Sleep Problems In Toddlers Research Articles

Developmental trajectories of toddler sleep problems: can a person-centered approach help identify children at risk?

Previous research examining toddler sleep problems has relied almost exclusively on variable-centered statistical approaches to analyze these data, which provide helpful information about the development of the average child. The current study examined whether person-centered trajectory analysis, a statistical technique that can identify subgroups of children who differ in their initial level and/or trajectory of sleep problems, has the potential to inform our understanding of toddler sleep problems and their development. Families (N = 185) were assessed at 12, 24, 30, and 36 months of child age. Latent class growth analysis was used to test for subgroups that differed in their 24-36 month sleep problems. Subgroups were compared on child 36-month externalizing, internalizing, and total problem behaviors, and on 12 month maternal mental health, inter-parental conflict, and maternal parenting behaviors. Results support a four-class solution, with "low, stable," "low, increasing," "high, increasing," and "high decreasing" classes. The classes whose sleep problems persisted or worsened over time had worse behavioral problems than those whose symptoms improved or remained stably low. Additionally, 12 month maternal depression and global symptom severity, intimate partner violence, and maternal harsh-intrusive parenting behaviors discriminated between the classes that had similar levels of 24 month sleep disturbance but who had diverging trajectories over time. This statistical approach appears to have the potential to increase understanding of sleep problem trajectories in the early years of life. Maternal mental health, intimate partner violence, and parenting behaviors may be clinically useful markers of risk for the persistence or development of toddler sleep problems.

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

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

Wake up to the benefits of timely management of sleep problems in toddlers with Williams Syndrome

This commentary relates to Gwilliam, Joyce, and Dimitriou [1] and their longitudinal work on sleep problems in toddlers with Williams syndrome (WS). WS is a rare and sporadic genetic disorder caused by a small deletion of genes on chromosome 7

걸음마기 유아의 부정적 정서성, 수면문제에 대한 어머니의 인식, 코슬리핑(co-sleeping)이 걸음마기 유아의 수면문제에 미치는 영향

The purpose of this study was to investigate the effects of negative emotionality in toddlers, mothers’ perceptions of sleep problems and co-sleeping on sleep problems in toddlers. The subjects of this study consisted of 203 mothers that were members of an internet community named ‘M cafe’ and who lived in Seoul and Gyeonggi-do Province. This study analyzed the maternal cognition of toddler sleep, the location of sleeping, and toddler sleep problems. The collected data were analyzed using SPSS 25.0 software by descriptive statistics analysis, frequency analysis, and multiple regression analysis. The main finding of this study was that the maternal cognition of young children’s sleep had the largest effect on toddler sleep problems. Young children’s negative emotionality had the second largest effect on toddler sleep problems. Lastly, co-sleeping was also related to toddler sleep problems. These results imply that children’s negative emotionality, co-sleeping, and mothers’ perceptions of infant sleep affect toddler sleep problems. These results can be used as baseline data to reduce infant sleep problems and the study may have implications for presenting maternal cognition and co-sleeping as variables that were not used in previous research.

Maternal stress during pregnancy alters fetal cortico-cerebellar connectivity in utero and increases child sleep problems after birth

Child sleep disorders are increasingly prevalent and understanding early predictors of sleep problems, starting in utero, may meaningfully guide future prevention efforts. Here, we investigated whether prenatal exposure to maternal psychological stress is associated with increased sleep problems in toddlers. We also examined whether fetal brain connectivity has direct or indirect influence on this putative association. Pregnant women underwent fetal resting-state functional connectivity MRI and completed questionnaires on stress, worry, and negative affect. At 3-year follow-up, 64 mothers reported on child sleep problems, and in the subset that have reached 5-year follow-up, actigraphy data (N = 25) has also been obtained. We observe that higher maternal prenatal stress is associated with increased toddler sleep concerns, with actigraphy sleep metrics, and with decreased fetal cerebellar-insular connectivity. Specific mediating effects were not identified for the fetal brain regions examined. The search for underlying mechanisms of the link between maternal prenatal stress and child sleep problems should be continued and extended to other brain areas.

The Association between Autistic Traits and Sleep Habits/Problems in Toddlers

ABSTRACT Sleep disturbances are the comorbid conditions most frequently associated with autism spectrum disorder (ASD). Sleep problems might precede and worsen the behavioral outcomes of ASD. This study examined the association between sleep habits/problems and autistic traits in toddlers. Eighteen-month-old toddlers (N = 426; boys/girls, 204/222) were assessed for autistic traits using the Japanese version of the Modified Checklist for Autism in Toddlers and sleep habits/problems using the Child and Adolescent Sleep Checklist during health checkups. There were no significant differences in sleep habits, including total sleep time, wake time, bedtime, and naps, between autistic toddlers (n= 26) and non-autistic toddlers (n= 400). However, toddlers with autistic traits more commonly exhibited bedtime resistance, abnormality in circadian rhythm, and sleepiness outside of naptime than toddlers without autistic traits. Moreover, autistic traits were significantly associated with daytime sleepiness. Autistic traits are associated with sleep problems in toddlers. In particular, daytime sleepiness might be avisible symptom that enables the earlier detection of ASD in children.

Early manifestation of sleep problems in toddlers with Williams Syndrome using a mixed method longitudinal approach

Children with neurodevelopmental disorders commonly experience sleep problems. Williams Syndrome (WS), a rare genetic disorder characterised by a complex, uneven cognitive profile, is no exception. Compared with children with typical development (TD), school-aged children with WS experience significant sleep disruption: shorter sleep duration, more night wakings, greater bedtime resistance and excessive daytime tiredness. In children with TD, sleep problems impede optimal daytime functioning. In WS, this could compound existing difficulties. Few studies have examined sleep in very young children with WS and little is known about the early emergence of sleep problems in this population. To date, studies have been based on parent-report and no studies have objectively assessed sleep patterns using longitudinal approach in toddlers with WS. Thus, the current study sought to objectively explore sleep patterns in toddlers with WS. Parents of 38 children (13 WS, 25 TD) completed the Brief Infant Screening Questionnaire and the Medical and Demographics Questionnaire and sleep patterns were assessed using actigraphy. Data were collected longitudinally at ages 18, 24 and 30 months. Significant sleep disturbances were present in WS from 18 months old. Sleep duration, as measured by actigraphy, was significantly shorter in WS at all ages and, furthermore, parents of children with WS reported more night wakings, longer settling times and high levels of parental involvement. Crucially, whereas actigraphy showed developmental improvements in sleep quality in TD, no longitudinal changes were found in WS. Findings could be instrumental in working towards instigating appropriate, timely sleep management in this group, thus improving outcomes for children and their families.

Prevalence of sleep problems and its relation to sleeping habits in toddlers

Background: Sleep problems in children have serious physical and psychological consequences such as obesity, aggression and attention deficit disorder in toddlers. The aim of the present study was to determine the prevalence of sleep problems and its relation with sleeping habits of toddlers in 2017.
 Methods: By random sampling from rural families of Razan city of Hamadan province, 120 mothers of 12- to 36-month-old children were selected and data collection tools included contextual questions, medical history and 33-question questionnaire of children's sleep habits (CSHQ) completed. Data were analyzed by SPSS software version 23, independent t-test, chi-square, Pearson correlation coefficient and multiple linear regression.
 Results: The mean age of the children was 22.82±7.53 months and 55% of them were boys and the prevalence of sleep problems was 70.8% (95% confidence interval: 71.9-69.7). The average sleep duration of the children was 11 hours and more than 60% of the children went to bed after 23 o'clock. Results show that age is an important factor in most dimensions of CSHQ and age predicts daytime sleepiness (β = -0.263), nocturnal wakefulness (β = -0.113) and duration, Sleep time (β = -0.108) and sleep resistance (β = 0.194) respectively. Also, parents' education and child's current weight were predictors of subscales of CSHQ questionnaire (P <0.05). In addition, there was a positive and significant correlation between sleep duration with infant sleep anxiety (r = 0.527) and resistance to sleep (r = 0.473) as well as nocturnal wakefulness with parasomnia (r = 0.416) (P <0.001).
 Conclusion: Given the alarming prevalence of sleep problems in toddlers in the present study and the impact of some changeable factors on children's sleep health, designing interventions aimed at educating mothers to improve healthy sleep habits in toddlers is necessary.

Prevalence of sleep problems and its relation to sleeping habits in toddlers

Background: Sleep problems in children have serious physical and psychological consequences such as obesity, aggression and attention deficit disorder in toddlers. The aim of the present study was to determine the prevalence of sleep problems and its relation with sleeping habits of toddlers in 2017.
 Methods: By random sampling from rural families of Razan city of Hamadan province, 120 mothers of 12- to 36-month-old children were selected and data collection tools included contextual questions, medical history and 33-question questionnaire of children's sleep habits (CSHQ) completed. Data were analyzed by SPSS software version 23, independent t-test, chi-square, Pearson correlation coefficient and multiple linear regression.
 Results: The mean age of the children was 22.82±7.53 months and 55% of them were boys and the prevalence of sleep problems was 70.8% (95% confidence interval: 71.9-69.7). The average sleep duration of the children was 11 hours and more than 60% of the children went to bed after 23 o'clock. Results show that age is an important factor in most dimensions of CSHQ and age predicts daytime sleepiness (β = -0.263), nocturnal wakefulness (β = -0.113) and duration, Sleep time (β = -0.108) and sleep resistance (β = 0.194) respectively. Also, parents' education and child's current weight were predictors of subscales of CSHQ questionnaire (P <0.05). In addition, there was a positive and significant correlation between sleep duration with infant sleep anxiety (r = 0.527) and resistance to sleep (r = 0.473) as well as nocturnal wakefulness with parasomnia (r = 0.416) (P <0.001).
 Conclusion: Given the alarming prevalence of sleep problems in toddlers in the present study and the impact of some changeable factors on children's sleep health, designing interventions aimed at educating mothers to improve healthy sleep habits in toddlers is necessary.

Sleep and new media usage in toddlers.

Several studies over the years have demonstrated the association between lack of sleep in children and certain physical, psychological, and behavioral disorders. The aim of this study was to disentangle the association between new screen-based electronic devices and sleep problems in toddlers, adjusting for other covariates already known to be associated with sleep quality. We conducted a cross-sectional study with the aid of a national sample of 1117 toddlers. Parents reported children's sleeping habits such as total sleep time and sleep onset latency, recreational activities, bedtime routines, and temperament. An ordered logistic regression was run to assess the associations between new media exposure and two sleep outcomes (total sleep time and sleep onset latency). Everyday use of a tablet or smartphone raised the odds of a shorter total sleep time (OR 1.95 [1.00-3.79], p < 0.05) and a longer sleep onset latency (OR 2.44 [1.26-4.73] p < 0.05) irrespective of other factors, such as temperament (restlessness, sociability), or traditional screen exposure (watching TV or playing videogames).Conclusion: New media usage is a factor associated in toddlers with sleeping fewer hours and taking longer to fall asleep, irrespective of other confounding factors. What is known • Studies have found an association between sleep behavior and the use of computers and video games in early childhood. • The blue light emitted from TV screens suppresses endogenous melatonin. What is new • The study found an association between daily new media (tablet and smartphone) usage and sleep quality in toddlers • New media usage exposes toddlers to the risk of fewer hours of sleep and taking longer to fall asleep, irrespective of other factors.

Sensory reactivity and sleep problems in toddlers with autism spectrum disorder and anxiety/depression symptoms in their mothers: are they related?

ABSTRACT Previous studies suggest that children with Autism Spectrum Disorder (ASD) are more prone to develop sleep problems and sensory reactivity, and these symptoms have an impact on parental mood. The current study examined the sleep problems and atypical sensory behaviour of 48 first-time diagnosed ASD children and the anxiety/depression levels of their mothers. We also investigated factors associated with maternal depressive symptoms. We found that sleep problems, atypical sensory reactivity, and mothers’ depression levels were higher in ASD children. Sleep problems and sensory reactivity were also significantly associated with mothers’ depression and autism severity. In regression analyses, parasomnia and sensory reactivity were significant predictors of mothers’ depression. Our results indicate that sleep-related symptoms and atypical sensory reactivity should be considered in all children diagnosed with ASD. In addition, our findings emphasize the importance of paying attention to caregiver distress and depression during the process of autism detection and intervention.

Correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in toddlers: results from the GET UP! Study

ObjectiveTo explore the correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in a sample of Australian toddlers. MethodsParticipants were 173 toddlers (average age 19.7 ± 4.1 months) from the GET UP! Study. Nocturnal sleep duration, nocturnal sleep variability, nap(s) and physical activity were measured using 24-h accelerometry (Actigraph GT3X+) over seven consecutive days. Nocturnal sleep problems were assessed using the Tayside Children's Sleep Questionnaire. Screen time was reported by the parents. Logistic regression models were used to examine the associations between potential correlates (ie, age, sex, socio-economic status, weight status, physical activity, screen time, nap(s), bedtimes, and wake-up times) and nocturnal sleep characteristics. ResultsOlder children were more likely to have greater sleep variability (OR: 1.97; 95% CI: 1.08–3.61). Less physical activity (OR: 2.38; 95% CI: 1.27–4.45), shorter nap(s) (OR: 2.42, 95% CI: 1.29–4.55), and later wake-up times (OR: 4.42; 95% CI: 2.32–8.42) were associated with higher odds of having longer nocturnal sleep duration. Late bedtimes were associated with shorter nocturnal sleep duration (OR: 0.09; 95% CI: 0.04–0.18) and with greater nocturnal sleep variability (OR: 1.97; 95% CI: 1.06–3.68). None of the potential correlates were associated with nocturnal sleep problems. ConclusionThe present study identifies several correlates of nocturnal sleep duration (total physical activity, nap(s), bedtime, and wake-up time) and nocturnal sleep variability (age and bedtime), whereas no correlates were identified for nocturnal sleep problems. The association between late bedtimes and shorter nocturnal sleep duration and greater nocturnal variability suggests that these may be modifiable targets for future sleep interventions in early childhood. Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12616000471482, 11/04/2016, retrospectively registered.

Perceived Toddler Sleep Problems, Co-sleeping, and Maternal Sleep and Mental Health.

Childhood sleep problems are associated with insufficient parental sleep and adverse maternal mental health symptoms, which may be exacerbated when mothers/toddlers co-sleep (i.e., bed/room sharing). This study examines maternal sleep duration as a mechanism linking perceived toddler sleep problems with maternal mental health and examines whether these associations vary by co-sleeping, in addition to exploring alternative models. Low-income mothers of toddlers (n = 280) (age 12-32 months) recruited from Women, Infants, and Children and pediatric clinics provided demographic information and completed questionnaires on their toddler's sleep and their own sleep duration and mental health symptoms (depressive symptoms, anxiety, and stress). Indirect and conditional indirect models were conducted to examine the relation between perceived toddler sleep problems and maternal mental health. Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping (mean = 6.1 h). Maternal sleep duration mediated the relation between perceived toddler sleep problems and maternal symptoms of depression, anxiety, and stress for co-sleeping mothers. Maternal sleep duration did not mediate relations between maternal mental health symptoms and perceived toddler sleep problems. This study provides a conceptual model by which parent and child sleep is related to parental mental health. Practitioners might consider alternatives to co-sleeping when discussing sleep arrangements with parents. Future studies should replicate results longitudinally and examine whether reducing co-sleeping improves maternal sleep duration and reduces perceptions of toddler sleep problems.

0985 SHORTENED MATERNAL SLEEP MEDIATES THE RELATION BETWEEN TODDLER SLEEP PROBLEMS AND MATERNAL PSYCHOPATHOLOGY

Toddler sleep problems have a major impact on mothers’ sleep, putting mothers at risk for shortened nighttime sleep and psychological difficulties. The mechanism of how toddler sleep problems affect maternal psychopathology (i.e. depressive/anxiety symptoms) has not been explored in a cohesive model, particularly among low-income populations. Low-income families frequently co-sleep, a practice that affects both maternal and toddler sleep duration/quality. The purpose of this analysis is to examine relations between toddler/maternal sleep, including co-sleeping practices, and maternal symptoms of psychopathology, in mothers of low-income toddlers; a population at risk for both poor sleep and mental health problems. We hypothesize that shortened maternal sleep duration mediates relations between toddlers sleep problems and maternal anxiety/depressive symptoms. This study utilizes baseline data from low-income mothers of toddlers (ages 12–32 months) who participated in a parenting intervention. Mothers provided demographic information and completed questionnaires on their toddler’s sleep (Brief Infant Sleep Questionnaire, BISQ), their own sleep (Pittsburgh Sleep Quality Index, PSQI) and their mental health symptoms (State-Trait Anxiety Inventory, STAI; Beck Depression Inventory, BDI). Moderated mediation models were conducted to predict maternal symptoms of anxiety/depression using the SPSS macro PROCESS, controlling for poverty level. Sample included 282 mothers, 68% African American, 70% living below the poverty threshold, and 61% co-slept with their toddler. The differences in indirect effects by sleep arrangement were tested in separate models for maternal symptoms of depression and anxiety, respectively. The results showed that toddlers sleep arrangement moderated the mediation effects of maternal sleep duration on the relationship between toddler sleep problems and maternal symptoms of depression (diff= 1.10, 95% bootstrapped CI: .21, 2.46) and anxiety (diff.= .44, 95% BCI: .08, 1.07). Further analysis showed significant mediation effects for depression (mediation effect= .87, CI: .22-1.84) and anxiety (mediation effect= .35 CI: .08-.84) for mothers of toddlers who co-slept, but not of those who slept by themselves. Findings support the hypothesis that among co-sleeping families, the relation between toddler sleep problems and maternal psychopathology is explained by shortened nighttime sleep. Further investigations should examine whether these relationships exist longitudinally between mothers and toddlers. none.

Infant respiratory sinus arrhythmia and maternal depressive symptoms predict toddler sleep problems.

This study examined the direct and interactive effects of infants' respiratory sinus arrhythmia (RSA) and maternal depressive symptoms (MDS) during the first 6 months of life in the prediction of children's sleep problems at age 18 months. Participants included 156 children and their mothers who were followed from 3 to 18 months of age. At ages 3 and 6 months, infants' cardiac activity was recorded at rest and during the still-face paradigm, a mother-child social challenge task, and estimates of infant baseline RSA (RSAB) and RSA withdrawal (RSAW) were calculated. Mothers reported about their depressive symptoms at 3, 6, and 18 months, and about infants' sleep problems at age 18 months. Less RSAW and higher levels of MDS predicted more sleep problems at age 18 months. Additionally, RSAB moderated the link between MDS and children's sleep problems such that MDS were related to more sleep problems only for infants with high levels of RSAB. Results illustrate the importance of RSA as both a direct predictor and a moderator of maternal influences in the prediction of early sleep problems.

Later emotional and behavioral problems associated with sleep problems in toddlers: a longitudinal study.

Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children. To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years. A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included. Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings. Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percentile). Risk ratios (RRs) were calculated using negative binomial regression, controlling for emotional and behavioral problems at 18 months and other relevant covariates. Short sleep duration (≤10 hours) in 556 children (1.7%) and frequent nocturnal awakenings (≥3 times) in 1033 children (3.2%) at 18 months significantly predicted both concurrent and later incidence of emotional and behavioral problems at 5 years. The longitudinal RRs were generally larger for internalizing problems, with adjusted RRs of 1.59 (95% CI, 1.23-2.08) for both short sleep duration and 1.57 (95% CI, 1.28-1.93) for nocturnal awakenings; RRs for externalizing problems were 1.77 (95% CI, 1.37-2.30) and 1.25 (95% CI, 1.00-1.58), respectively. Additional adjustment for emotional and behavioral problems at 18 months slightly reduced the strength of these associations, and all RRs remained significant in the fully adjusted models. Early sleep problems predict later development of emotional and behavioral problems. Intervention studies are needed to examine whether sleep programs targeting early childhood may avert the onset of later adverse outcomes.

Relations Between Toddler Sleep Characteristics, Sleep Problems, and Temperament

Two sources of information (parent-reported sleep diaries and actigraph records) were used to investigate how toddler sleep characteristics (bed time/sleep onset, wake time/sleep offset, total nighttime sleep, and total sleep time) are related to sleep problems and temperament. There were 64 toddler participants in the study. Consistent with studies of older children, parent reports differed from actigraph-based records. The findings that parent-reported and actigraph-recorded sleep characteristics varied as a function of parent report of toddler sleep problems and temperament add needed information on toddler sleep. Such information may contribute to improving parents’ awareness of their child’s sleep characteristics and correlates of problem sleep.

Negative emotionality moderates associations among attachment, toddler sleep, and later problem behaviors.

Secure parent-child relationships are implicated in children's self-regulation, including the ability to self-soothe at bedtime. Sleep, in turn, may serve as a pathway linking attachment security with subsequent emotional and behavioral problems in children. We used path analysis to examine the direct relationship between attachment security and maternal reports of sleep problems during toddlerhood and the degree to which sleep serves as a pathway linking attachment with subsequent teacher-reported emotional and behavioral problems. We also examined infant negative emotionality as a vulnerability factor that may potentiate attachment-sleep-adjustment outcomes. Data were drawn from 776 mother-infant dyads participating in the National Institute of Child and Human Development Study of Early Child Care. After statistically adjusting for mother and child characteristics, including child sleep and emotional and behavioral problems at 24 months, we found no evidence for a statistically significant direct path between attachment security and sleep problems at 36 months; however, there was a direct relationship between sleep problems at 36 months and internalizing problems at 54 months. Path models that examined the moderating influence of infant negative emotionality demonstrated significant direct relationships between attachment security and toddler sleep problems and between sleep problems and subsequent emotional and behavioral problems, but only among children characterized by high negative emotionality at 6 months. In addition, among this subset, there was a significant indirect path between attachment and internalizing problems through sleep problems. These longitudinal findings implicate sleep as one critical pathway linking attachment security with adjustment difficulties, particularly among temperamentally vulnerable children.

Parental behaviors and sleep outcomes in infants and toddlers: A cross-cultural comparison

Background To assess the prevalence of parental behaviors and other factors of sleep ecology and to analyze their relationships with sleep outcomes in a large sample of children ages birth to 36 months in multiple countries/regions. Methods Parents of 29,287 infants and toddlers (48% boys; Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, Philippines, Singapore, Taiwan, Thailand, United Kingdom, United States, and Vietnam) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire. Results Overall, there is a high level of parental involvement in sleep onset and sleep maintenance for young children, with significant differences in parenting behaviors across cultural groups. For predominantly-Caucasian, the most common behavior occurring at bedtime is falling asleep independently in own crib/bed (57%), compared to just 4% of those children living in predominantly-Asian regions. Parental behaviors and sleep ecology, including parental presence at sleep onset, bedtime, and bedtime routine, significantly explain a portion of the variance in sleep patterns. Overall, parental behaviors are more highly predictive of nighttime sleep outcomes in predominantly-Caucasian regions. Finally, parental involvement in sleep onset mediates the relationship between cosleeping and sleep outcomes. Conclusions Overall, the best predictors of nighttime sleep are related to parental behaviors at bedtime and during the night. Furthermore, sleep disruption and decreased total sleep associated with bed sharing and room sharing are mediated by parental presence at bedtime. These findings provide additional support for addressing parental behaviors in behavioral interventions for infant and toddler sleep problems.

Sleep Problems in Toddlers: Effects of Treatment on Their Daytime Behavior

This study investigated the effects of a treatment program for severely sleep-disturbed children on their daytime interaction with their mothers. Twenty-eight children with serious sleep problems and 30 matched controls, aged 12 to 36 months, were compared on behavior rating scales, on sleep patterns, and during play and feeding interactions with their mothers before and after an intervention program. After treatment the sleep-disturbed children improved in their behavior, in their sleep patterns, and during feeding interactions with their mothers. However, the behavior of the children but not that of their mothers improved. The findings of this study indicate that a brief behavioral intervention program focused on helping families manage children with sleep disturbances can generalize to daytime mother-child interactions. This suggests that a compromised relationship in early life may be modified by rather simple interventions since changes of one behavioral system may modify the total relationship of young children with those caring for them.