ArticleLiterature Review

Parent-child bed-sharing: The good, the bad, and the burden of evidence

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The practice of parent and child sharing a sleeping surface, or ‘bed-sharing’, is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed k=659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on k=98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - Anthropology, Psychology/Psychiatry, and Pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children’s social, emotional, and physical development.
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... Por lo tanto, dormir juntos se convirtió más en una cuestión de elección para la madre que un patrón de comportamiento requerido para la supervivencia del bebé. Sin embargo, desde el momento en que dormir juntos se convirtió en una práctica alternativa, comenzó una controversia que persiste hasta nuestros días (1,2). ...
... Esto podría reflejar cuestiones metodológicas, por ejemplo, métodos diferentes utilizados en la recopilación de datos, diferentes cuestionarios, edades de los lactantes o verdaderas diferencias intra poblacionales en la prevalencia de compartir la cama. Las estimaciones de las prevalencias regionales de colecho pueden ser imprecisas cuando múltiples etnias y culturas viven en la misma región, cuando las tasas de prevalencia cambian de acuerdo con la ubicación geográfica dentro de una región del país, y cuándo las prácticas han cambiado con el tiempo, como por ejemplo después de la introducción de campañas e intervenciones educativas dirigidas a modular tasas de uso compartido de la cama (1,8,9). ...
... Recomendaciones contra el colecho en el contexto de la SMSL se han realizado en varias oportunidades desde 1992 pero a menudo son poco claros, inconsistentes o contradictorios, y tienden a cambiar con el tiempo (1,(27)(28). ...
Article
El colecho es la práctica en la que el bebé duerme en la misma superficie que los padres. Esta es una práctica común en todo el mundo. A veces es una elección a conciencia y en otras ocasiones puede suceder cuando los padres están cansados. Los padres actualmente reciben mensajes contradictorios con respeto compartir la cama: “Debería dormir con su bebé” y que “es peligroso dormir juntos”. Aunque las madres que amamantan y comparten la cama se despiertan con frecuencia para alimentar al bebé, estas están despiertos por períodos más cortos y se vuelven a dormir más rápidamente. Compartir la cama es una estrategia utilizada por las madres que amamantan para reducir la interrupción del sueño y el desgaste físico que esto produce.
... While there are certainly environmental factors that may influence bed sharing, such as housing arrangements and economic access to beds, 39 there are 2 broad categories that define why parents choose to bed share with their children: reactive bed sharing and purposeful bed sharing. 40 In purposeful bed sharing, parents initiate and encourage the practice, often from birth. In reactive bed sharing, parents bed share in response to external factors, such as the child having nightmares and wishing to be comforted by their parents. ...
... The practice of purposeful bed sharing has been met with resistance from US health professionals, who discourage parent-infant bed sharing for the infant's safety, 40 as bed sharing with infants is associated with increased likelihood of Sudden Infant Death Syndrome. 47 Other risks include accidental asphyxiation, entrapment, falls, overheating, and strangulation. ...
... 60 Conversely, other studies using polysomnography support the claims that bed sharing leads to sleep fragmentation and lower quality sleep overall. 40 Bed sharing has also been associated with increased arousals throughout the night 56,61,62 and shorter sleep durations for the child or infant in both subjective and objective sleep measures. 41,63 While such effects of bed sharing are presumably negative in terms of infants' sleep quality, it is possible that increased nightly arousals from slow wave sleep due to bed sharing are beneficial for prevention of Sudden Infant Death Syndrome. ...
Article
Background Bed sharing is common practice across the global population. However, the vast majority of research on bed sharing has focused solely on mother-infant bed sharing. Methods Here, we provide a holistic review of research on bed sharing. Articles investigating the relationship between bed sharing and sleep were identified in 4 dyad categories: (1) parent and child, (2) couples, (3) siblings, and (4) pet owners and pets. Of interest was whether sleep-promoting factors such as psychological comfort were generalizable across bed-sharing dyads; alternatively, sleep-demoting factors such as movement or heat may be commonalities. Results We found that, across dyad types, in general, subjective reports of sleep quality were better when bed sharing despite generally worse objective measures of sleep. Conclusions Understanding bed sharing is important to treating sleep disturbances, given the prevalence of shared beds. This scoping review points to critical gaps in our understanding of bed sharing that motivate future research.
... Existing safe infant sleep advice seems to be based on at least two strong paradigms [21,22]: the risk-elimination approach advocated by the American Academy of Pediatrics (AAP) and a risk-reducing, cultural, and neurobiological approach that addresses what is thought to be natural for human beings [23,24]. Advice and counseling must be relevant for parents and conveyed in a sensitive and understandable way, taking into consideration cultural differences [25]. ...
... The program focused on sleep position, use of pacifier, bedsharing and feeding practices. [21] The Netherlands The prevalence of parent-child bed sharing (P-CBS) is investigated across 659 research articles (peer-reviewed, editorial pieces and comments). ...
... A risk-reducing approach may thus be more acceptable in many European countries, as health practitioners recognize that co-sleeping occurs, and their advice can focus on how to facilitate intentional bed-sharing securely. This seems important, as reactive or spontaneous unplanned bed sharing is associated with an increased risk of injuries or SUID [21]. It seems important to share knowledge with parents in a non-judgmental way regarding how bedsharing may affect infants' physiology. ...
Article
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Background This scoping review focuses on infant sleep-related factors and themes that are relevant when health practitioners provide preventive health services to expectant and new parents. Methods A systematic literature search in CINAHL, PubMed, and PsycINFO, published in 2010 or later, identified 1661 records. The search was further narrowed to focus on sleep in healthy term-born infants until the second half of the first year of life. A blinded review by both authors covered 136 papers, of which 43 papers were reviewed in the full text. Finally, 38 articles were included in the data extraction. Results The analysis process showed that the selected studies formed three main information categories: 11 studies thematised safe infant sleep issues, 10 studies described design and findings from sleep-related intervention studies, and 17 studies focused on different parent-child interactive aspects that may influence the quality and duration of infant sleep in the first six months of life. The main finding is that knowledge about early infant sleep is very complex, and includes both child, parent, and environmental factors. Several studies have shown that the concepts and factors related to safe infant sleep also influence the development of healthy infant sleep patterns. Thus, these aspects are interwoven with each other and should be addressed together in communication with parents. Conclusions Health practitioners with different professional backgrounds need to search for an agreement on when and how different aspects of sleep-related knowledge should be communicated to new and expectant parents to enable the design of national follow-up programs. Parents want coherent and personalized services regarding infant sleep issues that may allow them to choose sleeping arrangements, routines, and behaviors that fit in with their sociocultural attitudes and traditions. Many different sources and formats may be used to empower parents regarding infant sleep issues. Studies have described the use of group or individual meetings, videos, and written materials. The key issue is the importance of consistent and seamless knowledge-based services.
... Similarly, we humans sleep in small groups, and sometimes in relatively large groups, at close proximity to each other. Sleeping arrangements include bonded adult pairs, mother-infant pairs, siblings, grandparents, extended family, and sometimes other group members who are not biological relatives (e.g., Mileva-Seitz et al., 2017). In most of the world, and throughout most of human history, group sleeping in close proximity has been and continues to be the norm (Worthman & Melby, 2002). ...
... This practice is quite prevalent throughout the world, especially given the modest economic circumstances under which most humans live. In their review of bed-sharing practices across 45 different countries, Mileva-Seitz et al. (2017) found the median prevalence rate of bed-sharing in those surveyed was over 50%. Even in contemporary Western homes, which emphasize sleep as a private activity meriting an individual sleeping space apart from the rest of the family, other family members are still not far away. ...
... As already suggested, an infant or small child sleeping close to one's parents would have made it less likely in our evolutionary past that the child would be snatched by a predator (Boyden et al., 2018). This kind of co-sleeping arrangement is the norm throughout the world and presumably throughout human history (Crittenden et al., 2018;McKenna et al., 1993;Mileva-Seitz et al., 2017;Worthman & Melby, 2002). Such co-sleeping contrasts sharply with the Western practice, especially in the USA, of having infants and small children sleep alone in a separate bedroom. ...
Article
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Sleep is a behavioral state whose quantity and quality represent a trade-off between the costs and benefits this state provides versus the costs and benefits of wakefulness. Like many species, we humans are particularly vulnerable during sleep because of our reduced ability to monitor the external environment for nighttime predators and other environmental dangers. A number of variations in sleep characteristics may have evolved over the course of human history to reduce this vulnerability, at both the individual and group level. The goals of this interdisciplinary review paper are (1) to explore a number of biological/instinctual features of sleep that may have adaptive utility in terms of enhancing the detection of external threats, and (2) to consider relatively recent cultural developments that improve vigilance and reduce vulnerability during sleep and the nighttime. This paper will also discuss possible benefits of the proposed adaptations beyond vigilance, as well as the potential costs associated with each of these proposed adaptations. Finally, testable hypotheses will be presented to evaluate the validity of these proposed adaptations.
... Bed sharing-the sharing of a sleeping surface by parents and children-has been a common sleeping strategy throughout human evolution [1,2], offering the mother-infant dyad a sense of security and facilitating breastfeeding on demand [3]. In recent years, however, it has become the center of a polarized debate, due to its association with possible public health risks, particularly Sudden Infant Death Syndrome [4]. ...
... Bed sharing is a common choice among breastfeeding mothers, as it facilitates frequent and on-demand feedings [3,13,14]. The centrality of bed sharing in facilitating breastfeeding through skin-to-skin contact and frequent awakening throughout the night has been strongly argued by McKenna and Gettler (2016) who coined the term "breastsleeping". ...
... The centrality of bed sharing in facilitating breastfeeding through skin-to-skin contact and frequent awakening throughout the night has been strongly argued by McKenna and Gettler (2016) who coined the term "breastsleeping". Evidence from randomized controlled trials and observational studies shows that bedsharing infants have more night arousals, more breastfeeding sessions, and shorter sleeping intervals compared to solitary sleeping babies [3,13]. ...
Article
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Bed sharing—the sharing of a sleeping surface by parents and children—is a common, yet controversial, practice. While most research has focused on the public health aspect of this practice, much less is known regarding its effect on the marital relationship. The aim of the present study was to conduct a scoping review on the impact of parent–infant bed sharing sleeping practices on the sexual and marital relationship of couples. The qualitative synthesis of six studies on this topic suggests that overall, bed sharing does not exert a significant negative impact on family functioning; when it does, it appears to be related to incongruent parental beliefs and expectations, especially when bed sharing is not an intentional choice of sleep arrangement, and there are other confounding factors such as fatigue and psychological distress. Suggestions for future studies and clinical implications are discussed.
... In early childhood, sharing a bed with others during sleep, referred to as bedsharing, is a globally widespread, yet controversial practice (McKenna, Ball, & Gettler, 2007;Mileva-Seitz, Bakermans-Kranenburg, Battaini, & Luijk, 2017). Despite the ubiquity of bedsharing (Mileva-Seitz et al., 2017), debate regarding the impact of bedsharing on children's sleep and development continues to exist, particularly in the United States (Ball, 2006a(Ball, , 2006bOwens, 2004). ...
... In early childhood, sharing a bed with others during sleep, referred to as bedsharing, is a globally widespread, yet controversial practice (McKenna, Ball, & Gettler, 2007;Mileva-Seitz, Bakermans-Kranenburg, Battaini, & Luijk, 2017). Despite the ubiquity of bedsharing (Mileva-Seitz et al., 2017), debate regarding the impact of bedsharing on children's sleep and development continues to exist, particularly in the United States (Ball, 2006a(Ball, , 2006bOwens, 2004). With organizations such as the American Academy of Pediatrics developing guidelines regarding safe sleeping practices in infants and children (Moon, Darnall, Feldman-Winter, Goodstein, & Hauck, 2016), a better scientific understanding of the ages and contexts under which bedsharing occurs and whether it benefits or adversely affects sleep is crucially needed. ...
... While some work indicates greater sleep disturbances in bedsharing children (e.g., Cortesi et al., 2008;Hayes et al., 2001;Kim et al., 2017), other studies indicate no detrimental effects (e.g., Okami et al., 2002). In part, this discrepancy in findings may reflect a lack of objective sleep assessments, as most published work has used parent-reported questionnaires or interviews (Cortesi et al., 2008;Jenni et al., 2005;Kim et al., 2017;Liu et al., 2003;Mindell et al., 2013; for a review, see also Mileva-Seitz et al., 2017). Such subjective methods may present a confound when evaluating child sleep outcomes, because parents who bedshare may notice subtler disturbances in their child's sleep (or alternatively, may have positive attitudes toward bedsharing that bias their responses in favor of higher child sleep quality) compared with parents who do not bedshare. ...
Article
Bedsharing (sharing a bed with others during sleep) in early childhood (3–5 years old) is common across Western and non-Western societies alike. Though prior work indicates that bedsharing may relate to impairments in child sleep quantity or quality, the majority of studies conducted in young children are limited to parent-child bedsharing and rely almost exclusively on caregiver reports to measure child sleep. Here, the authors endeavored to gain further insights into the diversity of bedsharing practices among children in the United States, including how different bedsharing partners (caregivers, siblings) might impact actigraphy-derived measures of children’s sleep. Using a sample of 631 children ages 2:9 to 5:11 years, we found that over 36% of children bedshared in some form overnight, with approximately 22% bedsharing habitually. In a subset of children for whom actigraphy measures were collected (n = 337), children who bedshared habitually (n = 80) had significantly shorter overnight sleep, later sleep and wake times, and longer naps than solitary sleepers (n = 257), even when controlling for socioeconomic status. Despite supplementing their shorter overnight sleep with longer naps, habitually bedsharing children had significantly shorter 24-hr sleep time than did solitary sleepers, though differences in sleep efficiency were nonsignificant for all sleep periods. Additionally, sleep efficiency, onset latency, and duration did not differ between children who habitually bedshared with siblings versus those who habitually bedshared with parents. The present results add to prior work examining family contextual correlates of sleep differences in early childhood and provide a more objective account of relations between bedsharing and child sleep.
... 8 Bedtime parenting and child rearing styles vary among cultures. [12][13][14][15] Common bedtime routines in Western countries include feeding, bathing, reading bedtime story and letting children sleep by themselves. 12,15 Bed-sharing is not recommended in Western countries, as it is associated with an increased risk of sudden infant death syndrome as well as behavioral problems. ...
... 12,15 Bed-sharing is not recommended in Western countries, as it is associated with an increased risk of sudden infant death syndrome as well as behavioral problems. 14,15 In Thailand; however, parents sharing a bed with their infant is very common. 13,16 An infant's sleep pattern develops through parentinfant interconnection 2,17,18 ; however, which parenting style should be recommended is debatable. ...
... 15,29 Previous studies reported that bed sharing is related to a child's emotional problems. 14,30 However, bed sharing was the most common bedtime parenting practice in our study, partly due to the popularity of breastfeeding in this cohort. More than half of our cohort mothers continued their breastfeeding for least 12 months. ...
Article
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Objective: We aimed to determine the association between bedtime parenting practices and infant social-emotional competence (SEC).Material and Methods: Data from a birth cohort called: Prospective Cohort Study of Thai Children, were analyzed. Information on bedtime parenting and infant’s sleep information were collected at 3 and 12 months of age. Modified Infant-Toddler Social and Emotional Assessment (MITSEA) were used to measure the SEC at 12 months of age. All participating infants with a MITSEA score >75th percentile were classified as having high SEC. The association between bedtime parenting practices and high SEC were analyzed using multiple logistic regression.Results: Data from 2,109 infants were analyzed (male:female=1:1). Median age of mothers was 26 years. Ninety-two percent of caregivers shared a bed with their infants, at either their 3rd- or 12th-month-visits. Two-thirds of the caregivers reported bed sharing at both visits. About 70.0% of caregivers fed their infants until the infant fell asleep, and about two-thirds responded to infant’s awakening with milk feeding. Infants who were never fed until falling asleep were more likely to have high SEC, compared with infants who were always fed until sleep (odds ratio 1.49; 95% confidence interval 1.14, 1.96). Bed sharing showed no association with a high SEC. Older, female mothers, higher socioeconomic status and quality time were associated with a high SEC.Conclusion: The bedtime parenting practice associated with a high SEC was: “non-feeding until falling asleep”. Bed sharing, which was a popular practice in this cohort, showed no association with high SEC.
... Across human societies, it is also common for fathers and other family members to be present in the cosleeping environment, which is consistent with the importance of cooperative caregiving to the evolution of human life history and converges with sleep ecologies in other primate species that have evolved biparental and alloparental care [6,11,[14][15][16][17]. The present study focuses on infant sleep location and measures of psychosocial and affective dynamics in fathers-an area that has received little attention in the literature [9,15,18]. ...
... Moreover, some US-based studies have shown that cosleeping is associated with negative attitudes about the coparenting relationship [26], of which division of childcare labor is a component. As argued by Mileva-Seitz et al. [18], bedsharing may be linked to parental stress and marital distress in cultural contexts like the USA where bedsharing has historically been perceived negatively, even if recently such beliefs have attenuated somewhat in segments of the population. This may be especially true if partners disagree about family sleep arrangements or if bedsharing is 'reactive' in response to infant/child night wakings [22,28,39], which may likewise be seen as problematic nighttime behavior in some families that emphasize the importance of early sleep consolidation [18]. ...
... As argued by Mileva-Seitz et al. [18], bedsharing may be linked to parental stress and marital distress in cultural contexts like the USA where bedsharing has historically been perceived negatively, even if recently such beliefs have attenuated somewhat in segments of the population. This may be especially true if partners disagree about family sleep arrangements or if bedsharing is 'reactive' in response to infant/child night wakings [22,28,39], which may likewise be seen as problematic nighttime behavior in some families that emphasize the importance of early sleep consolidation [18]. Along these lines, research in Euro-American societies has shown that cosleeping was associated with parental reports about challenging infant temperament and strain between partners [26,[39][40][41][42]. Overall, associations between cosleeping and paternal stress could be linked to negative functioning of the family system, including fathers' coparenting and bonding. ...
Article
Full-text available
Background and objectives: Evolutionary-grounded sleep research has been critical to establishing the mutual dependence of breastfeeding and nighttime sleep proximity for mothers and infants. Evolutionary perspectives on cosleeping also often emphasize the emotional motivations for and potential benefits of sleep proximity, including for parent-infant bonding. However, this potential link between infant sleep location and bonding remains understudied for both mothers and fathers. Moreover, in Euro-American contexts bedsharing has been linked to family stress and difficult child temperament, primarily via maternal reports. We know relatively little about whether paternal psychosocial dynamics differ based on family sleep arrangements, despite fathers and other kin often being present in the cosleeping environment across cultures. Here, we aim to help address some of these gaps in knowledge pertaining to fathers and family sleep arrangements. Methodology: Drawing on a sample of Midwestern U.S. fathers (N=195), we collected sociodemographic and survey data to analyze links between infant nighttime sleep location, paternal psychosocial well-being, father-infant bonding, and infant temperament. From fathers' reports, families were characterized as routinely solitary sleeping, bedsharing, or roomsharing (without bedsharing). Results: We found that routinely roomsharing or bedsharing fathers, respectively, reported stronger bonding than solitary sleepers. Bedsharing fathers also reported that their infants had more negative temperaments and also tended to report greater parenting-related stress due to difficulties with their children. Conclusions: These cross-sectional results help to highlight how a practice with deep phylogenetic and evolutionary history, such as cosleeping, can be variably expressed within communities with the potential for family-dependent benefits or strains.
... 18,19 Different from intentional bed-sharers, these mothers report increased marital conflict and fatigue. 20,21 Thus, it is important to consider the role of infant sleeping difficulties in understanding the outcomes of bed-sharing. ...
... However, there is even a dearth of longitudinal observation studies that have investigated whether bed-sharing has any associations with infant subsequent relational (i.e., attachment) or behavioral (i.e., poor attention/hyperactivity and task persistence) development as well as maternal bonding and sensitive parenting. 21 To this point, only 1 previous study investigated the link between bed-sharing and infantmother attachment. 11 This Dutch study investigated bed-sharing at 2 months, and the infant-mother attachment was assessed at 14 months in 550 mother-infant dyads. ...
Article
Objective: The objective of this study was to investigate whether bed-sharing during the first 6 months of life is associated with infant's attachment and behavioral outcomes and mother's bonding and sensitive parenting at 18 months of age. Methods: The sample with complete longitudinal data comprised 178 infants and their caretakers. Bed-sharing was assessed with maternal report at term, 3, 6, and 18 months. Infant attachment was measured at 18 months using the strange situation procedure. Infant behavioral outcomes (i.e., poor attention/hyperactivity and task persistence) were assessed with 2 observational measures at 18 months. Maternal sensitivity was observed at 3 and 18 months, and mothers reported on bonding to their infant at term, 3, and 18 months. Results: Bed-sharing was common at term (41.2%), which decreased at 3 months (22.6%) followed by a slight increase at 6 (27.5%) and 18 months of age (31.3%). No associations between bed-sharing during the first 6 months and infant-mother attachment and infant behavioral outcomes at 18 months were found. Similarly, there were no associations between bed-sharing during the first 6 months and maternal bonding and sensitivity at consequent assessment points (i.e., 3 and 18 months). Conclusion: Bed-sharing during the first 6 months is not associated with positive or negative outcomes about infant-mother attachment, infant behavior, maternal bonding, or sensitive parenting.
... Bed-sharing, operationalized as a shared sleep surface (e.g., bed) between a parent and child, is among the most controversial topics in the early childhood parenting literature (Ferber, 2006). Co-sleeping, a related concept, captures a broader conceptualization of shared sleeping arrangements, including both bed-and room-sharing (Mileva-Seitz et al., 2017). Historically, co-sleeping has been the predominant sleeping strategy with deep cultural roots (Thoman, 2006). ...
... Only recently has society shifted, making the practice less common. The rise of industrialization, which brought about permanent dwellings, cribs, and alternative feeding options, was accompanied by shifting societal values (Mileva-Seitz et al., 2017). Shaped by medical recommendations (e.g., correlational links between bed-sharing and sudden infant death syndrome) (Vennemann et al., 2012) and parental and professional beliefs (e.g., interference with partner intimacy, decreases child autonomy) (McKenna et al., 2007;Okami et al., 2002;Owens, 2002), bed-sharing was no longer essential for infant survival and Western nations transitioned toward separate sleep surfaces for infants (McKenna et al., 2007). ...
Chapter
Over the past two decades, there has been heightened interest and awareness of the impact that sleep has on children's development, learning, mood, and behavior. Clinical services for pediatric sleep disorders are increasingly available and there has been a proliferation of research related to sleep disturbances in children. This article was designed to provide a broad overview of common sleep problems and their treatments in youth. Pediatric sleep medicine is a rapidly developing field with abundant opportunities for expanding our scientific understanding of sleep disorders and creating novel interventions for children and adolescents with disturbed sleep.
... Cosleeping is defined as an infant and adult sleeping on the same sleep surface during the night-time or main sleep period. Cosleeping is a characteristic practice of mammals that provides many benefits and is recommended by the World Health Organization (WHO) and United Nations International Children's Fund as part of the Baby Friendly Hospital's Initiative program [11,12]. Cosleeping plays an important role in the promotion and duration of breastfeeding, in addition to other benefits such as controlling infant irritability or illness, improving the baby's and parent's sleep quality, feeding the emotional needs of the child through maternal contact, and allowing sleep to be established more quickly [13]. ...
... Cosleeping plays an important role in the promotion and duration of breastfeeding, in addition to other benefits such as controlling infant irritability or illness, improving the baby's and parent's sleep quality, feeding the emotional needs of the child through maternal contact, and allowing sleep to be established more quickly [13]. Cosleeping also results in long-term benefits such as improved social skills, esteem, or neuro-affective responses and reduces fears, tantrums, or even anxiety to stress in adult life [12]. ...
Article
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The purpose of this paper is to analyse the association between cosleeping and the number of breastfeeding sessions in infants, OHRQoL of the child and the family, and the DMFT Child's index. The sample comprised 273 children (2-4 years old). In addition to the clinical examination of the child to assess the DMFT Index, the mother was requested to complete a questionnaire to collect data about the breastfeeding practice, diet, dental hygiene, dental checkups , quality of the child's oral life, and family impact (ECOHIS Scale). The children's OHRQoL is positively correlated with number of night-time breastfeeding sessions at 12 months (r 2 = 0.40 **), DMFT index (r 2 = 0.60 **), impact family (r 2 = 0.65 **), and duration of cosleeping (r 2 = 0.36 **). The moderating effect explained 41% of OHRQoL; the interaction between the number of breastfeeding sessions at 18 months and the DMFT index significantly increased the coefficient of determination. A longer practice time for cosleeping was associated with an increase in breastfeeding sessions, a higher impact on OHRQoL, a higher family impact, and a higher DMFT index. More than three night-time breastfeeding sessions moderate the relationship between the DMFT index and the child's OHRQoL.
... To begin, even among Western parents, cultural and socio-demographic factors play a substantive role in choices about whether to cosleep with one's infant. Both room-and bedsharing forms of cosleeping are significantly more common in non-Western samples, non-White samples, and in families with lower education and income (Jenni & O'Connor, 2005;Luijk et al., 2013;Mileva-Seitz et al., 2017;Mindell et al., 2010). Thus, any examination of correlates of infant sleep arrangements must, in one way or another, address and account for such broad contextual influences, if only to help identify linkages between sleep arrangements and individual and family functioning that are independent of socio-demographic confounds. ...
... Consistent with prior work (Jenni & O'Connor, 2005;Luijk et al., 2013;Mileva-Seitz et al., 2017;Mindell et al., 2010), families who co-slept from 3-to-6 months were more likely to have mothers who completed fewer years of education, to be at higher overall socioeconomic risk, to be non-White, to be unemployed at recruitment, and to be more likely to report inadequate space for sleeping. No differences emerged for fathers' education, maternal and paternal age, number of children, marital status, fathers' employment status, and sex of infant. ...
Article
The present study of 124 families examined linkages between patterns of sleep arrangement use across the first 6 months post-partum and (a) family socio-demographics, (b) nighttime sleep of infants, mothers, and fathers, and (c) coparenting distress, and mothers’ emotional availability with infants and bedtime. Families were recruited when infants were 1-month-old, and infants were classified, from video data available at 3 and 6 months post-partum, into one of three sleep arrangement pattern groups: Solitary sleep, cosleeping, and cosleeping (at 3 months)-to-solitary sleep (at 6 months). Mothers in cosleeping arrangements were more likely to be at higher socioeconomic risk, non-White, unemployed, and to have completed fewer years of education. Controlling for these variables and for duration of breast feeding and parental depressive and anxiety symptoms, subsequent 3 (sleep arrangement pattern) X 2 (infant age: 3 and 6 months) mixed-model analyses of covariance revealed that sleep arrangement patterns were more robustly linked with maternal sleep than with infant and father sleep. Mothers in cosleeping arrangements experienced more fragmented sleep and greater variability in fragmented sleep relative to mothers of infants in solitary sleep, and fathers in cosleeping arrangements showed greater variability across the week in the number of minutes of nighttime sleep. Cosleeping was associated with mother reports of less positive and more negative coparenting, and mothers in cosleeping arrangements were independently observed to be less emotionally available with their infants at bedtime compared to mothers in the other two sleep arrangement groups. These linkages were largely upheld after statistically controlling for mothers’ stated preference for sleep arrangements they were using.
... Compared to other high-income countries, the Nordic countries stand out with more generous paid parental leave policies [68]-possibly contributing to lower levels of fatigue compared to non-Nordic mothers. The prevalence of co-sleeping in our sample (16%) was also considerably lower than in, for instance, many East Asian and African countries [69]. In addition, forms of peri-and postnatal social support might differ considerably between cultures, with, for instance, grandmaternal support being associated with higher maternal peri-and postnatal health in Himba women [10]. ...
Article
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Background and objectives As the mother-offspring relationship is central to human reproduction, postpartum depression symptoms are difficult to explain in evolutionary terms. We proposed that postpartum depression might arise as a result of evolutionary mother-offspring conflict over maternal investment, and investigated the association between postpartum depression symptoms, infant night waking, maternal sleep disturbance and breastfeeding frequency. Methodology We conducted a cross-sectional analysis using survey responses at six months postpartum from 1598 Finnish mothers. We hypothesized that infant night waking at six months postpartum would be associated with postpartum depression symptoms, and that this association would be mediated by maternal sleep disturbance and a higher breastfeeding frequency. Results Infant night waking was moderately associated with postpartum depression symptoms, and this association was mediated by maternal sleep disturbance (R2 = .09). Contrary to our prediction, we found that increased breastfeeding was associated with less postpartum depression symptoms. Conclusions and implications We conclude that postpartum depression symptoms might partly be the result of increased maternal fatigue stemming from high offspring demands on maternal investment, but that this is not due to the metabolic strain from increased breastfeeding. Studying postpartum depression from the mother-offspring conflict perspective can potentially improve our understanding of the involved behavioral processes of both mother and offspring, and allow interventions designed to benefit the well-being of both parties.
... We note that our data are from Japanese children only. Previous studies suggest that sleep arrangements affect the incidence of attachment objects (Endoh, 1990;Hobara, 2003;Hong & Townes, 1976; but see Boniface & Graham, 1979), and the prevalence of bed-sharing in Japan is higher (54.4%) than in western cultures like the US (23.0%) or the UK (13.2%) (Mileva-Seitz, Bakermans-Kranenburg, Battaini, & Luijk, 2017). Thus, the developmental pattern in this study might be specific to Japanese children. ...
Article
Some children form an attachment to a variety of inanimate objects, such as cloths or soft toys, referred to as attachment objects. This study examined the developmental change in children’s behaviours toward their attachment objects to understand the role of such objects through an online survey of 700 parents with 0- to 9-year-old children, of whom 417 currently had attachment objects. Zero- and one-year-olds selected cloths and soft toys equally and used them with their mouth or skin, whereas older children preferred soft toys and personified them. Our results suggest that the role of attachment objects changes with age and that attachment objects contribute to reducing stress responses.
... [11][12][13][14] The prevalence indicated in this study is far higher than in other industrialised countries. 9,15 In spite of this, the incidence of sudden infant deaths has continued to decline. An in-depth study from Norway showed that there were approximately nine sleeprelated infant deaths each year between 2010 and 2016, which was an annual incidence of 0.16 per 1000 live births. ...
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Aim Campaigns to prevent prone sleeping and other modifiable risk factors have greatly reduced the incidence of sudden infant death syndrome in Norway. Sleep‐related infant deaths still occur sporadically and may be preventable. We studied infants’ sleeping environments and whether parents followed safe sleep recommendations. Methods Parents with infants up to 12 months of age were invited to complete an online questionnaire from May to December 2018. It was publicised by health centres and on websites and social media. Results We received 4886 responses and 4150 met the age criteria and were included. Just under two‐thirds (62.7%) reported routine bed‐sharing and this practice was associated with increased nocturnal breastfeeding, single parents and having more than one child. A small number of infants under six months were occasionally placed prone when they were laid down to sleep (2.1%) and 29.7% were placed on their side. Nearly three‐quarters (72.6%) of the 2330 parents with infants under six months of age reported previous high‐risk behaviour, such as sleeping together on a sofa or bed‐sharing after smoking or drinking.. Conclusion Norwegian parents rarely used prone sleeping positions for infants. However, bed‐sharing was common, including high‐risk scenarios such as smoking, alcohol use and sofas.
... In WEIRD societies models of infant care became biomedicalized as a consequence of the reliance on statistical normalcy, that is, conceptualized as within the purview of medical experts who set the standards for what is considered "normal" and "healthy" sleep (Ball, 2008;Ball et al., 2019;McKenna et al., 2007;Tomori, 2014). Biological and evolutionary views on infant sleep norms entered the discourse only over the past 20 years, but are now beginning to gain traction with both parents and health practitioners, and with a small but growing group of pediatricians and infant sleep researchers (e.g., Barry, 2020;Mileva-Seitz et al., 2017). This approach seeks to root guidance for parents in data related to human infant physiology and evolutionary expectations, rather than cultural norms that have shifted enormously in the last two centuries. ...
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Objectives We examine infant sleep from evolutionary, historico‐cultural, and statistical/epidemiological perspectives and explore the distinct conceptions of “normal” produced by each. We use data from the “Sleeping Like a Baby” study to illustrate how these perspectives influence the ideals and practices of new parents. Methods The “Sleeping Like a Baby” study investigated maternal–infant sleep in north‐east England. Sleep data for exclusively breastfeeding (EBF) and formula‐feeding (EFF) dyads were captured every 2 weeks from 4 to 18 weeks postpartum through actigraphy and maternal report. Mothers also reported their infant sleep ideals and practices. Results explore objective and maternally‐reported infant sleep parameters, and concordance of maternal ideals and practices with public health guidance. Results Comparison of sleep measures showed that mothers overestimate infant sleep duration compared with actigraphy; EFF mothers' reports were significantly more inaccurate than those of EBF mothers. For infants moved to a separate bedroom, maternally‐reported sleep increases were not borne out by actigraphy. Across the study period, concordance of maternal ideal sleep location with public health recommendations occurred on average for 54% of mothers, while concordance in practice fell from 75% at 4–8 weeks to 67% at 14–18 weeks. Discordance for EBF dyads occurred due to bedsharing, and for EFF dyads due to infants sleeping in a room alone. Conclusions Beliefs about “normal” infant sleep influence parents' perceptions and practices. Clinical and scientific infant sleep discourses reinforce dominant societal norms and perpetuate these beliefs, but biological and evolutionary views on infant sleep norms are beginning to gain traction with parents and health practitioners.
... In Japan, for example, children and parents frequently co-sleep, while in the United States children are more likely to have a rigid bedtime "ritual" with the child sleeping in their own room under firm supervision (Wolf et al., 1996;Steger and Brunt, 2003). Bed-sharing and room-sharing are indeed involved in parental regulation of infants' sleep and are considered in a different light in the Italian versus American culture (Cortesi et al., 2004;Mileva-Seitz et al., 2017;Beijers et al., 2019). In a recent longitudinal study (Beijers et al., 2019) and in a review paper (Task Force on Sudden Infant Death Syndrome, 2011), no support was found for the notion that early parent-infant room sharing (without bed sharing) during the first 6 months of life has negative consequences on later child behavior. ...
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Background Heavy media use has been linked to sleep problems in children, which may also extend to the infancy period. While international parent-advisory agencies, such as the American Academy of Pediatrics (2016), advise no screen time before 18 months, parents often do not follow this recommendation. Research on Italian infants’ early access to media is sparse, and only very few studies have investigated links with sleeping habits. Method To address this gap, we examined concurrent associations between parent-reported surveys of child technology use and sleeping patterns. The Italian version of the 60 item Comprehensive Assessment of Family Media Exposure (CAFE) Survey, developed as part of a larger international study, ( Barr et al., 2020 ), the Brief Screening Questionnaire for Infant Sleep Problems (BISQ) Sadeh, 2004 ) were completed online by 264 Italian parents of 8- to 36-month-olds and a subset ( n = 134) completed the Parenting Stress Index (PSI) Abidin, 1995 ) between April 2017 and April 2018. Results More devices located in the child’s room and the more time spent watching TV or using an iPad were associated with less hours of sleep at night. Furthermore, more time spent watching TV or using a smartphone, as well as the number of devices in the room was associated with going to sleep later at night. Instrumental media use was associated with less sleep. Conclusion Like other countries, Italian infants have high levels of exposure to media, and differences in media patterns were associated with sleep patterns. Cultural factors influence both instrumental reasons for media use and sleep practices. Further research should explore how media use may serve to regulate emotion as a function of both contextual factors and individual differences.
... The strong association between surface sharing and both chaotic lifestyle and socioeconomic vulnerability in this study suggests that a family's social environment may determine both the reason for shared sleep and the impact of surface sharing on the infant. Infantparent surface sharing is frequently reported to be a socially and culturally valued part of infant care, influenced by parental philosophy, breastfeeding facilitation and convenience (45). However, shared sleep arrangements in the SUDI population may result less from ideology and personal choice than from the complex interplay of individual, social, and structural factors that shape the lives of more vulnerable families. ...
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Background: Sudden Unexpected Death in Infancy (SUDI) is a leading cause of preventable infant mortality and strongly associated with social adversity. While this has been noted over many decades, most previous studies have used single economic markers in social disadvantage analyses. To date there have been no previous attempts to analyze the cumulative effect of multiple adversities in combination on SUDI risk. Methods: Based on sociological theories of social exclusion, a multidimensional framework capable of producing an overall measure of family-level social vulnerability was developed, accounting for both increasing disadvantage with increasing prevalence among family members and effect of family structures. This framework was applied retrospectively to all cases of SUDI that occurred in Queensland between 2010 and 2014. Additionally, an exploratory factor analysis was performed to investigate whether differing “types” of vulnerability could be identified. Results: Increased family vulnerability was associated with four major known risk factors for sudden infant death: smoking, surface sharing, not-breastfeeding and use of excess bedding. However, families with lower levels of social vulnerability were more likely to display two major risk factors: prone infant sleep position and not room-sharing. There was a significant positive relationship between family vulnerability and the cumulative total of risk factors. Exploratory factor analysis identified three distinct vulnerability types (chaotic lifestyle, socioeconomic and psychosocial); the first two were associated with presence of major SUDI risk factors. Indigenous infants had significantly higher family vulnerability scores than non-Indigenous families. Conclusion: A multidimensional measure that captures adversity across a range of indicators highlights the need for proportionate universalism to reduce the stalled rates of sudden infant death. In addition to information campaigns continuing to promote the importance of the back-sleeping position and close infant-caregiver proximity, socially vulnerable families should be a priority population for individually tailored or community based multi-model approaches.
... Future studies should use a more comprehensive measure of infant sleep, such as the Brief Infant Sleep Questionnaire (Sadeh, 2004) (which can be completed by mothers as well as other respondents for a more varied impression), for a more reliable and nuanced depiction of infant sleep quality. Along these lines, prior evidence suggests that sleeping arrangements (e.g., co-sleeping, roomsharing) and breastfeeding are associated with infant and maternal sleep quality (Galbally et al., 2013;Mileva-Seitz et al., 2017;Volkovich et al., 2018), but these factors were unaccounted for in the present study analyses. For a more comprehensive picture of maternal and infant sleep, sleeping arrangements and feeding should be thoroughly assessed. ...
Article
Objective: Emerging evidence links maternal and infant sleep problems to impairments in the mother-to-infant bond, but the independence and directionality of these associations remain unclear. The present study characterized concurrent and prospective effects of maternal sleep disturbances and poor infant sleep on the mother-infant relationship. As common sequalae of problematic sleep, nocturnal cognitive hyperarousal and daytime sleepiness were investigated as facilitating mechanisms. Participants: Sixty-seven pregnant women enrolled in a prospective study on maternal sleep. Methods: Sociodemographic information and clinical symptoms were measured prenatally then weekly across the first two postpartum months. Women reported insomnia symptoms, sleep duration, snoring, daytime sleepiness, nocturnal cognitive arousal (broadly focused and perinatal-specific), perseverative thinking, depression, infant colic, infant sleep quality, and mother-infant relationship quality. Mixed effects models were conducted to test hypotheses. Results: Prenatal snoring and weak maternal-fetal attachment augured poorer postpartum bonding. Poor infant sleep was associated with increased odds for maternal insomnia and short sleep. Impairments in the mother-to-infant bond were linked to maternal insomnia, nocturnal perinatal-focused rumination, daytime sleepiness, depression, and poor infant sleep. Postnatal insomnia predicted future decreases in mother-infant relationship quality, and nocturnal cognitive hyperarousal partially mediated this association. Conclusions: Both maternal and infant sleep problems were associated with poorer mother-to-infant bonding, independent of the effects of maternal depression and infant colic. Perseverative thinking at night, particularly on infant-related concerns, was linked to impaired bonding, rejection and anger, and infant-focused anxiety. Improving maternal and infant sleep, and reducing maternal cognitive arousal, may improve the maternal-to-infant bond.
... However, and remarkably, almost a quarter of the oldest group of toddlers (25-36 months) still fell asleep in their parents' bed (see Table 2). Bed sharing has been associated with infant and toddler sleep problems, although viewpoints vary on this issue [31]. In this study, as found in previous literature [4,23], parental presence at the time of sleep onset was significantly associated with a reduction in total sleep time, a longer sleep onset latency, and disruptive night awakenings. ...
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There is limited information on sleep patterns among infants and toddlers in Spain. The aim of this study was to assess sleep patterns in children three to 36 months of age in Spain. A cross-sectional study was conducted between February 2017 and February 2018. Sociodemographic data and sleep variables were collected using an expanded version of the validated Spanish version of the brief infant sleep questionnaire. A total of 1,404 parental reports on children (725 males; 679 females) with a mean age of 18.8 ± 9.5 months were collected. Parents who perceived their child’s sleep as problematic (39% of our sample) reported fewer sleep hours (median 9 versus 10 h), more night awakenings (median 2 versus 1), and longer periods of nocturnal awakenings (median 0.5 versus 0.08 min) (p < 0.001). Parental presence at the time of sleep onset and later and irregular bedtime routines were significantly associated with a reduction in total sleep time, longer sleep latency, and disruptive night awakenings (p < 0.001). These findings highlight the need for further studies to assess how to improve sleep patterns as a relevant modifiable lifestyle factor. Conclusion: A substantial percentage of the population perceived that their children slept poorly, which was evident in a variety of sleep patterns, including sleep duration and sleep quality.What is known:• Previous research has established that sleep difficulties among pediatric population affect up to 30% of all children and up to 20–30% of infants and toddlers.• A positive relationship between less parental bedtime involvement and sleep consolidation in infants and toddlers has been established.What is new:• More than a third of Spanish parents perceived their infants and toddlers sleep as problematic and their children reportedly have shorter night sleep hours, more night awakenings, and longer periods of nocturnal awakenings.• Later and irregular parental bedtime routines were associated with worst infants and toddlers sleep.
... Another direction for future research is to examine whether infant sleep arrangements (where and with whom the infant sleeps) impacts the relation between infant sleep problems and the infant-mother and infant-father attachment relationship. Associations between infant sleep arrangements and sleep problems are not consistent, and few studies have examined the association between bed-sharing and the quality of the infant-parent attachment relationship (Mileva-Seitz, Bakermans-Kranenburg, Battaini, & Luijk, 2017). Also, research has shown that fathers are more likely to support a limit-setting approach (e.g., resisting excessive demands of the infant to promote self-soothing abilities) in response to hypothetical case descriptions of infants with sleep problems (Sadeh, Flint-Ofir, Tirosh, & Tikotzky, 2007). ...
Article
This longitudinal study examined developmental trajectories of infant sleep problems from 3 to 24 months old and investigated associations with infant-parent attachment security and dependency. In a sample of 107 Israeli families, number and duration of infant nighttime awakenings were measured at 3, 6, 9, and 24 months old, using mothers’ and fathers’ reports on the Brief Infant Sleep Questionnaire (BISQ). Infant–parent attachment security and infant-parent dependency was assessed at 24 months old, using the observer Attachment Q-Sort procedure (AQS) with both parents. Latent growth curve models showed a non-linear decline in number and duration of infant nighttime awakenings over time. A higher number and longer duration of infant nighttime awakenings at 3 months were associated with higher infant-father attachment security at 24 months. In contrast, longer infant nighttime awakenings at 3 months were predictive of lower infant-mother attachment security at 24 months. A steeper decrease in duration of infant nighttime awakenings was associated with higher infant-father attachment security and lower infant-mother attachment security. As a potential mechanism, paternal involvement in nighttime caregiving was explored in relation to infant-father attachment security. Results of our post-hoc analyses revealed no significant associations between paternal involvement in nighttime caregiving and infant-father attachment security. Our results highlight the need to examine potential mechanisms explaining the divergent associations of infant sleep problems with infant-mother and infant-father attachment security in future research.
... The practice of parent and child sharing a sleeping surface, or "bed-sharing, " is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering claims of dangers and benefits, both physical and psychological, associated with bed-sharing (33). The bed-sharing practice is very prevalent at any age, which ranges from 69.9 to 78.3%. ...
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The sleep disturbance scale for children (SDSC) has been validated in the population of Chinese children (aged 5–16 years) and has good psychometric properties. However, valid assessment tools for sleep problems in the population of infants and young children from mainland China are relatively scarce, and rates of screening and management for pediatric sleep problems are low. Objective This study is to evaluate the reliability and validity of SDSC among infants (aged 6–36 months), and to provide a reference for expanding the application of the SDSC for Chinese infants (SDSC-I). Materials and methods From April to November 2021, parents of infants from Fuzhou, Quanzhou, Longyan, Sanming, and Nanping cities in Fujian Province, China completed the SDSC-I. Several factor analyses were performed to evaluate the reliability and validity of the scale. Results Of note, 432 out of 469 samples were valid. After item selections and exploratory factor analyses, the SDSC-I concluded six dimensions (disorders of initiating sleep, disorders of maintaining sleep, sleep hyperhidrosis, sleep breathing disorders, parasomnias, and non-restorative sleep and excessive somnolence) with 23 items. The Cronbach’s α coefficient of the scale was 0.863, and those for the six dimensions were within 0.576–0.835. The values of parameters for content validity of the scale were: IR = 0.87, I-CVI > 0.78, Kappa value > 0.74, S-CVI/UA = 0.87, S-CVI/Ave = 0.98. Principal component analysis revealed that the Kaiser-Meyer-Olkin (KMO) value was 0.84, and the factor loading of items ranged from 0.328 to 0.849, with six factors of eigenvalue more than one, which could explain 58.274% of the total variance. The confirmatory factor analysis results showed that χ ² /DF was 3.556, root-mean-square error of approximation (RMSEA) was 0.077, comparative fit index (CFI) was 0.809, and standardized RMR (SRMR) was 0.070. Conclusion Our study provides evidence that the SDSC-I is reliable and valid, and it is effective for the screening and management of sleep disturbances among infants (aged 6–36 months). Compared with other questionnaires such as the Brief Infant Sleep Questionnaire (BISQ), it is worthy of popularization and application in pediatric primary care.
... For example, the meaning of the "bed-sharing" item may not be generalizable across cultures. However, previous studies have linked bed-sharing with infant and child sleep problems, such as frequent night-waking, time spent awake at night, less nighttime sleep, and subsequent internalizing problems (Lee et al., 2019;Mileva-Seitz, Bakermans-Kranenburg, Battaini, & Luijk, 2017;Santos et al., 2017) in cultures where co-sleeping is a common and accepted practice [for example, in Korea (Lee et al., 2019) and Brazil (Santos et al., 2017)]. Future research with maltreated children might use actigraphy and polysomnography to measure not only characteristics of sleep quality, but also quantity, which is an important indicator of sleep health. ...
Article
This research sought to determine whether inadequate sleep conditions in childhood and sleep problems in young adulthood in part explain the relationship between childhood abuse and neglect and anxiety and depression later in life. Children with documented histories of abuse and neglect and matched controls were followed up and assessed in young and middle adulthood. Abused and neglected children were more likely to report experiencing inadequate sleep conditions in childhood, sleep problems in young adulthood, and higher levels of depression and anxiety later in middle adulthood. Results revealed significant indirect paths from childhood maltreatment to anxiety and depression in middle adulthood through inadequate sleep conditions in childhood and sleep problems in young adulthood. This longitudinal follow-up of children with documented cases of maltreatment reveals the important role of sleep disturbances in the lives of maltreated children and adults and sleep disturbances in the development of subsequent anxiety and depression.
... We provided institutionalized child rearing as a likely example of an evolutionary novelty (Humphreys & Salo, 2020;Tottenham, 2012). WEIRD societies also include standard parenting practices that likely fall outside the species-typical range, which may not be considered adverse by most people in WEIRD countries, but which are evaluated more negatively by people in non-WEIRD countries, such as caregivers sleeping apart from their babies and sleep training their babies by leaving them on their own to "cry it out" (Mileva-Seitz et al., 2017). However, the fact that certain forms of adversity likely fall within the species-typical range invites us to reconsider definitions of deprivation as "the absence of species-or age-expectant environmental inputs, specifically a lack of expected cognitive and social inputs" (Sheridan & McLaughlin, 2014, p. 581). ...
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In psychological research, there are often assumptions about the conditions that children expect to encounter during their development. These assumptions shape prevailing ideas about the experiences that children are capable of adjusting to, and whether their responses are viewed as impairments or adaptations. Specifically, the expected childhood is often depicted as nurturing and safe, and characterized by high levels of caregiver investment. Here, we synthesize evidence from history, anthropology, and primatology to challenge this view. We integrate the findings of systematic reviews, meta-analyses, and cross-cultural investigations on three forms of threat (infanticide, violent conflict, and predation) and three forms of deprivation (social, cognitive, and nutritional) that children have faced throughout human evolution. Our results show that mean levels of threat and deprivation were higher than is typical in industrialized societies, and that our species has experienced much variation in the levels of these adversities across space and time. These conditions likely favored a high degree of phenotypic plasticity, or the ability to tailor development to different conditions. This body of evidence has implications for recognizing developmental adaptations to adversity, for cultural variation in responses to adverse experiences, and for definitions of adversity and deprivation as deviation from the expected human childhood.
... B A fit spline described an inverse U-shape relationship of gestational age (weeks) with daily sleep hours (hours/day) delay of preterm children may also reflect other factors associated with preterm birth. A growing body of evidence indicates that unmodulated parental care and noncircadian environmental conditions may be detrimental to the establishment of circadian rhythms [52][53][54][55]. More behaviour problems and more social segregation have also been observed in children born preterm compared to full-term [56,57]. ...
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Abstract Background Both sleep quality and quantity are essential for normal brain development throughout childhood; however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term have not been examined. Our study investigated the sleep outcomes of children born at very-preterm (41 weeks). Methods A national retrospective cohort study was conducted with 114,311 children aged 3–5 years old in China. Children’s daily sleep hours and pediatric sleep disorders defined by the Children’s Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children. Results Compared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β = 1.827), moderate-preterm (β = 1.409), late-preterm (β = 0.832), early-term (β = 0.233) and post-term (β = 0.831) children, all p41) was also seen in very-preterm (adjusted odds ratio [AOR] = 1.287 95% confidence interval [CI] (1.157, 1.433)), moderate-preterm (AOR = 1.249 95% CI (1.110, 1.405)), late-preterm (AOR = 1.111 95% CI (1.052, 1.174)) and post-term (AOR = 1.139 95% CI (1.061, 1.222)), all p
... Whether infants and parents are close when infants sleep at night differs from culture to culture (Mileva-Seitz et al., 2017). In Western societies, many mothers tend to put infants to sleep in a separate room (Billingham & Zentall, 1996;Colson et al., 2013), and infants sleep apart from their mothers even immediately after discharge from maternal hospitals. ...
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Mothers and infants co-regulate their distance from one another at home. Continuous, naturalistic home observations of the changes in mother-infant distance were carried out in Japan and Scotland during infant ages of 0-1, 6-7, and 12-13 months. This study examined mutual distance-increasing and distance-reducing behaviours, referred to as parent-infant 'centrifugalism' and 'centripetalism'. Cultural differences emerged in the modes of mother-infant distance co-regulation. Scottish mothers were more active in initiating contact and leaving infants alone to sleep, whereas Japanese mothers showed stronger infant-centredness by maintaining physical contact with infants when they fell asleep and reacting to their crying when they woke up. Age differences were found relating to decrease in sleep and increase in object play in the middle of the first year, which resulted in more separation within a 0.5 m distance at 6-7 months, a compromise between closeness and distancing between mothers and awake infants. Cultural and age differences in the co-regulation of mother-infant distance were discussed in relation to the development of locomotion, object play, and intention-reading.
... The IG was informed about safe sleep environments for infants as per the updates of the American Academy of Pediatrics (AAP) (10). Although there are studies that mention certain positive physical and psychosocial aspects of parent-baby bed sharing, it is known to increase the risk of sudden infant death syndrome (SIDS) (11). AAP defined bed sharing, particularly in certain cases, as a risk condition in terms of SIDS (10). ...
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Objective:To know cultural characteristics of infant sleep pattern and guide the families can be useful to prevent sleep problems. The aim of this study to determine the sleep habits during infancy and to evaluate the effectiveness of sleep training.Materials and Methods:This longitudinal study included 127 healthy infants. Infants were randomly assigned to intervention group [(IG) n=33] or control group [(CG) n=94] and followed up from the 3rd to 18th months at well-child-visits. Face to face sleep training was given to the IG firstly in the 3rd month and then subsequent follow-ups. Families in both groups filled out a detailed questionnaire at each visit.Results:Bed sharing was not detected in the IG. The frequency of rocking was lower in the IG in each period, the difference was significant only at the sixth month (p=0.006). The frequency of sleeping in the supine position compared to the side position was higher in the IG than CG at the 3rd, 6th and 9th months (p=0.013, p=0.005, p=0.003; respectively). Bedtime was earlier and duration to fall asleep after night awakenings was shorter in the IG than CG at 9 and 12 months (p=0.009, p=0.018; p
... As suggested by Barry (2021), more work therefore needs to be done on infants experiencing co-sleeping. In China, young children seem more likely to share a room or bed with caregivers than those from Western countries (Mindell, Sadeh, Wiegand, How & Goh, 2010), and a recent systematic review suggested that non-WEIRD countries have higher reported bed-sharing prevalence than WEIRD countries (Mileva-Seitz, Bakermans-Kranenburg, Battaini & Luijk, 2017). In the debate on the roles of sleep problems in children's development one of the questions is whether they are causes or outcomes (or both) of infant's motor and cognitive development. ...
Article
The present study examined bidirectional effects between sleep problems (nocturnal awakenings and insufficient nocturnal sleep) and infant development (gross motor, fine motor, and cognition) in a sample of 182 infants (89 girls) and their parents living in Beijing (China). Using 3 waves of longitudinal data (at 6 months, 1 year, and 2 years of age), this study (a) explored the differences in sleep patterns and developmental outcomes between infants in the current sample and infants from other cultures; and primarily examined (b) whether nocturnal awakenings and insufficient nocturnal sleep prospectively predicted infant development; (c) or whether infant development predicted sleep problems. Mothers reported their children’s sleep problems, and infant development was assessed with Bayley III. Sleep patterns of Beijing infants were slightly different from those from Finland and Singapore, and most scores on Bayley III in this Beijing sample were higher than those in Danish, Dutch and Sri Lankan samples. Sleep problems and developmental measures were stable across the 3 times of assessments, but cross-lagged associations were limited in number and strength. High scores on the Bayley at 6 months predicted less nocturnal awakenings at 1 year of age. Insufficient nocturnal sleep at 1 year predicted poor fine motor development at 2 years. Thus, findings suggest some bidirectional associations between infant development and sleep problems and further highlight the need to understand these relations within specific cultural contexts.
... 2,11 Despite recommendations, BS is a common practice among parents worldwide. 12 Health professionals can counsel BS parents concerning certain risks to avoid. These include parental smoking, high level of tiredness, alcohol and of sedative drug use, parental obesity, other children also trying to share the bed, low birth weight or preterm babies, sleeping on a surface other than a bed, such as a sofa or a couch, sleeping on a soft surface such as water bed, other furniture or walls close to the bed that may present a crushing risk to the baby, and the baby sleeping face down. ...
Article
Objective: Studies have shown that mothers sleeping with their babies have longer breastfeeding duration. Bedsharing (BS) is thought to be a risk factor for Sudden Infant Death Syndrome. The aim was to investigate the frequency of BS and roomsharing (RS) and the effect of those on breastfeeding during the first 2 years of life. Also to evaluate risk-bearing situations regarding sleep environment. Methods and Study Design: This is a cross-sectional study, with retrospective cohort features for the evaluation of some data. The setting was a Well-Child Clinic at Bakırköy Research and Training Hospital. The children were followed from the first month until survey. Feeding history was collected retrospectively from child health records. Parents were surveyed concerning sleeping location and sleeping arrangements with a questionnaire. The study encompassed 351 children and their families. Results: The rate of exclusive breastfeeding was found to be 50.2% for the first 6 months of life and BS increased in exclusively breastfed infants. When breastfeeding continued after 6 months, the trend of increased BS through months was observed. RS, BS, and breastsleeping rates were 80.6%, 22.8%, 56.1%, respectively, in the whole cohort. Working mothers and mothers >35 years of age were significantly more likely to bedshare. Cigarette smoking in BS parents was identified as a child health risk. Unsafe sleep environment was found in 72.4% of the group. Conclusions: BS increases breastfeeding for the first 6 months. Families need guidance on safe sleeping practices and should be advised regarding avoidable risks and unsafe situations in BS. Parents should be counseled to make informed decisions.
... However, although many parents struggle with infant-related sleep loss and disruption, others display resilience to infant-related sleep disruption, adapting their own sleep patterns and sleep ecology to meet their infant's needs (Ball 2002;Ball et al. 1999;Mileva-Seitz et al. 2016;Rudzik and Ball 2016). These parents articulate an acceptance that their sleep will be disrupted during the period of infancy, but that they have the capacity to adapt and cope: Understanding how these parents differ from those who struggle will be informative in predicting who might be in most need of future support. ...
Article
Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the “review behind the review,” highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers’ decisions about infant sleep location influence infant behavior and development.
Article
Der Aufbau der Eltern-Kind-Bindung ist nicht nur auf die erste Zeit nach der Geburt beschränkt. Trotz ungünstiger Startbedingungen kann Bindung durch einfache körperorientierte Maßnahmen gefördert werden und gelingen. Der Einfluss dieser Maßnahmen wird in der Praxis noch immer unterschätzt. Studien zeigen aber, dass durch Praktiken wie Babymassage, das tägliche Tragen des Kindes am Körper oder Co-Sleeping physiologische Prozesse bei Eltern und deren Kindern angeregt werden, um Bindung aufzubauen.
Article
Background: Sleep problems are self-care deficits of sleep experienced by more than 44% of preschoolers. Some studies have showed that physical, psychological, family, environmental, and temperamental factors could cause sleep problems among children. However, other research showed that there is no correlation between sleep problems and environmental factors. There are pro-cons regarding the causes of sleep problems. Purpose: The purpose of this study was to analyze factors affecting sleep problems among preschoolers.Methods: A cross-sectional study was conducted among 297 preschoolers selected by systematic random sampling. Data were collected using the Children’s Sleep Habits Questionnaires (CSHQ) and analyzed using bivariate (Chi-Square and Fisher tests) and multivariate (logistic regression) analyses. Results: Results of the bivariate analysis showed that some variables were related to sleep problems among preschoolers, including family income (p=0.027), the education level of the mother (p<0.001), and bed-sharing (p=0.003). Multivariate analysis found that factors related to sleep problems were bed-sharing (p=0.031; OR=2.377), gadget use in two hours before sleep (p=0.039; OR= 2.703), and the education level of the mother (p=0.007; OR=2.244).Conclusion: Factors related to sleep problems in preschoolers were bed-sharing, gadget use in two hours before sleep, the education level of the mother, and family income. This study recommends that environmental and family factors should be modified by limiting bed-sharing and reducing the use of gadgets before bedtime.
Article
Objective/background: Co-sleeping is common practice around the globe. The relationship between early childhood co-sleeping and adolescent behavior problems remains uncertain. We aim to identify whether early childhood co-sleeping can predict behavior problems in preadolescence. Participants: A cohort of 1,656 Chinese preschool children were followed up in adolescence. Methods: Prospective cohort study design involving two waves of data collection from the China Jintan Cohort (1,656 children aged 3-5 years). Co-sleeping history was collected at 3-5-years-old via parent-reported questionnaire at wave Ⅰ data collection. Behavior problems were measured twice in childhood and preadolescence, respectively. Adolescent behavior problems were measured by integrating data from self-report, parent-report and teacher-report using the Achenbach System of Empirically Based Assessment. Predictions were assessed using the general linear model with mixed effects on the inverse probability weight propensity-matched sample. Results: 1,656 children comprising 55.6% boys aged 4.9 ± 0.6 were initially enrolled in the first wave of data collection. In the second wave of data collection, 1,274 children were 10.99 ± 0.74 (76.9%) aged 10-13 years were retained. Early childhood co-sleeping is significantly associated with increased behavior problems in childhood (Odds Ratio [OR] 1.22-2.06, ps<0.03) and preadolescence (OR 1.40-2.27, ps<0.02). Moreover, co-sleeping history significantly predicted multiscale increase in internal (OR 1.63-2.61, ps<0.02) and external behavior problems in adolescence. Conclusions: Early childhood co-sleeping is associated with multiple behavioral problems reported by parents, teachers, and children themselves. Early childhood co-sleeping predicts preadolescent internalizing and externalizing behavior after controlling for baseline behavior problems.
Article
Objective: Sleep-related problems, defined as sleep patterns atypical for the child's developmental stage, are common in children with elevated anxiety symptoms and linked to significant mental and physical health consequences. Despite the consequences of sleep-related problems, it remains unclear how these problems are initiated and maintained in children with elevated anxiety symptoms. The current study examines the relationship between sleep-related problems and parental accommodation (e.g., co-sleeping) to determine whether higher levels of accommodation are associated with more frequent sleep-related problems in a sample of children with elevated anxiety symptoms. Methods: Participants were 122 children aged 8 to 17 years old (M = 11.97, SD = 2.68; 57% female) and their parents who presented to a university-based anxiety specialty clinic for assessment and treatment. Children completed the Multidimensional Anxiety Scale for Children, and their parents completed the Children's Sleep Habits Questionnaire and Family Accommodation Checklist and Interference Scale. Multiple regression analyses were performed to examine variance in sleep-related problems explained by parental accommodation. Results: Parental accommodation accounted for a significant amount of variance in sleep-related problems over and above child anxiety and age for both mother report (19%) and father report (15%). When individual accommodation items were examined, parental sleep accommodations (e.g., slept in my child's bed) and nonsleep accommodations (e.g., came home early) were significant predictors for mother-reported sleep-related problems, but only sleep accommodations (e.g., let my child sleep with the lights on) were significant for father-reported sleep-related problems. Conclusion: Parents of children with elevated anxiety symptoms and sleep-related problems engage in accommodation related to their child's sleep (e.g., co-sleeping). Future research elucidating the potential bidirectional and causal links between parental accommodation and sleep-related problems is a necessary step in adapting sleep treatments for this population.
Article
Introducción: La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL). Objetivo: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL. Sujetos y Método: Estudio piloto, prospectivo concurrente, de lactantes < 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional < 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instru mentos para < 3 meses. Resultados: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dor mían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación. El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informa do sobre la posición segura de sueño, siendo el principal informante el pediatra (54%). Conclusio nes: En esta muestra se encontró alto porcentaje de lactantes < 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.
Article
Full-text available
El colecho ha sido una práctica ancestral de la humanidad. No existe una respuesta universal acerca de si una familia debe practicar o no el colecho y, lastimosamente, la tendencia actual es a tomar posturas extremas. No es una práctica que sea estrictamente necesaria para el desarrollo emocional del niño ni para mantener la lactancia materna, pero, como se ha expuesto, es claro que es un factor que contribuye de forma positiva. Existen escasos trabajos que valoren la posición de los padres ante el colecho, por lo que se debería procurar que se lleven a cabo investigaciones cualitativas que nutran sustancialmente la visión que se tiene respecto al tema, ya que hay aspectos como el amor y el apego que no se pueden medir matemáticamente.
Article
Background Research suggests that home visiting interventions can promote breastfeeding initiation, though their effects on breastfeeding continuation are unclear. No known studies have assessed the impact of home visiting on bedsharing. Aims To test the effects of home visiting on breastfeeding and bedsharing in a low-income, urban sample in the United States. Methods During a field trial conducted in Milwaukee, Wisconsin, from April 2014 to March 2017, referrals to a public health department were randomized to a Healthy Families America (HFA) program or a prenatal care and coordination (PNCC) program. Of the 204 women who accepted services, 139 consented to the study and were allocated to the two treatment groups, which were compared with each other and a third quasi-experimental group of 100 women who did not accept services. Data were collected at four time points up to 12 months postpartum. Results Breastfeeding initiation was higher among 72 HFA participants (88.4%; odds ratio [OR] = 2.7) and 67 PNCC participants (88.5%; OR = 2.2) than 100 comparison participants (76.5%). Similar results emerged for breastfeeding duration, though group differences were not statistically significant. Unexpectedly, bedsharing prevalence was higher among HFA participants (56.5%) than PNCC participants (31.1%; OR = 2.9) and comparison group participants (38.8%; OR = 2.0). Discussion Home visiting was linked to increased breastfeeding, while effects on bedsharing varied by program. Progress toward precision home visiting will be advanced by identifying program components that promote breastfeeding and safe sleep. Conclusion Further research is needed to examine whether home visiting reduces disparities in breastfeeding and safe sleep practices.
Article
None: Sleep disturbance is common in young children who are otherwise healthy, and even more so in children with cancer. To address sleep disturbance in early childhood, caregivers may utilize bedsharing to reduce stress. Although bedsharing is not typically discouraged in children over the age of one year, it may present a safety and infection control concern for youth preparing for stem cell transplantation (SCT).We highlight the successful application of evidence-based sleep interventions to eliminate bedsharing prior to admission to the SCT unit through three case examples of patients who were two years of age or younger diagnosed with cancer and preparing for SCT. The behavioral sleep interventions included sleep hygiene education, gradual fading, unmodified extinction, and graduated extinction. When medically indicated and tailored to family preferences, behavioral interventions can effectively and efficiently eliminate bedsharing for young children preparing for SCT.
Article
Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a “complex adaptive system” (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.
Article
This study examined the associations of parental movement behaviors (MBs; sleep, stationary time, light-intensity physical activity [LPA], and moderate- to vigorous-intensity physical activity [MVPA]) and parent–child proximity with preschool-aged children’s MBs. Parent–child MBs and proximity were assessed with Bluetooth-enabled accelerometers. Parent–child proximity behaviors were categorized as follows: no proximity (NP), proximity and matching parent–child MBs (Co), and proximity and mismatching parent–child MBs (Close). Lastly, proximity MBs were categorized specific to children’s MBs (e.g. NP-MVPA, Co-MVPA, and Close-MVPA). Compositional analyses were conducted. Children (n = 89) were mostly boys (69.7%) with a mean age of 4.6 ± 0.7 years. Parent MBs were not associated with children’s MBs. Reallocating 1% of the proximity behavior composition to Close resulted in +2.45 minutes/day of children’s LPA. Reallocating 1% of the proximity-MVPA composition to NP-MVPA resulted in +1.61 minutes/day of children’s MVPA. Parent–child proximity may be a modifiable correlate of children’s physical activity. Future research should measure the whole family.
Article
Introduction: Mitigation behaviors are key to preventing SARS-CoV-2 transmission. We identified behaviors associated with secondary transmission from confirmed SARS-CoV-2 primary cases to household contacts and described characteristics associated with reporting these behaviors. Methods: Households with confirmed SARS-CoV-2 infections were recruited in California and Colorado from January to April 2021. Self-reported behaviors and demographic were collected through interviews. We investigated behaviors associated with transmission, and individual and household characteristics associated with behaviors, using univariable and multivariable logistic regression with Generalized Estimating Equations to account for household clustering. Results: Among household contacts of primary cases, 43.3% (133/307) became infected with SARS-CoV-2. Upon adjusted analysis, household contacts who slept in the same bedroom with the primary case (aOR: 2.19, 95% CI: 1.25, 3.84) and ate food prepared by the primary case (aOR: 1.98 95% CI: 1.02, 3.87) had increased odds of SARS-CoV-2 infection. Household contacts in homes ≤2000 ft² had increased odds of sleeping in the same bedroom as the primary case compared to those in homes >2000 ft² (aOR: 3.97, 95% CI: 1.73, 9.10). Parents, siblings, and other relationships (extended family, friends, or roommate) of the primary case had decreased odds of eating food prepared by the primary case compared to partners. Conclusion: Sleeping in the same bedroom as the primary case and eating food prepared by the primary case were associated with secondary transmission. Household dimension and relationship to primary case were associated with these behaviors. Our findings encourage innovative means to promote adherence to mitigation measures that reduce household transmission.
Article
Objectives: To investigate the current status of sleep initiation patterns, influencing factors for sleep initiation patterns, and the influence of sleep initiation patterns on sleep quality in infants and young children. Methods: A total of 521 infants and young children, aged 0-35 months, who underwent physical examination at the outpatient service of the Department of Growth and Development in Shenzhen Bao'an Women's and Children's Hospital Affiliated to Jinan University were enrolled as subjects. A self-designed questionnaire and Brief Infant Sleep Questionnaire were used to collect the information on family background, parenting behaviors, and sleep quality in the past one week. A multivariate logistic regression analysis was used to evaluate the influencing factors for sleep initiation patterns. A multiple linear regression analysis was used to evaluate the influence of sleep initiation patterns on the number of nighttime awakenings. Results: Among the 521 infants and young children, 258 (49.5%) were breastfed/bottle fed to initiate sleep, 62 (11.9%) were rocked/held to initiate sleep, 39 (7.5%) slept independently, and 162 (31.1%) initiated sleep accompanied by parents. The multivariate logistic regression analysis showed that the children with breastfeeding and a younger age were more likely to be breastfed/bottle fed to initiate sleep (P<0.05) and that the children with a younger age were also more likely to be rocked/held to initiate sleep (P<0.05). The multiple linear regression analysis showed that sleep initiation with breastfeeding/bottle feeding significantly increased the number of nighttime awakenings (P<0.05). Conclusions: Most infants and young children initiate sleep by being breastfed/bottle fed, rocked/held, or accompanied. The sleep initiation pattern is associated with the age of children and whether they are still breastfeeding. Sleep initiation with breastfeeding/bottle feeding can increase the number of nighttime awakenings. io.
Chapter
Sleep during infancy and toddlerhood is a high-priority issue for parents, especially at night, because when the baby doesn’t sleep, neither do the parents. Many mothers and fathers resume their work within a few months after the birth, and working after a poor night’s sleep is both difficult and exhausting. Babies often nap during the day, but many parents cannot afford that luxury, especially if they do not remain at home during the day. This chapter systematically reviews the evidence about the “normal” evolution of night- and daytime sleep in babies and toddlers as the child ages and about factors other than age that may influence sleeping behaviors: infant feeding, the sleeping arrangements of the baby and parents, the baby’s sleeping position, noise and light in the baby’s bedroom, and the use of pacifiers. After a brief section summarizing the evidence concerning possible effects of the baby’s sleep on long-term health and brain development, most of the chapter summarizes the evidence from randomized trials of interventions designed to help the baby sleep through the night.
Article
Objective To assess the effects of bed-sharing experiences in infancy on sleep patterns and sleep problems at two years of age. Study design A total of 1,564 children from an ongoing Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) were included. Bed-sharing experiences were collected when children were 2, 6, and 24 months old via caregiver-completed questionnaires (whether caregivers shared a bed with children during the night), and children’s bed-sharing experiences were classified as follows: no bed-sharing, early-only bed-sharing, late-onset bed-sharing, and persistent bed-sharing. Sleep outcomes at month 24 were assessed using the Brief Infant Sleep Questionnaire. Sleep patterns and problems were compared among the four types of bed-sharing experiences. Results Of the 1,564 infants, 10.10% were no bed-sharing, 18.35% were early-only, 27.94% were late-onset, and 43.61% were persistent bed-sharing. Compared with children with no bed-sharing, children with late-onset and persistent bed-sharing had shorter nighttime sleep durations and longer daytime sleep durations (P < 0.05) and were more likely to snore (aOR : 1.87 [95% CI: 1.25–2.79]; aOR:1.68 [95% CI: 1.14–2.47]) and have sleep onset difficulty (aOR: 2.06 [95% CI: 1.37–3.09]; aOR:2.07 [95% CI: 1.41–3.05]). However, caregivers of infants in the late-onset and persistent bed-sharing groups perceived less problematic sleep (aOR: 0.38 [95% CI: 0.26–0.56] and aOR: 0.40 [95% CI: 0.28–0.58]). Conclusions Bed-sharing is a common experience among Chinese children. Although bed-sharing may reduce caregivers’ perception of children’s problematic sleep, late-onset or persistent bed-sharing in infancy is associated with sleep problems at two years of age.
Article
Justification: Breastfeeding provides the best infant food, and closeness to the mother is crucial for successful breastfeeding. However, sharing parents' beds and sleeping on the stomach poses a high risk for sudden infant death syndrome (SIDS). There is little information on these practices regarding the Spanish population. Objective: To explore breastfeeding and bed-sharing practices in the study population Materials and Methods: A cross sectional observational study was conducted through an anonymous telephone survey with a representative random sample of babies born in the Health Area of La Marina Baixa, Alicante, between 2018 and 2019. A previous-day strategy was implemented to determine the feeding and bed-sharing variables. Results: The total breastfeeding and formula-feeding rates were 47.0% and 52.9%, respectively. The overall bed-sharing rate was 66.5%. The breastfeeding rate was 86.4% with bed-sharing and 13.6% without bed-sharing. The rate of prone sleeping position in children younger than 6 months of age was 9.3-3.5% with breastfeeding and 5.8% with formula feeding. Lower frequencies of tobacco, alcohol, and nonsupine sleeping positions were observed among mothers who practiced breastfeeding and bed-sharing. Conclusions: We found a close relationship between breastfeeding and bed-sharing and a lower frequency of SIDS risk factors associated with both practices. Families should be informed about the risk factors associated with SIDS to encourage safe bed-sharing while avoiding recommendations that discourage breastfeeding.
Article
Background: There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. Objectives: To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. Search methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. Selection criteria: We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. Data collection and analysis: We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. Main results: Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. Authors' conclusions: We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
Article
Objectives Sleep disturbances are common in preschoolers, and profoundly affected by parenting. Grandparents are increasingly involved in childcare and have attracted worldwide attention for their potential impacts on child wellbeing. However, no studies have explored child sleep health within the context of grandparental care. We aimed to explore the association between grandparents as primary caregivers and children’s sleep disturbances. Methods Participants included 20,324 preschoolers from the Shanghai Children’s Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) in Shanghai, China. They were initially assessed in November 2016 and were reassessed in April 2018 and April 2019. Children’s primary caregivers were collected at each survey. Sleep disturbances were assessed by the Children’s Sleep Habits Questionnaire (CSHQ). Results At baseline, 84.4% of children had global sleep disturbances (CSHQ total score >41). Compared with parents, random-effects model indicated that grandparents as primary caregivers increased the adjusted odds ratio (OR) for children’s global sleep disturbances by 30% (OR [95%CI]: 1.30 [1.21, 1.40]). To the specific domains of CSHQ, two-way repeated-measures ANOVA showed significant “caregiver transition” group × wave interaction in the behavioral sleep disturbances, such as “Bedtime Resistance” (p <0.001). At each survey, children with grandparents as primary caregivers demonstrated significant higher behavioral sleep disturbances than their counterparts with parental care. Conclusions Grandparental care is associated with increased sleep disturbances, particularly behavioral sleep disturbances, in preschoolers. Future studies should explore the underlying mechanisms and whether sleep programs targeting grandparents can decrease children’s sleep disturbances.
Article
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La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL).Objetivo: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL.Sujetos y Método: Estudio piloto, prospectivo concurrente, de lactantes < 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional < 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instrumentos para < 3 meses.Resultados: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dormían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación.El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informado sobre la posición segura de sueño, siendo el principal informante el pediatra (54%).Conclusiones: En esta muestra se encontró alto porcentaje de lactantes < 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.
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A steady-state mathematical model is built in order to represent plant behavior under stationary operating conditions. A novel modeling using LS-SVR based on Cultural Differential Evolution with Ant Search is proposed. LS-SVM is adopted to establish the model of the net value of ammonia. The modeling method has fast convergence speed and good global adaptability for identification of the ammonia synthesis process. The LS-SVR model was established using the above-mentioned method. Simulation results verify the validity of the method.
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Objectives: To examine: (1) the prevalence and characteristics of bed-sharing among non-Hispanic Black and White infants in Georgia, and (2) differences in bed-sharing and sleep position behaviors prior to and after the American Academy of Pediatrics' 2005 recommendations against bed-sharing. Methods: Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) data were obtained from the Georgia Department of Public Health. Analysis was guided by the socioecological model levels of: Infant, Maternal, Family, and Community/Society within the context of race. Data from 2004 to 2011 were analyzed to address the first objective and from 2000 to 2004 and 2006 to 2011 to address the second objective. Rao-Scott Chi square tests and backward selection unconditional logistic regression models for weighted data were built separately by race; odds ratios (OR) and 95 % Confidence Intervals (CIs) were calculated. Results: A total of 6595 (3528 Black and 3067 White) cases were analyzed between 2004 and 2011. Significantly more Black mothers (81.9 %) reported "ever" bed-sharing compared to White mothers (56 %), p < 0.001. Logistic regression results indicated that the most parsimonious model included variables from all socioecological levels. For Blacks, the final model included infant age, pregnancy intention, number of dependents, and use of Women, Infant and Children (WIC) Services. For Whites, the final model included infant age, maternal age, financial stress, partner-related stress, and WIC. When comparing the period 2000-2004 to 2006-2011, a total of 10,015 (5373 Black and 4642 White cases) were analyzed. A significant decrease in bedsharing was found for both Blacks and Whites; rates of non-supine sleep position decreased significantly for Blacks but not Whites. Conclusions for practice: Continued high rates of bed-sharing and non-supine sleep position for both Blacks and Whites demonstrate an ongoing need for safe infant sleep messaging. Risk profiles for Black and White mothers differed, suggesting the importance of tailored messaging. Specific research and practice implications are identified and described.
Article
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Objective: To investigate thermal balance of infants in a Mongolian winter, and compare the effects of traditional swaddling with an infant sleeping-bag in apartments or traditional tents (Gers). Design: A substudy within a randomised controlled trial. Setting: Community in Ulaanbaatar, Mongolia. Subjects: A stratified randomly selected sample of 40 swaddled and 40 non-swaddled infants recruited within 48 h of birth. Intervention: Sleeping-bags and baby outfits of total thermal resistance equivalent to that of swaddled babies. Outcome measure: Digital recordings of infants' core, peripheral, environmental and microenvironmental temperatures at 30-s intervals over 24 h at ages 1 month and 3 months. Results: In Gers, indoor temperatures varied greatly (<0->25°C), but remained between 20°C and 22°C, in apartments. Despite this, heavy wrapping, bed sharing and partial head covering, infant core and peripheral temperatures were similar and no infants showed evidence of significant heat or cold stress whether they were swaddled or in sleeping-bags. At 3 months, infants in sleeping-bags showed the 'mature' diurnal pattern of a fall in core temperature after sleep onset, accompanied by a rise in peripheral temperature, with a reverse pattern later in the night, just before awakening. This pattern was not related to room temperature, and was absent in the swaddled infants, suggesting that the mature diurnal pattern may develop later in them. Conclusions: No evidence of cold stress was found. Swaddling had no identifiable thermal advantages over sleeping-bags during the coldest times, and in centrally heated apartments could contribute to the risk of overheating during the daytime. Trial registration number: ISRTN01992617.
Article
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The commentary by McKenna and Gettler in Acta Paediatrica was an eloquent song of praise to breastfeeding (1). Nothing is wrong with that. However, when they dealt with the advice given in several countries that bed sharing should be avoided when babies are below three months old (2), they failed to give a fair account of why that advice is given. This article is protected by copyright. All rights reserved.
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Objective: Universal coverage with insecticide-treated bed nets is a cornerstone of modern malaria control. Mozambique has developed a novel bed net allocation strategy, where the number of bed nets allocated per household is calculated on the basis of household composition and assumptions about who sleeps with whom. We set out to evaluate the performance of the novel allocation strategy. Methods: A total of 1994 households were visited during household surveys following two universal coverage bed net distribution campaigns in Sofala and Nampula provinces in 2010-2013. Each sleeping space was observed for the presence of a bed net, and the sleeping patterns for each household were recorded. The observed coverage and efficiency were compared to a simulated coverage and efficiency had conventional allocation strategies been used. A composite indicator, the product of coverage and efficiency, was calculated. Observed sleeping patterns were compared with the sleeping pattern assumptions. Results: In households reached by the campaign, 93% (95% CI: 93-94%) of sleeping spaces in Sofala and 84% (82-86%) in Nampula were covered by campaign bed nets. The achieved efficiency was high, with 92% (91-93%) of distributed bed nets in Sofala and 93% (91-95%) in Nampula covering a sleeping space. Using the composite indicator, the novel allocation strategy outperformed all conventional strategies in Sofala and was tied for best in Nampula. The sleeping pattern assumptions were completely satisfied in 66% of households in Sofala and 56% of households in Nampula. The most common violation of the sleeping pattern assumptions was that male children 3-10 years of age tended not to share sleeping spaces with female children 3-10 or 10-16 years of age. Conclusions: The sleeping pattern assumptions underlying the novel bed net allocation strategy are generally valid, and net allocation using these assumptions can achieve high coverage and compare favourably with conventional allocation strategies.
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To compare self-reported safe sleep data from a community social service agency and primary care centers. Cross-sectional Pregnancy Risk Assessment Monitoring System (PRAMS)-based survey data from a community social service agency and survey data from primary care centers were compared using descriptive statistics. There were 166 community survey respondents, average age of 25 years (SD = 5.4 years), and 79 primary care center respondents, average age of 24 years (SD = 5.4 years). Two binary logistic regressions were performed to examine the association between demographic differences and safe sleep position/bed sharing. Safe sleep position responses did not differ significantly between the community-based (n = 126, 85%) and primary care center-based (n = 62, 79%) samples, χ(2)(1) = 0.79, P = .372. Reported bed sharing was significantly higher in the community sample (n = 54, 36%) than the health care center sample (n = 4, 5%), Fisher's exact test, P< .001. Black race was determined to be significantly associated with increased unsafe sleep positioning (OR = 2.86, P = .022). The community center cohort was the only significant predictor of bed sharing (OR = 25.40, P = .002). Differences in reported safe sleep environments may be due to knowledge variances of safe sleep guidelines, or clinic-based respondents may have been more likely to provide socially desirable responses. The comparison data further highlight the need for continued targeted effort to improve safe sleep behaviors to improve infant health outcomes. © The Author(s) 2015.
Article
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The emergence of consolidated nighttime sleep and the formation and maintenance of parent-infant relationships are 2 primary developmental achievements of the infancy period. Despite the development of a transactional model that links parenting behaviors to infant sleep, limited attention has been devoted to examining experimental manipulations of infant sleep that may impact the discrete parent-infant interactions that may form the foundation for emerging attachment relationships. In the present study, infants were randomly assigned to wear high-absorbency disposable diapers or to continue using traditional low-absorbency cloth diapers that necessitate frequent changes and associated disruptions of nighttime sleep. Parents reported on infant sleep before and during the 6-week experimental manipulation; a subset of infants also wore actigraphs. Parents and infants also participated in a parent-infant interaction task both before and near the end of the experimental manipulation. Infants who wore cloth diapers experienced more frequent sleep disruptions overall as well as a greater number of disruptions that did and did not wake the infant from sleep. Infants who wore disposable diapers were rated as experiencing more engagement and positive affect near the end of the intervention relative to infants who wore cloth diapers; mothers of infants who wore disposable diapers were rated as more engaged and sensitive near the end of the intervention relative to mothers of infants who wore cloth diapers. These findings suggest that the disposable diaper manipulation was causally related to characteristics of mother-infant interactions that may form the foundation for emerging attachment relationships. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Background: We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control. Methods: In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting ≥14 days were enrolled and evaluated for pertussis using DNA polymerase chain reaction (PCR) and ELISA serology tests. Results: Pertussis prevalence was 67 (15% (95% Confidence Interval (CI): 12-18)) and 81 (20% (95% CI: 16-24)) by PCR and ELISA, respectively among 449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination coverage of 94% in this age group. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30%) had a coughing household member and 316 (70%) did not. Among 133 children that had a coughing household member, sex of child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR) 7.16 (95% CI: 1.24-41.44)). Among the 316 children that did not have a coughing household member, age <23 months, having or contact with a coughing individual in neighborhood, a residence with one room, and having a caretaker with >40 years of age were the factors associated with pertussis. Age <23months was three times more likely to be associated with pertussis compared to age 24-59 months (OR 2.97 (95% CI: 1.07-8.28)). Conclusion: Findings suggest high prevalence of pertussis among children with persistent cough at a health facility and it was marked in children >59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.
Conference Paper
Objectives: To determine the prevalence of the carrier state in household contacts in children with tinea capitis, the duration of the carrier state, factors associated with carriage, and the proportion of carriers who develop clinical disease. Design: Cross-sectional, cohort, prevalence study. Setting: General pediatric clinic sewing an indigent, inner-city, African American population. Patients: Household contacts in children with tinea capitis. Index cases and carriers (no clinical evidence of infection) were identified by culture. Carriers were monitored until the results of their culture became negative, they developed clinical disease, or a 6-month period had elapsed. Results: Fifty-six index cases and 114 contacts (50 adults and 64 children) were evaluated. Ninety-eight percent of the dermatophytes identified in index cases and 100% in carriers were Trichophyton tonsurans. At the initial visit, 18 (16%) of 114 (95% confidence interval [95% CI], 10-24) of contacts were carriers and 14 (32%) of 44 of the families studied had at least 1 carrier. At the 2-, 4-, and 6-month visits, the carrier state persisted in 7 (41%) of 17 (95% CI, 19-67), 3 (20%) of 15 (95% CI, 4-48), and 2 (13%) of 15 (95% CI, 2-40), respectively. Three of the carriers were lost to follow-up. Of the carriers, 1 (7%) of 15 (95% CI, 0.2-32) developed tinea capitis. Univariate and multivariate analysis showed no association of carrier state to age, sex, comb sharing, or cosleeping. However, cosleeping and comb sharing were common among the contacts, occurring 75% and 78% of the time, respectively, making statistical correlation difficult with our sample size. Conclusions: Initial prevalence of asymptomatic carriage of dermatophytes among household contacts of a child with tinea capitis was 16%, with 41% of carriers persisting up to 2 months. Thirty-two percent of families had at Last 1 member who was a carrier. Seven percent of the carriers developed an active infection. Treatment of carriers with sporicidal shampoo should be considered since they may act as a reservoir for infection or develop active disease. The high prevalence of cosleeping and comb sharing may: be important factors in the spread of the disease.
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Behavioural and emotional problems in Finnish three-year-olds was studied using the Child Behavior Checklist for ages 2-3 as a standardised rating scale at well-baby clinics in two cities in Finland. Altogether 374 questionnaires were analysed which is 71% of the target population. When compared with studies from other countries the mean scores and prevalences of preschool children's problem behaviours were rather similar. Boys were reported to be more destructive than girls. Parental education level, living in one-parent family and parental unemployment were associated with a higher level of problem behaviours. No significant differences were found in emotional or behavioural problems related to the child's day care. Co-sleeping with parents was associated with sleep problems.
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Study Objective: Temperament was explored as a factor in both night-waking and bedsharing in preschool-aged children. Design: Bedsharers and solitary sleepers were categorized based on the frequency of current bedsharing. MANOVA was used to examine associations among temperament and sleep measures. Setting: Two preschools affiliated with a rural university in the Northeast United States. Participants. 67 children between 2.4-5.6 years of age from two University-affiliated preschools were studied. Intervention: Child temperament was rated by parents and teachers using the Carey Temperament Scale and compared to night-waking, current sleep habits, and the circumstances in which bedsharing occurred Measurements and Results: Parents and preschool teachers completed the Carey Temperament Scale for 3-7 year olds. Parents also scored the Sleep Habits Inventory and the Sleeping Arrangements Inventory, which provided a current and retrospective history of the child's sleep location and sleep patterns. Parents' ratings showed that bedsharers have less regular bedtimes; difficulty with sleep onset; more night-waking; and seek out the parents following awakening during the night. Temperamentally, bedsharers were found to be more intense and exhibit less adaptability and rhythmicity. However, teachers' temperament ratings did not predict bedsharing and were not concordant with parental ratings. Conclusions: These findings suggest that bedsharing at preschool age is a complex phenomenon related to parents' ratings of child temperament, sleep habits, and disturbances such as night waking. Implications for the clinical assessment of sleep disorders are discussed.
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This Chapter introduces the concept of smart grid, with an emphasis on the characteristics as well as the requirements and technical demands of smart grid. The status of worldwide development of smart grid, mostly about US, Europe and China, is presented. Measurements and testing become a core part of the grid and new challenging problems have to be dealt with and solved. The demand and requirements of sensors, measurement and testing in future smart grid are identified. Also, the state of art in measurement and test of smart grid is described.
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A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Objective. —To determine the independent contribution of changes in infant sleep position to the recent decline in sudden infant death syndrome (SIDS) rate in Tasmania.Design. —(1) A comparison of the whole population incidence of SIDS before and after an intervention to reduce the prevalence of prone sleeping position. (2) A within-cohort analysis of the contribution of sleep position and other exposures to the decline in SIDS after the intervention.Setting. —Tasmania, Australia.Participants. —(1) All SIDS cases from 1975 through 1992. (2) A sample of one in five infants born in Tasmania who at perinatal assessment were scored to be at higher risk for SIDS since January 1988. Of 5534 infants included in the study, 39 later died of SIDS.Interventions. —Multiple public health activities to reduce the prevalence of the prone infant sleeping position in Tasmania and verbal information on the association between prone position and SIDS to cohort participants from May 1, 1991.Main Outcome Measure. —Sudden infant death syndrome incidence.Results. —The Tasmanian SIDS rate decreased (P<.01) from 3.8 (95% confidence interval [CI], 3.5 to 4.2) deaths per 1000 live births from 1975 through 1990 to a rate of 1.5(95% CI, 0.9 to 2.2) deaths per 1000 live births in 1991 through 1992. The SIDS mortality rate in the cohort by period of birth was 7.6 (95% CI, 4.9 to 10.3) deaths per 1000 live births for those born from May 1, 1988, through April 30, 1991, and 4.1 (95% CI, 1.3 7.0) deaths per 1000 infants for those born from May 1,1991, through October 31, 1992. The prevalence of usual prone sleeping position at 1 month of age was 29.9% and 4.3% in these two cohorts, respectively (adjusted odds ratio, 0.11; 95% CI, 0.08 to 0.13). Logistic regression demonstrated that 70% of the SIDS rate reduction in the cohort could be accounted for by the decreased prevalence of the prone sleeping position. Other factors examined individually contributed to less than 10% of the SIDS rate reduction.Conclusions. —The major contributing factor to the recent SIDS rate decline in Tasmania has been the reduction in the proportion of infants usually sleeping prone.EVIDENCE has
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Parent-child cosleeping is typically considered by researchers and parenting advisors to be a unitary construct. However, existing evidence suggests that parents who purposefully sleep with their young children at night (intentional cosleepers) may be very different than those who co-sleep in reaction to existing sleep problems (reactive cosleepers). The object of the current study is to compare these two groups along three dimensions: demographics, sleep behaviors, and maternal attitudes toward sleep. Participants recruitment occurred through two parenting e-mail listservs; one considered mainstream and one devoted to attachment parenting. The survey was completed online and submitted electronically. Participants included 450 mothers in the United States (mostly White and well-educated) with a target child between the ages of 6 and 59 months who cosleeps at least occasionally. Reactive cosleepers and intentional cosleepers reported many differences in their children's sleep behaviors and their own attitudes about family sleep, but few demographic differences. Frequent all-night cosleeping and parental ideological endorsement of cosleeping characterize intentional cosleeping. Reactive cosleeping is characterized by reduced parental satisfaction. Reactive and intentional cosleepers both report shared beliefs with their partners and a select group of friends, but a definite lack of shared beliefs with other elements of their social support systems. The distinction between intentional and reactive cosleeping appears to be a valid and useful one. Researchers should be aware of the differences when studying sleep in families with young children.
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Between 1981 and 1993, the Sudden Infant Death Syndrome (Cot Death) rate in New Zealand declined by 50 percent. Traditionally, New Zealand had experienced the highest death rates from this cause in the Developed World. The improving situation was widely attributed to the National Cot Death Prevention Programme which began in the early 1990s. This sought to persuade parents to modify their behaviour in four areas. Specifically, breast feeding was encouraged and smoking and infant bed sharing discouraged. Parents also were advised to ensure that the child slept on its back. However, despite improvements in these four risk-related behaviours, cot death mortality again appears to be rising in New Zealand. It is suggested here that this is because the root causes of cot death in New Zealand are widespread soil and associated dietary deficiencies in selenium and iodine. The impressive reduction in the Sudden Infant Death Syndrome rate in the early 1990s appears to have largely reflected greater consumption by the New Zealand population of selenium-enriched imported wheat and dairy products containing iodine from sanitizing solutions, rather than the benefits of deliberate risk-reduction behaviour.
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Several studies attempted to evaluate the predictive value or the associated risk of several factors only on generic sleep disorders and mainly night-wakings. Aim of this study was to evaluate the influence of biological and historical and clinical factors on the different aspect of sleep behavior and disturbances evaluated by the Sleep Disturbance Scale for Children. Mothers of 1157 children (583 M, 574 F) aged 6.5 to 15.3 years (mean 9.8) completed the SDSC together with a questionnaire on demographic data about family composition, parent's education and professional activities, as well as clinical data about pregnancy, delivery and medical history of the child with specific questions regarding pathologies that could affect sleep; sleep habits of parents and children were also investigated. Global sleep disturbances measured as SDSC total score were affected by co sleeping, early sleep disorders, adenotonsillitis, asthma and parents' sleep disorders. Early sleep disorders, asthma and parents' sleep disorders had a significant main effect on disorders of initiating and maintaining sleep. Sleep breathing disorders score was associated with the presence of cosleeping, adenotonsillitis, asthma, food allergy. Disorders of Arousal score was affected by early sleep disorders and parents' sleep disorders. There was a significant main effect of co-sleeping, early sleep disorder, adenotonsillitis, parents' sleep disorder on sleep-wake transition disorders score; of gender, parents' sleep disorder on Disorders of excessive somnolence score and of gender, early sleep disorder and parents' sleep disorder on Sleep hyperhydrosis score. Post-hoc comparisons showed that females vs. males have higher scores in Disorders of excessive somnolence score while males scored higher in Sleep hyperhydrosis score. A visual generalized model revealed that predictors for Total SDSC score are early sleep disorders, parents' sleep disorders, adenotonsillitis and asthma. Our results underline the role of genetic and neurobiological substrate on the development of children sleep, delineating the areas of the sleep that are involved and rising some suggestions on which factors could lead to different later sleep disturbances.
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Most of us would probably agree that mankind's survival has until modern age always depended on breastfeeding. It is also non-controversial that minimising mother-infant separation enhances breastfeeding. Nevertheless, there is currently a relatively pronounced polarization on the issue of mother-infant co-sleeping (same surface bed-sharing). Countries with very low incidence of sudden infant death syndrome (SIDS), such as Sweden, have recently changed their preventive advice to include a general recommendation against co-sleeping, also for breastfeeding non-smoking mothers to healthy term infants. This article is protected by copyright. All rights reserved.
Article
Objective: Controversies exist regarding the impact of co-sleeping on infant sleep quality. In this context, the current study examined: (a) the differences in objective and subjective sleep patterns between co-sleeping (mostly room-sharing) and solitary sleeping mother-infant dyads; (b) the predictive links between maternal sleep during pregnancy and postnatal sleeping arrangement; (c) the bi-directional prospective associations between sleeping arrangement and infant/maternal sleep quality at three and six months postpartum. Methods: The sample included 153 families recruited during pregnancy. Data were obtained in home settings during the third trimester of pregnancy and at three and six months postpartum. Mothers were asked to monitor their own sleep and their infants' sleep for five nights using actigraphy and sleep diaries. Questionnaires were used to assess sleeping arrangements, feeding methods, socio-demographic characteristics, and maternal depressive and anxiety symptoms. Results: Mothers of co-sleeping infants reported more infant night-wakings than mothers of solitary sleeping infants. However, none of the objective sleep measures was significantly different between co-sleeping and solitary sleeping infants, after controlling for feeding techniques. Co-sleeping mothers had significantly more objective and subjective sleep disturbances than mothers in the solitary sleeping group. Moreover, poorer maternal sleep during pregnancy and at three months postpartum predicted higher levels of co-sleeping at six months. Conclusion: Mothers of co-sleeping infants report more infant night-wakings, and experience poorer sleep than mothers of solitary sleeping infants. The quality of maternal sleep should be taken into clinical consideration when parents consult about co-sleeping.
Article
Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths, including accidental suffocation, account for ~4000 US deaths annually. Parents may have higher self-efficacy with regards to preventing accidental suffocation than SIDS. The objective of this study was to assess self-efficacy in African-American mothers with regards to safe sleep practices and risk for SIDS and accidental suffocation. As part of randomized clinical trial in African-American mothers of newborn infants, mothers completed a baseline survey about knowledge of and attitudes towards safe sleep recommendations, current intent, self-efficacy, and demographics. Tabular and adjusted, regression-based analyses of these cross-sectional data evaluated the impact of the message target (SIDS risk reduction vs. suffocation prevention) on perceived self-efficacy. 1194 mothers were interviewed. Mean infant age was 1.5 days. 90.8 % of mothers planned to place their infant supine, 96.7 % stated that their infant would sleep in the same room, 3.6 % planned to bedshare with the infant, and 72.9 % intended to have soft bedding in the crib. Mothers were more likely to believe that prone placement (70.9 vs. 50.5 %, p < 0.001), bedsharing (73.5 vs. 50.1 %, p < 0.001), and having soft bedding in the sleep area (78.3 vs. 59.5 %, p < 0.001) increased their infant's risk for suffocation than it did for SIDS. Mothers had higher self-efficacy, viz. increased confidence that their actions could keep their infant safe, with regards to suffocation than SIDS (88.0 vs. 79.4 %, p < 0.001). These differences remained significant when controlled for sociodemographics, grandmother in home, number of people in home, and breastfeeding intention. Maternal self-efficacy is higher with regards to prevention of accidental suffocation in African-Americans, regardless of sociodemographics. Healthcare professionals should discuss both SIDS risk reduction and prevention of accidental suffocation when advising African-American parents about safe sleep practices.
Article
Prior studies have found that close mother-child sleep proximity helps increase rates of breastfeeding, and breastfeeding itself is linked to better maternal and infant health. In this study, we examine whether breastfeeding and infant bed-sharing are related to daily rhythms of the stress-responsive hormone cortisol. We found that bed-sharing was related to flatter diurnal cortisol slopes, and there was a marginal effect for breastfeeding to predict steeper cortisol slopes. Furthermore, mothers who breastfeed but do not bed-share had the steepest diurnal cortisol slopes, whereas mothers who bed-shared and did not breastfeed had the flattest slopes (P < .05). These results were significant after controlling for subjective sleep quality, perceived stress, depression, socioeconomic status, race, and maternal age. Findings from this study indicate that infant parenting choices recommended for infants (breastfeeding and separate sleep surfaces for babies) may also be associated with more optimal stress hormone profiles for mothers. © The Author(s) 2015.
Article
Recently Mobbs et al. 2015 describe the need for, and benefits of, immediate and sustained contact, including cosleeping, to establish an appropriate foundation for optimal human infant breastfeeding, neonatal attachment and brain growth. To further support this model we propose a new concept, 'breastsleeping', aimed to help both resolve the bedsharing debate and to distinguish the significant differences (and associated advantages) of the breastfeeding-bedsharing dyad when compared with the non-breastfeeding-bedsharing situations, when the combination of breastfeeding-bedsharing is practiced in the absence of all known hazardous factors. Breastfeeding is so physiologically and behaviorally entwined and functionally interdependent with forms of cosleeping that we propose the use of the term breastsleeping to acknowledge: 1) the critical role that immediate and sustained maternal contact plays in helping to establish optimal breastfeeding; 2) the fact that normal, human (species-wide) infant sleep can only be derived from studies of breastsleeping dyads because of the ways maternal-infant contact affects the delivery of breastmilk, the milk's ingestion, the infant's concomitant and subsequent metabolism and other physiological processes, maternal and infant sleep architecture, including arousal patterns, as well as breastfeeding frequency and prolongation and; 3) that breastsleeping by mother-infant pairs comprises such vastly different behavioral and physiological characteristics compared with non-breastfeeding mothers and infants, this dyadic context must be distinguished and given its own epidemiological category and benefits to risks assessment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Article
The objective of this study was to compare the prevalence of home care practices in very to moderately preterm (VPT), late preterm (LPT) and term infants born in Massachusetts. Using 2007 to 2010 Massachusetts Pregnancy Risk Assessment Monitoring System data, births were categorized by gestational age (VPT: 23 to 33 weeks; LPT: 34 to 36 weeks; term: 37 to 42 weeks). Home care practices included breastfeeding initiation and continuation, and infant sleep practices (supine sleep position, sleeping in a crib, cosleeping in an adult bed). We developed multivariate models to examine the association of infant sleep practices and breastfeeding with preterm status, controlling for maternal sociodemographic characteristics. Supine sleep position was more prevalent among term infants compared with VPT and LPT infants (77.1%, 71.5%, 64.4%; P=0.02). In the adjusted model, LPT infants were less likely to be placed in supine sleep position compared with term infants (adjusted prevalence ratio=0.86; 95% confidence interval: 0.75 to 0.97). Breastfeeding initiation and continuation did not differ among preterm and term groups. Nearly 16% of VPT and 18% of LPT and term infants were not sleeping in cribs and 14% of LPT and term infants were cosleeping on an adult bed. Compared with term infants, LPT infants were less likely to be placed in supine sleep position after hospital discharge. A significant percent of preterm and term infants were cosleeping on an adult bed. Hospitals may consider improving their safe sleep education, particularly to mothers of LPT infants.Journal of Perinatology advance online publication, 6 August 2015; doi:10.1038/jp.2015.90.