Non-parental Caregivers Research Articles

Should You Stick Around? Children’s Associational Rights and the Duties of Nonparental Caregivers

Should You Stick Around? Children’s Associational Rights and the Duties of Nonparental Caregivers

Are grandparents a good substitute for parents as the primary caregiver? The impact of grandparents on Children's academic performance

This study examines the impacts of caregiving by grandparents on children's academic performance in China. Using data from the China Family Panel Studies (CFPS 2010 and 2014), we find evidence that grandparents appear to have an adverse effect on the test scores of their school-age grandchildren, and the negative effect is concentrated on grandparents with lower educational attainment and on boys. We further examine the mechanisms of this negative effect. Our results suggest that parenting styles play an important role in the success of grandchildren and the common parenting styles of grandparents in China compromise childhood development. Given that grandparents taking care of grandchild is prevalent nowadays and its negative effect on children's academic performance is worrisome, our results have important policy implication: parenting training could help to mitigate the negative effects of non-parental caregivers.

Clinical characteristics and influence ofpostoperative Hirschsprung-associated enterocolitis: retrospective study at a tertiary children's hospital.

To explore the influence of postoperative Hirschsprung-associated enterocolitis (post-HAEC) on long-term outcomes and to identify risk factors of post-HAEC. The medical records of 304 eligible patients diagnosed with Hirschsprung's disease (HSCR) were reviewed. We analyzed the clinical characteristics of post-HAEC and its influence on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were identified separately. The overall incidence of post-HAEC was 29.9% (91/304). We categorized early HAEC as occurring within postoperative 3months (n = 39) and recurrent HAEC as occurring ≥ 3 episodes within postoperative 6months (n = 25). Patients with early HAEC were more likely to experience worse nutritional status, defecation function, and quality of life compared to those with late or no episodes (P < 0.05). Similarly, the adverse influences of recurrent HAEC on these outcomes were also significant (P < 0.05). The risk factors for early HAEC included preoperative undernutrition, long-segment HSCR, and postoperative Grade 3-4 complications within 30days. For recurrent HAEC, risk factors were preoperative malnutrition, non-parental caregivers, long-segment HSCR, and postoperative Grade 3-4 complications within 30days. Classification of post-HAEC based on the first episode time and frequency was necessary. The earlier or more frequent episodes of post-HAEC have detrimental influences on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were different.

Identifying elevated child weight from 3 to 24 months: Early transitions into nonparental care and to solid foods.

Early entry into nonparental care (NPC) and introduction to solid foods (ITS) have been linked to elevated weight, however, little research exists on the combined influence of these transitions on child weight over time. Identify groups of children based on early NPC and ITS timing and examine whether NPC-ITS groups differentially affect child weight over time. Data were drawn from STRONG Kids2 (n = 468). Primary predictors include NPC (by 3M)-ITS (< or ≥6M) groups; outcome variables include child weight-for-length/height z-scores (WFL/WFHz) (3, 12, 18, and 24 months). Multilevel regression was used to examine the NPC-ITS groups as predictors of child WFL/WFHz. Six groups were identified: 27% Parental Care-ITS before 6M, 31% Parental Care-ITS after 6M, 12% Daycare-ITS before 6M, 14% Daycare-ITS after 6M, 10% Kincare-ITS before 6M, and 7% Kincare-ITS after 6M. Children who were in daycare (regardless of ITS) or kincare-ITS before 6M demonstrated the highest WFL/WFHz over time, compared to their parental care counterparts. NPC-ITS combinations on child WFL/WFHz across the first 2 years of life highlight the need for a partnership approach among parental and nonparental caregivers to support the feeding of infants throughout the transition to solid foods.

A machine learning approach to identifying non-parental caregivers' risk for harsh caregiving towards infants in daycare centers

BackgroundHarsh Caregiving behavior amongst daycare providers (i.e., non-parental Harsh Caregiving) negatively impacts children's development across a variety of domains. As prevalences of non-parental Harsh Caregiving appear to increase worldwide, identifying its predictors is crucial for screening and intervention. ObjectiveThe goal of this study was to identify a set of indicators and predictive rules that may accurately predict women's risk for Harsh Caregiving behavior in daycare environments. Participants and SettingThe study recruited 75 female non-parental caregivers, from the general population, who work with infants aged 0-1. Caregivers filled out self-report questionnaires including a Harsh Caregiving measure as well as a broad variety of potential predictors. MethodsTo elucidate combinations of input variables that are predictive of non-parental Harsh Caregiving, we used machine learning Decision Three Inference and CHAID algorithms. ResultsStudy results revealed a predictive model including 27 questions and four different prediction paths. For example, the first path indicated that women who reported low levels of attention deficit and hyperactivity problems and low levels of rigid-negative caregiving philosophies, had 100 % chance to report low levels of Harsh Caregiving behavior. Overall classification accuracy for "High Harsh Caregiving behavior" was 95.2 %. ConclusionsAfter replication in larger samples, the model can be used as a screening tool for women expressing their wish to work with infants. Women at risk can either be declined employment or alternatively receive targeted supervision throughout their work with small infants.

Examining live-in foreign domestic helpers correlates and parenting correlates in children’s externalizing behavior in Hong Kong

BackgroundApproximately one third of Hong Kong households with children aged 12 and below employed live-in foreign domestic helpers (FDHs). However, research is scarce on examining the relationships between this FDHs-involved childcare and children’s socio-emotional outcomes. ObjectiveThis study aims to examine the non-parental (i.e., FDHs) childcare correlates and parenting correlates which are associated with children’s self-reported externalizing behavior (e.g., noncompliance, fighting). MethodThis study invited 244 Hong Kong families with Grade 4 to Grade 6 children who have live-in FDHs in their families. Child-reported attachment to FDHs was assessed. Parental warmth, control, and guan, an indigenous Chinese parenting dimension, were reported by fathers and mothers respectively. 216 children, 199 fathers, and 212 mothers returned their questionnaires. FindingsThe hierarchical regression analyses found that, among parental correlates, only maternal warmth had a significant negative correlation with children’s externalizing behavior. When including the non-parental and parental correlates, only children’s attachment toward FDHs showed a significant negative correlation with children’s externalizing behavior. ConclusionThis study pioneered in examining the relationship between children’s secondary attachment toward non-parental caregivers (i.e., FDHs) and children’s socioemotional outcome. It also extended the attachment theory to the setting of non-parental childcare in late childhood.

They do not have symptoms – why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

BackgroundLatent tuberculosis (TB) infection has been known as a seedbed for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only 40.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2021. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers.MethodsBetween October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment or TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach.ResultsThe mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. Most healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, TPT’s child-unfriendly formula, TPT supply-chain issues, caregivers’ concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement.ConclusionFindings from this study suggest that the national TB program should provide more TPT training to healthcare providers and strengthen supply chain mechanisms to ensure adequate TPT drug supplies. Improving community awareness of TPT among caregivers should also be intensified. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.

Additive and synergistic relations of early mother–child and caregiver–child interactions and socioeconomic outcomes in adulthood

AbstractPrior theoretical and empirical studies have linked the first 3 years of children's life with later life outcomes. One primary explanation is the critical role these experiences play in children's early brain development (including their early language and cognitive abilities) and subsequent schooling achievement. The current study is a registered report with two complementary research objectives: (1) examine to what extent stimulating and responsive interactions with mothers and nonparental caregivers during the first 3 years of life show additive or synergistic associations with key socioeconomic outcomes in adulthood (i.e., educational attainment, salary, and employment status), and (2) examine to what extent academic skills (i.e., mathematics, vocabulary, and literacy) during childhood and adolescence mediate these associations. The sample included 1364 individuals from a birth cohort study who were followed until age 26. Mother–child interactions had positive associations with educational attainment and negative associations with full‐time employment, though no synergistic associations were found for the socioeconomic outcomes. In addition, the indirect effects of mother–child interactions on educational attainment through mathematics were strongest for children with less stimulating and responsive caregiver–child interactions. Potential implications of these findings for developmental theory are discussed.

Non-Parental Child-Caregivers’ Utilization and Non-Utilization of Treated Mosquito Bed Nets in a Community on the Atlantic Ocean Coast of Lagos, Nigeria

Objective: To evaluate perception, ownership, use and defects in LLINs among non-parental caregivers in Iyaafin community on the Atlantic Ocean coastline of Lagos State, Nigeria. Methods: This cross-sectional, community-based study was conducted between February-April 2014. Residences of 129 non-parental caregivers to children under the age of five years were surveyed, using a convenience sampling method. Semistructured, interviewer-administered questionnaires were used to gather data. NCSS21 statistical software was used for data analysis. Results: Use of “Mosquito coils” a smoky repellent, is what most (72.1%) respondents said was how this coastal community prevent malaria. Only 22 (17.1%; 10, 15.2% male, 12, 19.1% female) said sleeping under mosquito nets prevent malaria. Majority (114, 88.4%) of the respondents said that living in a clean environment is the best way that malaria can be prevented. Approximately half (49.6%) of surveyed households did not have any mosquito nets while only 21 (16.3%) households had 1 mosquito net. Conclusions: Mosquito coil was the most common method of preventing malaria in the community of study. Few people possessed Long Lasting mosquito nets or any other nets and fewer slept under mosquito nets, night before survey.

A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia

Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in both the healthcare facility and home environments are scarce. We assessed the limited efficacy of a novel multimodal behaviour change intervention, delivered at the facility, to improve the hand hygiene practices among midwives and caregivers during childbirth through the return to the home environment. The 6-month intervention was implemented in 4 of 8 purposively selected facilities and included environmental restructuring, hand hygiene infrastructure provision, cues and reminders, and participatory training. In this controlled before-and-after study, the hand hygiene practices of all caregivers present along the care continuum of 99 women and newborns were directly observed. Direct observations took place during three time periods; labour, delivery and immediate aftercare in the facility delivery room, postnatal care in the facility ward and in the home environment within the first 48 h following discharge. Multilevel logistic regression models, adjusted for baseline measures, assessed differences in hand hygiene practices between intervention and control facilities. The intervention was associated with increased odds of improved practice of birth attendants during birth and newborn care in the delivery room (Adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.7, 7.7), and that of parental and non-parental caregivers prior to newborn care in the post-natal care ward (AOR = 9.2; CI = 1.3, 66.2); however, the absolute magnitude of improvements was limited. Intervention effects were not presented for the home environment due COVID-19 related restrictions on observation duration at endline which resulted in too low observation numbers to warrant testing. Our results suggest the potential of a facility-based multimodal behaviour change intervention to improve hand hygiene practices that are critical to maternal and neonatal infection along the continuum of care.

Parents’ perceptions of ethical issues in adolescents’ HIV care and treatment at Temeke Regional Referral Hospital, Tanzania

&#x0D; &#x0D; &#x0D; &#x0D; Background. Decisions to test, enrol and disclose HIV status are among the ethical challenges that may influence adherence to antiretroviral therapy (ART) and HIV care and treatment in adolescents living with HIV. In the Tanzanian setting, how parental perceptions of ethical issues affect adolescents’ adherence to HIV care and treatment is not well known.Objective. To explore parental perceptions of ethical issues in adolescent HIV care and treatment.&#x0D; Methods. The study employed a descriptive qualitative exploratory design and was conducted at Temeke Regional Referral Hospital in Dar es Salaam Care and Treatment Centre (CTC) in the Outpatient Department (OPD). The study population were parents and non-parent caregivers of HIV-infected adolescents 10 - 19 years of age. A total of 16 persons participated in semi-structured interviews after their consent was obtained. All interviews were audiotaped, transcribed verbatim in Swahili and back-translated into English. An inductive content analysis was used, and standards of qualitative rigour applied.&#x0D; Results. Three qualitative themes emerged: balancing adolescents’ autonomy with parents’ desire to protect their children; parental dilemmas regarding disclosure of adolescents’ HIV status; and parental reasons for delayed disclosure.Conclusion. Participants perceived that parental authority should override adolescents’ autonomy in HIV care and treatment. Disclosure of HIV status to adolescents is a challenge to parents. Delays in disclosure often occur because parents feel guilty and because they have fears of rejection by their adolescent children.&#x0D; &#x0D; &#x0D; &#x0D;

Factors Associated Depression In Secondary Schools Adolescents In Gombe, North-eastern, Nigeria

Background: Depression is a mood disorder characterised by loss of interest and enjoyment (anhedonia), and reduced energy leading to increased fatigability and diminished activity. Depression is a major contributor to the overall global burden of disease. It has a profound effect on adolescents because those who experience depression at an early age often struggle with depression throughout their lives, and in many cases, early onset of depression predicts more severe depression during adulthood. Objectives: This study aimed to determine the prevalence of depression and associated factors among secondary school adolescents in Gombe, Nigeria. Methodology: Three hundred and ninety-five adolescents aged 13- 18 years were selected using a multistage sampling method. The Beck Depression Inventory-II (BDI-II) was used to assess depression and a structured questionnaire was used to obtain the sociodemographic characteristics of the subjects. Results: The mean age of subjects was 16.2±1.4 years. The prevalence of depression was 37.7% (142/377). Subjects from low socio-economic class (χ2= 30.601, p&lt; 0.001). Subjects with non-parental caregivers were 4.8 times more likely to be depressed than those that had parental caregivers (OR 4.760, CI 1.882-12.04). Depression was significantly higher among subjects from public schools (χ2= 22.698, p&lt; 0.001). Also, the majority of the subjects who failed the exams preceding the study had depression as compared to those that passed the exams (χ2=5.389, p= 0.030). Conclusion: The burden of depression is high among adolescent secondary school students in Gombe. Psychosocial stressors such as low social class, non-parental care, parental divorce and poor academic performance are significant determinants of depression among adolescents. Early detection of depression is recommended as it has a strong relationship with suicidal ideation among adolescents.

Family Alliance and Intergenerational Transmission of Coparenting in Gay and Heterosexual Single-Father Families through Surrogacy: Associations with Child Attachment Security.

Parents tend to internalize the coparenting model they experienced during childhood and enact it in their coparenting relationships as adults. These interactive patterns may, in turn, shape their children’s internal working models of attachment relationships. The present study recruited 31 gay and 28 heterosexual single-father families through surrogacy to examine family alliance quality and the mediating role of observed supportive and conflictual coparenting in the association between the coparenting quality single fathers experienced in their families of origin and the attachment security of their children. All single fathers lived in Italy, were cisgender and White, and had a child aged 6–12 years (M = 97.73 months; SD = 20.48; 47.5% girls) who they coparented with nonparental caregivers (i.e., 33 grandparents, 18 babysitters, 8 uncles/aunts). Families did not differ in family alliance dimensions based on fathers’ sexual orientation. Additionally, single fathers who experienced greater coparenting quality in their families of origin demonstrated lower levels of conflictual coparenting, which, in turn, were associated with greater child attachment security. In contrast, observed supportive coparenting did not mediate this relation. The results emphasize the need to reconceptualize the dyadic coparental unit in single-father surrogacy families to include extended family members and nonrelatives.

The Perception and Behavioral Attitude to Malaria of Non-parental Care-givers Living on an Atlantic Ocean Coastal Community in Nigeria: Paper 1

Introduction: Malaria is still both a health and an economic burden to various communities in sub-Saharan Africa. Few studies have been conducted on perception of and behavioral pattern of young care-givers to malaria, especially in the populated communities along the Atlantic Ocean coastline in Nigeria.

Involvement of Non-Parental Caregivers in Obesity Prevention Interventions among 0-3-Year-Old Children: A Scoping Review.

Introduction: We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions. Methods: We conducted a scoping review following the Arksey and O’Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded. Results: Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions (n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions (n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake (n = 5), parental feeding practices (n = 3), and screen time (n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.

Non-parental caregivers, low maternal education, gastrointestinal problems and high blood lead level: predictors related to the severity of autism spectrum disorder in Northeast China

BackgroundThe prevalence of autism spectrum disorder (ASD) has increased rapidly in recent years. Environmental factors may play an important role in the pathogenesis of ASD. These factors may include socioeconomic factors, nutritional factors, heavy metal exposure, air pollution, etc. Our aim is to analyze possible environmental factors associated with the severity of ASD.MethodsAll participating children were divided into two groups (mild and moderate/severe) according to the severity of their symptoms, as determined by their Childhood Autism Rating Scale (CARS) scores. The socioeconomic, demographic factors and the nutritional factors that may affect the severity of ASD were included in the logistic regression to analyze whether they were predictors that affected the severity of ASD.ResultsLogistic regression showed that caregivers(P = 0.042), maternal education (P = 0.030), gastrointestinal problems (P = 0.041) and a high serum concentration of lead (P = 0.003) were statistically significantly associated with ASD severity.ConclusionMany environmental factors affect the severity of ASD. We concluded that non-parental caregivers, low maternal education, gastrointestinal problems and high blood lead level maybe predictors that affected the severity of ASD in northeast China.

Factors moderating the link between early childhood non-parental care and ADHD symptoms

IntroductionThere is little known about the association between non-parental care in early childhood and attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers. Therefore, we examined the association between childcare from grandparents/babysitters during infancy/preschool and ADHD symptoms in preschoolers. MethodsUsing stratified random sampling, we developed a sample comprising 1597 parents of children aged 1.6–7 years who were enrolled in preschool in rural and urban areas of China. Parental reports of ADHD symptoms were assessed using the preschool version of the ADHD Rating scale-IV. A regression analysis was used to examine the association between childcare from grandparents/babysitters and ADHD symptoms. ResultsChildcare from grandparents during infancy was associated with ADHD symptoms in childhood (β = 1.03, P < 0.0001). Significant associations between grandparental care and ADHD symptoms were also observed in children from families with more than one child (β = 0.64, P = 0.0035) and children living in rural areas (β = -0.78, P = 0.0032). A babysitter as the primary child caregiver in preschool was especially strongly correlated with ADHD symptoms in girls (β = 7.95, P = 0.0042). Moreover, region was strong factor associated with ADHD symptoms without adjustment for the non-parental caregivers’ age and education, whereas family income was not strongly associated with ADHD symptoms. ConclusionNon-parental caregiving (i.e., from grandparents or babysitters) in early childhood was associated with more ADHD symptoms in children. Certain characteristics in children, such as female gender and the existence of siblings, were stronger moderating factors than were family income and region.

Examination of dietary intake of UK preschool children by varying carers: evidence from the 2008-2016 UK National Diet and Nutrition Survey.

Early years caregivers can play a key role in young children's eating and the prevention of childhood obesity. The UK National Diet and Nutrition Survey (NDNS) is a large representative survey collecting detailed food and nutrition consumption data. Using these data, the aim of this study was to investigate the relationship between dietary intake of preschool children in the UK aged 2 to 4 years and accompanying adult/s. Nutrition consumption data from 1218 preschool children from years 1 to 8 of the 2008-2016 NDNS were accessed. Dietary data were captured using 3 or 4 day estimated food diaries. Regression analyses revealed significant differences in consumption when children were not accompanied by their parents. Compared with when children were with parents, children consumed significantly more energy dense meals (0·32 kJ/g, 95% CI 0·1-0·6 kJ/g), energy (62 kJ/g, (95% CI 27-97 kJ)) Na (19 mg, (95 % CI 6, 32)), added sugars (0·6 g, (95 % CI 0·1, 1·1)), vegetables (3 g, (95 % CI 1, 4)), total grams (12 g, (95 % CI 3, 21)) and saturated fat (0·2 g, (95 % CI 0·1, 0·4)) per eating occasion when accompanied by wider family. When children were accompanied by a formal childcare provider, they consumed significantly lower energy dense meals (-0·9 kJ/g, (95% CI -1·4 - -0·3 kJ/g)), less added sugars (-1·6 g, (95 % CI -2·4, -0·8)) and more fruit (12 g, (95 % CI 3, 21)) per eating occasion than when they were with their parents. The results demonstrate that non-parental caregivers might be an important target to promote healthy eating in young children. Further research is needed to establish which caregivers would benefit most.

Associations of Childcare Arrangements with Adiposity Measures in a Multi-Ethnic Asian Cohort: The GUSTO Study.

Childcare arrangements shape behavioural patterns that influence the risk of childhood obesity. However, little is known of its influence on childhood obesity in Singapore. We aim to examine the associations between childcare arrangements at the age of 5 years and childhood adiposity at age 6 years. Children from the GUSTO study were grouped into three childcare arrangements at age 5: full-time centre-based childcare (FC), partial centre-based with parental care (PCP), and partial centre-based with non-parents (grandparents and domestic helpers) as caregivers (PCN). Diet, physical activity and sedentary behaviour information were collected at age 5, while anthropometric measurements were collected at age 6. Associations were analysed using multivariable regression models. Among 540 children, those in PCN had higher BMI z-scores (β: 0.34; 95% CI: 0.01, 0.66), greater sum of skinfold thicknesses (mm) (β: 3.75; 95% CI: 0.53, 6.97) and were 3.55 times (95% CI: 1.78, 7.05) more likely to be overweight/obese than those in FC. Adiposity measures in PCP children did not differ from those in FC. PCN children were reported to have more screen time and greater fast-food intake. Children in PCN tended to have higher adiposity measures. Greater engagement of non-parental caregivers should be considered in interventions targeting child obesity.

Sleep disturbances and correlates among a sample of preschool children in rural China.

This study aimed to explore the prevalence of sleep disturbances among preschool children in rural areas of China and identify the underlying associated factors. A cross-sectional study was conducted in rural areas of Anhui Province, China, from September 2019 to January 2020. The caregivers of children from 26 kindergartens completed the demographic questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), the Strengths and Difficulties Questionnaire (SDQ), the Self-rating Anxiety Scale (SAS), and the adapted Identification and Management of Feeding Difficulties (IMFeD) tool. One-way analysis of variance, independent-samples t-test, and hierarchical multiple linear regression were conducted to explore the potential influencing factors of sleep disturbances in preschool children. For the specific sleep disturbances based on each subscale of the CSHQ, bedtime resistance (54.9%) and sleep anxiety (47.9%) were the most common types of sleep disturbances, followed by daytime sleepiness (21.3%), sleep duration (20.8%), parasomnias (16.5%), sleep-onset delay (12.6%), night wakings (12.2%) and sleep-disordered breathing (10.3%). The ages of children, children's emotional/behavioral problems, children's feeding difficulties, inconsistent parenting attitudes of parents, poor parenting styles, non-parent caregivers, and caregiver anxiety contributed significantly to the CSHQ total score, accounting for approximately 27.1% (R2 = 0.271) of the variance. Our study indicates that the prevalence of sleep disturbances among preschool children in rural areas of China is quite high. Furthermore, the potential risk factors are complicated, including factors related to both children and their caregivers.