optimal physical and mental health, as well as assisting them to cope with challenges that may continue post-COVID-19.

Relationship between bedtime, nighttime sleep duration, and anxiety symptoms in preschoolers in China

Background

Sleep problems in preschoolers are becoming increasingly prominent, and the association between sleep status and anxiety symptoms has attracted growing attention. However, studies investigating the relationship between bedtime and nighttime sleep duration in preschoolers and their anxiety symptoms remain scant. We used the large sample data from the Longhua Cohort Study of Children in Shenzhen, China (LCCS) to analyze the association between bedtime and sleep in preschoolers and their anxiety symptoms.

Methods

A cross-sectional study of 69,138 preschoolers in Longhua District, Shenzhen, China was conducted in 2022. Data on sociodemographic characteristics of families, bedtime, nighttime sleep duration of preschoolers, and their anxiety symptoms (measured by the Spence Preschool Children Anxiety Scale) were collected through a structured questionnaire completed by the parents. Using binary logistic regression models, the relationship between bedtime, nighttime sleep duration, and childhood anxiety symptoms was examined.

Results

The bedtimes of preschoolers were concentrated between 21:01-22:00 (52.41%). Among the preschoolers, 38.70% had bedtimes later than 22:00, and 75.49% had insufficient nighttime sleep duration. The positive screening rate for anxiety symptoms among preschoolers was 3.50%. After adjusting for confounding factors using binary logistic regression models, compared with preschoolers with bedtime ≤21:00, The OR (95%CI) values of anxiety in preschoolers with bedtime ≥23:01, 22:01-23:00 and 21:01-22:00 were 2.86 (2.21-3.69), 1.51 (1.27-1.79) and 1.48 (1.26-1.76), respectively. Compared with those with sufficient nighttime sleep duration, the OR (95%CI) of children with nighttime sleep duration less than 9 h was 1.36 (1.23-1.51).

Conclusion

An association exists between bedtime and nighttime sleep duration in preschoolers and their anxiety symptoms. Preschoolers with 21:00 for bedtime and a nighttime sleep duration of 10 h may have lower anxiety symptoms. These findings support the importance of adequate sleep for preventing anxiety symptoms in children.

Social Capital and Sleep Outcomes Across Childhood in United States Families

OBJECTIVE

To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income.

METHODS

Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration.

RESULTS

In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime.

CONCLUSIONS

Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes.

What daily factors affect the sleep habits of Japanese toddlers?

STUDY OBJECTIVES

Good sleep, especially during early childhood, is important for development. In Japan, the mean nocturnal sleep duration of toddlers is < 10 hours, and even if toddlers slept for > 11 hours/day, as recommended by the National Sleep Foundation, some of them showed late bedtime and late wake-up time or took long naps. Therefore, we provisionally assumed the minimal sleep conditions for Japanese toddlers, named Nenne-criteria, such as bedtime before 10:00 pm, nocturnal sleep duration of ≥ 9 hours, and < 1 average time of awakening after sleep onset, and investigated the important factors for good sleep.

METHODS

We analyzed cross-sectional data from online surveys describing the sleep-related behaviors of 2,124 toddlers and their caregivers. We compared the daily schedules that affect sleep between the Nenne-criteria-meet group and the not-meet group.

RESULTS

The Nenne-criteria-meet group showed better daytime behaviors than the not-meet group. Structural equation modeling on daily schedules revealed that, to increase sleep pressure at the appropriate time, it is important to restrict media viewing, play outdoors in the morning, have an early nap ending time, avoid hyperarousal-inducing behaviors before bedtime, maintain daily schedules regularly, and decrease social jetlag.

CONCLUSIONS

The Nenne-criteria are useful for screening Japanese toddlers who require intervention for sleep hygiene. To improve toddlers' sleep, it is important not only to guide the ideal bedtime but also to provide tips for improving daily schedules and to avoid suboptimal sleep-related behaviors.

CITATION

Murata E, Yoshizaki A, Fujisawa TX, Tachibana M, Taniike M, Mohri I. What daily factors affect the sleep habits of Japanese toddlers? J Clin Sleep Med. 2023;19(6):1089-1101.

Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study

BACKGROUND

Exposure to environmental risk factors increases the negative impact maltreatment has on children's development. Sleep ecology (i.e., sleep hygiene and home sleeping conditions) can be one of these factors. Poor sleep hygiene and suboptimal home sleeping conditions can alter sleep characteristics, which in turn, may lead to behavior problems (BPs), highly prevalent in maltreated preschoolers.

OBJECTIVES

Describe sleep ecology in maltreated preschoolers and explore associations between their sleep ecology, objective sleep characteristics and BPs.

METHOD

Parents (n = 22) completed the Children's Sleep Hygiene Scale (CSHS), and a sleep environment questionnaire to document sleep ecology. Children wore an actigraph to record objective sleep characteristics. Parents completed the Behavioral Assessment Scale for Children (BASC-2) to assess children's BPs. Descriptive and correlational analyses were performed.

RESULTS

Most of the parents (90.5 %) reported adequate sleep hygiene. However, 20 parents (95.2 %) reported suboptimal home sleeping conditions. Better physiological and overall sleep hygiene were related to earlier sleep onset. Better emotional sleep hygiene was associated with shorter nighttime awakenings and better sleep efficiency. Later sleep onset was associated with lower anxiety, and longer 24-hour sleep duration with higher somatization. Better physiological sleep hygiene was associated with less depression, and better emotional sleep hygiene with less hyperactivity.

CONCLUSION

This study showed that sleep hygiene could be associated with maltreated preschoolers' sleep characteristics and BPs, and that their home sleeping conditions may be of concern. Associations between sleep ecology, objective sleep characteristics and BPs deserve to be better understood, and further explored.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Associations between cumulative risk, childhood sleep duration, and body mass index across childhood

Background

Although associations between cumulative risk, sleep, and overweight/obesity have been demonstrated, few studies have examined relationships between these constructs longitudinally across childhood. This study investigated how cumulative risk and sleep duration are related to current and later child overweight/obesity in families across the United States sampled for high sociodemographic risk.

Methods

We conducted secondary analyses on 3690 families with recorded child height and weight within the Fragile Families and Child Well-Being Study. A cumulative risk composite (using nine variables indicating household/environmental, family, and sociodemographic risk) was calculated for each participant from ages 3-9 years. Path analyses were used to investigate associations between cumulative risk, parent-reported child sleep duration, and z-scored child body mass index (BMI) percentile at ages 3 through 9.

Results

Higher cumulative risk experienced at age 5 was associated with shorter sleep duration at year 9, b = − 0.35, p = .01, 95% CI [− 0.57, − 0.11]. At 5 years, longer sleep duration was associated with lower BMI, b = − 0.03, p = .03, 95% CI [− 0.06, − 0.01]. Higher cumulative risk at 9 years, b = − 0.34, p = .02, 95% CI [− 0.57, − 0.10], was concurrently associated with shorter sleep duration. Findings additionally differed by child sex, such that only male children showed an association between sleep duration and BMI.

Conclusions

Results partially supported hypothesized associations between child sleep duration, cumulative risk, and BMI emerging across childhood within a large, primarily low socioeconomic status sample. Findings suggest that reducing cumulative risk for families experiencing low income may support longer child sleep duration. Additionally, child sleep duration and BMI are concurrently related in early childhood for male children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03587-6.

Associations Between Diaper Need and Child Sleep in Under-resourced Families

OBJECTIVE

Sleep is critical for child health, but factors related to poverty create barriers to the achievement of healthful sleep. In this study, we examined the associations of insufficient diaper supply, a measure of material hardship, with child sleep.

METHODS

This cross-sectional study included 129 parents of very young children. Each participant responded to an online material hardship assessment and the Brief Infant Sleep Questionnaire-Revised. Multiple linear regression was used to analyze the relationship between diaper need and sleep.

RESULTS

Controlling for family and socioeconomic variables, diaper need was associated with disrupted, shorter sleep periods (β = -11.95, p < 0.001) and lower total sleep scores (β = -6.49, p = 0.004). High diaper need was associated with parent perception of poor sleep (β = -7.28, p = 0.017).

CONCLUSION

The findings suggest that an inadequate supply of diapers adversely affects children's sleep. Further research should evaluate how screening and connecting families to resources may improve pediatric sleep.

Socioemotional behaviour of toddlers influenced by the sleep patterns: Prevalence study

Background:

This study investigates the influence of sleep duration and sleep patterns on the social-emotional behaviour of 3–70-month-old children.

Methods:

A Brief Infant Sleep Questionnaire (BISQ) and Ages, Stages Questionnaire: Social-Emotional (ASQ:SE) were filled by the participants through a web link. The internal consistency of the items used in the questionnaire was analysed using Cronbach’s alpha and the effects of sleeping disorders on the likelihood of children having social-emotional problems were performed by binary logistic regressions.

Results:

The highest level of bedtime resistance and nocturnal awakening was observed in children of 27–32 months of age, while sleep anxiety was maximum in 42–53-month-old children. The logistic regression models were found to be statistically significant with Χ² (3) =19.556 for 3–8-month-old children, Χ² (3) =11.874 for 9–14-month-old children, Χ² (3) =8.928 for 15–20-month-old children, Χ² (3) =10.061 for 21–26-month-old children and Χ² (3) =38.358 for 54–70-month-old children, P < 0.0005.

Conclusion:

Our findings imply that no statistically significant association was observed between sleep duration and social-emotional problems, however, sleep disorders significantly impacted social-emotional behaviour and also night-waking caused social-emotional behavioural issues in preschoolers.

The Japanese Sleep Questionnaire for preschoolers within a Malaysian context

BACKGROUND

Childhood sleep practices impact growth, development, and long-term health. There is a paucity of sleep data pertaining to preschool children in Asia, especially South-East Asia.

METHODS

This cross-sectional study involved parents of well siblings, aged 2-6 years. It aimed to: (i) test the reliability of the English version of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P), and (ii) obtain the prevalence, as well as describe, sleep-related issues. Ninety-one (91) parents (74.7%; mothers) self-administered the questionnaire in the pediatric clinic waiting area of a Malaysian tertiary hospital. Recruitment was from August to November 2020.

RESULTS

The English version of the JSQ-P has good internal consistency (Cronbach alpha = 0.85). Range of Cronbach alpha values for each item: 0.36-0.87. Many (77%) children slept at 10:00 p.m. or later, similar to parents' late bedtimes. One-third had difficulty waking up in the morning. There were significant strong positive correlations between some features of restless leg syndrome, daytime tiredness, morning symptoms, and obstructive sleep apnea symptoms. Co-sleeping was prevalent (97.9%). Mean screen time for those who had set time limits was 2.35 ± 1.68 h.

CONCLUSIONS

The English-language translation of the JSQ-P is a questionnaire with good internal consistency that can be used in non-Japanese speaking countries. Parents need to be educated on healthy sleep and screen time practices to optimize children's sleep quality and quantity.

Analysis of sleep problem in children aged 1-3 years with autism spectrum disorder in Zhejiang province, China

BACKGROUND

High prevalence of sleep problems have been founded in children with Autism Spectrum Disorder (ASD), with rates ranging from 50 to 80%. We aimed to study the sleep status and the occurrence of sleep problems in children with autism spectrum disorder (ASD) aged 1-3 years, and to provide reference for guiding early comprehensive intervention for ASD children from the perspective of sleep.

METHODS

From January 1 to December 31, 2021, 74 ASD children who met the diagnostic criteria of "Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V)" served as case group while 84 typically-developing children of the same sex and age served as control group. An original Children's Sleep Habit Questionnaire was adopted to compare the sleep status of children in the two groups and to conduct statistical analysis on related factors.

RESULTS

The incidence of sleep problems in the case group (78.4%) was significantly higher than that in the control group (34.5%) (P < 0.001). Compared with the children in the control group, children in the case group had later bedtime (P < 0.05) and less sleep duration (P < 0.05), and required longer time to fall asleep (P < 0.001) The incidence of sleep problems in children who could fall asleep autonomously in the case group was significantly lower than that in children who needed parental help (P < 0.05). In the case group, the longer the screen exposure time, the higher the incidence of sleep problems (P < 0.05).

CONCLUSIONS

The incidence of sleep problems in ASD children aged 1-3 years is also high, mainly manifested in late bedtime, difficulty falling asleep, frequent night awakenings and less sleep duration. Both sleep patterns and screen exposure can impact their sleep. In the early comprehensive intervention of ASD children, it is necessary to pay full heed to their sleep status and take timely intervention measures in order to improve the quality of life for the ASD children and their families.

Bedtime Routines of Young Children, Parenting Stress, and Bedtime Resistance: Mediation Models

This study examined if inconsistent bedtime routines are a mechanism through which high levels of parenting stress are related to bedtime resistant behaviors. Bedtime resistant behavior is a common problem in young children. Although previous studies have linked parenting stress to problematic behaviors at bedtime, understanding how and why that may be has been subject to limited empirical investigation. Caregivers (N = 118) of a child age 2-5 were recruited on Amazon's mechanical turk. There was a significant indirect effect of parenting stress on bedtime resistance through bedtime routines as well as a significant indirect effect of bedtime routines on bedtime resistant behavior through parenting stress. These findings suggest that there is a bidirectional relationship between inconsistent routines and parenting stress. Clinically, these results suggest that implementing a consistent routine at bedtime may improve both parent (less stress) and child (less bedtime resistance) functioning.

Sleep in times of crises: A scoping review in the early days of the COVID-19 crisis

During the early days of the pandemic and in the context of a seemingly unknown global threat, several potential major sleep disruptors were identified by sleep researchers and practitioners across the globe. The COVID-19 pandemic combined several features that, individually, had been shown to negatively affect sleep health in the general population. Those features included state of crisis, restrictions on in-person social interactions, as well as financial adversity. To address the lack of a comprehensive summary of sleep research across these three distinctive domains, we undertook three parallel systematic reviews based on the following themes: 1) Sleep in times of crises; 2) Sleep and social isolation; and 3) Sleep and economic uncertainty. Using a scoping review framework, we systematically identified and summarized findings from these three separated bodies of works. Potential moderating factors such as age, sex, ethnicity, socioeconomic status, psychological predisposition, occupation and other personal circumstances are also discussed. To conclude, we propose novel lines of research necessary to alleviate the short- and long-term impacts of the COVID-19 crises and highlight the need to prepare the deployment of sleep solutions in future crises.

Bedtime routines and objectively assessed sleep in infants

AIMS

To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability.

DESIGN

This was a prospective observational study conducted between November 2012 and November 2016.

METHODS

Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest.

RESULTS

One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b = -23.55, p < 0.01). Infants with a bedtime routine of <3-4 nights per week were associated with more variable night-time sleep duration than a bedtime routine of 5-6 nights per week (b = -7.81, p < 0.05) or every night (b = -8.47, p < 0.05).

CONCLUSION

A bedtime routine of at least 5 nights a week and initiated no later than 9 PM was associated with longer and less variable night-time sleep in infancy. Findings suggest that a consistent bedtime routine implemented in accordance with age-appropriate bedtimes should be addressed as part of anticipatory guidance in the well-child clinics. Future studies should include infant sleep variability as an outcome in addition to the conventional mean-level sleep variable analyses to more thoroughly characterize bedtime routine effects.

Trajectories of sleep in Child Protective Services (CPS)-referred children predict externalizing and internalizing symptoms in early childhood

BACKGROUND

Previous studies have established links between poor sleep and negative developmental outcomes. However, it remains unclear whether young maltreated children demonstrate atypical sleep patterns and whether sleep duration is associated with emotional and behavioral problems.

OBJECTIVE

Explore trajectories of sleep among Child Protective Services (CPS)-referred children and examine whether sleep duration is significantly associated with externalizing and internalizing symptoms, even when controlling for the home environment.

PARTICIPANTS

Participants included 197 children (Mage at first assessment = 10.24 months, SD = 6.39) whose parents were referred to CPS due to allegations of maltreatment.

METHODS

Parents completed sleep diaries for their children at up to five time-points and the preschool version of the Child Behavior Checklist (CBCL) when children were approximately 2 years of age (Mage = 26.40 months, SD = 3.36). The Home Observation for Measurement of the Environment Scale (HOME) assessed the quality of the early home environment.

RESULTS

Results from latent growth curve modeling demonstrated that CPS-referred children significantly varied (B = 3.28, SE = 0.90, p < .001) in the amount they slept in a 24-hour period at baseline (i.e., 4.1 months of age), and the amount of total sleep in a 24-hour period significantly decreased across time (B1 = -0.03, SE = 0.01, p < .001). When controlling for characteristics of the home environment, total sleep in a 24-hour period at baseline significantly inversely predicted externalizing (B = -1.03, SE = 0.06, p < .001) and internalizing symptoms (B = -0.19, SE = 0.03, p < .001) in early childhood.

CONCLUSIONS

This study is an important first step in exploring trajectories of sleep among CPS-referred children. Findings underscore sleep as a promising target for interventions aimed at promoting regulation and highlight the need for future research to examine sleep in maltreated children as a predictor of later developmental outcomes.

Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families

OBJECTIVE

To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families.

METHODS

We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, and multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (eg, later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association.

RESULTS

In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B = -0.59 hours, 95% confidence interval [CI]: -1.04, -0.14; and B = -0.54 hours, 95% CI: -1.00, -0.08). Housing disrepair was associated with decreased 24-hour sleep (B = -0.64 hours, 95% CI: -1.29, -0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B = -0.19 hours, 95% CI: -0.29, -0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (P < .001), with greater increases for those with food insecurity or multiple hardships.

CONCLUSION

Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.