Infant Sleep Patterns Research Articles

A Cluster Analysis of Reported Sleeping Patterns of 9-Month Old Infants and the Association with Maternal Health: Results from a Population Based Cohort Study.

The aim of this study was to identify, using cluster analysis, novel sleep phenotypes in a population based cohort of infants, and to explore the associations between infant sleep profiles and their mothers' health and well-being. 11,134 mothers of 9-month old infants were interviewed as part of the Growing Up in Ireland National Longitudinal study and reported on their health and infant's sleep patterns. 16 infant sleep variables were recorded together with measures of parental stress, depression, health and well-being. Multiple iterations of a two-step hierarchical cluster analysis were carried out to identify the optimum number of clusters and the subset of parental-reported sleep variables required to identify distinct sleep profiles. Four distinct sleep profiles were identified based on the following variables; (1) infant sleep duration at night, (2) parental sleep duration, (3) does baby wake during night (yes, no)? (4) Usual sleep location for most of the night and, (5) parental reporting of problem infant sleep patterns. This identified two less favorable profiles with both infants and mothers sleeping less and where mothers are more likely to report their infants' sleep patterns as problematic. Mothers of infants belonging to these sleep profiles were more likely to have higher levels of stress, depressive symptoms, and poorer self-reported health than other sleep profiles. Breastfeeding was associated with both groups and rates were highest in a group of infants that were more likely to co-sleep with their parents and have diverse ethnic backgrounds. This study demonstrates, for the first time, two infant sleep profiles with distinct phenotypical frameworks that are significantly associated with maternal stress, depression, and poorer self-report of health.

Breastfeeding surveyed using routine data.

The purpose of this study was to investigate breastfeeding as a health indicator through routine data registered at public child health centres. The prevalence and course of breastfeeding were surveyed, as well as factors that affect breastfeeding. Breastfeeding status at six weeks and six months of age and other routine data were systematically recorded in a newly developed electronic medical records system (Health Profile 0-20 years) for infants attending public child health centres in Bergen in the period 2010-11. This information was linked to data from the Medical Birth Registry. Of 6,093 infants, 73.6% were exclusively breastfed at six weeks of age and 18.9% at six months. In adjusted analyses, there was an association between breastfeeding cessation before six months and the factors smoking, low maternal age, marital status as single, unsatisfactory family situation and social network, and birth weight under 2,500 g. Attendance at a specialist breastfeeding centre and uncertain/abnormal sleep patterns in infants were associated with continued breastfeeding after six months. The medical records system «Health Profile 0-20 years», linked to the Medical Birth Registry, was well suited to studying factors that can affect breastfeeding. Mothers and infants with increased need for follow-up were identified.

Advising parents on infant sleep

Most parents want their child to sleep through the night. Suneeta Kochhar discusses infant sleep patterns

Cortisol levels and sleep patterns in infants with orofacial clefts undergoing surgery.

BackgroundTraumatic events during early infancy might damage infants’ psychobiological functioning, such as sleep and cortisol secretion. Infants born with orofacial clefts (OFCs) undergo functional, anatomical, and aesthetic surgery. The aim of the present study was to determine whether infants with OFC and undergoing OFC surgery show deteriorated sleep and cortisol secretion compared with healthy controls and with their presurgery status.MethodsA total of 27 infants with OFC (mean age: 22 weeks) and 30 healthy controls (mean age: 23 weeks) took part in the study. For infants with OFC, sleep actigraphy was performed and saliva cortisol was analyzed 5 days before, during, and 5 days after surgery. For controls, sleep and saliva cortisol were assessed similarly, except for the period taken up with surgery.ResultsCompared with healthy controls, infants with OFC undergoing OFC surgery did not differ in sleep and cortisol secretion. Their sleep and cortisol secretion did deteriorate during the perisurgical period but recovered 5 days postsurgery.ConclusionIn infants with OFC undergoing corrective surgery, the pattern of results for sleep and cortisol suggests that OFC surgery does not seem to constitute a traumatic event with long-term consequences.

Pacifier use does not alter sleep and spontaneous arousal patterns in healthy term-born infants.

Impaired arousal from sleep has been implicated in sudden infant death syndrome (SIDS). Sleeping in the prone position is a major risk factor for SIDS. Epidemiological studies have shown that pacifier use decreases the risk of SIDS, even when infants sleep prone. We examined spontaneous arousability in infants slept prone and supine over the first 6 months of life and hypothesised that spontaneous arousals would be increased in pacifier users, particularly in the prone position. Healthy term infants (n = 30) were studied on three occasions over the first 6 months after birth. Spontaneous cortical arousals and subcortical activations were scored and converted into frequency per hour of sleep. There was no effect of pacifier use on total time spent sleeping or awake or the number of spontaneous awakenings at any age. There was also no effect of pacifier use on the frequency or duration of the total number of spontaneous arousals or on cortical arousals and subcortical activations. Pacifier use did not alter infant spontaneous arousability at any of the three ages studied, in either the prone or supine sleeping position. Any preventative effect of pacifiers for SIDS may be through physiological mechanisms other than increased arousability.

50 Years Ago in The Journal of Pediatrics: Infant Sleep Patterns: From Birth to 16 Weeks of Age

50 Years Ago in The Journal of Pediatrics: Infant Sleep Patterns: From Birth to 16 Weeks of Age

Translating research-based knowledge about infant sleep into practice

Review infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well-being during nighttime care. This review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns. Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families. NPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.

Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial

To evaluate a prevention program for infant sleep and cry problems and postnatal depression. Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score >9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend >20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P < .05). Infant frequent feeders (>11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months. An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.

SLEEP patterns at 6 months and at 4/5 years of age in a portuguese birth cohort

Sleep/wake patterns are recognized to be established early in life, namely during the first year of life. In this study we were specifically interested in identifying infant sleep patterns at 6 months and 4/5 years of age, and their association. This study included 1092 singleton children of the Portuguese population-based birth cohort Generation XXI, evaluated at 6 months and at 4/5 years of age by face-to- face interview, with data on sleep habits. Sleep patterns were constructed through latent class analyses and included data at both ages on afternoon naps, waking hour, bedtime hour, and locale of night-time sleep and night awakenings. The number of latent classes was identified by the Bayesian information criteria (BIC). Globally, at 6 months of age, 39.7% napped more than 2.0 h in the afternoon, 45.0% go to bed from 10.0 pm and 42.8% wake up between 7.0 and 8.0 am. Also, at 6 months of age only 18.7% of the children sleep in their own bedroom at night (alone or with siblings) and 27.7% wake up more than 2 times per night 3 or more times per week. At 4/5 years of age, 39.3% of the children did not nap during the afternoon, 57.8% go to bed between 9.0 and 10.0 pm and 54.7% wake up between 7.0 and 8.0 am. At these ages, 73.3% of the children sleep in their bedroom (alone or with siblings) and 15.2% wake up at least once by night. Further, the BIC supports a subdivision in two classes (BIC = 21856.291). The first class ( n = 574, 52.6%) is mainly characterized by earlier bedtime and waking hours and sleeping in the child’s bedroom (alone or with siblings) at 6 months and at 4/5 years of age. On the contrary, the second class ( n = 518, 47.4%) presented at both ages, later bedtime and waking hours, and the lowest prevalence of sleeping in their own room. In childhood, sleep patterns are mainly determined by bedtime hour, wake-up hour and the place where night-time sleep occurs. This pattern is influenced by sleep patterns noted during the first months of age which highlights the importance of parental behaviors particularly those related to bedtime interactions and soothing routines for infant sleep. We would like to thank to all members of the research team and staff of Generation XXI for their essential daily work.

Infant sleep problems: A qualitative analysis of first-time mothers' coping experience

Objectiveto describe the aspects of infant sleep perceived as problematic by first-time Taiwanese mothers and to discover how mothers cope in response to infant sleep concerns. Designa qualitative approach was used for data collection. Settingin-depth interviews were conducted and audio-taped at mothers' homes. Participants12 first-time mothers within three months post partum. Measurement and findingscontent analysis was performed to identify patterns, similarities, and differences in the individual and collective interview data. The major themes describing maternal coping experiences were ‘self-help’ and ‘seek-help.’ Self-help coping efforts included reception and acceptance of suggestions as well as changing behaviour to allow mothers to feel capable of adapting to infant sleep patterns or problems. Seek-help was a later stage of coping for mothers when they actively utilised formal and informal sources of help to identify and manage infant sleep problems. The majority of mothers sought informal help sources from family members, friends, or online information. Mothers who suspected their infant of suffering from sleep problems either delayed seeking medical advice or did not actively consult a health care provider. Conclusions and implications for practicenurses and health care providers who work in antenatal, postnatal, and paediatric clinics should actively educate and provide information about infant sleep patterns and sleep management options to first-time mothers and discuss maternal coping strategies.

Helping New Mothers and Newborns Sleep: An Innovative Sleep Support Program

Purpose for the Program The goal of the Sleep Support program is to improve newborn/infant and maternal sleep opportunities by using a personalized education approach focused on evidence‐based behavioral and environmental sleep hygiene adjustments. Proposed Change Families frequently voice frustration with newborn and infant sleep patterns, often holding unrealistic expectations or lack of understanding of expected sleep patterns during the day and night. Typical resources used for seeking sleep pattern information include the pediatric visit, popular books, and the Internet. The Sleep Support consultation offers parents an opportunity to speak by phone with a trained sleep counselor for targeted education. Anticipatory guidance, a supportive sleep plan that is designed in conjunction with family desires, and follow‐up are provided. Implementation, Outcomes, and Evaluation New parents who were self‐selected participated in the Sleep Support option. Once the consult request was initiated, families completed a detailed intake form outlining their infant's current sleep habits, patterns, routines, environmental factors, and any medical, clinical, or feeding issues. The intake form served as an initial screening tool: infants with snoring, sleep apnea, severe reflux, severe eczema, or other clinical factors that affect sleep were referred to the pediatrician for treatment or clearance. The phone‐based 45‐minute consultation included the mother/parents and consultant. Other family members or caregivers involved in the infant's care were invited to participate. Information about the sleep environment, newborn/infant sleep and feeding patterns, sleep safety, and maternal sleep hygiene were reviewed. Appropriate suggestions were designed into a sleep plan in accordance with the mother's/parents’ situation and reasonable goals. A 15‐minute follow‐up call occurred within 1 to 2 weeks. Continuous evaluation found that 90% of the participants felt the consultation provided increased understanding of infant sleep, sleep safety, environmental and behavioral sleep approaches, and consequently, had improved sleep for infant and mother. Evaluation methods included feedback during follow‐up calls, survey scores, requests for additional consultations, referrals of family, and numerous unsolicited e‐mails. Parents most often stated that the individualized approach was key to the success of the intervention. Implications for Nursing Practice Infant and maternal sleep is highly personalized. When areas for adjustment or improvement are identified and effective education provided, sleep health can be improved. Nurses are able to use their unique skills to assess and educate a family struggling with newborn/infant sleep and suggest individualized environmental and behavioral adjustments to improve overall sleep health. The goal of the Sleep Support program is to improve newborn/infant and maternal sleep opportunities by using a personalized education approach focused on evidence‐based behavioral and environmental sleep hygiene adjustments. Families frequently voice frustration with newborn and infant sleep patterns, often holding unrealistic expectations or lack of understanding of expected sleep patterns during the day and night. Typical resources used for seeking sleep pattern information include the pediatric visit, popular books, and the Internet. The Sleep Support consultation offers parents an opportunity to speak by phone with a trained sleep counselor for targeted education. Anticipatory guidance, a supportive sleep plan that is designed in conjunction with family desires, and follow‐up are provided. New parents who were self‐selected participated in the Sleep Support option. Once the consult request was initiated, families completed a detailed intake form outlining their infant's current sleep habits, patterns, routines, environmental factors, and any medical, clinical, or feeding issues. The intake form served as an initial screening tool: infants with snoring, sleep apnea, severe reflux, severe eczema, or other clinical factors that affect sleep were referred to the pediatrician for treatment or clearance. The phone‐based 45‐minute consultation included the mother/parents and consultant. Other family members or caregivers involved in the infant's care were invited to participate. Information about the sleep environment, newborn/infant sleep and feeding patterns, sleep safety, and maternal sleep hygiene were reviewed. Appropriate suggestions were designed into a sleep plan in accordance with the mother's/parents’ situation and reasonable goals. A 15‐minute follow‐up call occurred within 1 to 2 weeks. Continuous evaluation found that 90% of the participants felt the consultation provided increased understanding of infant sleep, sleep safety, environmental and behavioral sleep approaches, and consequently, had improved sleep for infant and mother. Evaluation methods included feedback during follow‐up calls, survey scores, requests for additional consultations, referrals of family, and numerous unsolicited e‐mails. Parents most often stated that the individualized approach was key to the success of the intervention. Infant and maternal sleep is highly personalized. When areas for adjustment or improvement are identified and effective education provided, sleep health can be improved. Nurses are able to use their unique skills to assess and educate a family struggling with newborn/infant sleep and suggest individualized environmental and behavioral adjustments to improve overall sleep health.

Breastfeeding and infant sleep patterns: an Australian population study

Our purpose was to determine if babies breastfed at 6 months of age were more likely to wake at night and less likely to sleep alone than formula-fed babies. Data were drawn from the first wave of The Longitudinal Study of Australian Children, an ongoing, nationally representative study of the growth and development of Australia's children. The 4507 participants met the criteria for this study. The measures examined infant sleep problems as the outcome and breastfeeding at 6 months of age as the exposure in addition to the demographic data, maternal mental health, infant birthweight and gestational age at delivery. After adjustment for covariates, reports by mothers of infants that breastfed at 6 months of age suggested infants were 66% more likely to wake during the night and 72% more likely to report difficulty sleeping alone. However, breastfeeding had a strongly protective effect on wheezing, coughing, snoring and breathing problems, and it was not associated with restless sleep or problems getting to sleep for the infant. Breastfeeding was found to be associated with increased night waking and this is consistent with other studies. There are biological reasons why this might be required to ensure breastfeeding continues to 6 months and beyond. The current low rates of sustained breastfeeding in many Western countries needs to be reconsidered in relation to parental and public health practices promoting prolonged nocturnal infant sleep patterns.

Sleep and Attachment in Preterm Infants

Infants born preterm are at elevated risk for social emotional difficulties. However, factors contributing to this risk are largely understudied. Within the present study, we explored infant sleep as a biosocial factor that may play a role in infant social emotional development. Within a prospective longitudinal design, we examined parent-reported sleep patterns and observed parenting quality as predictors of infant-mother attachment in 171 infants born preterm. Using structural equation modeling, we examined main effect and moderator models linking infant sleep patterns and parenting with attachment security. Sleep patterns characterized by more daytime sleep and positive/responsive parenting predicted infant attachment security. Parent-reported nighttime sleep patterns were unrelated to attachment in this sample of infants born preterm. These results indicate that daytime sleep and parenting quality may be important for emerging attachment relationships in infants born preterm.

Effect of current breastfeeding on sleep patterns in infants from Asia‐Pacific region

The aim of this study was to assess the relationship between breastfeeding and sleep patterns in infants from Asia-Pacific region. Parents of 10 321 infants (0-11 months) from Australia, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand and Vietnam completed an expanded version of the Brief Infant Sleep Questionnaire. Overall, 4714 (45.72%) were currently being breastfed; 61.3% of those between 0 and 5 months and 36.6% of those between 6 and 11 months. Currently breastfed infants, when compared with not currently breastfed infants, had a significant increase in the number and duration of night-time wakings and less consolidated sleep. Interestingly, currently breastfed infants less than 6 months also showed longer duration of daytime sleep and obtained more sleep overall. Of note, of those who were currently breastfed, those infants who were nursed back to sleep during night, woke up more often at night (2.41 vs. 1.67 times) and had shorter continuous night-time sleep period (5.58 vs. 6.88 h; P < 0.001). There was no significant difference between breastfeeding and non-breastfeeding infants in the number of night wakings, when the nursing to sleep variable was controlled for in the analysis of variance. Breastfeeding is associated with reduced sleep consolidation in infants. This relationship, however, may be moderated by parenting practices of nursing to sleep and back to sleep during the night. Thus, parents of infants with night waking problems should be encouraged to limit the association between nursing and falling to sleep, to improve sleep while maintaining breastfeeding.

Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression.

BackgroundInfant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach.Methods/Design750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups.DiscussionTo our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems.Trial registration numberISRCTN: ISRCTN63834603

Infant sleep, parental sleep and parenting stress in families of mothers on maternity leave and in families of working mothers

The purpose of the present study was to investigate the links between infants’ sleep and their parents’ sleep and to assess the links between infant/parent sleep and parenting stress. Furthermore, we explored whether the links between sleep and parenting stress are moderated by maternal leave status. Participants were 50 families with an infant between the ages of 4–5 months. Half of the mothers were on maternity leave while the others returned to work. Parents completed daily sleep logs about infants’ and their own sleep for 4 consecutive nights. Each parent also completed the Parenting Stress Index. Infant sleep was associated with sleep of both mothers and fathers, but the correlations with maternal sleep were stronger. Parental perceptions of their infant's sleep as problematic were associated with higher parenting stress. Poorer infant and maternal sleep patterns were associated with parenting stress only in families with mothers on maternity leave, probably because these mothers need to provide intensive caregiving “around the clock” without sufficient opportunities to rest.

Infant sleep and early parental sleep-related cognitions predict sleep in pre-school children

To investigate early predictors of sleep patterns in pre-school age children. Specifically, we were interested in exploring whether infant sleep patterns and parenting factors assessed at 12 months would predict sleep in four year-old children. This was a follow-up study of a home-based longitudinal study, exploring the links between parental cognitions and children's sleep. The present study included 71 families (boys 58%) and focused on data collected when children were 12 months and four years old. Sleep at both time points was assessed for four weekdays by actigraphy and parental reports. Statistically significant zero-order correlations were found between early sleep patterns, maternal cognitions, and soothing behaviors at 12 months, and sleep patterns at four years. Multiple regression analysis revealed that 12 months maternal cognitions reflecting difficulties with limiting parental nighttime involvement were a statistically significant predictor of fragmented child's sleep and of parental bedtime involvement at four years. More objective infant night-wakings at 12 months predicted lower sleep efficiency at four years. Both early sleep patterns and maternal sleep-related cognitions during infancy are significant predictors of sleep quality of pre-school children. These findings are clinically meaningful as they suggest that improving infant sleep and addressing early parental beliefs and perceptions regarding infant sleep may help in preventing sleep problems of pre-school children.

Parental report of infant sleep behavior by electronic versus paper-and-pencil diaries, and their relationship to actigraphic sleep measurement

Reliable, valid and cost-effective methods for the assessment of infant sleep and sleep problems are of major importance. In this study, the first aim was to assess the agreement of an electronic diary as well as a paper diary with actigraphy for measuring infant sleep patterns in a community sample. The second aim was to assess the feasibility and acceptance of, and compliance with, the electronic diary and the paper diary. Ninety parents reported infant sleep behavior in a paper diary in their home environments for a total of 6 days, 95 in an electronic diary, within two consecutive weeks while actigraphic data were obtained simultaneously. We found moderate to good agreement between electronic diaries and actigraphy (r = 0.41-0.65, P < 0.01), and paper diaries and actigraphy (r = 0.47-0.70, P < 0.01). In addition, this study also found good agreement between both diaries and also between both diaries and actigraphy for sleep percentage over 24 h (electronic diaries and actigraphy: 54.1 ± 0.7%, 52.5 ± 0.7%, P < 0.05; paper diaries and actigraphy: 55.1 ± 0.5%, 52.2 ± 0.6%, P < 0.01) and for daytime (electronic diaries and actigraphy: 27.3 ± 0.9%, 23.5 ± 1.2%, P < 0.01; paper diaries and actigraphy: 27.3 ± 0.8%, 23.2 ± 1.0%, P < 0.01), with the exception that less daytime sleep was recorded on actigraphy than on either diary. In conclusion, the electronic diary and the paper diary are valid and well-accepted methods for the assessment of infant sleep. Parents preferred the electronic diary but, conversely, they were less compliant in completing it.

Infant well‐being following neonatal cardiac surgery

To investigate infant well-being as measured by feeding and sleeping and parental support following discharge from the NICU in infants following major cardiac surgery. Infant feeding and sleeping have been identified as two of the most important concerns reported by parents. These concerns have been reported anecdotally for infants who have undergone cardiac surgery in the neonatal period. A prospective study using questionnaires and phone interviews followed a cohort of parents of neonates who underwent surgery in the neonatal period for congenital heart disease. The study was conducted using validated questionnaires and phone interviews with a semi-structured questionnaire. The questionnaires were administered prior to discharge from the NICU and interviews took place following discharge on five occasions within nine months. Fifty six infants and mothers were followed for nine months following discharge from NICU. Sixty-eight per cent were breastfeeding on discharge however the rates decline over time in line with healthy infants. Mothers were not bothered by their infant's sleep patterns which were consistent with those of healthy infants at six months. There were 37 episodes of re-hospitalisation and the average time of further surgery was five months following discharge from their initial period of hospitalisation. The issues from this pilot study warrant further investigation. Factors such as multiple hospitalisations, parent education and support may vary within contexts and need to be studied to ensure optimal supports are identified for this high risk population. This study identified several issues that can improve care provided to these infants and their parents. Support following discharge could include: lactation consultant to provide follow-up calls to identify concerns with breastfeeding, lactation course for paediatric nurses providing follow-up and education for Early Childhood Clinics on Congenital Heart Disease.

Infant Growth in Length Follows Prolonged Sleep and Increased Naps

The mechanisms underlying infant sleep irregularity are unknown. This study tests the hypothesis that sleep and episodic (saltatory) growth in infant length are temporally coupled processes. Daily parental diaries continuously recorded sleep onset and awakening for 23 infants (14 females) over 4-17 months (n = 5798 daily records). Multiple model-independent methods compared day-to-day sleep patterns and saltatory length growth. Approximate entropy (ApEn) quantified temporal irregularity in infant sleep patterns; breastfeeding and infant sex explained 44% of inter-individual variance (P = 0.001). Random effects mixed-model regression identified that saltatory length growth was associated with increased total daily sleep hours (P < 0.001) and number of sleep bouts (P = 0.001), with breastfeeding, infant sex, and age as covariates. Infant size and illness onset were non-contributory. CLUSTER analysis identified peaks in individual sleep of 4.5 more h and/or 3 more naps per day, compared to intervening intervals, that were non-randomly concordant with saltatory length growth for all individuals (P < 0.05), with a time lag of 0-4 days. Subject-specific probabilities of a growth saltation associated with sleep included a median odds ratio of 1.20 for each additional hour (n = 8, 95% CI 1.15 to 1.29) and 1.43 for each additional sleep bout (n = 12, 95% CI 1.21-2.03). Increased sleep bout duration predicted weight (P < 0.001) and abdominal skinfold accrual (P = 0.05) contingent on length growth, and truncal adiposity independent of growth (P < 0.001). Sleeping and length growth are temporally related biological processes, suggesting an integrated anabolic system. Infant behavioral state changes may reflect biological mechanisms underlying the timing and control of human growth.