Infant Sleep Questionnaire Research Articles

Sleep disorders and allergic diseases in Chinese toddlers

ObjectiveOptimal sleep is important for child growth, development, and immune function. We aimed to explore whether sleep disorders were associated with the risk of allergic diseases in Chinese toddlers. MethodsThis study included 566 children (aged 23.9 ± 0.7 months; 51.1% boys) in Shanghai, China. Sleep parameters (total sleep time, sleep onset latency, nocturnal awaking and snoring) were assessed by an expanded version of the Brief Infant Sleep Questionnaire (BISQ-expanded). Information on four allergic diseases (wheeze, eczema, food allergy, and allergic rhinitis) in the past year was collected via standard questionnaire and judged by pediatricians. We used logistic regression to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for having any/and each of the four allergic diseases, based on sleep parameters, adjusting for children's age and gender, mode of delivery, any breastfeeding duration, children's body mass index (BMI), children's exposure to passive smoking, maternal education, family income, family allergic history, and children's antibiotic use. ResultsThere were 23.3% of children with at least one of the four allergic diseases. Snoring was significantly associated with increased odds of having any allergy (adjusted OR = 1.95; 95% CI: 1.17, 3.26), eczema (OR = 1.83, 95% CI: 1.03, 3.23) and food allergy (OR = 4.31, 95% CI: 1.23, 15.14), after adjustment for potential confounders. Nocturnal awaking ≥2 times per night was associated with higher risk of food allergy (OR = 3.92, 95% CI: 1.00, 15.35) and wheeze (OR = 6.16, 95% CI: 1.28, 29.74). ConclusionIn this study, presence of certain sleep disorders was associated with higher risk of having allergic diseases in Chinese toddlers.

Infant night sleep trajectory from age 3–24 months: evidence from the Singapore GUSTO study

ObjectiveLongitudinal studies on night sleep trajectories throughout infancy are sparse. Moreover, most studies have examined samples in Caucasian individuals, although cultural differences in sleep habits have been described. To expand on the current literature, we aimed to determine night sleep trajectories in an Asian population from age 3–24 months. MethodsNight sleep duration from a subset of 893 infants within the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study was determined using the caregiver-reported Brief Infant Sleep Questionnaire. Latent growth curves were used to analyze sleep trajectories at 3, 6, 9, 12, 18, and 24 months. ResultsThe overall trajectory was modeled with a piecewise model with two freely estimated curves. In the first phase (age 3–12 months), infants displayed an average curvilinear increase in night sleep trajectories of 0.12 h per month. In the second phase (age 12–24 months), infants continued to display a curvilinear increase, but at a slower average rate of 0.02 h per month. ConclusionsThe sleep trajectory of Singaporean infants appeared similar to other predominantly Caucasian cohorts for 3–12 months but not for 12–24 months, in which infants from predominantly Caucasian cohorts mostly displayed a decreasing or a stable-plateaued trajectory. This is in concordance with existing studies that suggest that the underlying influences of night sleep shift from predominantly biological influences to increasing environmental influences with age.

Sleep patterns of young children with newly diagnosed atopic dermatitis.

IntroductionEven though atopic dermatitis (AD) most often begins in the first year of life, it is not well known whether sleep disturbances occur following the onset of the disease or whether they develop later.AimTo determine the sleep patterns of young children already diagnosed with AD in comparison to a control group by using a validated questionnaire, the Brief Infant Sleep Questionnaire (BISQ).Material and methodsForty-six children with a new diagnosis of AD and 60 healthy children, aged 3–36 months, participated in the study. Their sleep behaviors were assessed using the BISQ along with a structured sociodemographic data form.ResultsIt was found that when compared with healthy children, children with AD did not have decreased daily total sleep duration (p = 0.1); however, it was found that they woke up more frequently at night (52.2% vs. 40%, p = 0.4) and they stayed awake significantly longer than 60 min when they woke up (41.3% vs. 11.7%, p < 0.05). In addition, mothers of children with AD reported that their children had three times as many sleep problems compared to the reports of mothers of healthy children.ConclusionsThe findings of this study showed that sleep disturbance was more common in young children with already diagnosed AD, and the BISQ provided a practical way to assess the sleep patterns. The use of a screening tool to enable early identification and treatment of childhood sleep problems among patients with AD should be encouraged.

Young child and maternal sleep in the Middle East

BackgroundThis study aimed to characterize sleep patterns and sleep problems in a large sample of infants and toddlers (from birth to three years) and their mothers in Arabic-speaking families in the Middle East and compare the results to those living in predominantly Asian and predominantly Caucasian countries/regions. MethodsMothers of 669 young children (from Saudi Arabia, Egypt, Algeria, United Arab Emirates, Jordan, Morocco, Iraq, Kuwai, Oman, Palestinian territories, Libyan Arab Jamahiriya, Bahrain, Israel, and other Arab countries) completed an Internet-based expanded version of the Brief Infant Sleep Questionnaire, Daily Infant Mood Scale, and the Pittsburgh Sleep Quality Index. ResultsOverall, children and their mothers in the Middle East slept on a shifted schedule, with late bedtimes and waketimes compared to those from predominantly Asian and predominantly Caucasian countries/regions. Almost all families room-shared with their children, although less than half bed-shared. A significant percentage of parents perceived that their child had a sleep problem (37%), with a high prevalence of poor sleep in mothers (72%). Parent-reported child mood was modestly associated with sleep patterns but more so with parent-perceived sleep problems. Parent-perceived sleep problems in their young child were predicted by bedtimes, prevalence of a bedtime routine, and night wakings. ConclusionsOverall, both young children and their mothers in the Middle East have a delayed sleep schedule, going to bed late in the evening and waking up late in the morning. Sleep was associated with mood outcomes, with bedtimes, bedtime routines, and falling asleep independently predicting sleep outcomes. The high prevalence of sleep problems in both the infants and toddlers and their mothers supports the need for sleep to be addressed by pediatric and adult healthcare practitioners.

Mothers massaging their newborns with lotion versus no lotion enhances mothers’ and newborns’ sleep

Sleep is frequently interrupted in newborns and their mothers. Massage therapy is noted to facilitate sleep in adults and infants. Infant massage has also been more effective with oil versus no oil. In this study 76 mothers of newborns were randomly assigned to a massage with lotion versus a massage without lotion group and a non-massage control group. The mothers were then taught a simple newborn massage and were asked to massage their newborns daily for 15min at bedtime for one month. The Brief Infant Sleep Questionnaire was adapted for newborns and for mothers, and the mothers completed the questionnaires on their newborns’ and their own sleep behaviors (the same behaviors for both mothers and newborns). The 3 groups were compared on the mothers’ and their newborns’ sleep behavior changes from birth to one month. By the last day of the study, the lotion massage group versus the other two groups showed a shorter latency to sleep and longer sleep for the mothers and fewer nightwakings and longer sleep for their infants. This may relate to the lotion group mothers massaging their infants more frequently as the number of massages was correlated with the total time sleeping and negatively correlated with nightwakings for both the mothers and the infants on the last day of the study. And, the mothers’ and the infants’ sleep behaviors were significantly correlated.

Sleep and Social-Emotional Development in Infants and Toddlers

The aim of this study was to examine the cross-sectional and longitudinal relationships among variables related to sleep patterns and both social-emotional problems (i.e., internalizing, externalizing, and dysregulation) and healthy social development (i.e., social competence). Assessments were completed at 6, 12, and 18 months across 5 cohorts of children for a total of 117 mother–child dyads. Mothers completed the Brief Infant Sleep Questionnaire at 6, 12, and 18 months, as well as the Infant Toddler Social Emotional Assessment at 12 and 18 months. Later bedtimes and less total sleep across the 24-hr period predicted higher internalizing problem scores, which includes indices of depression/withdrawal, general anxiety, separation distress, and inhibition. In contrast, sleep fragmentation was minimally associated with decreased social competence but not with any negative social-emotional outcomes. These results indicate that sleep patterns, primarily later bedtimes and less total sleep, appear to be associated with and predictive of social-emotional problem areas, namely, internalizing issues, in infants and toddlers. These findings add to the growing literature on the role of sleep in early social-emotional development and suggest that sleep schedule and duration should be addressed in clinical assessment and interventions for infant sleep.

Parent Report and Actigraphically Defined Sleep in Children with and without Developmental Coordination Disorder; Links with Fatigue and Sleepiness

Impaired sleep is associated with negative effects on quality of life and daytime functioning. Higher rates of sleep disturbance are reported in children with various developmental disorders. However, little is known about sleep in children with developmental coordination disorder (DCD), a condition characterized by everyday movement difficulties. Previously, in a preliminary study, we found higher rates of parent-reported sleep disturbance in children with DCD compared to controls. To examine sleep in DCD using objective measures and to examine links with daytime fatigue and sleepiness. Two groups (primary and secondary school-aged) of 15 children with DCD, plus matched controls, participated. Parent-reported child sleep was assessed using the Children's Sleep Habits Questionnaire and actigraphy provided an objective measure of sleep-wake patterns over 1 week (including weekdays and weekend). Pediatric restless legs syndrome (RLS) semi-structured diagnostic interview was conducted with each child and parent to capture symptoms of RLS. Aspects of self-rated child functioning were assessed with questionnaires (Pre-sleep Arousal Scale, Pediatric Daytime Sleepiness Scale, PedsQL Multidimensional Fatigue Scale) and mothers' reported thoughts about child sleep with the Maternal Cognitions about Infant Sleep Questionnaire. The DCD groups had greater parent-reported sleep disturbance. Actigraphy results suggested that for secondary aged children with DCD their sleep quality was impaired and there were differences in the timing of sleep compared to controls (including some differences in the variation between weekday and weekend sleep times). The actigraphy of the primary age group with DCD was unremarkable compared to controls. No child in the study met the criteria for RLS. Exploratory analyses suggested that daytime fatigue, aspects of pre-sleep arousal, and daytime sleepiness were reported as greater in the DCD groups and were particularly related to objective sleep parameters in the DCD groups. Maternal thoughts about sleep did not differ between the DCD and control groups. The nature and underlying cause of sleep disturbance and how it might be linked with aspects of daytime functioning in adolescents with DCD requires further research. Meanwhile, clinical awareness of the risk of atypical sleep patterns/sleep problems in DCD is important to ensure early identification and implementation of appropriate support.

Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting.

Shortened sleep duration is associated with poor health and obesity among young children. Little is known about relationships among nighttime sleep duration, sleep behaviors, and obesogenic behaviors/obesity among toddlers. This study characterizes sleep behaviors/duration and examines relationships with obesogenic behaviors/obesity among toddlers from low-income families. Mothers of toddlers (age 12-32 months) were recruited from urban/suburban sites serving low-income families. Mothers provided demographic information and completed the Brief Infant Sleep Questionnaire (BISQ); a 6-item Toddler Sleep Behavior Scale was derived (TSBS-BISQ, higher score reflects more recommended behaviors). Toddler weight/length were measured; obesity defined as ≥95th percentile weight-for-length. Measures of obesogenic behaviors: physical activity [accelerometry, minutes/day in Moderate-to-Vigorous Physical Activity (MVPA)] and diet quality [24-hour recall, Healthy Eating Index 2005 (HEI-2005)]. Bivariate and adjusted multivariable models examined associations between nighttime sleep behaviors/duration and obesogenic behaviors/obesity. Sample included 240 toddlers (mean age = 20.2 months), 55% male, 69% black, 59% urban. Toddlers spent 55.4 minutes/day in MVPA, mean HEI-2005 score was 55.4, 13% were obese. Mean sleep duration was 9.1 hours, with 35% endorsing 5-6 recommended sleep behaviors (TSBS-BISQ). In multivariable models, MVPA was positively related to sleep duration; obese toddlers had a shorter nighttime sleep duration than healthy weight toddlers [odds ratio = 0.69, p = 0.014]. Nighttime sleep duration was associated with high TSBS-BISQ scores, F = 6.1, p = 0.003. Toddlers with a shorter nighttime sleep duration are at higher risk for obesity and inactivity. Interventions to promote healthy sleep behaviors among toddlers from low-income families may improve nighttime sleep duration and reduce obesogenic behaviors/obesity.

INSIGHT Responsive Parenting Intervention and Infant Sleep.

Inadequate sleep during infancy is associated with adverse outcomes for infants and families. We sought to improve sleep behaviors and duration through a responsive parenting (RP) intervention designed for obesity prevention. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control. Primiparous mother-newborn dyads were randomized after childbirth, and research nurses delivered intervention content at home visits at infant ages 3, 16, 28, and 40 weeks and at a research center visit at 1 year. The RP sleep component included developmentally appropriate messages about bedtime routines, sleep location and behaviors, and responses to wakings. Portions of the Brief Infant Sleep Questionnaire were administered 2, 8, and 52 weeks after birth with expanded sleep-related data collection at 16 and 40 weeks. Two hundred and seventy-nine dyads completed the first home visit; 90.7% completed the 1-year visit. Compared with controls, RP group infants were less likely to have prolonged bedtime routines >45 minutes and more likely to have earlier bedtimes at 16 and 40 weeks. They were less likely to be fed immediately before bed and more likely to self-soothe to sleep. At 8, 16, and 40 weeks, RP group nocturnal sleep duration was longer by 35, 25, and 22 minutes, respectively (P < .05 for all). Sleep duration at 1 year was similar between groups. The INSIGHT RP intervention positively influenced developmentally appropriate bedtime routines, sleep-related behaviors, and sleep duration for infants.

Sleep, Depression, and Fatigue in Late Postpartum.

To study the relation of infant characteristics and home environment on maternal sleep, depression, and fatigue in late postpartum. Forty-two healthy mother-infant dyads completed a home-based study at infant age 32 weeks. Maternal measures included Patient Reported Outcomes Measurement Information System (PROMIS) sleep and wake disturbance, depression, and fatigue scales. Home regularity was assessed using the Confusion, Hubbub, and Order Scale (CHAOS). Infant sleep and regulation were measured respectively by the Brief Infant Sleep Questionnaire (BISQ) and Infant-Toddler Symptom Checklist (ITSC). Significant correlations among maternal sleep and wake disturbance, fatigue, and depression were detected (r = .519 to .746, p < .01), but not with infant variables. Home regularity was significantly related with maternal variables (r = .597 to .653, p < .01). Regularity of the home environment appears to contribute to maternal sleep, depression, and fatigue. Implications for intervention include establishment of daily routines and household management to improve regularity and consequently improve maternal outcomes.

Pediatric sleep problems and social-emotional problems. A population-based study

ObjectiveTo examine the association between sleep and social-emotional development in two-year-old toddlers. MethodsThe study is part of a longitudinal cohort study, the Akershus Birth Cohort Study, which targeted all women giving birth at Akershus University Hospital in Norway. The current study is from the fourth round of the study, including 2014 women two years after delivery. The Brief Infant Sleep Questionnaire (BISQ) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) were filled out by the mothers and were used to assess toddler sleep, and social-emotional development, respectively. Other domains of development (communication problems, gross motor problems, and fine motor problems) were assessed with the Ages and Stages Questionnaire (ASQ). Confirmatory factor analysis was conducted on the ASQ:SE, and logistic regression analyses were used to examine both crude associations between sleep variables and social-emotional problems, and adjusting for potential confounders. ResultsThe mean sleep duration of the toddlers was 12h and 27min; the majority of the children (54%) had 1–2 awakenings per night, while 10% of the children had a sleep onset latency of more than 30min. All sleep parameters, including short sleep duration, nocturnal awakenings and sleep onset problems, were significantly associated with social-emotional problems in a dose-response manner. For example, sleeping less than 11h per night was associated with a five-fold increase in the odds of social-emotional problems, compared to sleeping 13–14h per night. Adjusting for potential confounders, including maternal age, maternal education, marital status, parity, gestational age, child birth-weight and other developmental problems, did not, or only slightly, attenuate the associations between any of the sleep variables and social-emotional problems. ConclusionsShort sleep duration, nocturnal awakenings and sleep onset problems were all associated with higher odds of social-emotional problems, even after accounting for developmental problems and demographic factors. Thus, a broad assessment of sleep and social-emotional problems when toddlers present with either can be useful.

Sleep Patterns among South Korean Infants and Toddlers: Global Comparison.

The purpose of this study was to examine sleep patterns in a large sample of infants and toddlers (ages birth to 36 months) in Korea, and to compare sleep patterns, sleep problems, sleep ecology, and parental behaviors to global sleep data on young children in both predominately Asian (P-A) and predominately Caucasian (P-C) countries/regions. We additionally examined parent and child demographic information, parental behaviors, and aspects of the sleep ecology as predictors of sleep patterns among infants and toddlers in Korea. Parents/caregivers of 1,036 Korean infants and toddlers completed an expanded, internet-based version of the brief infant sleep questionnaire. Consistent with other studies of sleep in early childhood, sleep/wake patterns became increasingly consolidated with older child age for the Korea sample. Compared to both P-A and P-C infants and toddlers, children in Korea had the latest bedtimes, shortest total sleep and daytime sleep durations, and the least frequent rates of napping. Even though half of parents perceive their children’s sleep problematic, parental perceptions of severe child sleep problems were the lowest. Within Korea, breastfeeding and bottle-feeding at sleep resumption were associated with increased nocturnal awakenings. Evening television viewing was associated with later bedtimes, which may have implications for sleep hygiene recommendations in clinical practice. The current study provides important information about sleep/wake patterns, parental behaviors, and aspects of the sleep ecology for infants and toddlers for physicians to support healthy sleep in Korea.

Multi-center study on the effects of television viewing on sleep quality among children under 4 years of age in China

To explore the current television viewing situation among children less than 4 years of age in our country and investigate effects of television viewing on sleep quality. According to the"Hospital of Province-City-County"sampling technical route, a total of 1 046 full term healthy children at the age of 4-48 months were sampled by stratified cluster random sampling method from 8 provinces in China from 2012-2013. The information of television viewing and family and personal information was investigated by Shanghai Children's Medical Center Socio-demographic Questionnaire. Brief Infant Sleep Questionnaire (BISQ) and Brief Child Sleep Questionnaire (BCSQ) were employed to assess the sleep behaviors of children 0-3 years old and over 3 years old respectively.The effects of television viewing on sleep quality were analyzed by multiple linear regression analysis. The children's average age was (20±13) months, with boys accounted for 53.3% (558/1 046). The percentage of children who viewed television was 70.3% (735/1 046). Moreover, 58.7% (408/695) of infants and young children under the age of 2 viewed TV per day, and 19.9% (70/351) of 2 years and older infants and young children viewed television ≥2 hours per day. With the increase of age, the percentage of children who viewed television time gradually increased (P<0.001). Child sex, geographic area, paternal education, and family structure were not associated with television viewing time among children aged 4-48 months. However, the presence of a bedroom TV(χ(2)=13.682, P=0.001) and maternal employment (χ(2)=15.053, P=0.005) were commonly correlated with long screen-watching time among children. After adjusting for age, gender, mother' education level, and working state, it was revealed by multiple linear regression analysis that television viewing was not only positively correlated with later bedtime (t=5.49, P<0.001) and shorter night sleep duration (t=-3.49, P=0.001) but also significantly associated with longer sleep onset latency (t=2.63, P=0.009). The percentage of children under 4 years of age who viewed television is very high in our country, and many infants under 6 months of age exposed to TV environment. Bedroom TV and mother full-time job were associated with higher proportion of children viewing TV. In early childhood, television viewing was positively correlated with later bedtime, shorter sleep duration and longer sleep onset latency. There is a need for parents and pediatricians to pay more attention to the behavior of children viewing TV and improve sleep quality.

Pacifier Use, Finger Sucking, and Infant Sleep

Few studies to date have investigated the relationship between pacifier use or finger sucking and infant sleep. One hundred and four mothers of infants (ages 0–11 months) completed the Brief Infant Sleep Questionnaire (BISQ). Infants who engaged in finger sucking had fewer night wakings and longer stretches of nighttime sleep, although less daytime sleep. There were no significant differences in sleep patterns between pacifier users and infants who did not engage in nonnutritive sucking. Furthermore, no significant differences were found across groups for sleep ecology, including parental involvement at bedtime and following night wakings. Finally, infants were consistently able to retrieve their pacifiers independently by 7 months of age, although this did not appear to be associated with sleep outcomes. Results suggest that when parents are deciding whether to give their infant a pacifier, sleep may not be a critical factor. In contrast, parents of finger and thumb suckers should be reassured that this nonnutritive sucking is beneficial to sleep, at least in the first year of life.

Pattern of Sleep in Infants and Toddlers Visiting at a Teaching Hospital in Lalitpur

Introduction: Sleep is an integral part in a child’s health and development. During different stages of development, there are aberrations in normal physiology of sleep which make children more susceptible to various types of sleep problems. This study was conducted to identify sleep pattern and sleep problems in Nepalese children using Nepali translation of Brief Infant Sleep Questionnaire (BISQ) screening tool.Materials and Methods: This was a descriptive cross-sectional study. Data were collected from parents of children aged 6 to 36 months attending paediatric out-patient clinic for general health check-up from July 2013 to December 2013. Nepali translation of the BISQ was used as a screening tool for sleep problems in this study.Results: The study included 553 children (52.4% boys). Mothers completed the questionnaire in 92% of children. Mean total duration of sleep in 24 hours was 11.7 ±1.7 hours. Respondents reported sleep problem in 16.9% of children whereas 20.3% of children had sleep problems according to BISQ criteria. As per this criteria, 2.7% of children had total sleep duration less than 9 hours, 5.9% of children had total night awakening duration of more than one hour, 13.9% of children had night waking &gt;3 times. These BISQ sleep parameters differed significantly in children with and without sleep problems (p&lt;0.001). In addition, children with sleep problem took longer time to sleep than children without sleep problems (p&lt;0.001).Conclusion: Sleep problems are common in Nepalese infants and toddlers according to the BISQ. Screening for sleep problems is highly recommended during health care visits given the prevalence of sleep problems identified by this study to reduce their potential adverse impact.J Nepal Paediatr Soc 2015;35(1):24-30

Sleep, mood, and development in infants

BackgroundThe aim of the study was to assess the relationship of sleep with mood and development in infancy. MethodsMothers of 1351 mothers of infants (ages 3–13 months) in Brazil completed an internet-based expanded version of the Brief Infant Sleep Questionnaire and the Ages & Stages Questionnaire. ResultsOverall, there were associations among parental ratings of infants’ bedtime, morning, and daytime mood with sleep outcomes, especially sleep fragmentation, duration of nighttime sleep, and parental perception of sleep problems. There were no relationships between any sleep variables and developmental outcomes, including communication, fine and gross motor skills, problem-solving, and personal social relationships. ConclusionsOverall, these results indicate that sleep patterns and sleep problems during infancy are associated with parental ratings of infant mood but not more global developmental outcomes.

Sensory Processing and Sleep in Typically Developing Infants and Toddlers

To explore the relationship between sensory processing patterns and sleep problems in typically developing infants and toddlers. A retrospective chart review of 177 infants and toddlers from a community occupational therapy sleep clinic included descriptive and correlational analyses of data from the Infant/Toddler Sensory Profile and Brief Infant Sleep Questionnaire. More than half of participants (55%) demonstrated a pattern of increased sensory processing in one or more quadrants, with sensitivity being most common (36%). We found small but significant correlations between increased seeking and shorter daytime sleep duration (r=-.24, p=.002) and between increased sensitivity and longer time to settle to sleep (r=.27, p<.001). This study adds to recent literature linking sensory processing patterns to sleep problems and is the first to demonstrate this relationship in young, typically developing children. Results support the role of occupational therapy in addressing sleep difficulties in children.

The Zurich 3-step concept for the management of behavioral sleep disorders in children: a before-and-after study.

Several strategies have been found to be effective for the treatment of childhood behavioral sleep disorders. One which has yet to be evaluated is the Zurich 3-step concept, which combines basic notions of the two-process model of sleep regulation (introducing a regular rhythm and adjusting bedtime to sleep need) with behavioral strategies. This uncontrolled before-and-after study describes our concept and its step-wise approach, assesses changes in sleep-wake variables and behavior problems, and also examines associations between changes in sleep-wake variables and behavior problems. A total of 79 children with sleep problems (age range 6-47 months, 42% females) were included. Sleep problems were assessed by the Infant Sleep Questionnaire, sleep-wake variables by diary and actigraphy, and behavior problems of children ≥ 18 months by the Child Behavior Checklist. A significant decrease in nocturnal wake duration (Cohen's d = -0.34) and a significant increase in the duration of the longest continuous nocturnal sleep period (Cohen's d = 0.19) were found from before to after intervention (on average 2.7 months, SD 1.5). The variability for sleep onset and end time decreased, and actigraphically measured circadian rest-activity cycle measures improved. Parent-reported internalizing and total behavior problems also decreased (Cohen's d = 0.66). The findings of both objective and subjective assessment techniques suggest that the Zurich 3-step concept is effective. Thus, the intervention concept may be useful in clinical practice with sleep-disordered children.

A Nepali Translation of Brief Infant Sleep Questionnaire (BISQ) For Assessment of Sleep in Infants and Toddlers: A Preliminary Report

Background: Sleep problems are common in children and various questionnaires have been devised to screen these problems. Brief Infant Sleep Questionnaire (BISQ) is one of the sleep screening tools which is simple, reliable and valid tool and is being used for screening of sleep problems in infants and toddlers in various countries. Objectives: The objective of this study was to translate English version of Brief Infant Sleep Questionnaire to Nepali language using a standard technique so that Nepali version could be used to screen sleep problems in Nepalese infants and toddlers. Methods: This article describes the process of translation of original BISQ questionnaire into Nepali language in a standard method. Four bilingual paediatricians translated English BISQ to Nepali language which was then tested among few parents for understanding, clarity and uniformity of expected response. A draft version was finalized after consensus of translators, two expert paediatricians and original author. This version was then translated back into English by two independent medical professionals and compared with original BISQ for content and meaning. The final version of Nepali translation was approved after consensus agreement. Results: The translated Nepali BISQ was then tested among 15 parents who had a child below three years of age. These parents did not find difficulty in understanding and responses were uniform and as expected from the original questionnaire. Conclusion: The Nepali version of BISQ could be applicable as a screening tool to assess sleep in infants and toddlers in clinical setup as well as research studies.DOI: http://dx.doi.org/10.3126/jkmc.v3i3.12245Journal of Kathmandu Medical CollegeVol. 3, No. 3, Issue 9, Jul.-Sep., 2014, apge: 102-106

Maternal Negative Affect and Infant Sleep: Investigating Bi-directional Relationships Using Structural Equation Modelling

It is well documented that problematic sleep patterns in children are related to maternal mental health issues, such as stress, depression and anxiety. Although it is not clear whether it is the sleep patterns that predict maternal mental health or vice versa. Studies have called for the use of transactional models to allow for the contextual representation of the complexities of the interaction between mother and child. The current paper examines the potential bi-directional relationship between infant sleep patterns and maternal negative affect. Maternal negative affect was measured using the Edinburgh Postnatal Depression Scale and the Depression Anxiety Stress Scales. Infant sleep was measured using the Brief Infant Sleep Questionnaire (BISQ) and maternal ratings of infant sleep. Structural equation modeling suggests relationships are bi-directional but appear to weaken after 8 weeks, although there is some re-emergence of the relationship again at 9-12 months. Moreover, the results indicate poor maternal negative affect during pregnancy predicts poorer infant sleep at birth to eight weeks and two to six months, and poor infant sleep at birth to eight weeks predicts poorer maternal negative affect at 8 weeks old. The results indicate the relationship between maternal negative affect and infant sleep is bi-directional. Clinically, this has important implications for assessment and treatment, advocating the need for both constructs to be considered in the context of each other. They also highlight the importance of screening and treatment for maternal mental health during pregnancy and potential intervention for infant sleep problems in the early postnatal period.