Brief Infant Sleep Questionnaire Research Articles

Sleep initiation patterns and sleep quality among toddlers in the southeast of China: initial study results

BackgroundA large number of psychological consequences including sleep health emerged during the 2019 Coronavirus disease (COVID-19) pandemic. Sleep patterns in toddlers are vulnerable to negative environmental exposures, however, very few studies on this topic have been published so far.ObjectivesIn this paper, we aimed to investigate the sleep patterns and associated factors in toddlers from China confined at home in the context of COVID-19 pandemic.MethodsFrom April to November 2021, a convenience sample of 493 parents of young children aged (12–35 months) were surveyed from Fuzhou, Sanming, Quanzhou, Nanping, and Longyan cities in the Fujian Province, China. A cross-sectional survey was conducted via Electronic questionnaires to collect parent and child social-demographic characteristics. The Brief Infant Sleep Questionnaire (BISQ) was used to collect data on sleep practices, sleep duration and patterns, as well as the number of nocturnal awaking .ResultsThe mean age of toddlers was 2.11 years old, and 52.54% (259/493) were males. Among the 493 toddlers’ sleep patterns, 331(67.1%) initiated sleep accompanied by parents, 67(13.6%) slept independently, 59 (12.0%) were breast fed/bottle fed to initiate sleep, 27 (5.5%) were held and 9 (1.8%) rocked. The clear longitudinal association between the duration of night-time sleep, the frequency of nighttime awakenings, and various sleep patterns remains clear (p < 0.05). Multiple linear regression analysis indicated that sleep initiation with bottle-feeding/breast-feeding and rocked significantly increased the frequency of nighttime awakenings and reduced the duration of nighttime sleep (p < 0.05), as held was dramatically only for increasing the number of nighttime awakenings (p < 0.05). Multi-variate logistic regression analysis demonstrated that toddlers with severe sleep difficulties had a higher probability of being rocked to initiate sleep (p < 0.05). Conversely, young children with minor sleep problems were more apt to be in bed alone to initiate sleep (p < 0.05).ConclusionsDuring the COVID-19 pandemic, most infants and toddlers initiated sleep accompanied by parents and tend to have electronic media exposure before bedtime. Increased waking at night may be associated with sleep initiation with breast-feeding/bottle-feeding. Therefore, pediatric practitioners in primary community hospitals should pay attention to the education and promotion of sleep hygiene and parenting knowledge of young children to avoid the formation of poor sleep hygiene habits.

Persian version of brief infant sleep questionnaire (BISQ): a psychometric evaluation

BackgroundThe high prevalence of sleep problems and their negative consequences on children and parents highlight the need to design early screening instruments to evaluate sleep problems in early childhood. We aimed to determine the validity and reliability of the Brief Infant Sleep Questionnaire (BISQ) among the Iranian population.Methods and materialsThis study included 646 one-year-old infants by random sampling from the PERSIAN birth cohort study. Following the forward-backward translation of the BISQ, its psychometric properties, including construct validity in terms of concurrent and convergent validities as well as reliability, were evaluated.ResultsThe CVIs and CVR ranged between 0.8 and 1.00 for all items. Therefore, we keep all the items of the original version of the BISQ in the Persian BISQ. Concurrent validity was assessed by comparing items of the Persian BISQ among different maternal views regarding their infant’s sleep. All BISQ items were significantly different among the two levels of maternal view about the infant’s sleep problem except daytime sleep duration. The convergent validity of the BISQ was evaluated by calculating the correlation between BISQ items and the ISQ (infant sleep questionnaire) total score as a similar tool. ISQ score was adequately correlated with nocturnal sleep latency and the number of waking at night (rs ranged from 0.59 to 0.72). In addition, the associations of mothers’ and infants’ demographic variables and nutritional and gestational variables with BISQ items were presented to confirm construct validity. Strong correlations were found between the repeated sleep measures for sleep arrangement, sleep position, and sleep situation (kappa ranged from 0.65 to 0.84), nocturnal sleep duration, daytime sleep duration number of wakings at night, night waking duration, nocturnal sleep latency and sleep-onset time (ICC ranged 0.91 to 0.99).ConclusionThe Persian version of the BISQ is a reliable and valid measure for assessing sleep problems in infants. It would be helpful to be utilized for the early diagnosis of infants’ sleep problems.

Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period

ObjectiveThis study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9–20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics. MethodsSeventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). ResultsThe total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001). ConclusionsSleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.

Breastfeeding and Sleeping Patterns Among 6–12-Month-Old Infants in Norway

BackgroundParental behavior and infant sleep patterns can vary widely both within and between cultures and settings. Breastfeeding during the second half-year of infancy has been associated with frequent night waking, which is perceived as sleep problem among the Western societies. An understanding of sleeping patterns among breastfed infants during the second half-year of infancy is important in supporting continued breastfeeding.ObjectivesThe study aimed to investigate the sleeping patterns among breastfed infants during second half-year of infancy.MethodsThis is a cross-sectional study. Three hundred and forty-two mothers of 6–12 months old breastfed infants completed the questionnaires on socio-demographic factors, breastfeeding practices, and infant sleeping patterns, which were assessed by using the Brief Infant Sleep Questionnaire (BISQ). The Cox regression model was used to assess the factors that were associated with night sleep duration whereas demographic factors and breastfeeding practices that were associated with night waking frequency were investigated using the Poisson regression model.ResultsOn average, the breastfed infants slept for 11 h during the night and most infants were reported to have night waking (96.8%) and were breastfed at least once at night (93.5%). In the adjusted analyses, infants in the age group 9–12 months were less likely to sleep longer compared to infants in the 6–8 months age group [HR 1.52 95% CI (1.17, 1.98)]. A one-hour increase in daytime sleep and in night wakefulness increased the likelihood of waking up at night by 19% and 24%, respectively. Infants who had been vaccinated within the last 7 days and infants who were breastfed to sleep were more likely to have a shorter nighttime sleep duration. Nighttime breastfeeding frequency was significantly associated with a 17% increase in the likelihood of night waking [IRR 1.17 95% CI (1.13, 1.22)]. Infants who slept on their parents’ bed were 1.28 times more likely to wake up at night compared to infants who slept in a separate room [IRR 1.28 95% CI (1.05, 1.59)]. Infants of parents who reported that their infants’ sleep was not a problem were 34% less likely to wake up compared to infants of parents who reported that their infants’ sleep was a problem [IRR 0.66 95% CI (0.49, 0.87)].Conclusions for PracticeFrequent night waking, bed sharing and night breastfeeding were common among 6–12 months old breastfed infants. Frequent night breastfeeding may lengthen an infant’s nighttime sleep duration. The study findings indicate that adequate information and support should be given to breastfeeding mothers in relation to the sleeping pattern of breastfed infants in order to promote continued breastfeeding practices.

2 Infant Imitation: Detecting Risk in the First Year with PediaTrac™

Objective:Imitation has pervasive associations with social and communicative development. However, few methods have been developed to measure this construct in typically developing infants, and even less is available for at-risk populations, such as infants born preterm. Autism spectrum disorder (ASD), a particular risk of premature birth, is associated with atypical imitation and social communication. Although imitation emerges in infancy, most current screening and diagnostic tools for ASD cannot be utilized prior to 12 months. The present study aimed to develop and validate a caregiver-report measure of infant imitation, characterize imitation profiles at 4, 6, and 9 months in term and preterm infants, and explore the relationship between imitation and scores on an ASD screening questionnaire at 18 months.Participants and Methods:Participants (N = 571) were recruited from a larger multi-site study of PediaTrac™ v3.0, a web-based tool for monitoring and tracking infant development, and were surveyed longitudinally at birth, 2, 4, 6, 9, 12, 15, and 18 months. Participants completed the online PediaTrac™ survey and several reliable and validated questionnaires via pen-and-paper format. For the purposes of this study, only the Ages and Stages Questionnaire (3rd ed.; ASQ-3), Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP), Brief Infant Sleep Questionnaire (BISQ), and the Modified Checklist for Autism in Toddlers - Revised with Follow-Up (M-CHAT-R/F) were examined. The following hypotheses were tested: (1) proposed imitation items will represent a unitary latent construct, for which convergent and discriminant validity will be demonstrated, (2) there will be measurement invariance between term status groups at each assessment period, (3) preterm infants will obtain lower caregiver-reported imitation scores compared to term infants, and (4) imitation abilities at the assessment period with the most robust imitation factor will predict M-CHAT-R/F scores at 18 months.Results:Distinct imitation factors at 4, 6, and 9 months were modeled with confirmatory and exploratory factor analyses. Relationships between the factors and established measures of infant communication (CSBS; ASQ) and sleep (BISQ) revealed convergent and discriminant validity, respectively. Strict measurement invariance was demonstrated for the 4- and 9-month factors, and metric invariance for the 6-month measure. Full term infants scored higher on imitation at 9 months, though variance in this outcome was related to term status differences in sensorimotor skills. Lastly, the 9-month imitation factor, coupled with 6-month sensorimotor skills, predicted 18-month ASD risk over and above gestational age.Conclusions:This study provides support for the assessment of infant imitation, utilizing imitation to detect risk in preterm infants, and extending the age of identification for ASD risk into the first year. PediaTrac™ imitation, in combination with the PediaTrac™ sensorimotor domain, may be useful in detecting developmental risk, and specifically risk for ASD, within the first year, leading to earlier initiation of intervention. Further, with its minimal completion time and ease of dissemination through digital platforms, this measure can expand access to care and improve long-term outcomes for children and families.

Safety and efficacy of melatonin supplementation as an add‐on treatment for infantile epileptic spasms syndrome: A randomized, placebo‐controlled, double‐blind trial

AbstractThis was a prospective, randomized, double‐blind, single‐center placebo‐controlled trial to assess the efficacy and safety of melatonin as an add‐on treatment for infantile epileptic spasms syndrome (IESS). Participants aged 3 months to 2 years with a primary diagnosis of IESS were recruited and assigned to two groups in a 1:1 ratio. Both treatment groups received a combination of adrenocorticotrophic hormone (ACTH) and magnesium sulfate (MgSO4) for 2 weeks, and the treatment group also received melatonin (3 mg) between 20:00 and 21:00 daily, 0.5–1 h before bedtime. The study's primary endpoint was the average reduction rate in spasm frequency assessed by seizure diaries. Secondary endpoints included assessment of the response rate, EEG hypsarrhythmia (Kramer score), and psychomotor development (Denver Developmental Screening Test, DDST). Sleep quality was assessed by using the Brief Infant Sleep Questionnaire (BISQ), the Infant Sleep Assessment Scale (ISAS), and actigraphy. Safety parameters were also evaluated. Statistical analyses were conducted on intention‐to‐treat and per‐protocol populations. The trial is registered at Clinicaltrials.gov (ChiCTR2000036208). Out of 119 screened patients, 70 were randomized and 66 completed treatments. In the intention‐to‐treat population, there were no significant differences in the average percentage reduction of spasm frequency (median [interquartile range, IQR: Q3–Q1], 100% [46.7%] vs. 66.7% [55.3%], p = .288), the 3‐day response rate (51.4% vs. 37.1%, p = .229), the 28‐day response rate (42.9% vs. 28.6%, p = .212), EEG Kramer scores (2 [3.5] vs. 2 [3], p = .853), or DDST comprehensive months (5 [2.5] vs. 6 [6], p = .239) between the melatonin (n = 35) and placebo (n = 35) groups. However, caregivers reported improved sleep quality after melatonin treatment, with 85.7% reporting regular sleep compared to 42.9% with placebo (42.9%, p &lt; .001). The melatonin group had lower ISAS scores in 4–11‐month‐old patients compared to the placebo (mean ± SD, 29.3 ± 4.4 vs. 35.2 ± 5.9, p &lt; .001). Moreover, the median (IQR) value of sleep‐onset latency was shortened by 6.0 (24.5) min after melatonin treatment, while that in the placebo group was extended by 3.0 (22.0) min (p = .030). The serum melatonin (6:00 h) level (pg/mL) of the children in the melatonin group after treatment was significantly higher than in the placebo group (median [IQR], 84.8 [142] vs. 17.5 [37.6], p &lt; .001). No adverse effects related to melatonin were observed in the study, and there were no significant differences in adverse effects between the melatonin and placebo groups. Although not statistically significant, the results of this randomized clinical trial proved that melatonin supplementation, as an add‐on treatment, can improve spasm control rate in the treatment of IESS. For IESS children treated with ACTH, the addition of melatonin was found to improve sleep quality, shorten sleep onset latency, and increase blood melatonin levels. Moreover, it was observed to be a safe treatment option.

Sleep disturbances are associated with feeding practices and age in preterm infants

BackgroundPreterm infants are under risk of several shortcomings including sleep disturbances (SD). This cross-sectional study evaluated factors associated with SD in preterm and low birth weight infants in a reference center for preterm children at a University Hospital, southeastern Brazil. MethodsA hundred-four dyads of mothers-infants 0–3 years participated. Mothers answered an online questionnaire (Google Forms®) evaluating childbirth characteristics, gestational age, breastfeeding, bottle feeding, non-nutritive sucking habits and sociodemographic information. The Brazilian version of the Brief Infant Sleep Questionnaire (BISQ) evaluated SD. Bivariate and Logistic Regression analyses were performed (p < 0.05). ResultsSD was present in 45.2% of the sample. Multivariate Logistic Regression Model showed that infants breastfed ≥3 times at night had 5.006 more chances to have SD (CI 95% = 1.229–20.400) compared to those who did not breastfeed at night. Infants who were bottle-fed 3 ≥ times at night had 6.952 more chances to have SD (CI = 95% = 1.364–35.427) compared to those who were bottle fed less frequently. The chance of SD decreased 6.6% (CI 95% = 0.889–0.982) for each increase of a month in infant's age, and infants from families with higher income had 3.535 more chances to have SD (CI 95% = 1.006–12.416). ConclusionThe younger the child, a higher frequency of night feeding and belonging to higher income families were associated with SD. Recognizing the associated factors with SD in newborns and infants can aid families to better deal with this issue, promote better sleep quality and individualized counseling.

0791 The Association of Sleep with Developmental and Behavioral Factors in Premature Infants

Abstract Introduction Children with neurodevelopmental conditions often experience sleep problems. Whereas sleep is a predictor of behavioral outcomes in children, there is limited evidence regarding sleep as an indicator of neurodevelopmental concerns. This study examined the prevalence of sleep issues and neurodevelopmental conditions in children with a history of prematurity, as well as the role of sleep as a potential indicator for future developmental and behavioral concerns. Methods Electronic health records of 57 young children (M = 31.9 gestational weeks, range = 23 to 40 weeks; 35.1% girls) presenting to a neonatal follow-up clinic were reviewed. Caregivers completed the Brief Infant Sleep Questionnaire (BISQ-R) between 6-16 corrected months (Mage = 11.6 mos) and then completed the Modified Checklist for Autism in Toddlers (M-CHAT) between 16-26 corrected months (Mage = 20.9 mos). Caregivers also completed the Survey of Wellbeing of Young Children (SWYC; n = 56; Mage = 20.9 mos) and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; n = 32; Mage = 17.4 mos). Results Approximately one-quarter (26.3%) of subjects had a caregiver-perceived child sleep problem at ages 6-16 corrected months. A total of 40.4% of children had clinically significant autism concerns on the M-CHAT and 67.9% had clinically significant concerns on the SWYC. Subsequent caregiver ratings showed that 25.0% of children exhibited challenging behaviors and 34.4% lower social-emotional competency on the BITSEA. Children who demonstrated clinically significant autism risk on the M-CHAT were more likely to have a prior caregiver-identified child sleep problem. Those who later failed the M-CHAT also had increased night waking frequency (2.43 vs 1.82 wakings) earlier in development. Logistic regression indicated that caregiver-identified sleep problems significantly predicted subsequent challenging behaviors on the BITSEA but not later neurodevelopmental concerns on the SWYC or social-emotional competencies on the BITSEA. Conclusion These pilot data suggest that a caregiver-identified child sleep problem at age 6-16 months corrected is linked to more frequent challenging child behaviors in toddlerhood (16-26 corrected months). Caregiver-identified child sleep problems and more night wakings also predicted later neurodevelopmental concerns. Sleep problems in premature infants may thus be an early indication of later behavioral and neurodevelopmental issues. Support (if any)

Characterization of Parental Knowledge on Early Child Sleep and Association with Child Sleep Quality: A Cross-Sectional Pilot Study in Chongqing, China.

Parental knowledge of child sleep is typically poor, and profiling of knowledge patterns has not been performed. In recent years, the Chinese government has issued a series of administrative and legal documents to promote guidance on family education and parenting knowledge. The purpose of this study was to characterize the pattern of parental sleep knowledge for 0~3-year-old children in Chongqing, China, and to examine the associations among the knowledge pattern, guidance channel, and sleep quality. This was a cross-sectional pilot study of 264 primary caregivers of children aged 1~36 months who completed a brief survey using the 9-item Parents' Knowledge of Child Sleep (PKCS) and a modified Chinese version of the Brief Infant Sleep Questionnaire (BISQ). Hierarchical clustering was performed to determine knowledge patterns. Logistic and multiple linear regressions were used to assess the associations. The average PKCS score was 50.2%. Parental knowledge showed a five-group pattern from I to V, with knowledge score increasing with the group number. Parents' access to sources for guidance and information on children's sleep was categorized into three categories from i to iii considering the authenticity of sources and richness of channels. Significant correlates of knowledge pattern were age (mo.) of the child (OR=0.97, p=0.019), low family income (vs high, OR=0.44, p=0.022; vs medium, OR=0.55, p=0.014), and information access patterns i and ii (vs iii with the lowest credibility and richness, OR=2.22/1.85, p=0.004/0.022). Knowledge pattern IV, with a few critical structural defects, showed a significant association with longer daytime napping (β=0.121, p<0.001). The child sleep knowledge of parents in Chongqing, China, was at a low level but showed characteristic patterns. Considering the social need and policy directions, it is necessary to improve public services to provide authentic and extensive guidance to strengthen parental knowledge on child sleep in Chongqing.

Associations between chronotype, sleep quality, maternal mental health, and child development in mother-infant dyads

Objective/backgroundStudies on circadian rhythms throughout development and their physiological and behavioral impacts at early stages are still scarce. Previous studies have shown that mother-infant interactions are important for both sleep and child development. In this cross-sectional study we investigated whether infants' chronotype, sleep and development were associated with their respective mothers’ chronotype, sleep, mental health and socioeconomic status. Patients/methodsthe following were used to evaluate mothers: the Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Self-Reporting Questionnaire 20 (SRQ-20). To assess the infants’ characteristics, the following were used: the 19th question from the Morningness-Eveningness Questionnaire (MEQ), infant nocturnal midpoint of sleep (iMSF), Brief Infant Sleep Questionnaire (BISQ) and Ages and Stages Questionnaire-3 (ASQ3). Socioeconomic aspects were assessed using the Brazilian Economic Class Criterion of the Brazilian Association of Research Companies (ABEP). ResultsA hundred and eight mother-infant dyads participated in the study. Sleep disorders were observed in 38 (35%) infants and atypical development (ASQ3) in 35 (32%). The infants' sleep phases were partially explained by the mother's chronotype. Infants' sleep duration was negatively correlated with sleep latency, which was higher in the group with atypical development. Mothers of infants with sleep disorders or discordant chronotypes (32%) had higher Pittsburgh scores (worse sleep quality) and higher SRQ-20 scores (screen for Common Mental Disorders). ConclusionsWe found evidence for the contribution of sleep quality and chronotypes to mothers’ mental health and infant development. However, further studies are needed to confirm the influence of sleep and circadian phenotypes in the early stages.

Does sleep correlate with neurodevelopmental outcomes in preterm and term infants in early-preschool children?

Does sleep correlate with neurodevelopmental outcomes in preterm and term infants in early-preschool children?

Parental Discontent with Infant Sleep During the First Two Years of Life

ABSTRACT Background Problematic sleep in infants can have a high impact on families. We examined parental discontent with infant sleep in the first six months of life and parent-perceived problematic sleep during the second year of life. Methods We used Sarphati Cohort data of 1471 children. During periodic youth health care visits in the first six months of life, professionals registered parental discontent with infant sleep. In the second year of life, parents filled out the Brief Infant Sleep Questionnaire (BISQ), from which we defined parent-perceived problematic sleep and BISQ-defined problematic sleep. We examined the association of parental discontent with infant sleep during the first six months with both BISQ-derived outcomes up to age two, using multivariable logistic regression analysis. Results 26% of parents were discontented with infant sleep during the first six months of life. During the second year of life, 27% of the parents perceived their child’s sleep as problematic, and 9% of the infants had BISQ-defined problematic sleep. Early parental discontent with infant sleep was associated with parent-perceived problematic sleep [adjusted OR 2.50 (95% CI 1.91–3.28)], and BISQ-defined problematic sleep [adjusted OR 1.88 (1.11–3.17)]. Conclusions Early registered parental discontent with infant sleep was a predictor of parent-perceived problematic sleep in early toddlerhood. Registering parental discontent during infancy might enable professionals to identify a group of infants at risk for later problematic sleep. We recommend screening and parental support for sleep difficulties in an early stage.

Identification of nutritional status and incidence of sleep disturbance in children aged 6-23 months living in areas prone to flooding and landslide

Disaster can cause several major problems such as food availability (quantity and quality) and mental illness especially in vulnerable group like children, women and the elderly, which in turn will cause disruption to the quality of sleep. Availability of food in good quantity and quality as well as sleep comfort are important factors that cannot be underestimated, especially for children who are still in their first 1000 days of life, because this stage is the golden stage of physical, cognitive, and social-emotional growth and development and would impact their quality of life in the future. Based on that matter, in this paper we will discuss the impact of floods and landslides in Agam Regency, West Sumatra on nutritional status and sleep disturbance in children aged 6-23 months. Sampling was done by consecutive sampling. The children were then asked by their parents to fill out the BISQ (Brief Infant Sleep Questionnaire) questionnaire for ages 6 months to 23 months There were 32,1 % of the infants experienced sleep disturbances. Furthermore, our analysis of nutritional status revealed that of 35,7 % those with nutritional disorders is from the areas prone to flooding and landslides.

Validation of the sleep disturbance scale for children (SDSC) in infants and toddlers from mainland China.

This study is to evaluate the reliability and validity of SDSC among infants (aged 6-36 months), and to provide a reference for expanding the application of the SDSC for Chinese infants (SDSC-I). From April to November 2021, parents of infants from Fuzhou, Quanzhou, Longyan, Sanming, and Nanping cities in Fujian Province, China completed the SDSC-I. Several factor analyses were performed to evaluate the reliability and validity of the scale. Of note, 432 out of 469 samples were valid. After item selections and exploratory factor analyses, the SDSC-I concluded six dimensions (disorders of initiating sleep, disorders of maintaining sleep, sleep hyperhidrosis, sleep breathing disorders, parasomnias, and non-restorative sleep and excessive somnolence) with 23 items. The Cronbach's α coefficient of the scale was 0.863, and those for the six dimensions were within 0.576-0.835. The values of parameters for content validity of the scale were: IR = 0.87, I-CVI > 0.78, Kappa value > 0.74, S-CVI/UA = 0.87, S-CVI/Ave = 0.98. Principal component analysis revealed that the Kaiser-Meyer-Olkin (KMO) value was 0.84, and the factor loading of items ranged from 0.328 to 0.849, with six factors of eigenvalue more than one, which could explain 58.274% of the total variance. The confirmatory factor analysis results showed that χ2/DF was 3.556, root-mean-square error of approximation (RMSEA) was 0.077, comparative fit index (CFI) was 0.809, and standardized RMR (SRMR) was 0.070. Our study provides evidence that the SDSC-I is reliable and valid, and it is effective for the screening and management of sleep disturbances among infants (aged 6-36 months). Compared with other questionnaires such as the Brief Infant Sleep Questionnaire (BISQ), it is worthy of popularization and application in pediatric primary care.

Sleep patterns of infants and young children and their association with breastfeeding: a study based on K-means clustering

To investigate the sleep patterns and characteristics of infants and young children and the association between sleep patterns and breastfeeding. A general information questionnaire, Brief Infant Sleep Questionnaire (BISQ), and a questionnaire on feeding were used to investigate the sleep quality and feeding patterns of 1 148 infants and young children aged 7-35 months. The K-means clustering method was used to identify sleep patterns and characteristics. A multivariate logistic regression analysis was used to investigate the association between sleep patterns and breastfeeding. Three typical sleep patterns were identified for the 1 148 infants and young children aged 7-35 months: early bedtime and long sleep time; short sleep latency and moderate sleep time; late bedtime, prolonged sleep latency, and insufficient sleep time. The third pattern showed sleep disorders. The multivariate logistic regression analysis showed that compared with formula feeding, exclusive breastfeeding within 6 months after birth reduced the risk of sleep disorder patterns by 69% (OR=0.31, 95%CI: 0.11-0.81). The risk of sleep disorder patterns was reduced by 40% (OR=0.60, 95%CI: 0.38-0.96) in the infants receiving breastfeeding for 4-6 months compared with those receiving breastfeeding for 1-3 months. There are different sleep patterns in infants and young children, and breastfeeding can reduce the development of sleep disorder patterns.

The influence of sleep patterns and screen time on the sleep needs of infants and toddlers: A cross-sectional study

PurposeThe purpose of this study was to examine the effects of screen time and sleep patterns on the sleep needs of infants and toddlers. Design and methodsA descriptive cross-sectional data were collected from 304 parents of children aged 6 to 36 months old. The screen use of children and parents was assessed with seven questions and A Brief Infant Sleep Questionnaire (BISQ) was used to assess infant sleep. ResultsThe results of this study indicate that children's adherence to the recommended sleep standards is poor. The most important criteria that caused poor sleeping were the number of awakenings at night, the duration of sleeplessness at night and the minimum total sleep time of <9 h. The most frequently used screen type in all of the age groups and parents was TV, followed by smartphones. As the age of the children increased, the rate of all screen-type use also increased. Factors predicting sleep needs included bedtime, the PED usage of children, parents' watching TV and care of the children by the babysitter. ConclusionsSleep needs are associated with the sleep patterns and screen usage of the children and parents. Practice implicationsGiven that screen usage behaviors are tracked from infancy to early childhood, these findings highlight the need for prevention and intervention efforts, as well as for education and policy measures, to limit screen use and exposure from an early age.

Infant sleep patterns and maternal postpartum fatigue: A cross-sectional study.

Unpredictable nature of infant sleep-wake cycles go against that of the adult sleep. Maternal sleep quality is acknowledged as a main factor to postpartum fatigue. This study explored the effects of infant sleep patterns on maternal postpartum fatigue. A total of 319 mothers of infants from two teaching hospitals in the Nantong City were enrolled. Maternal fatigue status and infant sleep patterns were assessed by the Fatigue Scale (FS-14) and the Brief Infant Sleep Questionnaire (BISQ). Generalized estimating equation analyses were perform to explored the effect of infant sleep patterns on maternal fatigue. Sleep-onset time later than 10p.m., and nocturnal wakefulness more than 60 min were risk factors of postpartum fatigue. After controlling the confounding variables, infant sleep patterns were still the determinant factors of postpartum fatigue. Infant sleep pattern is a factor of maternal postpartum fatigue. It is recommended to promote infant sleep so as to improve maternal sleep quality and finally alleviate postpartum fatigue.

Early childhood sleep trajectories and association with maternal depression: a prospective cohort study.

To investigate trajectories of early childhood sleep in the first 3 years and their association with maternal depressive symptoms. Data were from 243 Chinese mother-child dyads. Children's sleep duration and night-waking were assessed using the Brief Infant Sleep Questionnaire (BISQ) at 42 days, 3, 6, 9, 12, 18, 24, and 36 months postpartum. The Center for Epidemiological Survey-Depression Scale (CES-D), Edinburgh Postnatal Depression Scale (EPDS), and Profile of Mood States (POMS) were used to assess maternal depressive symptoms at late pregnancy, 42 days, and 36 months postpartum, respectively. Early childhood sleep trajectories were estimated with group-based trajectory models. The association between early childhood sleep trajectories and maternal depressive symptoms was examined with binary and multinomial logistic regression models and linear regression models. Three trajectories of daytime sleep duration ("short", 14.4%; "medium", 60.4%; "long", 25.2%), nighttime sleep duration ("increasing", 17.6%; "stable", 76.3%; "decreasing", 6.1%), and total sleep duration ("short", 21.5%; "medium", 59.9%; "long",18.6%), and two trajectories of night-waking ("resolving", 22.9%; "persistent", 77.1%) were identified. Controlling for confounding factors, maternal depression at 42 days postpartum was associated with higher risks for short daytime sleep duration and persistent night-waking in children. Persistent night-waking in children was associated with increased maternal depressive symptoms at 36 months postpartum. Early childhood sleep follows distinct trajectories in the first 3 years of life. The trajectories of short daytime sleep duration and persistent night-waking are associated with maternal depression. The findings indicate tailored interventions should target both unfavorable early childhood sleep trajectories and maternal depression.

Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children’s functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017–2018, n = 1380) and another during COVID-19 pandemic (March–May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child’s sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively.Conclusion: Home confinement generally affected infant’s and toddler’s sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns. What is Known:• Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning.• Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak.What is New:• Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants’ and toddlers’ sleep latency by >30 min during confinement.• Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children’s sleep based on the BISQ criteria. Supplementary informationThe online version contains supplementary material available at 10.1007/s00431-022-04376-0.

Association of maternal prenatal depression and anxiety with toddler sleep: the China-Anhui Birth Cohort study.

Maternal prenatal depression is associated with child sleep. We investigated whether maternal depression comorbid with anxiety worsens toddler's sleep problems in a prospective cohort study. A total of 1583 mother-infant pairs from the China-Anhui Birth Cohort study were examined. The participants completed the Center for Epidemiologic Studies Depression Scale (CES-D) and Self-Rating Anxiety Scale (SAS) at 30-34weeks of gestation, and the Edinburgh Postnatal Depression Scale (EPDS) at 3-month postpartum. Toddler's sleep was assessed by the Brief Infant Sleep Questionnaire (BISQ) at 30months old. Logistic regression models were used to investigate the associations between prenatal depression and anxiety and toddler's sleep, while adjusting for maternal gestational age, education, family income, alcohol use, premature birth, fetal growth restriction, mode of delivery, postnatal depression, and 3-month breastfeeding. In total, 9.0% of participants reported prenatal depression comorbid with anxiety symptoms, and the prevalence of depression, anxiety was 6.7% and 7.3%, respectively. Compared with mothers without depression and anxiety, maternal depression combined with anxiety were significantly associated with shorter total sleep duration (11.16 ± 1.06h), longer settling time (29.25 ± 23.57min), and higher risk of toddlers' sleep problems assessed by BISQ (OR = 2.09, 95% CI: 1.22-3.57) or parental report (OR = 1.84, 95% CI: 1.22-2.77). However, there was no significant association between maternal postnatal depression and toddler sleep behaviors. Maternal prenatal depression comorbid with anxiety significantly associated with poorer toddler's sleep. Strategies to regulate prenatal mood status should be considered during prenatal health care to improve children's sleep development.