Sleep In Toddlers Research Articles

How strong is the evidence supporting the WHO guidelines on physical activity, sedentary behaviour and sleep in early childhood?

The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation. All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result. Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes. While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.

0818 Room-sharing and Bed-sharing: Reasons, Beliefs, and Sleep in Mothers and Toddlers from Mexican American Families

0818 Room-sharing and Bed-sharing: Reasons, Beliefs, and Sleep in Mothers and Toddlers from Mexican American Families

Sleep in infants and toddlers with Down syndrome

Sleep in infants and toddlers with Down syndrome

Is the association between sleep and socio-emotional development mediated by weight in toddlers aged 12 to 36 months?

Childhood is an important stage for socio-emotional development. Understanding the associations of lifestyle habits with the healthy development of social and emotional skills is crucial for better interventions early in life. This study aims to analyze the association between sleep and socio-emotional development in toddlers aged 12 to 36 months and examine whether weight mediated these associations. This study is part of a cluster randomized controlled trial developed in Portuguese childcare centers. A sample of 344 children (176 females) enrolled in the study. Participants' anthropometrics were measured while at childcare centers using standardized procedures. Body mass index (BMI) was computed as the body weight/height2 (kg/m2) ratio. Sleep quality was collected with the Tayside Children's Sleep Questionnaire, a 10-item scale that evaluates the child's ability to initiate and maintain sleep. Two additional questions regarding sleep duration were added. Parental questionnaires assessed the child's sex and date of birth, socioeconomic status, and total energy intake (TEI). Motor (fine and gross) was assessed using Bayley-III scales and socio-emotional (SE) by the Greenspan Social-Emotional Growth Chart questionnaire. Linear regression models were used to examine the associations between sleep (duration and quality) and SE with adjustments for sex, age, BMI, mothers' education, motor development, and TEI. Mediation analysis was conducted using path analysis. SE development was significantly associated with nighttime sleep duration even when adjusted for confounders (β = 0.223; 95% CI: 0.001, 0.004 and β = 0.168; 0.0003, 0.003; respectively). Sleep quality was not significantly associated with SE development, and the weight did not explain the associations between sleep and SE development. This study supports that sleep duration is directly associated with SE development in toddlers. From a public health perspective, sleep duration should be prioritized in intervention programs to improve socio-emotional development early in life.

Five-year follow-up of a clinic-based sleep intervention for paediatric epilepsy: A randomized clinical trial.

Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5-year follow-up of a clinic-based sleep intervention study that randomized 100 toddlers and preschool-age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long-term benefits of a clinic-based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow-up was 9.55 years. Thirty-eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5-year follow-up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5-year follow-up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic-based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool-age children with epilepsy had long-lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring.

Bedtime routines, development, and caregiver educational attainment in toddlerhood

BackgroundImplementing a consistent bedtime routine is an empirically supported intervention to improve sleep in toddlers, but little is known about its association with social-emotional outcomes, and among children living in lower socioeconomic status (SES) contexts.ObjectiveThis study examined the longitudinal associations between bedtime routines, social-emotional development, and caregiver educational attainment in toddlers presenting to primary care.MethodCaregivers of 40 toddlers (Mage = 12.85 months, 57.5% female, 62.5% Black/African American) completed questionnaires on sociodemographic factors and child bedtime routine consistency at their 12-month well visit. At the 15- and 24-month well visits, data were collected on child bedtime routine consistency and social-emotional development, including the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) for social-emotional problems and competency and the Ages and Stages Questionnaire (3rd edition; ASQ-3) to assess communication and personal-social skills.ResultsOverall, the majority of families engaged in a consistent bedtime routine (≥5 nights/week) at all time points (63% at 12 months, 75% at 15 months, and 86% at 24 months). Controlling for concurrent bedtime routine consistency, toddlers with a more consistent bedtime routine at 12 months exhibited less dysregulation at age 15 months. Toddlers without a consistent bedtime routine at 15 months exhibited more externalizing and internalizing problems and dysregulation at 24 months. Furthermore, there was a significant interaction between bedtime routine consistency at 15 months and caregiver education for internalizing problems at 24 months, such that toddlers of caregivers with a high school education or less who lacked a consistent bedtime routine showed the most internalizing problems.ConclusionClinicians should consider recommending that families with toddlers incorporate a nightly bedtime routine not only to improve overall sleep health, but also to potentially optimize toddlers' positive social-emotional and behavioral trajectories, especially in families with lower educational attainment.

Longitudinal associations between sleep and weight status in infants and toddlers.

The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent-reported sleep and cross-sectional studies. Examine whether average sleep duration and changes in sleep duration among 6-24-month-old children were associated with weight-for-length z-scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight-for-length z-scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between- and within-person changes in sleep duration were estimated with weight-for-length z-score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. At time points where children slept longer at night compared to their own average, their weight-for-length z-score was lower. This relationship was attenuated by physical activity levels. Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels.

0781 Relationship between Bedtime Routines with Sleep, Development, and Parenting Stress in Toddlers

Abstract Introduction Institution of a nightly bedtime routine is a key component of sleep health and is likely to foster positive early childhood development. The current study investigated the longitudinal and concurrent relationships between a bedtime routine and sleep, social-emotional development, and parenting stress in toddlers living in lower income homes and/or neighborhoods. Methods Caregivers of 78 toddlers (56.4% female; M=12.87 mos; 67.9% Black; 73.1% WIC) reported on their child’s bedtime routine at their 12-month well-child visit. At their child’s 15- and 24-month well visit, caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R SF), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Parenting Stress Index (PSI-SF). Results were considered significant at p<.05. Results Toddlers with a consistent bedtime routine (5+ nights per week) at 12 months had significantly earlier bedtimes (20:54 vs 21:24) and waketimes (7:21 vs 8:48) at 24 months compared to those without a consistent routine. At 15 months, a more frequent bedtime routine was associated with fewer concurrent social-emotional problems (r = -.32) and decreased bedtime difficulty (r = -.34). At 24 months, toddlers with a consistent bedtime routine (33.3%) were less likely to exhibit concurrent BITSEA social-emotional competency concerns (66.7%). Caregivers also reported better nighttime sleep in toddlers with a consistent routine at 24 months. Additionally, caregivers whose child had a consistent routine at 15 and 24 months perceived their child as less difficult (PSI) at 24 months. However, no associations emerged between bedtime routine frequency and consistency at 12, 15, and 24 months with ASQ communication and personal-social concerns. Conclusion Bedtime routine frequency and consistency in toddlers was associated with better caregiver-perceived sleep, social-emotional development, and lower parental stress regarding their child being perceived as difficult, but not communication and personal-social concerns. A bedtime routine may be a cost-effective strategy to promote toddlers’ sleep, overall development, and family’s functioning. Support (if any) This study was partially funded by the Simms/Mann Institute

P033 Associations between sleep and emotional self-regulation in toddlers

Abstract Introduction Emotional self-regulation (ESR) skills are vital for mental and physical health. There is growing evidence linking sleep to ESR in school-aged children, but associations in toddlers remain unclear. The current study examined associations between toddlers’ sleep duration and behaviors and ESR. Materials and methods This study utilized baseline data from 1358 toddlers (Mage=26±3.9mo) from the Let’s Grow trial. Total sleep duration was calculated by summing parent-reported average nighttime sleep and daytime nap duration. Sleep behaviors (bedtime routine, bedtime resistance, sleep latency, and night waking) were assessed using the Children’s Sleep Habits Questionnaire and Brief Infant Questionnaire. Toddlers’ ESR skills were assessed via a 4-item parent-report scale adopted from the Fast Track Project Child Behaviour Questionnaire, with a lower score indicating better ESR. Linear regression models assessed associations of sleep duration and behaviors with ESR. Results Toddlers’ average daily total sleep, nighttime sleep, and nap duration were 12.1h, 10.6h, and 1.5h, respectively. Girls and boys had similar nighttime sleep, total sleep, and ESR scores. However, girls had longer naps than boys (1.6h vs 1.4h, t=-3.5, p=0.0004). Total sleep, nighttime sleep, and nap duration were inversely associated with ESR (all p<0.01), indicating that higher sleep duration was associated with better ESR. Sleep behaviors were positively associated with ESR (all p<0.01), with more problem sleep behaviors associated with poorer ESR. Conclusion Initial results suggest that improving sleep duration and behaviors are associated with better ESR in toddlers. Supporting parents to improve their toddlers’ sleep may help foster better ESR skills.

Effects of Omega-3-6-9 fatty acid supplementation on behavior and sleep in preterm toddlers with autism symptomatology: Secondary analysis of a randomized clinical trial

BackgroundChildren born extremely preterm disproportionately experience sequelae of preterm birth compared to those born at later gestational ages, including higher prevalence of autism spectrum disorder (ASD) and associated behaviors. AimExplore effects of combined dietary docosahexaenoic acid, eicosapentaenoic acid, gamma-linolenic acid, and oleic acid (omega 3-6-9) on caregiver-reported behavior and sleep in toddlers born at ≤29 weeks' gestation who were exhibiting symptoms commonly seen with ASD. Study design90-day randomized (1:1), double blinded, placebo-controlled trial. SubjectsThirty-one children aged 18–38 months received omega 3-6-9 (n = 15) or canola oil placebo (n = 16). Outcome MeasuresMixed effects regression analyses followed intent to treat and explored treatment effects on measures of caregiver-reported behavior (Child Behavior Checklist 1.5–5, Toddler Behavior Assessment Questionnaire – Short Form, Vineland Adaptive Behavior Scales, 2nd Edition) and sleep (Children's Sleep Habits Questionnaire, Brief Infant Sleep Questionnaire). ResultsTwenty-nine of 31 (94%; ntx = 13, nplacebo = 16) children randomized had data available for at least one outcome measure, 27 (87%; ntx = 12, nplacebo = 15) had complete outcome data. Children randomized to omega 3-6-9 experienced a medium magnitude benefit of supplementation on anxious and depressed behaviors (ΔDifference = −1.27, d = −0.58, p = 0.049) and internalizing behaviors (ΔDifference = −3.41, d = −0.68, p = 0.05); and a large magnitude benefit on interpersonal relationship adaptive behaviors (ΔDifference = 7.50, d = 0.83, p = 0.01), compared to placebo. No effects were observed on other aspects of behavior or sleep. ConclusionsFindings provide preliminary support for further exploration of omega 3-6-9 during toddlerhood to improve socioemotional outcomes among children born preterm, especially for those showing early symptoms commonly seen with ASD. Results need to be replicated in a larger sample. Trial registrationRegistered with ClinicalTrials.gov: NCT01683565.

A Persian Translation of “Brief Infant Sleep Questionnaire Revised (BISQ-R)” for Assessment of Sleep in Infants and Toddlers: A Pilot Study

A Persian Translation of “Brief Infant Sleep Questionnaire Revised (BISQ-R)” for Assessment of Sleep in Infants and Toddlers: A Pilot Study

Filtering respiratory motion artifact from resting state fMRI data in infant and toddler populations

The importance of motion correction when processing resting state functional magnetic resonance imaging (rs-fMRI) data is well-established in adult cohorts. This includes adjustments based on self-limited, large amplitude subject head motion, as well as factitious rhythmic motion induced by respiration. In adults, such respiration artifact can be effectively removed by applying a notch filter to the motion trace, resulting in higher amounts of data retained after frame censoring (e.g., “scrubbing”) and more reliable correlation values. Due to the unique physiological and behavioral characteristics of infants and toddlers, rs-fMRI processing pipelines, including methods to identify and remove colored noise due to subject motion, must be appropriately modified to accurately reflect true neuronal signal. These younger cohorts are characterized by higher respiration rates and lower-amplitude head movements than adults; thus, the presence and significance of comparable respiratory artifact and the subsequent necessity of applying similar techniques remain unknown. Herein, we identify and characterize the consistent presence of respiratory artifact in rs-fMRI data collected during natural sleep in infants and toddlers across two independent cohorts (aged 8–24 months) analyzed using different pipelines. We further demonstrate how removing this artifact using an age-specific notch filter allows for both improved data quality and data retention in measured results. Importantly, this work reveals the critical need to identify and address respiratory-driven head motion in fMRI data acquired in young populations through the use of age-specific motion filters as a mechanism to optimize the accuracy of measured results in this population.

Safe sleep after 1 year of age.

Safe sleep after 1 year of age.

Ночной сон у детей раннего возраста

A regular restful sleep for a recommended time affects the quality of life and psychic/physical health and prevents cognitive, emotional, and somatic disorders. Meanwhile, the rate of nocturnal awakenings among toddlers is 20–66%. This paper reviews current data on night sleep in toddlers. Techniques for assessing sleep duration in children are addressed. Research findings demonstrate that the most important causes of sleep disturbances are breastfeeding, mother’s anxiety and depression, and sleeping with parents. Sleeping with parents is not only a culturological feature but also indicates potential problems in the family being a means of compensating for the lack of partner intimacy and family relations. Factors affecting sleep transition and sleep quality (including the specifics of food intake) are discussed. It was demonstrated that amino acids are important for falling asleep and sleep regulation. A high-carbohydrate diet is also beneficial. KEYWORDS: night sleep, toddlers, nocturnal awakenings, sleeping with parents, nutrition. FOR CITATION: Dubrovskaya M.I., Ryazanova O.V., Netrebenko O.K. et al. Night sleep in toddlers. Russian Journal of Woman and Child Health. 2021;4(2):173–177. DOI: 10.32364/2618-8430-2021-4-2-173-177.

Memory-related hippocampal activation during sleep and temporal memory in toddlers

Nonhuman research has implicated developmental processes within the hippocampus in the emergence and early development of episodic memory, but research in humans has been constrained by the difficulty of examining hippocampal function during early development. In the present study, we assessed 48 2-year-olds with a novel paradigm in which participants completed two games on a tablet that required remembering associations between unique characters, the places they visited, and the temporal order with which they did so. At the completion of each game, a unique, novel song played. Toddlers remembered spatial locations better than temporal order during an immediate test, after a 20-minute delay, and after a week delay. After the last behavioral session, toddlers underwent an fMRI task during natural nocturnal sleep evaluating hippocampal activation in response to learned and novel songs. We found that the extent of hippocampal activation for learned songs compared to novel songs during sleep was correlated with memory for temproal order across all time delays, but not with memory for spatial locations. The results confirm that that the functional contribution of the hippocampus to early memory can be assessed during sleep and suggest that assessment of temporal aspects of memory in the current task best capture this contribution.

Sleep and Sensory Processing in Infants and Toddlers: A Cross-Sectional and Longitudinal Study.

Typically developing children who are sensitive to sensory stimulation appear to have more sleep difficulties than children with average sensory sensitivities; however, at what age sleep difficulties emerge and whether they extend to children outside of sleep clinics are unclear. To investigate cross-sectional and longitudinal relationships between sleep and sensory processing in typically developing infants and toddlers. Observational; cross-sectional and longitudinal. Community. Children (N = 160) enrolled in a larger four-armed randomized controlled trial of overweight prevention in infancy (40 randomly selected from each arm). Parent-reported sleep patterns at ages 6 mo, 1 yr, 2 yr, and 2.5 yr. Sensory Processing Measure-Preschool questionnaire covering five sensory systems and higher level functions: praxis and social participation at age 2.5 yr. Relationships between sleep and sensory variables were analyzed using multiple linear regression models. More problematic sleep at age 2.5 yr was associated with more difficulties in social-relational skills (p < .001), a finding supported by the longitudinal data. Longer settling times were associated with higher vision (p = .036) and touch (p = .028) sensitivities at age 2.5 yr; in the longitudinal data (ages 6 mo-2.5 yr), longer settling times were associated with more sensitive hearing (p = .042). Results support a link between sleep patterns and sensory processing difficulties in toddlers that, in some, can emerge in infancy. Practitioners should be alert to this association in young children presenting with sensory sensitivity or sleep challenges. Study findings illustrate that bedtime challenges in typically developing toddlers could be related to sensory processing. A possible way to assist more sensitive children in settling to sleep is to pay attention to visual, tactile, and auditory stimuli that potentially interfere with sleep onset.

Docosahexaenoic Acid and Arachidonic Acid Supplementation and Sleep in Toddlers Born Preterm: Secondary Analysis of a Randomized Clinical Trial.

This secondary analysis characterized sleep patterns for toddlers born preterm and tested effects of docosahexaenoic acid (DHA)+ arachidonic acid (AA) supplementation on children's caregiver-reported sleep. Exploratory analyses tested whether child sex, birth weight, and caregiver depressive symptomatology were moderators of the treatment effect. Omega Tots was a single-site 180-day randomized (1:1), double-blinded, placebo-controlled trial. Children (n = 377) were age 10 to 16 months at enrollment, born at less than 35 weeks' gestation, assigned to 180 days of daily 200 mg DHA + 200 mg AA supplementation or placebo (400 mg corn oil), and followed after the trial ended to age 26 to 32 months. Caregivers completed a sociodemographic profile and questionnaires about their depressive symptomatology (Center for Epidemiologic Studies Depression Scale) and the child's sleep (Brief Infant Sleep Questionnaire). Analyses compared changes in sleep between the DHA+AA and placebo groups, controlling for baseline scores. Exploratory post hoc subgroup analyses were conducted. Eighty-one percent (ntx = 156; nplacebo = 150) of children had 180-day trial outcome data; 68% (ntx = 134; nplacebo = 122) had postintervention outcome data. Differences in change between the DHA+AA and placebo groups after 180 days of supplementation were not statistically significant for the entire cohort. Male children (difference in nocturnal sleep change = 0.44, effect size = 0.26, P = .04; sleep problems odds ratio = 0.36, 95% confidence interval = 0.15, 0.82) and children of depressed caregivers (difference in nocturnal sleep change = 1.07, effect size = 0.65, P = .006; difference in total sleep change = 1.10, effect size = 0.50, P = .04) assigned to the treatment group showed improvements in sleep, compared to placebo. Although there is no evidence of an overall effect of DHA+AA supplementation on child sleep, exploratory post hoc analyses identified important subgroups of children born preterm who may benefit. Future research including larger samples is warranted. Registry: ClinicalTrials.gov; Identifier: NCT01576783. Boone KM, Rausch J, Pelak G, Li R, Turner AN, Klebanoff MA, Keim SA. Docosahexaenoic acid and arachidonic acid supplementation and sleep in toddlers born preterm: secondary analysis of a randomized clinical trial. J Clin Sleep Med. 2019;15(9):1197-1208.

Negative temperament, hair cortisol, and sleep in toddlers reared in poverty

Negative temperament, hair cortisol, and sleep in toddlers reared in poverty

Disentangling the Direction of Associations between Sleep and Temperament in Toddlers

ABSTRACT Objectives/Background Although much research has investigated the associations between children’s sleep and their temperament, the direction of these associations remains unclear, largely due to a lack of longitudinal studies with repeated assessments of both sleep and temperament. Aiming to clarify the temporal precedence of these two constructs, the current study investigated reciprocal associations between toddlers’ sleep and temperament with a longitudinal design. Participants The sample consisted of 82 toddlers (39 girls) assessed twice. Methods At both 2 (M = 25.23 months; SD = 1.11) and 3 years of age (M = 36.81 months; SD = 0.91), toddlers’ sleep duration and quality were assessed using actigraphy and their temperament was reported by their mothers with the Toddler Behavior Assessment Questionnaire. Results Shorter nighttime sleep duration (ß = − .28, p = .03) and lower sleep efficiency (ß = − .33, p = .01) at 2 years predicted more temperamental proneness to anger at 3 years, while greater temperamental social fear at 2 years was predictive of shorter 24-hour (ß = − .44, p = .02) and nighttime (ß = − .36, p = .04) sleep duration at 3 years. Associations between temperamental activity level and sleep variables were non-significant. Conclusion The direction of the associations between toddlers’ sleep and their temperament may vary according to which dimension of temperament is considered. These findings should encourage practitioners to identify the beginning of the causal chain leading to sleep or temperamental difficulties so as to develop well-tailored intervention plans.

Sleep in infants and toddlers with Down syndrome compared to typically developing peers: looking beyond snoring

AimsTo compare sleep in infants and toddlers with Down syndrome (DS) to typically developing controls, including differences in snoring and sleep ecology (sleep setting and parent behaviors). MethodsParents of 104 children with DS and 489 controls aged 6–36 months completed the Brief Infant Sleep Questionnaire (BISQ). We explored group differences, controlling for demographic variables. ResultsParents of children with DS reported more sleep problems (45% v 19%), snoring (19% vs 2%), room-sharing (37% vs 17%), as well as less night-time sleep (55 mins) and total sleep over 24 h (38 mins). They were more likely to be present when their child fell asleep (OR 4.40). Snoring increased night waking but did not limit night-time/24-hour sleep. However, parental presence was associated with 55 min less night-time and 64 min less 24-hour sleep. After controlling for snoring and parental presence, children with DS slept less at night (38 mins) but more during the day (21 mins) with no significant difference in 24-hour sleep. ConclusionsOverall, significant differences in sleep patterns, problems, and ecology were found between children with DS and controls. Parental presence at settling, not snoring, explained most differences, including over an hour's less 24-hour sleep. Early intervention programmes that promote self-soothing skills could prevent the burden of sleep loss in young children with DS.