No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Parent-child bed-sharing: The good, the bad, and the burden of evidence
Abstract and Figures
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.
Figures - uploaded by Maartje P C M Luijk
Author content
All figure content in this area was uploaded by Maartje P C M Luijk
Content may be subject to copyright.
... Shared sleeping is when an adult sleeps on the same sleep surface as an infant, where falling asleep may be intended or not (International Society for the Study and Prevention of Perinatal and Infant Death (ISPID), 2023; Mileva-Seitz et al., 2017). This is sometimes referred to as 'bed-sharing' or 'co-sleeping' , although definitions can vary in the literature (Kruse et al., 2024). ...
... This review uses the term 'shared sleeping' to refer to an adult sharing an adult bed with an infant. In some countries and cultures, shared sleep is common (Mileva-Seitz et al., 2017;Owens, 2004), and it can be beneficial in promoting parent-child bonding, and secure attachment (Barry, 2019). ...
... International Society for the Study and Prevention of Perinatal and Infant Death (ISPID) (2023) noted that with regard to shared sleeping, some countries take a risk elimination (RE) approach while others choose to adopt a risk minimisation (RM) approach. RE recommends against all engagement in shared sleeping (Moon et al., 2022;Queensland Health, Queensland Clinical Guidelines, 2022) while RM recommends against shared sleep in circumstances where the risk is known to be increased (Carpenter et al., 2013;Mileva-Seitz et al., 2017;Young and Shipstone, 2018). RM also considers the family's personal circumstances, and supports the idea of providing information on risks, benefits and how to increase infant sleep safety in all sleep environments in parent education resources to allow for informed decision making (Australian College of Midwives (ACM), 2014; Queensland Health, Queensland Clinical Guidelines, 2022). ...
To reduce the occurrence of sudden infant death, organisations have created recommendations about infant safer sleep and shared sleep. With the considerable volume of documents, consistency in messaging is paramount to reduce caregiver confusion and to reduce engagement in practices deemed to be unsafe for their infant. This review aimed to systematically compare documents that contain recommendations on infant safer sleep, including shared sleep, in Australia. Documents were identified by researchers with subject matter expertise, and through a systematic webpage search. A total of n = 32 eligible documents were included from n = 26 organisations. If an organisation had a separate document for shared sleeping, both documents were included and reviewed together. Consistency of recommendations were evaluated against the recommendations within the International Society for the Study and Prevention of Perinatal and Infant Death’s (ISPID)‘s guidelines, while the approach taken to discuss shared sleep from via Risk Minimisation vs. Risk Elimination was also evaluated using a coding framework. No organisation’s document/s contradicted ISPID’s guidelines, although there was variation in the quantity included. The approaches taken towards shared sleep by organisations were diverse between Risk Elimination and Risk Minimisation. Strategies to engage in safer shared sleep were provided by less than half of the organisations, as was the acknowledgement of familial, cultural, or logistical preferences for shared sleep, or that shared sleep may also occur unintentionally. Most organisations recommended that infants be breastfed but did not discuss the bi-directional link between breastfeeding and shared sleeping. Organisations need to provide consistent messaging on infant safer sleep to avoid public confusion. The adoption of a Risk Minimisation approach with clearer messaging provides considerations for informed choice, and strategies for safer shared sleeping; intentional or unintentional.
... Parent-child bedsharing and cosleeping are common sleep practices in many US households. 1,2 Families bedshare for many reasons, such as cultural and parental preferences, limited sleep spaces in the household, or in reaction to a child's night wakings with a desire for parental presence. In a review of parenting advice books for child sleep, some authors endorsed the practice, some were neutral, and others opposed it. ...
... 3 While bedsharing is a well-known safety risk to infants, no consensus exists on its benefits or detriments beyond infancy. 2 Numerous studies have reported on the relationships between bedsharing and sleep patterns in different cultural groups, community-based cohorts, and clinical samples of children. However, the findings are inconsistent about whether bedsharing has a positive, negative, or neutral relationship with sleep health outcomes. ...
... However, the findings are inconsistent about whether bedsharing has a positive, negative, or neutral relationship with sleep health outcomes. [1][2][3][4][5][6][7][8][9][10][11] In general, bedsharing is more common in younger children, 8,10,12 children with lower socioeconomic status, 2,13 and children with co-occurring sleep, medical and psychiatric problems. 2,4,8,12,14 Specifically, bedsharing is common in children with snoring and sleep-disordered breathing (SDB). ...
Study objectives:
Examine sleep patterns in children with sleep-disordered breathing (SDB) who habitually bedshare.
Methods:
We evaluated associations of bedsharing with parent-reported (n=457) and actigraphy-based (n=258) sleep patterns in a diverse child sample (mean age 6.6±2.3 years, range 3.0-12.9) with mild SDB using baseline data from the Pediatric Adenotonsillectomy Trial for Snoring. Multivariable linear regressions examined associations between sleep patterns and bedsharing, adjusting for sociodemographic, child, and parent/environmental factors. Moderation effects were investigated using interaction terms. Analyses were stratified by age, categorizing children as younger (<6) and older (≥6) years.
Results:
Bedsharing rates were 38%, with higher rates in younger (48%) vs. older (30%) children (p<0.001). In adjusted models, bedsharing was associated with about 30 minutes shorter actigraphy-derived nocturnal sleep duration (p=0.005) and parent-reported later sleep midpoint (p< 0.005) in younger children. In older children, associations of bedsharing with shorter parent-reported sleep duration were more pronounced in children with greater SDB symptom burden (p=0.02), and in children with higher ratings of anxiety (p=0.048) and depressive symptoms (p=0.02).
Conclusions:
In children with mild SDB, bedsharing is associated with shorter sleep duration and later sleep timing in younger children. In older children, these relationships were modified by child factors, including SDB symptom burden and internalizing symptoms. These findings suggest that whereas age and parenting factors may play a greater role in the younger group, SDB and internalizing symptoms may play more of a role in older children who bedshare, suggesting the need to address co-occurring medical and emotional problems in children with SDB.
Clinical trial registration:
Registry: ClinicalTrials.gov; Name: Pediatric Adenotonsillectomy for Snoring (PATS); Identifier: NCT02562040.
... Co-sleeping is an umbrella term that refers to proximal contact during sleep between parent and child, and within the literature encompasses bed-sharing, room-sharing, or any other proximal sleep arrangement. Bed-sharing refers to parent-child sharing the same surface designed for sleep (e.g., adult mattress), and room-sharing refers to sharing the same sleep space (e.g., parent's room or child's room but not the same sleep surface, such as a mattress or bed; Mileva-Seitz et al., 2017). Co-sleeping, including bed-sharing, is widely practiced worldwide (Huang et al., 2010;Mileva-Seitz et al., 2017), with rates of co-sleeping increasing in Western countries (Cole et al., 2020;Colson et al., 2013). ...
... Bed-sharing refers to parent-child sharing the same surface designed for sleep (e.g., adult mattress), and room-sharing refers to sharing the same sleep space (e.g., parent's room or child's room but not the same sleep surface, such as a mattress or bed; Mileva-Seitz et al., 2017). Co-sleeping, including bed-sharing, is widely practiced worldwide (Huang et al., 2010;Mileva-Seitz et al., 2017), with rates of co-sleeping increasing in Western countries (Cole et al., 2020;Colson et al., 2013). However, parent-infant bed-sharing is often discouraged in Western societies. ...
... According to Ramos et al. (2007) co-sleeping can be practiced proactively or reactively. Proactive co-sleepers intentionally encourage parent-child bed-sharing from birth onward, and this is often informed by cultural beliefs, breastfeeding convenience, or practical nighttime caregiving (Mileva-Seitz et al., 2017), to maintain physical proximity to the child, support the child's emotional needs, and respond to child sleep difficulties (Andre et al., 2021;Bastida-Pozuelo et al., 2018;Mileva-Seitz et al., 2017). Reactive co-sleepers bed-share with their child in response to seemingly extraneous factors or problematic circumstances, such as perceived poor child sleep patterns (Mileva-Seitz et al., 2017), parental sleep disturbance, or undiagnosed physical/psychological issues underlying the sleep disturbance, wherein the child may return to bedsharing after having endured a period of solitary sleep from infancy (Keller & Goldberg, 2004). ...
Objective
The study objective was to understand intentions, sleep location preferences, and satisfaction with co‐sleeping (including bed‐sharing) arrangements in an internet‐based sample of self‐identified co‐sleeping parents.
Background
Western‐centric ideologies favor independent, self‐regulated, and consolidated sleep. Safe‐sleep recommendations advise against all forms of parent–child bed‐sharing while promoting room‐sharing. Co‐sleeping including bed‐sharing and room‐sharing is widely practiced globally and rates continue to increase in Western countries. Yet perspectives of co‐sleeping parents remain under‐researched.
Method
A cross‐sectional study design was used to understand co‐sleeping parents' ( n = 3,146) intentions, preferences, and satisfaction with co‐sleeping (room‐sharing and bed‐sharing) choices through a survey.
Results
Co‐sleeping practices were nuanced and varied with parents and children transitioning between sleep location and surfaces through the night. Although 64% of parents did not intend to co‐sleep before the birth of their child, 88% preferred the current co‐sleeping location, and 81% indicated satisfaction with it. Parental intention to co‐sleep (including bed‐share) was related to satisfaction with the arrangement. Parents who did not prefer any co‐sleeping arrangement at the current time were likely to be parenting older children. A thematic analysis yielded themes relating to the motivations underlying intent and preference, as well as reluctance and dissatisfaction with co‐sleeping arrangements.
Conclusion
Co‐sleeping including bed‐sharing continues to be practiced by parents in Western countries. Despite a lack of intent to engage with co‐sleeping including bed‐sharing, the majority of the parents in this sample were bed‐sharing with their infants and young children. Parents choose to room‐share and bed‐share for a range of reasons.
Implications
Parents voices highlight the need for safe co‐sleeping including bed‐sharing education. Considerations must be given to parents' perspectives in implementing nighttime infant care practices, including facilitating collaborative discussions with parents to assess and minimize potential risks associated with bed‐sharing.
... Co-sleeping in the present study refers to both bed-sharing and roomsharing between the caregiver and the child (McKenna & Volpe, 2007). Whether or not co-sleeping should be encouraged remains a controversial topic for decades (Mileva-Seitz et al., 2017). On the one hand, individualistic societies generally consider co-sleeping undesirable because of the perception that it will hinder the development of independence among children (Germo et al., 2007;Morelli et al., 1992). ...
... Most studies were done in Western individualistic countries. Co-sleeping is not a norm in most individualistic cultures, which emphasize independence (Mileva-Seitz et al., 2017). It is possible that parents in such cultures only decide to co-sleep with their children when there is a need to cope with (emotional) problems. ...
... In contrast, co-sleeping is a normative practice in collectivistic cultures as it is considered a way of fostering family bonding (Mileva-Seitz et al., 2017). Malaysia is generally considered a collectivistic culture (Bochner, 1994), and has a high prevalence of practising cosleeping (ranging from 65.4% to 84.1% in previous studies; Lope et al., 2010;Mindell et al., 2010). ...
The present study investigated the role of experienced parenting styles and previous co-sleeping habits in attachment patterns among Malaysian young adults. Eighty-six participants completed the Sleep Arrangement Questionnaire, Parental Authority Questionnaire, and Experiences in Close Relationship-Revised-General Short Form. Hierarchical multiple regression revealed that, while controlling for demographic covariates, an authoritative parenting style significantly related to a lower level of attachment anxiety, whereas an authoritarian parenting style significantly related to a higher level of attachment anxiety. However, the relationship was only found in the dimension of attachment anxiety but not in attachment avoidance, suggesting that attachment avoidance may be more open to influences of later interpersonal experiences other than parent-child relationships. Besides, total co-sleeping frequency was not related to attachment patterns. Future research is encouraged to investigate different aspects (location/duration/reason) of co-sleeping that could affect the outcome.
... Third, it was not possible to consider the influence of reactive and intentional bed-sharing. It was shown that reactive bed-sharing mothers reported increased marital conflict and fatigue than intentional bed-sharing mothers (Messmer et al., 2012;Mileva-Seitz et al., 2017), which may have influenced our findings. However, we considered the role of night-waking frequency in our analyses, which is higher in reactive bed-sharing mothers than intentional bed-sharers (Mileva-Seitz et al., 2017). ...
... It was shown that reactive bed-sharing mothers reported increased marital conflict and fatigue than intentional bed-sharing mothers (Messmer et al., 2012;Mileva-Seitz et al., 2017), which may have influenced our findings. However, we considered the role of night-waking frequency in our analyses, which is higher in reactive bed-sharing mothers than intentional bed-sharers (Mileva-Seitz et al., 2017). Further, the impact of bed-sharing in infancy on children's emotional and behavioral development may only be apparent based on the extent to which this creates stress in the family. ...
Bed-sharing is a controversial but common parenting practice with claimed benefits for emotional and behavioral development. Using data from the UK Millennium Cohort Study (N = 16,599), this prospective study investigated whether bed-sharing at 9 months is associated with childhood internalizing and externalizing symptom trajectories. Children were grouped by their patterns of co-developing internalizing and externalizing symptoms from 3 to 11 years of age using a parallel process latent class growth analysis. There were no associations between bed-sharing at 9 months of age and internalizing and externalizing symptom trajectories across childhood. This finding suggests that bed-sharing at 9 months has no positive or negative influence on the development of internalizing and externalizing symptoms across childhood. Clinicians should inform parents that bed-sharing during the second half of the first year is unlikely to have an impact on the later emotional and behavioral development of the children.
... Our pilot study failed to collect information on the reasons for bed-sharing, which is crucial for interpreting this result. It is known that sleeping arrangements are strongly influenced by cultural tradition, with bed-sharing reported to be one of the parental choices most influenced by cultural practice and beliefs [57,58]. In many Aboriginal communities, purposeful bed-sharing is a cultural norm; however, bed-sharing may also be reactive and the result of environmental influences including socioeconomic factors, housing arrangements, heating and economic access to beds [57,59,60]. ...
... It is known that sleeping arrangements are strongly influenced by cultural tradition, with bed-sharing reported to be one of the parental choices most influenced by cultural practice and beliefs [57,58]. In many Aboriginal communities, purposeful bed-sharing is a cultural norm; however, bed-sharing may also be reactive and the result of environmental influences including socioeconomic factors, housing arrangements, heating and economic access to beds [57,59,60]. We hope the results of the larger multisite observational studies will provide the information needed to better translate this result, be it with advocacy for adequate housing infrastructure and/or empowering the community to consider health promotion messages that are appropriate and culturally strong. ...
Background
Indigenous children in colonised nations experience high rates of health disparities linked to historical trauma resulting from displacement and dispossession, as well as ongoing systemic racism. Skin infections and their complications are one such health inequity, with the highest global burden described in remote-living Australian Aboriginal and/or Torres Strait Islander (hereafter respectfully referred to as Aboriginal) children. Yet despite increasing urbanisation, little is known about the skin infection burden for urban-living Aboriginal children. More knowledge is needed to inform service provision, treatment guidelines and community-wide healthy skin strategies. In this pilot study, we aimed to test the feasibility and design of larger multi-site observational studies, provide initial descriptions of skin disease frequency and generate preliminary hypotheses of association.
Methods
This project has been co-designed with local (Noongar) Elders to provide an Australian-first description of skin health and disease in urban-living Aboriginal children. In collaboration with an urban Aboriginal Community Controlled Health Organisation (Derbarl Yerrigan Health Service), we conducted a week-long cross-sectional observational cohort study of Aboriginal children (0–18 years) recruited from the waiting room. Participants completed a questionnaire, skin examination, clinical photos, and swabs and received appropriate treatment. We assessed the feasibility and impact of the pilot study.
Results
From 4 to 8 October 2021, we recruited 84 Aboriginal children of whom 80 (95%) were urban-living. With a trusted Aboriginal Health Practitioner leading recruitment, most parents (or caregivers) who were approached consented to participate. Among urban-living children, over half (45/80, 56%) of parents described a current concern with their child’s skin, hair and/or nails; and one-third (26/80, 33%) reported current itchy skin. Using a research-service model, 27% (21/79) of examined urban-living participants received opportunistic same-day treatment and 18% (14/79) were referred for later review.
Conclusions
This co-designed pilot study to understand skin health in urban-living Aboriginal children was feasible and acceptable, with high study participation and subsequent engagement in clinical care observed. Co-design and the strong involvement of Aboriginal people to lead and deliver the project was crucial. The successful pilot has informed larger, multi-site observational studies to more accurately answer questions of disease burden and inform the development of healthy skin messages for urban-living Aboriginal children.
... Bed sharing is a controversial topic in the US due to its association with the risk of sudden infant death syndrome (SIDS). According to previous studies, bed-sharing is more common among Asian families than white families [10,11]. However, there is also evidence that bed-sharing is increasing regardless of race. ...
... However, there is also evidence that bed-sharing is increasing regardless of race. As bed-sharing is recognized as a risk factor for SIDS [12], organizations such as the American Academy of Pediatrics (AAP) are working to raise awareness of the dangers of bed-sharing [11,13]. ...
Neck hair-thread tourniquet syndrome (NHTTS) is a rare condition that can be a pediatric emergency, occurring when a hair or thread becomes tightly wrapped around a body part, leading to vascular or tissue damage. NHTTS commonly affects infants and young children and can result in severe complications if not promptly diagnosed and treated. The unusual nature of this event, the diffuse petechial hemorrhage on the face, and the presentation of ligature marks extending around the neck led us to admit the child to the general pediatric ward for follow-up and further investigation of the possibility of non-accidental trauma.
Co-sleeping is a common cultural practice in Japan where parents sleep in close proximity to their infants. This case report aims to raise awareness among pediatricians and parents about the possibility of NHTTS occurring in infants who co-sleep, particularly when a strand of hair becomes entangled around their neck, about the early detection and appropriate management of NHTTS. And we also summarize the reported NHTTS cases.
... Combining key bed-sharing subtypes may contribute to these mixed findings. Conceptual models of bedsharing [21][22][23] distinguish between intentional bed-sharing that is chosen proactively by parents due to parenting preferences and/or cultural norms and reactive bed-sharing that is a response to factors such as child behavior or limited resources [6,24]. In comparison to intentional bed-sharing, reactive bed-sharing has been associated with a higher rate of sleep problems such as night wakings [25] and may have stronger associations with child behaviors such as refusal to sleep alone [6], night-time fears, nightmares, bedtime resistance/tantrums or clinical problems such as separation anxiety, hyperactivity or oppositionality. ...
... infancy through early childhood) using a multi-method approach (i.e., parent report, direct measurement using actigraphs and/or video). These factors have been identified as central to understanding bedsharing [24]. Then, guided by the transactional model of child sleep [21,23], a bed-sharing model accounting for dynamic, bidirectional interactions between proximal child (e.g., child behavior at bedtime, sleep disturbances and anxiety) and parenting (e.g., maternal depression/ anxiety, stress and parenting values/style) factors and distal, contextual factors (e.g., social/cultural norms in different raceialand ethnic groups and impact of socioeconomic status) could have been stipulated and tested. ...
Objective
To advance understanding of early childhood bed-sharing and its clinical significance, we examined reactive bed-sharing rates, sociodemographic correlates, persistence, and concurrent and longitudinal associations with sleep disturbances and psychopathology.
Methods
Data from a representative cohort of 917 children (mean age 3.8 years) recruited from primary pediatric clinics in a Southeastern city for a preschool anxiety study were used. Sociodemographics and diagnostic classifications for sleep disturbances and psychopathology were obtained using the Preschool Age Psychiatric Assessment (PAPA), a structured diagnostic interview administered to caregivers. A subsample of 187 children was re-assessed approximately 24.7 months after the initial PAPA interview.
Results
Reactive bed-sharing was reported by 38.4% of parents, 22.9% nightly and 15.5% weekly, and declined with age. At follow-up, 48.9% of nightly bed-sharers and 88.7% of weekly bed-sharers were no longer bed-sharing. Sociodemographics associated with nightly bed-sharing were Black and (combined) American Indian, Alaska Native and Asian race and ethnicity, low income and parent education less than high school. Concurrently, bed-sharing nightly was associated with separation anxiety and sleep terrors; bed-sharing weekly was associated with sleep terrors and difficulty staying asleep. No longitudinal associations were found between reactive bed-sharing and sleep disturbances or psychopathology after controlling for sociodemographics, baseline status of the outcome and time between interviews.
Conclusions
Reactive bed-sharing is relatively common among preschoolers, varies significantly by sociodemographic factors, declines during the preschool years and is more persistent among nightly than weekly bed-sharers. Reactive bed-sharing may be an indicator of sleep disturbances and/or anxiety but there is no evidence that bed-sharing is an antecedent or consequence of sleep disturbances or psychopathology.
... It is known that sleeping arrangements are strongly in uenced by cultural tradition, with bed-sharing reported to be one of the parental choices most in uenced by cultural practice and beliefs. 57,58 In many Aboriginal communities purposeful bed-sharing is a cultural norm; however, bed-sharing may also be reactive and the result of environmental in uences including socioeconomic factors, housing arrangements, heating and economic access to beds. 57,59,60 We hope the results of the larger multisite observational studies will provide the information needed to better translate this result, be it with advocacy for adequate housing infrastructure and/or empowering the community to consider health promotion messages that are appropriate and culturally strong. ...
... 57,58 In many Aboriginal communities purposeful bed-sharing is a cultural norm; however, bed-sharing may also be reactive and the result of environmental in uences including socioeconomic factors, housing arrangements, heating and economic access to beds. 57,59,60 We hope the results of the larger multisite observational studies will provide the information needed to better translate this result, be it with advocacy for adequate housing infrastructure and/or empowering the community to consider health promotion messages that are appropriate and culturally strong. ...
Background
Indigenous children in colonised nations experience high rates of health disparities linked to historical trauma resulting from displacement and dispossession, as well as ongoing systemic racism. Skin infections and their complications are one such health inequity, with the highest global burden described in remote-living Australian Aboriginal and/or Torres Strait Islander (hereafter respectfully referred to as Aboriginal) children. Yet despite increasing urbanisation, little is known about the skin infection burden for urban-living Aboriginal children. More knowledge is needed to inform service provision, treatment guidelines and community-wide healthy skin strategies. In this pilot study we aimed to test the feasibility and design of larger multi-site observational studies, provide initial descriptions of skin disease frequency and generate preliminary hypotheses of association.
Methods
This project has been co-designed with local (Noongar) Elders to provide an Australian-first description of skin health and disease in urban-living Aboriginal children. In collaboration with an urban Aboriginal Community Controlled Health Organisation (Derbarl Yerrigan Health Service), we conducted a week-long cross-sectional observational cohort study of Aboriginal children (0–18 years) recruited from the waiting room. Participants completed a questionnaire, skin examination, clinical photos, swabs and received appropriate treatment. We assessed the feasibility and impact of the pilot study.
Results
From 4–8 October 2021, we recruited 84 Aboriginal children of whom 80 (95%) were urban-living. With a trusted Aboriginal Health Practitioner leading recruitment, most parents (or caregivers) who were approached consented to participate. Among urban-living children, over half (45/80, 56%) of parents described a current concern with their child’s skin, hair and/or nails; and one third (26/80, 33%) reported current itchy skin. Using a research-service model, 27% (21/79) of examined urban-living participants received opportunistic same-day treatment and 18% (14/79) were referred for later review.
Conclusions
This co-designed pilot study to understand skin health in urban-living Aboriginal children was feasible and acceptable, with high study participation and subsequent engagement in clinical care observed. Co-design and strong involvement of Aboriginal people to lead and deliver the project was crucial. The successful pilot has informed larger, multi-site observational studies to more accurately answer questions of disease burden and inform development of healthy skin messages for urban-living Aboriginal children.
... 78 97 The BCSQ also provides environmental information about room-sharing/bedsharing, which is important given racial and ethnic variation in sleep arrangements and the potential impacts of this arrangement on caregiver-rated child sleep. 98 Caregivers complete the full BCSQ measure, with teachers completing items related to child daytime sleep (naps) to assess nap frequency and duration. The National Sleep Foundation items are used to assess the presence and number of electronics in the child's bedroom and the daily frequency and type of caffeine consumption. ...
Introduction
Sleep deficiencies, such as sleep disordered breathing (SDB) and insufficient sleep, are linked to adverse health outcomes. These sleep deficiencies are more common in racial and ethnic minoritised children and have significant negative impacts on neurobehavioural and social-emotional development. Non-Latine Black/African American children are 4–6 times more likely than non-Latine White children to experience both SDB and short sleep duration. Although SDB and insufficient sleep often co-occur in young children, there is a paucity of research considering the potential unique and additive impacts of SDB and insufficient sleep on child outcomes, as well as racial disparities in these outcomes, thus hindering comprehensive interventions. Our study objectives are to (1) examine racial disparities in the neurobehavioural and social-emotional impacts of early childhood SDB and/or insufficient sleep and (2) identify proximal and distal socioecological factors linked to these sleep disparities and outcomes.
Methods and analysis
A cross-sectional observational study comparing neurobehavioural (executive functioning, attention, vigilance) and social-emotional functioning (social skills, emotion regulation) in 400 dyads consisting of caregivers and their otherwise healthy Black and White 3–5 year-old children and divided into four groups: (A) preschoolers with SDB; (B) preschoolers with insufficient sleep; (C) preschoolers with both SDB and insufficient sleep and (D) matched controls. Child SDB, insufficient sleep, neurobehavioural skills and social-emotional functioning are measured using validated objective and subjective assessment tools, with a subset of caregivers completing qualitative interviews. Primary outcomes include individual differences in neurobehavioural and social-emotional functioning in these groups of Black and White preschoolers, and multilevel socioecological factors associated with variation in outcomes. Quantitative data will be analysed using descriptive analyses, linear regression and comparison of model coefficients. Qualitative data will be coded using thematic analysis and a joint display to stratify qualitative themes by child race and sleep deficiencies.
Ethics and dissemination
The study protocol has been approved by the institutional review board of the Children’s Hospital of Philadelphia and the University of Oregon. Results will be disseminated through peer-reviewed publications and conferences.
... Mothers who have childhood maltreatment experience were unable to respond emotionally and behaviorally in a reasonable way when parenting their children because they have not learned positive parenting styles (Dvir et al., 2014), resulting in inadequate perceived parental support for their children (Enlow et al., 2018). In turn, as children's sleep development depended on caregiver support (Mileva-Seitz et al., 2017), the low level of perceived parental support was negatively associated with their sleep quality (Kent de Grey et al., 2018). In an stressful home environment, perceived parental support can reduce the sense of instability that leads to poor sleep (Tsai et al., 2015), possibly lead to improve the quality of the children's sleep. ...
Based on the hyperarousal theory and self-control theory, this study investigated the link between parental childhood maltreatment and children’s sleep quality by examining the mediation effect of parental self-control and children’s perceived parental support from an inter-generational transmission perspective. A total of 334 Chinese primary school students in grades 4–6 (50% girls, Mage=10.49, SD=0.97) reported on perceived parental support and sleep quality. In addition, childhood maltreatment and self-control were reported by their parents Mfather’s age=40.48, Mmother’s age=38.18). The results showed that the father’s childhood maltreatment was directly associated with children’s sleep quality, while the mother’s childhood maltreatment was indirectly linked to children’s sleep quality. Furthermore, children’s perceived rental support acted as mediators in the effect of mother’s childhood maltreatment on children’s sleep quality, and mother’s childhood maltreatment also affected children’s perceived parental support via mother’s self-control, thus affecting children’s sleep quality directly. These results have important practical implications for family-based interventions in children’s sleep quality.
... First, Western culture values infants sleeping alone as normal and ideal, and second, some American epidemiologists and medical researchers have concluded that bed-sharing is associated with sudden infant death syndrome (SIDS). In addition, Mileva-Seitz et al. (2017) pointed out that there are socioeconomic and cultural factors encourage parents to share their beds with their children coming with problems and risks such as sleeping disorders, poor sleep quality for parents, risk of developing infectious diseases, risk of sudden infant death syndrome (SIDS), and difficulties in sexual affairs of the couple. ...
This study is primarily designed to reveal the bedtime routines of the wife, husband, and child in a family as well as the effects of these routines on family relationships. Bedtime routines refer to the activities in a bedroom, including the time before and after going to sleep. An online survey was conducted on 250 Japanese women (wives) living with their husbands and their children aged between 0 and 11. Three aspects were examined: the basic attributes (the age of the wife, husband, and child, the gender of the child, and the layout of the living space), the bedroom-sharing practice of the families (between the wife and child/ between the wife and husband), and lastly the bedtime routine satisfaction of the wife. As for “family relationships”, it includes the studies of marital, parent, and family satisfaction. Our cross-tabulation showed that 89.2% of wives shared a bedroom with their children. A two-factor analysis of variance indicated that wives who shared bedrooms with their children had significantly lower bedtime routine satisfaction than those who did not. At the same time, wives who shared bedrooms with their husbands had much higher bedtime routine, marital, parent, and family satisfaction than those who did not. The findings revealed the solid effects of the wife, husband, and child’s bedtime routines on family relationships. The sleeping arrangement in a family contributes to the social health of the families and it is also discussed in this paper.
... Co-sleeping is defined as an "intentional" or "reactive" practice in which children and parents sleep together during the night. This practice includes 'bed-sharing' (sharing the same bed for sleeping) and 'room-sharing' (sharing the same room) (Mileva-Seitz et al., 2017). The overall prevalence of co-sleeping is difficult to determine. ...
The current study aimed (1) to provide an analysis of the frequency and prevalence of sleep disturbances in a large Italian sample of children and adolescents with ASD, detecting specific predictors of the presence/absence of sleep disorders, (2) to examine the phenomenon of co-sleeping within a subgroup of participants with ASD. A total of 242 children and adolescents with ASD (194 males, mean age 5.03 ± 3.15 years) were included. After the diagnostic procedure, caregivers were requested to complete the Sleep Disturbance Scale for Children (SDSC) to assess sleep disorders among participants. The presence of co-sleeping was investigated in a subgroup of 146 children and adolescents with ASD. An elevated or clinically relevant global score for sleep disorders (≥ 60) was found in 33% of participants. The most prevalent sleep disorder in our group was related to difficulties with sleep onset and sleep maintenance (~ 41% of cases). Sleep disturbances were predicted by higher intelligence quotient (IQ)/developmental quotient (DQ), increased internalizing problems, and elevated parental stress. The subgroup of participants engaged in co-sleeping (N = 87) were younger and had lower IQ/DQ scores, reduced adaptive functioning, and diminished psychological wellbeing than the non-co-sleeping group. Our findings are consistent with the current literature highlighting that insomnia is the most widespread sleep problem associated with ASD. The relationship between IQ/DQ and sleep alterations is a crucial topic that deserves additional research. Future studies should assess sleep by objective measures such as EEG topography to better understand the mechanisms underlying sleep alterations in this neurodevelopmental disorder.
... The practice of infant sleep is complex [8], and despite the known risks of bed-sharing, parents are often motivated to use infant sleep practices inconsistent with AAP guidelines [29]. Additionally, infant sleep is a controversial parenting topic, and while bed-sharing is discouraged in the United States, this practice is commonplace worldwide [30]. While much research focuses on knowledge-based interventions regarding infant sleep practices, we suggest a shift to focus on supporting parents so they can create a sleep environment consistent with AAP guidelines. ...
Background:
Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers' group is instrumental for policy makers, health care providers, and researchers.
Objective:
This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed.
Methods:
Data were extracted from a Facebook mothers' group in May 2019. After trialing various search terms, searching for the term "SIDS" on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers.
Results:
Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified.
Conclusions:
This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers.
... It is likely that there are inherent biases and assumptions about users that impact data-related decision making and interpretation (Raza et al., 2023). For instance, to our knowledge, only one study of infants has evaluated impact of shared versus nonshared sleep surfaces (e.g., bed-or couch-sharing) on the validity of accelerometer-based sleep estimates (Camerota et al., 2018), yet this sleep arrangement is common among families with young children, including toddlers and preschoolers, in many parts of the world (e.g., African and Asian countries/regions (Mileva-Seitz et al., 2017;Mindell et al., 2010), including among Black and Latine families with young children in the United States; Barajas et al., 2011). In many cases, it is unclear whether research teams have included an assessment of the sleep arrangement or other aspects of the sleep environment when collecting accelerometer data, particularly when an accompanying child and/or caregiver-reported sleep diary was not administered. ...
Sensors, including accelerometer-based and electronic adherence monitoring devices, have transformed health data collection. Sensors allow for unobtrusive, real-time sampling of health behaviors that relate to psychological health, including sleep, physical activity, and medication-taking. These technical strengths have captured scholarly attention, with far less discussion about the level of human touch involved in implementing sensors. Researchers face several subjective decision points when collecting health data via sensors, with these decisions posing ethical concerns for users and the public at large. Using examples from pediatric sleep, physical activity, and medication adherence research, we pose critical ethical questions, practical dilemmas, and guidance for implementing health-based sensors. We focus on youth given that they are often deemed the ideal population for digital health approaches but have unique technology-related vulnerabilities and preferences. Ethical considerations are organized according to Belmont principles of respect for persons (e.g., when sensor-based data are valued above the subjective lived experiences of youth and their families), beneficence (e.g., with sensor data management and sharing), and justice (e.g., with sensor access and acceptability among minoritized pediatric populations). Recommendations include the need to increase transparency about the extent of subjective decision making with sensor data management. Without greater attention to the human factors involved in sensor research, ethical risks could outweigh the scientific promise of sensors, thereby negating their potential role in improving child health and care.
... Increasing the number of days measured by actigraphy (e.g., covering about 1 week) should increase the reliability of the acquired data. However, the present data were in line with those reported by previous studies regarding the characteristics of the infants, sleep parameters, and co-sleeping rates [5,45,46]. Therefore, the present results can be considered to reflect the sleep state of normal healthy infants in general. ...
... 8 The development of regular routines and habits in the newborn's initial months of life, which assist the infant to synchronize his or her circadian cycle with that of his or her family, is the first step in preventing infant sleeping problems. 9 Various research and review studies have compared sleep indices and practices of young children in different countries [10][11][12] and significant cross-cultural differences have been found. Except for a few studies, [13][14][15] very little information is available on infant sleep habits in West Asia, at least in English. ...
Objective To identify sleep patterns and sleep behaviors in a group of infants and toddlers (0 to 36 months) in Iran.
Methods Parents and caregivers of 602 infants and toddlers in Iran completed a Persian translation of the Brief Infant Sleep Questionnaire. To assess the differences among the age groups, non-parametric statistical approaches such as the Kruskal-Wallis and chi-square tests were employed.
Results The infants and toddlers went to bed relatively late (22:30), and the median night awakening was 2 times (20 min). They most likely slept in the same room with their parents (55.5%), and commonly in the same bed (18.9%). They slept a median of 11.50 hours per day. A significant percentage of the parents felt that their child had moderate or severe sleep problems (22.4%). These children's sleep patterns had significant developmental changes, including decreased daytime sleep, reduced overall sleep, and increased sleep consolidation (reduced number and duration of night awakenings and increased overall sleep duration). The parents commonly used holding-and-rocking and bottle/breastfeeding to initiate infants' sleep and bottle/breastfeeding to resume their infants' sleep.
Discussion These findings provide reference data for professionals to assess sleep in children under 3 years of age and also supply knowledge about common parenting practices related to a child's sleep. Cross-cultural comparisons using the findings can offer new insights into the practices and behaviors of parents concerning infant and toddler sleep.
... The Peds B-SATED framework points to several areas of research opportunity. For instance, research shows that family and cultural beliefs may influence sleep-related behaviors, 48 but more information within and across cultural groups is necessary. The field also needs to move beyond association studies of sleep and electronics and screen time to identify the causal impact of electronic usage on sleep. ...
Healthy sleep and optimal ventilatory control begin in early development and are crucial for positive child outcomes. This paper summarizes information presented at the Sleep and Ventilatory Control sessions of the National Heart, Lung, and Blood-sponsored 2021 Defining and Promoting Pediatric Pulmonary Health workshop. These sessions focused on pediatric sleep health, screening for sleep health and sleep disorders in primary care using the electronic health record, infant sleep and ventilatory control, and home sleep testing. Throughout this summary, we discuss key gaps in and barriers to promoting sleep and ventilatory health that were identified during the workshop sessions. We conclude with strategies to address these gaps and barriers and directions for future multidisciplinary research, patient care, and training.
... In the literature, results about bed-sharing and night wakings are controversial (35). In addition, the rate of bed-sharing has been reported to be a cultural variable (36). Informing parents of children with SRNC in appropriate age groups about the effects of bed-sharing may improve the situation, although both the other benefits and possible problems should also be discussed. ...
... The practice of bed-sharing is more prevalent in non-Western cultures, such as Africa than in China and The United States of America. [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] The apparent correlation found in this study between SUDI and African ancestry has not been investigated and could be purely co-incidental. SUDI also occurs in high-income areas, but those cases will not necessarily be investigated at the academic Tygerberg Medico-legal Mortuary. ...
Background: Infant mortality remains a major global concern. Sudden unexpected death in infancy (SUDI) is common in South Africa, but evidence on the effect of possible risk factors remains limited. Respiratory infections have repeatedly been implicated in the death of these infants, but temporality has not yet been confirmed and SUDI remains a multi-factorial phenomenon.
... Previous studies that showed the sleep aids' effectiveness were conducted in countries where sleeping alone is common 5,29,34 . Kushnir and Sadeh's 12 study was conducted in Israel, where it was predominant 40 . Thus, children in these countries may actively use sleep aids to comfort themselves. ...
It is well known that children use sleep aids, such as blankets or soft toys, at bedtime. However, there is a lack of understanding regarding the factors associated with their use and role in addressing sleep problems. This study investigated 96 Japanese children aged 40 to 47 months to examine these associations. We measured children’s stress (through a questionnaire and salivary cortisol [cortisol awakening response]), anxiety symptoms, behavioral problems, and temperament, and created a model to predict the status of sleep aid use. Furthermore, we explored the association between sleep aid use and children’s sleep problems as evaluated by their caregivers. We found that children who used sleep aids were more likely to experience anxiety symptoms. Moreover, most children used sleep aids even when they co-slept with their caregivers and/or siblings. Their use was not uniquely associated with sleep problems. These findings suggest that sleep aid serves as a defense against anxiety, including that caused by the absence of a caregiver, rather than as a substitute for a caregiver. Our study sheds light on their role and emphasizes the importance of viewing development within the complex interactive processes of humans and objects.
... African and Asian countries have a higher prevalence of recorded bed-sharing than Europe and North and South America. Bed-sharing, as a matter of habit and purpose, will happen pro-actively (Mileva-seitz, Bakermans-kranenburg, Battaini, & Luijk, 2017). Personality has a coherent framework in middle childhood, is heritable, and is essential to developmentally significant outcomes such as activity externalization, drug use, and academic involvement. ...
... The marked difference in bedtime likely reflects that the structure of the evening varies between cultures. Cultural differences between evening and sleeping practices are well documented [5,23,24], and include differences in bed sharing and mealtimes. These practices, along with differences in parents' cultural beliefs and priorities regarding child sleep, and the wider structure of a family's day (e.g., working patterns) may account for the difference in bedtime between the two groups of children. ...
Objective:
The study aimed to examine sociodemographic, temporal and bedtime routine correlates of parent-reported sleep duration and timing in a biethnic sample of 18 month and 36 month old children from a disadvantaged location.
Methods:
Between October 2010 and September 2012, parents completed a bespoke three day sleep diary when their child was approximately 18 months (n = 276) and 36 months of age (n = 262) (45.1% South Asian; 54.9% white). Parents reported their child's overnight sleep duration (h/day), the time their child fell asleep, their wake time and their child's bedtime and napping routines. Data were available at both time points for 135 children.
Results:
In line with previous literature, South Asian children had shorter overnight sleep duration and later sleep and wake times than white children. In both ethnic groups, children slept and woke up later on weekends, and children went to bed earlier and slept longer in winter. In white children only, napping duration was associated with overnight sleep period. No significant associations were found between napping frequency and overnight sleep duration. Based on parent-reported data, children who consistently adhered to regular bedtimes and had set times for sleeping tended to go to sleep earlier, wake earlier and have longer overnight sleep.
Conclusions:
The data showed parent-reported variation in sleep patterns between two ethnic groups within a single geographical and deprived area. It is important that researchers, clinicians and early years workers are considerate of cultural norms in sleep practices.
In this chapter, I argue that it is important to acknowledge variations in the way human and nonhuman animals interact with others, variations that result from the different ways in which different groups behave and adapt to their environments. I also explore the implications for comparative cognition of acknowledging these variations. I start by, first, examining how studies in nonhuman primates have been used as a biological foundation for the core ideas used to describe the mother-infant interaction and how these biological foundations are used to support universal statements about mother-infant interaction. I describe the limitations of creating and applying these universal statements. I then focus on other forms of universal statements found in the study of mother-infant interaction: describing the mother-infant interaction only from the perspective of Western-urban families. Through several examples, I examine the complexities of comparative studies and the difficulties of aiming to find commonalities and individual differences among different primates. I will argue for the importance of acknowledging variation among the behaviors of mothers and infants and the ways they interact in various groups, cultures, societies, and species.
Background . There is limited Russian data on infant sleep environment. Updating this data within large-scale studies, as well as identifying risk factors of unsafe organization of infant sleep environment are crucial for targeted preventive work and implementation of effective educational program. Objective. The aim of the study is to examine infant sleep environment organization and parents’ characteristics associated with co-sleeping with children. Methods . The study included mothers of infants referred to a doctor in 8 children’s out-patient clinics (in cities of Syktyvkar, Yakutsk, Petrozavodsk, Arkhangelsk, and Severodvinsk). Socio-demographic and behavioral characteristics of parents were recorded. The organization of infant sleep was evaluated by the presence of separate baby bed, its appearance, location, use of pillow, blanket, presence of any other objects in the bed, co-sleeping in the same bed with parents, baby’s posture during sleep, use of special sleep devices and soother. Results . 2,990 mothers took part in the survey. Co-sleeping was practiced in 1849 (61.8%) families, allowed infant to sleep on the side or stomach — in 1133 (37.9%), confirmed the use of pillows — in 720 (24.1%). There are toys and care items in 1179 (39.9%) babies’ beds during their sleep. According to multi-factor analysis: co-sleeping is associated with low (< 50 thousand rubles/month) family income — odds ratio (OR) 1.55 (95% confidence interval (CI) 1.30–1.86), artificial or mixed infant feeding — OR 0.55 (95% CI 0.47–0.64), and family alcohol intake — OR 0.65 (95% CI 0.42–0.99). Conclusion . High prevalence of unsafe organization of infant sleep environment was revealed. Modifiable risk factors are the infant’s posture during sleep, use of soft bedding, and co-sleeping with the infant.
This study developed and validated the Sleep-Wake Disorders Questionnaire (SWDQ) for children and adolescents in Mexico, addressing the need for culturally tailored diagnostic tools. The SWDQ comprises 43 items divided into two sections: diagnostic questions and sleep habits. A cross-sectional study with 103 participants (aged 6–17 years) from psychiatric hospitals revealed moderate reliability. Exploratory factor analysis identified two key factors—dyssomnias and parasomnias—explaining one-third of the variance. Internal consistency scores were moderate for parasomnias (α=0.68) and low for dyssomnias (α=0.25). The SWDQ aligns with clinical observations, offering a culturally relevant instrument for evaluating pediatric sleep-wake disorders and associated habits.
Background
Nowadays, the increasing importance of mother-infant contact, the significant impact of mother and baby’s sleep quality, and the positive effects on breastfeeding are factors that make breastfeeding sleep important.
Aim
The aim of this study was to examine the effect of mothers’ breastsleeping behavior on attachment and postpartum sleep quality.
Methods
This study is cross-sectional. The research was conducted with 202 mothers. The data of the study were collected using a descriptive information form, the Maternal Attachment Scale (MAS), and the Postpartum Sleep Quality Scale (PSQS). Data were analyzed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics for Windows, version 22.0. Armonk, NY: IBM Corp.) for Windows 22.0 software.
Results
There was no statistically significant difference between the groups in terms of the MAS score and PSQS score of mothers who breastsleep and mothers who did not. No statistically significant difference was found when the mothers’ socio-demographic characteristics, breastsleeping-related characteristics, maternal attachment, and sleep quality mean scores were compared ( P > 0.05).
Conclusion
The literature is very limited in assessing the effects of breastsleeping on mothers’ sleep quality and attachment. This study found that breastsleeping did not affect maternal sleep quality and attachment.
The purpose of this study was to explore research trends in sleep from infancy through to adolescence. To achieve this, an examination was conducted of sleep research published in Korea based on the publication year, developmental stages of the study participants, research designs, measurement tools, and research topics. A total of 362 academic journal articles and theses/dissertations published in Korea up until 2023 were selected. In terms of publication year, the first study was conducted in 1967 and the field became more active from 2010 onwards. The age group studied the most was adolescents, with cross-sectional research being the most common study design. Regarding sleep measurement tools, most scales measuring sleep in infants, preschoolers, children, and adolescents were developed abroad, then adapted or validated in Korea, or were modifications of adult scales tailored for specific studies. Lastly, in terms of research topics, the most common focus was the relationship between sleep and developmental characteristics, particularly its effects on emotional development. Based on these results, future research could focus on developing sleep-related intervention programs and measurement tools.
Parent-child co-sleeping is a common practice in many cultures, although in Western countries, families who engage in parent-child co-sleeping can encounter attitudes about co-sleeping that feel critical from the people around them, as it is not commonly accepted and often stigmatized. This systematic scoping review examined and synthesized the available literature on the attitudes about parent-child co-sleeping that people encounter, their origins, and their effect on parents' own attitudes and behaviors. A total of 9796 abstracts were screened, and 33 studies were included. While the scope of the literature on this topic was narrow, this review demonstrated that parents/caregivers mostly encounter encouraging attitudes about co-sleeping from their extended family members and within their culture and discouraging attitudes from healthcare professionals. Findings suggest that encouraging attitudes enhance the likelihood of parents engaging and continuing with co-sleeping behavior, while discouraging attitudes can lead to the avoidance of parents discussing sleep with their healthcare professionals and can cause conflicts with other family members, including partners. Based on these findings, we conclude that further research is needed in several areas related to co-sleeping in Western culture, most specifically in how external attitudes influence the decision to co-sleep, as well as other behaviors and cognitions such as engagement with healthcare professionals, family satisfaction, parental self-efficacy, and overall mental health.
Study objectives:
Maternal depressive symptoms (MDS) affect most women during the first year postpartum. Mothers provide most of the nighttime care for infants, so studying the relationship between MDS and infant sleep location (ISL) is highly relevant to understanding maternal mental health over the first year of life and beyond. Infant sleep is studied by anthropologists, health care providers, and psychologists, with very little communication across disciplines. This review aimed to determine if there is a predictive relationship between MDS and ISL.
Methods:
This systematic review searched six databases with terms related to maternal mood and ISL. Final analysis included 14 published studies, analyzed with narrative synthesis and PRISMA guidelines. Included studies directly compared infant sleep location (ISL) and maternal depressive symptoms (MDS).
Results:
Five studies showed no relationship between ISL and MDS, and one study found bedsharing reduced MDS. Five studies found co-sleeping was related to higher MDS although directionality is mixed or missing, and three studies found an association at some ages or for some populations only. Examining studies according to type of infant sleep assessment, study design, age of infant, or breastfeeding status failed to detect consistent patterns.
Conclusions:
A variety of study designs, types and definitions of variable measures, sample recruitment and study outcomes prevent detection of a consistent relationship between MDS and ISL. We explore reasons for the elusive nature of a relationship and make recommendations for future research in MDS and ISL, including cross-disciplinary collaborations.
ZUSAMMENFASSUNG
Wir haben untersucht, inwiefern der Schlaf von Müttern und schwangeren Frauen mit dem Alter der eigenen Kinder und der Schlafkonstellation zusammenhängt. Dafür wurden 380 Frauen (mittleres Alter 38 Jahre) mittels Pittsburgh Sleep Quality Index (PSQI) zu ihrem Schlaf und zur Häufigkeit von Bedsharing (Schlafen mit Kind im gleichen Bett) befragt. Die Frauen waren entweder gerade schwanger oder hatten Kinder im Alter von 3 Monaten, 6 Monaten, 1, 2, 8 oder 13 Jahren. In jedem der unterschiedlichen Bereiche des PSQI erzielten mehr als 10 % der Befragten auffällige Werte (Beispiel Schlafqualität: 32 %). Der Schlaf war schlechter, wenn Bedsharing vorlag (z. B. auffällige Werte Schlafqualität: 43 % bei Bedsharing vs. 25 % ohne Bedsharing). Im Vergleich zum Schlaf von Müttern 13-jähriger Kinder war der Schlaf von Müttern jüngerer Kinder signifikant schlechter (z. B. auffällige Werte Schlafqualität: 29–50 % bei Müttern jüngerer Kinder vs. 16 % bei Müttern 13-Jähriger). Die Ergebnisse legen nah, dass junge Kinder im Haushalt und vor allem Bedsharing den Schlaf von Müttern stören können und daher bei Müttern besonders auf Schlafprobleme geachtet bzw. diesen entgegengewirkt werden sollte.
The current systematic review sought to identify the relationship between the range of different parental sleep‐related practices that had been explored in relations to child sleep outcomes in children aged 1–3 years. A systematic literature review was carried out in CINAHL, The Cochrane Library, PsycArticles, PsycInfo, PubMed and Web of Science, as well as relevant grey literature in August 2022 using the terms; population (children, aged 1–3 years), exposure (parental sleep‐related practice) and outcome (child sleep). Any quantitative study published between 2010 and 2022 that explored the relationship between parental sleep‐related practices and the sleep of children aged 1–3 years were included. The Mixed Methods Appraisal Tool was employed to quality appraise included studies and results were narratively synthesised. In all, 16 longitudinal and cross‐sectional quantitative studies met inclusion criteria. Parental presence or physical involvement, as well as broader parental practices including using screens or devices at bedtime and night‐time breastfeeding were all related to poorer child sleep outcomes. Consistent and relaxing routines, sleeping in a cot, and spending all night in their own sleep location were associated with better child sleep outcomes. Acknowledging the plethora of diverse parental sleep‐related practices, which may have varying relationships with child sleep outcomes, could be usefully considered in theoretical models and to inform clinical practice. Issues of definitional and measurement ambiguity are highlighted and discussed.
Objectives: Co-sleeping is defined as caregivers and infants sleeping in the same place or room. The purpose of this study was to investigate associations between co-sleeping, infant sleep, and parental misperceptions about infant sleep.Methods: The participants were 832 English-speaking caregivers. Most of the sample comprised of mothers (70.79%). The infants ages ranged from 6 to 12 months. All participants completed the Brief Infant Sleep Questionnaire-Revised and Parental Understanding and Misperceptions about BAby’s Sleep-Questionnaire in an online survey. Infant sleep and nighttime parental intervention were recorded using auto-videosomnography. The chi-square, non-parametric covariance analysis, and moderation analysis were conducted to analyze the results.Results: Among the respondents, 771 (92.70%) reported that their infants were in the solitary-sleeping group and 61 (7.30%), in the co-sleeping group. Parental misperceptions about infant sleep were higher in the co-sleeping group (29.67±11.28) than the solitary-sleeping group (23.5±10.79; p <0.001). The co-sleeping group had lower total sleep time (523.51±76.38) compared to the solitary-sleeping group (604.91±61.29; p <0.001) based on auto-videosomnography. The moderating effect of parental misperceptions about infant sleep in the relationship between parent-reported infant number of awakenings during the night (NWAK) and co-sleeping was significant (B=0.033, p =0.017).Conclusions: Co-sleeping had low prevalence in this study compared to solitary-sleeping. Co-sleeping was associated with higher levels of parental misperception about infant sleep. Additionally, in the case of co-sleeping caregivers, a higher misperception about infant sleep was more strongly associated with parent-reported infant NWAK. Parental misperceptions about infant sleep may be an important factor to consider in pediatric sleep.
Objectives:
To develop the Parenting Behavior Checklist to Promote Preschoolers' sleep (PCPP), quantify sleep-promoting parenting behaviors for children, and examine the scale's reliability and validity.
Methods:
The PCPP was developed based on the recommendations of the ABCs of SLEEPING for children's sleep, which is strongly supported by research evidence. Its validity and reliability were evaluated using data from 140 participants. Structural validity was estimated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency was evaluated by Cronbach's α. Hypothesis testing was evaluated by analyzing the correlations between each factor of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) and the PCPP.
Results:
Regarding structural validity, EFA was conducted because CFA showed a poor model fit. The PCPP comprised one factor and six items. The JSQ-P subfactors of insomnia or circadian rhythm sleep-wake disorders, undesirable morning symptoms and behaviors, and insufficient sleep were moderately negatively correlated with the PCPP; the subfactor of undesirable daytime behaviors related to sleep problems was weakly negatively correlated with the PCPP. Thus, the sleep-promoting parenting behaviors listed in the PCPP were associated with better sleep in children.
Conclusions:
The PCPP showed sufficient reliability and validity. Future studies should use the scale to examine more effective interventions regarding sleep-promoting parental behaviors for children.
Background
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample.
Methods
This cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ).
Results
Children with autism had significantly more sleep problems than non-autistic children [t(226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t(165) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t(165) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ.
Conclusion
In summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.
This paper illustrates the insights that can be gained from using a multidimensional poverty measurement method based on the capability approach to analyse the scale, characteristics, and spatial distribution of poverty in segregated cities. We assess the poverty gaps between formal and informal neighbourhoods and across districts, compare the results with income-based poverty estimates, and analyse the dimensional composition of poverty and disparities across population subgroups. The results show a weaker correlation between multidimensional and income-based measures and less overlap in terms of who is identified as poor in informal settlements than in the rest of the city. After adjusting for underrepresentation of the slum population in the household survey, informal settlements account for 10% of the city's population but nearly half of the multidimensionally poor. The results highlight the need to design poverty reduction policies that target informal neighbourhoods.
This article reviews disparities in pediatric sleep health and sleep disorders from early childhood through adolescence (birth to age 18 years). Sleep health is a multidimensional construct including sleep duration, consolidation, and other domains, whereas sleep disorders reflect both behaviorally (eg, insomnia) and medically based (eg, sleep disordered breathing) sleep diagnoses. Using a socioecological framework, we review multilevel (ie, child, family, school, health-care system, neighborhood, and sociocultural) factors linked to sleep health disparities. Mechanistic research and studies using an intersectional lens to understand overlapping marginalized identities are needed to inform multilevel interventions to promote sleep health equity in pediatrics.
Objective:
To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged.
Methods:
We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR).
Results:
An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors.
Conclusions:
More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
Sleep-related infant deaths remain a major public health issue. Multiple interventions have been implemented in efforts to increase adherence to safe sleep recommendations. We conducted a systematic review of the international research literature to synthesize research on interventions to reduce the risk of sleep-related deaths and their effectiveness in changing infant sleep practices. We searched PubMed, CINAHL, PsycINFO, and Google Scholar for peer-reviewed articles published between 1990 and 2015 which described an intervention and reported results. Twenty-nine articles were included for review. Studies focused on infant caregivers, health care professionals, peers, and child care professionals. Targeted behaviors included sleep position, location, removing items from the crib, breastfeeding, smoke exposure, clothing, pacifier use, and knowledge of Sudden Infant Death Syndrome. Most articles described multi-faceted interventions, including: one-on-one or group education, printed materials, visual displays, videos, and providing resources such as cribs, pacifiers, wearable blankets, and infant t-shirts. Two described public education campaigns, one used an educative questionnaire, and one encouraged maternal note taking. Health professional interventions included implementing safe sleep policies, in-service training, printed provider materials, eliciting agreement on a Declaration of Safe Sleep Practice, and sharing adherence data. Data collection methods included self-report via surveys and observational crib audits. Over half of the studies utilized comparison groups which helped determine effectiveness. Most articles reported some degree of success in changing some of the targeted behaviors; no studies reported complete adherence to recommendations. Future studies should incorporate rigorous evaluation plans, utilize comparison groups, and collect demographic and collect follow-up data.
To elucidate characteristic sleep architecture of different nocturnal sleep patterns in early infancy.
Participants were 27 infants at the same conceptional age of 3-4months. Nocturnal sleep of these infants was monitored at home by simultaneously using actigraphy and a one-channel portable EEG device. According to the infants' activity for 6h from sleep onset, each night's sleep pattern was classified into three categories: sleeping through the night (STN), sleeping with weak signals (crying/fuss episodes <10min or fed), and sleeping with strong signals (crying/fuss episodes≧10min). Associations of sleep patterns with sleep variables (percentage of time in sleep stages, pattern of slow-wave sleep (SWS) recurrence, etc.) were investigated.
Analysis was conducted in 95 nights. STN pattern (n=36) was characterized by suppressed body movements while EEG represented a state of wakefulness. Weak signal pattern (n=27) tended to indicate rich and regular distributions of SWS across the night. Strong signal pattern (n=32) was characterized by reduced sleep time, although the amount of SWS was not reduced to that degree. Exclusively breastfed infants accounted for 78% of weak signal patterns, whereas formula-feeding infants, 67% of STN patterns. In several nights with STN or strong signal pattern, SWS did not occur in >50% of the sleep cycles. Multiple regression analysis showed that exclusive breastfeeding may increase the proportion of SWS in non-REM sleep.
Each nocturnal sleep pattern was associated with some sleep architecture, part of which would be attributed to infant's feeding methods.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
The American Academy of Pediatrics endorses and accepts as its policy the position on bed sharing as articulated below by a panel of experts convened by the National Institute of Child Health and Human Development (NICHD). The Panel attended a conference sponsored by the NICHD entitled 'InfantSleep Environment and SIDS Risk' in Bethesda, MD, on January 9-10, 1997. After hearing presentations from a variety of experts from the United States and several other countries, the Panel prepared the following statement regarding the relationship of bed sharing and SIDS.
The recommendation to place infants on their backs to sleep has been widely known since the mid-1990s. Upon implementation of this recommendation, sudden infant death syndrome (SIDS) and sudden unexplained infant death (SUID) were dramatically decreased. However since that time, further reduction in the death rates has not been evident. This literature review focused on implementation of safe sleep practices in the inpatient setting prior to discharge of the mother and infant. Evidence supports staff consistency as it relates to educational strategies and role modeling, as this is integral in parental compliance of the recommendations. Additionally, tailoring the educational components specific to parental ethnicity and socioeconomics may influence their perceptions of safe sleep and its value in the safe care of their infant.
Sudden infant death syndrome (SIDS) is the sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation. The incidence of SIDS has decreased more than 50% in the past 20 years, largely as a result of the Back to Sleep campaign. The most important risk factors relate to the sleep environment. Prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is strongly correlated with an increased risk of SIDS, especially in infants younger than 12 weeks. Apparent life-threatening events are not a risk factor for SIDS. Parents should place infants on their backs to sleep, should not share a bed, and should avoid exposing the infant to tobacco smoke. Other risk-reducing measures include using a firm crib mattress, breastfeeding, keeping vaccinations up to date, avoiding overheating due to overbundling, avoiding soft bedding, and considering the use of a pacifier during sleep once breastfeeding is established. One consequence of the Back to Sleep campaign is a significant increase in the incidence of occipital flattening. Infants who develop a flat spot should be placed with the head facing alternating directions each time he or she is put to bed. Supervised prone positioning while the infant is awake, avoiding excessive use of carriers, and upright positioning while awake are also recommended.
Data on sleep behaviour have been extracted from a prospective longitudinal study of growth in a random sample of, originally, about 200 children, with annual examinations. The purpose was to assess to what extent data at 4 years on duration of sleep, night-awakening and habitual sharing of the parents’bed can predict conditions in these respects at 8, 12 and 16 years. The predictive power is slight in general concerning the first two variables, while the habit of sharing the parents’bed is rather more difficult to shake off, above all when the child has reached school age (6–7 years in Sweder).
Editor—Blair et al investigated the factors influencing the risk of the sudden infant death syndrome.1 In an increasing number of infant deaths that we have investigated over recent years we have found several recurring themes: infant under 3 months; shared sleeping arrangements, particularly sharing a sofa; young carer; consumption of alcohol the night before the infant was found dead. Typically, the infant is found between the adult and the back of the sofa, often covered by a duvet. Sharing a sofa seems to be particularly common in single parent households with poor socioeconomic support, in which the mother sleeps on the sofa, often with more than one child, simply because it is the warmest place in the house. Some of the risk factors highlighted by Blair et al have long been recognised in law in the Children and Young Persons Act 1933.
We are concerned with the use of the term sudden infant death syndrome in this paper because it is potentially misleading in deaths associated with cosleeping. In such cases the infant may have been accidentally overlaid, smothered by the bedclothes, or squashed between the adult and back of the sofa. We accept that this cannot, at present, be proved beyond reasonable doubt, but we found in a recent study that intra-alveolar haemorrhage was increased in infants who died in the context of bed sharing and that this may be a marker of accidental asphyxia.2 This often manifests as bloodstained fluid issuing from the nose and mouth with consequent bloodstaining of the bedding and infant's clothing. Examination of the clothing and bedding is therefore essential.
It is inappropriate to accuse a carer unjustly in a cosleeping death. Nevertheless, it strikes us as being more honest to raise the suspicion that accidental upper airway obstruction may be a factor in the death and to give the cause of death as unascertained while giving appropriate support to parents.
BACKGROUND
Fresh intrapulmonary and oronasal haemorrhages in cases of sudden infant death syndrome (SIDS) might be markers for accidental or intentional smothering inappropriately diagnosed as SIDS.
AIM
To compare the incidence, epidemiological association, and inter-relation of nasal haemorrhage, intrapulmonary haemorrhage, and intrathoracic petechiae in infant deaths certified as SIDS.
METHODS
In SIDS cases from a large nationwide case–control study, a wide range of variables were compared in cases with and without reported nasal haemorrhage and, in a subgroup of cases, in those with and without pathologically significant intrapulmonary haemorrhage.
RESULTS
Nasal haemorrhage was reported in 60 of 385 cases (15%) whose parents were interviewed. Pathologically significant intra-alveolar pulmonary haemorrhage was found in 47% of 115 cases studied, but was severe in only 7%. Infants with nasal haemorrhage had more haemorrhage into alveoli and air passages than age matched cases without nasal haemorrhage. In multivariate analysis, nasal haemorrhage was associated with younger infant age, bed sharing, and the infant being placed non-prone to sleep. Intrapulmonary haemorrhage was associated with the same three factors in univariate analysis, but in multivariate analysis only younger infant age remained statistically significant. There was no significant association between nasal or intra-alveolar haemorrhages and intrathoracic petechiae.
CONCLUSIONS
Nasal and intrapulmonary haemorrhages have common associations not shared with intrathoracic petechiae. Smothering is a possible common factor, although is unlikely to be the cause in most cases presenting as SIDS.
Sudden infant death syndrome (SIDS) remains the leading cause of death between 1 month and 1 year of agePlacing infants in the prone position (on their stomach) to sleep and exposure to maternal smoking are major risk factors for SIDSInfants born preterm are at four times the risk compared with infants born at termThe safest place for infants to sleep is in the parental bedroom in their own cot and in close proximity to parents to allow for feeding and comforting; sleeping on a sofa or couch with an infant is extremely dangerousBed sharing with infants is a risk factor for SIDS—infants are at highest risk if younger than 3 months or if the parents smoke, use illicit drugs, or consume alcoholBreast feeding decreases the risk of SIDS and therefore mothers should be encouraged to breast feed for this reason and other health benefits
To evaluate whether an educational video would impact infant sleep practices among new mothers.
Survey responses of new mothers who did (n = 43) versus did not (n = 49) watch the educational video were compared to identify differences in observed and planned infant sleep practices.
Mothers who watched the video were more likely to observe safe sleep practices while in the hospital (67.4% vs. 46.9%, p < .05). They were also less likely to plan for (unsafe) side positioning (23.9% vs. 7.1%, p < .05).
Given the potentially fatal consequence of unsafe sleep, a brief video provided by nursing staff can be a prudent component of new parent education.
© 2015, Wiley Periodicals, Inc.
Despite significant reductions in infant sleep-related deaths, they continue to be a leading cause of infant mortality and further reductions have proven difficult to achieve compared with the initial dramatic reductions brought about by Back to Sleep campaigns. Because night-time caregiving behaviours and infant sleep environments involve a complex interplay between environmental, biological and behavioural variables, designing effective interventions to improve sleep-related outcomes represents a significant public health challenge. Hayman and colleagues1 present data on infant suffocation deaths involving wedging or overlay in the sleep environment which occurred in New Zealand between 2002 and 2009. They examine the scenarios which resulted in sleep-related infant mortality and which may be used to refine existing paediatric recommendations. The authors claim that their data reinforce the need for ‘consistent, persistent’ safe sleep messages which are disseminated widely. However, this type of authoritative health promotion has been critiqued and other models for delivering negotiated, individualistic messages are considered to be more effective where complex behaviours are involved. With regard to infant sleep safety, message exposure and awareness of sleep-related risk factors represents only one possible reason why sleep-related risks to infants exist. Furthermore, a singular focus on message delivery inhibits the very types of conversations with healthcare providers that are necessary for parents to engage in contingency planning. In many cases, healthcare providers are not well prepared for conversations with parents who cannot or will not comply with recommended practices. Situations which require contingency planning and challenge parents to know how to transfer recommendations to different sleeping arrangements than the one … [Full text of this article]
To describe the sleep patterns and problems in children aged between 12 and 36 mo of age.
This cross sectional survey was collected over a span of 1 y in Advanced Pediatric Centre, PGIMER, Chandigarh and crèches of Chandigarh. Children in the age group of 12 to 36 mo were included in study. Children with chronic illness, developmental delay, seizure disorder and lack of consent were excluded. A total of 368 children were enrolled. Main outcome measures were sleep duration over 1 to 3 y of life; sleep behavior at onset, during and waking of sleep and parent reported sleep problems and their predictors.
The average duration of sleep was 12.5 h (S.D = 1.9). The mean total sleep duration and mean day time sleep duration decreased, while mean night time sleep increased as the age advanced from 12 to 36 mo. Following were the frequency of sleep habits seen in the index study; bed time routine was seen only in 68(18.5 %), a regular bed time ritual was seen in 281(76.4 %), 329(89.4 %) children frequently required 0-20 min time to fall asleep, 11(3 %) parents used sleep inducing drugs. Night waking (1 to 3 times a night) was seen in 297(80.7 %) and its frequency declined with age. Parent reported sleep problems were seen in 12.8 % (47/368). Lack of co-sleeping and night waking were considered as strongest predictors of parent reported sleep problems.
Toddlers' sleep duration, night waking behavior, and day time naps decrease as the age progress while night time sleep duration increases with age. Lack of co-sleeping and night waking are considered as strongest predictors of parent reported sleep problems.
Background:
Findings from prior research into the effect of feeding methods on infant sleep are inconsistent. The objectives of this study were to examine infants' sleep patterns by feeding methods and sleep arrangement from birth to eight months old.
Methods:
This longitudinal cohort study enrolled 524 pregnant women at 34-41 weeks of gestation and their infants after delivery in 2006 and followed up until eight months postpartum. The study subjects were recruited from nine women and children hospitals in nine cities in China (Beijing, Chongqing, Wuhan, Changsha, Nanning, Xiamen, Xi'an, Jinan, and Hailin). Participating infants were followed up weekly during the first month and monthly from the second to the eighth month after birth. Twenty-four hour sleep diaries recording infants' sleeping and feeding methods were administered based on caregiver's self-report. Multivariable mixed growth curve models were fitted to estimate the effects of feeding methods and sleep arrangement on infants' sleep patterns over time, controlling for maternal and paternal age, maternal and paternal education level, household income, supplementation of complementary food, and infant birth weight and length.
Results:
Exclusively formula fed infants had the greatest sleep percentage/24 h, followed by exclusively breast milk fed infants and partially breast milk fed infants (P<0.01). Night waking followed a similar pattern. However, the differences in sleep percentage and night waking frequency between exclusively formula and exclusively breast milk fed infants weakened over time as infants developed. In addition, compared to infants with bed-sharing sleep arrangement, those with room sharing sleep arrangement had greater daytime and 24-hour infant sleep percentage, whereas those with sleeping alone sleep arrangement had greater nighttime sleep percentage.
Conclusions:
Our data based on caregiver's self-report suggested that partial breastfeeding and bed-sharing may be associated with less sleep in infants. Health care professionals need to work with parents of newborns to develop coping strategies that will help prevent early weaning of breastfeeding.
I was pleased to see The BMJ’s commentary on the new National Institute for Health and Care Excellence guidance on co-sleeping,1 2 which I read online, but was less happy to see the particularly hazardous example of parent-baby co-sleeping in the print journal.During my research career I have made and analysed hundreds of videos of co-sleeping parents and babies. The illustration of a baby sleeping face down on a pillow next to the mother in the print journal is not a typical or safe scenario, and it is not what the authors are describing when they suggest that co-sleeping with breastfeeding mothers carries minimal risk. A typical depiction of “safe” co-sleeping shows a baby on his or her back flat on a mattress, well away from any pillows, with the mother curled up facing the baby, one arm above the baby’s head and knees tucked up below the baby’s feet.The juxtaposition of a photo of a co-sleeping baby face down on a pillow with the heading “Making informed choices on co-sleeping with your baby” might lead readers to assume the picture depicts an informed co-sleeping choice. It does not. Interested readers can find more information at the Infant Sleep Info Source website (www.isisonline.org.uk) and in the publications cited therein.NotesCite this as: BMJ 2015;350:h993
Literature on sleep and child development is growing rapidly in exciting new directions across several disciplines and with this comes a need for guiding conceptual principles and methodological tools. In this introductory chapter, the importance of sleep for child development across multiple domains is highlighted. The aims of this monograph are presented and pertain to the need to consider and integrate theory and research across multiple disciplines and use state-of-the-art methodologies. A developmental ecological systems perspective adapted to sleep illustrates the multiple levels of influence and their importance in the study of child sleep and development. A focal aim is to provide examples of longitudinal studies linking sleep with child development, which are presented in seven chapters of this volume.
© 2015 The Society for Research in Child Development, Inc.
Although parents' structuring of infant sleep is complexly determined, little attention has been given to parents' marital and personal adjustment in shaping sleep arrangement choices. Linkages were examined between infant sleep arrangements at 1 and 6 months and mothers' marital adjustment, co-parenting quality, and depressive symptoms. The final study sample was composed of 149 families (53% girl infants, 86% European American). Bed sharing mothers had lower co-parenting quality, and, at 6 months, more depressive symptoms than mothers of infants in solitary sleep. One-month co-parenting quality was associated with predictable shifts in sleep arrangements from 1 to 6 months, but 1-month sleep arrangements did not predict changes in personal or co-parenting quality. Findings emphasize the need for greater attention to marital and emotional health in influencing family-level decisions about infant sleep arrangements.
© 2015 The Society for Research in Child Development, Inc.