Toddler Sleep Research Articles

Infant and Toddler Sleep: The Existing Knowledge Gaps!

Abstract Background: Sleep architecture of infants is vastly different from adults and a significant knowledge gap exists in understanding infant sleep. We aimed to study infant sleep behavior by using validated revised Brief Infant Sleep questionnaire at a tertiary care center in Western Maharashtra. Methodology: We enrolled 65 infants from 1 month to 3 years of age visiting Pediatric OPD between October 2023 to March 2024. We aimed to study infant sleep behavior in a cross section of population at a tertiary care center with a view to find out prevalence of behavioral insomnia of childhood in study population. Results: Around 38.5% children were sleeping less than 5 hours at night and 12.3 % were sleeping only for 6-7 hours. 58.5% children had prolonged sleep onset latency between 30-60 minutes. Around 27.7% children had sleep latency even more than 60 minutes after being put to bed. 70.8% children reported nocturnal awakenings of whom 18.3% reported frequent awakenings. Total sleep duration in our study was 8.592 ± 1.79 hours (Mean ± 2SD). Longest stretch of nocturnal sleep was 5.869 ± 3.72 hours (Mean ± 2SD). Based on the total duration of sleep, prevalence of behavioural insomnia of childhood in our study was 41.5%. The most common associations with behavioural insomnia of childhood were breastfeeding, bottle feeding and rocking but the results were not statistically significant. Conclusion: Prevalence of behavioral insomnia of childhood in India is higher than western population. Indian children have shorter average sleep duration compared to their western counterparts. Bedtime routine needs to be observed regularly to avoid development of behavioral insomnia of childhood which requires strict bedtime rules and consistency.

The measurement of young children’s nocturnal sleep health and the development of the Perception of Infant and Toddler Sleep Scale (PoITSS) in Aotearoa New Zealand whānau (families)

ObjectivesTo modify an existing questionnaire Brief Infant Sleep Questionnaire – Revised (BISQ-R) to ensure that it is suitable to measure nocturnal sleep health in a diverse sample of young children from Aotearoa New Zealand whānau (families), and to develop a “Perception of Infant and Toddler Sleep Scale” (PoITSS) to use as a primary outcome measurement in an upcoming trial. MethodsItems from the BISQ-R were adapted for use among ethnically diverse whānau, and tested online with caregivers of 0-2 year old children. A PoITSS score was generated by scaling the responses from three of the questionnaire items to create a value between 0 (very poor) and 10 (very good). Caregivers provided qualitative feedback about the ease of interpreting and answering questionnaire items. ResultsCaregivers of 957 children (35% Māori, 12% Pacific) completed the questionnaire. Few differences in children’s nocturnal sleep were observed by demographic characteristics. The mean PoITSS score was 6.9 (SD 2.3) and was slightly higher among Māori children (mean difference 0.4, 95% CI 0.1, 0.7). Test-retest indicated good reliability (ICC=0.81). While the majority (86%) of caregivers did not find it difficult to answer any of the items which formed the PoITSS, qualitative feedback indicated that simple modifications to some items would help ensure that they would be well understood by most caregivers. ConclusionsItems from the BISQ-R were successfully adapted, and the PoITSS scale was shown to be appropriate, for use in ethnically diverse Aotearoa New Zealand whānau with young children.

Trying to Do What's Best: Maternal Perspectives About Toddler Sleep Health Among an Underresourced Sample of Mothers With Diverse Racial and Ethnic Identities

This study describes mothers' knowledge, attitudes, beliefs, and practices about their toddler's sleep health among an underresourced sample of mothers with diverse racial and ethnic identities. This was a descriptive qualitative study with 16 mothers and their 12- to 36-month-old child. Mothers completed a semistructured, audio-recorded interview about their toddler's sleep health. Data were analyzed using inductive content analysis on the basis of established methods. Mothers self-identified as 18.8% Black, 43.8% White, 12.5% multiracial, 25.0% other race, and 37.5% Hispanic. Of the mothers, 80.0% reported a past year household income of ≤ $40,000. A core construct, "Trying to do What's Best," emerged from the interview data, and this construct included three domains: Getting Good Sleep, Getting Thrown Off, and Rolling With It. Findings support future strengths-based and multilevel sleep health-promoting interventions.

Maternal beliefs and cognitions about naps in infants and toddlers.

Infant and toddler sleep affects family functioning and maternal mental health and well-being. However, little is known about parental perceptions regarding child daytime sleep. The current study aimed to determine maternal beliefs and cognitions of child naps, assessing how naps impact perceived child and maternal functioning. Mothers of 465 infants and toddlers (4-36mos; M = 18.5mos) in the United States completed an online questionnaire addressing those aims, including maternal perception of naps after napping cessation. Most mothers agreed that naps were important (98%). Over two-thirds wanted to change something about their child's naps and one-quarter reported that naps were problematic. About half wished their child fell asleep faster/easier for naps, and one-third wished they napped longer. Few reported that child naps were more trouble than they were worth (4%). Most mothers believed that when their child naps well their child is in a better mood (97%), more easy-going (96%), has fewer tantrums (89%), and listens better (84%, toddlers). Finally, most mothers believed that their child's naps were important for their own day (94%), improved their own mood (87%) made them feel calmer (90%), and enabled them to nap (51%), do more in the house (92%), complete work (87%), spend time with others (78%), and spend time doing things for themselves (80%). Conclusion: Considering most mothers believed their child's naps were important for their child and themselves, yet many wanted to change something about those naps and/or thought naps were problematic, intervention development is warranted focusing on daytime sleep issues to improve both child and family functioning. What is Known: • Although maternal perceptions of overnight sleep in young children has been well studied, little is known about beliefs and cognitions regarding daytime sleep. What is New: • Mothers of infants and toddlers believe naps are beneficial for their child and are important for child mood, behavior, and sleep. • Mothers find child naps valuablefor themselves, allowing time for other activities.

What is the Sleep Pattern of Infants and Toddlers in the Iranian Population? An Epidemiological Study.

Objective To identify sleep patterns and sleep behaviors in a group of infants and toddlers (0 to 36 months) in Iran. Methods Parents and caregivers of 602 infants and toddlers in Iran completed a Persian translation of the Brief Infant Sleep Questionnaire. To assess the differences among the age groups, non-parametric statistical approaches such as the Kruskal-Wallis and chi-square tests were employed. Results The infants and toddlers went to bed relatively late (22:30), and the median night awakening was 2 times (20 min). They most likely slept in the same room with their parents (55.5%), and commonly in the same bed (18.9%). They slept a median of 11.50 hours per day. A significant percentage of the parents felt that their child had moderate or severe sleep problems (22.4%). These children's sleep patterns had significant developmental changes, including decreased daytime sleep, reduced overall sleep, and increased sleep consolidation (reduced number and duration of night awakenings and increased overall sleep duration). The parents commonly used holding-and-rocking and bottle/breastfeeding to initiate infants' sleep and bottle/breastfeeding to resume their infants' sleep. Discussion These findings provide reference data for professionals to assess sleep in children under 3 years of age and also supply knowledge about common parenting practices related to a child's sleep. Cross-cultural comparisons using the findings can offer new insights into the practices and behaviors of parents concerning infant and toddler sleep.

Pengaruh Akupresure Terhadap Kuantitas Tidur Balita

Background : Sleep disturbances in children are often complained of by parents, where sleep disturbances in children under five are 44.2%. A toddler's sleep quantity will greatly affect his growth, if a child has poor sleep quantity (<11 hours/day) then this will also have a negative impact on the child's growth. Interventions that can be done to meet toddlers' sleep needs are by means of acupressure therapy. Acupressure is stimulation of acupuncture points with pressure that stimulates sensory nerve cells in the acupuncture point area thereby increasing local endorphins production and relieving pain in certain areas. Purpose: To analyze the effect of acupressure on the quantity of sleep for toddlers in the RW 12 Rejosari Karanggeneng Boyolali area. Method : This type of research is pre-experimental with one grub design (before and after) treatment. The sample obtained is from the calculation of the freeder formula plus 30% of the total sample calculation results, namely as many as 21 toddlers. Results: The results of the study with the Wilcoxon Signed Rank test obtained a P value = 0.000 where the P value is smaller ? (0.005) meaning that there is an effect of giving acupressure on the quantity of sleep for toddlers. Conclusion: There is an effect of acupressure on the quantity of sleep for toddlers in the RW 12 Rejosari Karanggeneng Boyolali area.

0809 Development and validation of a questionnaire to assess toddler sleep

Abstract Introduction Few sleep questionnaires focus on toddlers, whose sleep is unique from both infants and older children. Fewer include both medical and behavioral items, or have been externally validated against polysomnograms (PSGs). Methods Caregivers of children 12 to 36 months old were recruited through social media, flyers in common hospital spaces, general pediatrics clinics, a pediatric neurology clinic, and at the sleep lab. A questionnaire using a 5-point Likert scale was developed. Questionnaire items pertained to behavioral issues, restless legs syndrome, sleep-disordered breathing, dysautonomia, feeding, attitudes toward sleep, and comorbidities. Factor analysis was used to determine which items represent distinct dimensions of toddler sleep. A diagnosis of sleep apnea was not included in the generation of the factors. Cronbach’s alpha was calculated to evaluate internal consistency within the derived factors. Sleep apnea was defined as the presence of either obstructive or central sleep apnea diagnosed by PSG. We used receiver operating characteristic (ROC) curves to determine which factors most closely estimate sleep apnea. Concordance of factors with the presence of sleep apnea was determined by measuring the area under the ROC curve (AUC). Results Responses from 720 caregivers of toddlers were used to generate the factors. External validation was performed using the PSG data of 35 children. One distinct factor emerged which had good concordance with a diagnosis of sleep apnea (AUC≥0.70). The factor was comprised of the following items: “My child has noisy breathing during sleep”, “My child snorts and gasps during sleep”, “My child snores”, “My child's breathing is heavy during sleep”, “My child breathes through their mouth while sleeping”, “My child breathes through their mouth during the day”, “My child "belly breathes" during sleep”; Cronbach’s alpha=0.83; AUC=0.70). Factors associated with daytime behavior, behavioral insomnia of childhood, and excessive daytime sleepiness were not associated with sleep apnea. Conclusion Obstructive features are most associated with sleep apnea, whereas daytime and bedtime behavioral characteristics, and excessive daytime sleepiness are not, unlike in studies of older children. This may reflect the natural history of sleep apnea in children. Further study with a larger sample size is required to confirm this finding. Support (if any) NIH 2T32HL110952-06

0754 Sleep Ecology in Low-Income Mexican American Toddlers

Abstract Introduction Healthy sleep is critical for child development, yet disparities exist, with Latino children disproportionately affected by deficient sleep. Most of what is known about sleep ecology and interventions to improve sleep in young children is based on studies of primarily White, non-Latino, and economically-advantaged families. To ensure the effectiveness of interventions, it is important to understand the contribution of socioecological factors on sleep among toddlers in low-income Mexican American families. Methods This study employed in-depth interviews with a purposeful sample of low-income Mexican American Spanish-speaking (n=10) and English-speaking mothers (n=10) of toddlers (18-34 months old). Interviews focused on daily sleep routines, perceptions of toddler sleep behaviors, and environmental contributors. Transcripts were coded by two investigators and analyzed using a content analytic approach. Results For sleep-related parenting practices, 70% of mothers reported late child bedtimes (≥9:00 pm), 75% reported room/bed sharing, and almost a third of children fell asleep at bedtime with a bottle or cup. Maternal beliefs about child sleep included concerns that child crying during the night might disturb neighbors or wake siblings, and child sleep quality improved when the child is not hungry. Contextual factors impacting sleep included schedules, neighbors, and siblings. Specifically, later weekday bedtimes were attributed to maternal (but not paternal) work schedules, while wake times were often a result of a sibling’s school schedule. Weekend bedtimes were commonly reported to be delayed for toddlers due to families watching movies. Noisy neighbors, in particular upstairs neighbors, were identified as disrupting children’s sleep. Siblings were identified as both facilitating sleep (e.g., helping with routines) and disrupting sleep (e.g., distracting child at nap time). Conclusion Findings provide insights on socioecological factors and parental beliefs about sleep ecology in low-income Mexican American toddlers that have implications for the design of interventions to improve child sleep. For example, commonly used behavioral sleep interventions have children sleeping in their own room, or require some crying during the night. However, these approaches may not be a good fit or feasible for this population. To address sleep health disparities, further work is needed to understand socioecological factors that require inclusive adaptations to pediatric sleep interventions. Support (if any) R01HL163859

From ontogenesis to clinical practice: waking up to infant sleep.

This article describes the author's research journey exploring infant and toddler sleep. From polygraphic recording in hospital nurseries to using videosomnography in homes, the author traced the longitudinal development of infant/toddler nighttime sleep and waking behaviors. The home-based video observations led to a redefinition of a pediatric milestone; namely, "sleeping through the night," and provided a framework for assessing and treating infant/toddler nighttime sleep problems.

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.

Predictors of television at bedtime and associations with toddler sleep and behavior in a medicaid-eligible, racial/ethnic minority sample

This study examined predictors of TV use at bedtime and associations with toddlers’ sleep and behavior using data from the Smart Beginnings study with 403 Medicaid-eligible, racial/ethnic minority participants from two cities in the United States. We first estimated predictors of TV use at bedtime at 18 months. We then examined whether TV at bedtime was associated with concurrent parent-report of nighttime sleep duration and quality, and later problem behavior at 24 months. Results showed that around half of the sample reported using TV at bedtime with their toddlers, and particularly first-time mothers and those receiving public assistance. We also found that use of TV at bedtime was related to concurrent sleep issues and increases in later problem behavior. Mediational path analyses revealed that TV at bedtime affected behavior via sleep quality. Despite the heterogeneity within this Medicaid-eligible sample, the results underscore the universally harmful effects of TV use at bedtime and lend support for structuring nighttime routines for toddlers to promote better sleep and behavioral outcomes.

Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children’s functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017–2018, n = 1380) and another during COVID-19 pandemic (March–May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child’s sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively.Conclusion: Home confinement generally affected infant’s and toddler’s sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns. What is Known:• Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning.• Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak.What is New:• Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants’ and toddlers’ sleep latency by >30 min during confinement.• Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children’s sleep based on the BISQ criteria. Supplementary informationThe online version contains supplementary material available at 10.1007/s00431-022-04376-0.

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.

Temperament and sleep behaviors in infants and toddlers living in low-income homes

Temperament is a dynamic trait that can be shaped by maturity and environmental experiences. In this study, we sought to determine whether and the extent to which temperament was predicted by sleeping behaviors in an understudied sample of primarily Black and White infants and toddlers living in low-income homes (N = 150). Sleeping behaviors were assessed at 15–19 months of age with caregiver report of the Tayside Children’s Sleep Questionnaire. Temperament was examined as effortful control, negativity, and surgency with the Infant Behavior Questionnaire Very Short Form at 9–12 months of age and with the Early Childhood Behavior Questionnaire Short Form at 20–24 months of age. Covariates were maternal education, household income, and child sex and race. Continuous variables were standardized, then missing data from independent variables were multiply imputed in 20 datasets. Regression analyses showed that about 1 SD improvement in toddler sleep behaviors significantly predicted about 1/5 SD better toddler effortful control. However, sleep behaviors did not significantly predict toddler surgency or negative affect. This study shows that for a sample of infants and toddlers in low-income homes, how a child learns to regulate sleeping behaviors may influence the development of overall effortful control about six months later.

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.

Development and dissemination of a consumer health information website on infant and toddler sleep.

Sleep problems are prevalent in early childhood, with the majority of caregivers desiring to change something about their child's sleep. Quality-assured education and resources are needed to be related to infant and toddler sleep. This article describes the development and dissemination of a global consumer health information website (http://www.babysleep.com) by the Pediatric Sleep Council to provide publicly accessible evidence-based information and resources for caregivers and practitioners. The website includes sleep health-related information and resources. Three phases, including the launch, social media strategy, and search engine optimization, for promotion and dissemination of the site was implemented. Analysis of dissemination indicates exponential growth of the site since its launch. With access across the globe, the site has developed from its inception into a widely-used resource, with over 800,000 users from around the world (99% of countries).

713 Sleep of infants and toddlers during 12 months of the COVID-19 pandemic

IntroductionSARS-CoV-2 changed the lives of children and their parents in 2020. To our knowledge, no studies have examined infant and toddler sleep during this pandemic. We sought to compare parent-reported sleep characteristics of infants and toddlers over successive quarters of the past year.MethodsParents of children aged 0–36 months were surveyed primarily in the Midwestern USA between 01/17/2020 and 12/07/2020. Each parent responded only once. Age was categorized as: <6 months, 6–12 months, 12–24 months, and 24–36 months. Income was categorized as: <$50,000, $50-100,000, $100-150,000, and >$150,000. The year was divided into quarters. Multivariable linear regression included Total Sleep Time (TST), Sleep Onset Latency (SOL) and parental frustration with sleep (any frustration, scale of 1–5) as dependent variables and year quarter, child’s age, prematurity, child’s comorbidities, maternal age (during their child’s birth), parenting experience, household income, and room sharing as independent variables. Logistic regression included nap consistency (napping at the same time daily) as the dependent variable, and year quarter, child’s age, prematurity, comorbidity, maternal age, parenting experience, household income, and room sharing as independent variables.ResultsOf 594 children, mean age was 18.5±9.7 months and 52% were female. Prematurity and comorbidities were reported for 8% and 15%, respectively. Mean maternal age was 31.8±4.5 years. Neither TST (β=-0.488; p= 0.16) nor SOL (β= 0.029; p=0.23) were associated with year quarter. SOL was 3 minutes less for each increase in income category (β =-0.051; p= 0.003). TST (β = -0.994; p<0.001) and SOL (β =0.092; p<0.0001) were most associated with child’s age. Parental frustration was associated with child’s age (β=0.12; p= 0.04), comorbidity (β=0.30; p=0.05) and room sharing (β= -0.38; p=0.006), but not year quarter. Nap consistency was associated with increased child age category (OR 1.47; 95% CI 1.13, 1.94) and lack of room sharing (OR=2.09; 1.10, 3.97), but not year quarter.ConclusionParent-estimated TST, nap consistency and sleep-related frustration did not differ significantly over the first 12 months of the pandemic. Yet, our results underscore that special attention should be given to the sleep of infants and toddlers with comorbidities, who share a room, and who have a lower household income.Support (if any)2T32HL110952-06

Maternal Mental Health Symptoms and Clusters Predict Toddler Sleep in Low-Income Homes

The authors examined the association of maternal mental health symptoms and symptom clusters with the sleeping behaviors of toddlers living in low-income homes. The sample is comprised of 174 racially diverse mother and toddler (15–19 months old) dyads who were participating in a longitudinal birth cohort study. Dyads were initially recruited from Women, Infant, and Children clinics in a Midwestern county of the United States. Maternal mental health symptoms were measured with self-reports of depression (Center for Epidemiological Studies–Depression), parenting stress (Parenting Stress Index Very Short Form), and parenting self-efficacy. Toddler sleeping behaviors were measured with an adaptation of the Tayside Children’s Sleep Questionnaire that assessed toddler difficulties in initiating or maintaining sleep (DIMS). Maternal mental health symptom clusters were identified with latent profile analysis and toddler DIMS were regressed on maternal mental health symptoms. We found that 1 SD worse maternal depression, parenting stress, or parenting self-efficacy predicted 0.18–0.24 SD worse toddler DIMS (p < .05). Moreover, we found that the cluster of adverse maternal mental health symptoms predicted nearly 0.75 SD worse toddler DIMS as compared with the cluster of good maternal mental health symptoms (p < .05). These findings provide insight into how maternal mental health symptom clusters may be important in understanding sleep behaviors in early toddlerhood, a sensitive period of sleep development, and underscore the need to support mothers with co-occurring adverse mental health symptoms, as their children may be at higher risk for DIMS.

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.

Screen use before bedtime: Consequences for nighttime sleep in young children

There is increasing interest in the relation between screen use and sleep problems in early childhood. In a sample of 30-month-old children, this study used observational measures of screen use during the hour or so leading up to bedtime, parent reports of screen use during the child’s bedtime routine, and actigraphic measures of toddler sleep to complement parent-reported sleep problems. Whether screen use was observed during the pre-bedtime period or was reported by the parents as part of the nightly bedtime routine, greater screen use in either context was associated with more parent-reported sleep problems. Additionally, more frequent parent-reported screen use during the bedtime routine was also associated with actigraphic measures of later sleep, shorter sleep, and more night-to-night variability in duration and timing of sleep. These associations suggest the negative consequences of screen use for children’s sleep extend both to aspects of sleep reported by parents (e.g., bedtime resistance, signaled awakenings) and to aspects measured by actigraphy (e.g., shorter and more variable sleep).