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We report the case of a 10-year-old boy with autism spectrum disorder who had difficulty initiating and maintaining sleep. Through home consultation, his parents were trained to implement a multicomponent sleep intervention that included (a) faded bedtime, (b) regimented pre-bedtime routines, and (c) elimination of positive social consequences contingent on sleep problems including unwanted co-sleeping. A critical element in the case was functional assessment of the conditions associated with poor sleeping and matching intervention to parent preferences. Compared to a baseline phase, intervention reduced night waking frequency and duration as well as the time required for the boy to fall asleep. Follow-up results one and 2 months post-intervention documented sustained improvement.

Objectives Investigate the direct and moderating effects of daytime parenting practices on the relationship between bedtime routines and pediatric sleep problems. Methods A community sample of 407 parents with children 2–10 years old completed measures of parenting practices (i.e., laxness and over-reactivity) and bedtime routines (i.e., consistency and reactivity to changes in routines). Sleep problems (i.e., severity and signaled night waking) were assessed by a parent-report questionnaire and sleep diaries. Results Higher parenting laxness (β = .13) and less bedtime routine consistency (β = −.34) significantly predicted sleep problem severity. Laxness moderated the relationship between bedtime reactivity and sleep problem severity: when bedtime reactivity was high, higher parental laxness was associated with more severe sleep problems. Conclusions Daytime parenting practices are important to consider when children are reactive to changes in bedtime routines, as permissive or inconsistent daytime parenting practices were found to be associated with more severe sleep problems. Future research should examine the effects of parenting practices and bedtime routines on problematic signaled night waking in a clinical sample of children.

Objective A central adrenergic hyperactivation is described in the neurobiology of posttraumatic stress disorder (PTSD) with probable variable symptomatic impact. Few studies have evaluated using the alpha-1 adrenergic antagonist prazosin for such symptoms; however, given the likely pathophysiology involved, this drug may play an important role in the pharmacological approach to PTSD.Methods This study assessed articles already published on the use of prazosin through a systematic review along a timeline in view of the symptomatic target of difficult access by standardized treatments. The impact of using this medication for the general symptoms of PTSD is also discussed. Several databases were searched for articles in the literature on the use of prazosin to treat PTSD.Results A total of 168 articles were found containing search terms in the title or abstract. Overall, 85 articles met the criteria described, and 48 studies were explored to conduct the present systematic review. Most articles showed some improvement after prazosin administration, especially in relation to sleep symptoms (nightmares and night waking). Only one article demonstrated no improvement after the use of this drug. More randomized studies are needed.Conclusion Several clinical studies demonstrated the relevant role of prazosin for treating PTSD symptoms. Prazosin is an affordable and cost-effective pharmacological option compared to other drugs used to treat PTSD.

Women with gestational diabetes mellitus have higher rates of perinatal depressive symptoms, compared to healthy pregnant women. In the general population, maternal depressive symptoms have been associated with infant sleep difficulties during the first year postpartum. However, there is lack of data on infants of mothers with gestational diabetes mellitus. This study assessed the prospective associations between maternal perinatal depressive symptoms and infant sleep outcomes. The study population consisted of 95 Swiss women with gestational diabetes mellitus and their infants, enrolled in the control group of the MySweetheart trial (NCT02890693). Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale at the first gestational diabetes mellitus visit during pregnancy, at 6-8 weeks postpartum, and 1 year postpartum. The Brief Infant Sleep Questionnaire was used to assess infant sleep (i.e., nocturnal sleep duration, number of night waking, and maternal perception of infant sleep) at 1 year postpartum. Relevant maternal and infant measurements (e.g., infant sex or maternal age or social support) were collected or extracted from medical records as covariates. Antenatal maternal depressive symptoms at the first gestational diabetes mellitus visit were inversely associated with infant nocturnal sleep duration at 1 year postpartum (β = -5.9, p = 0.046). This association became marginally significant when covariates were added (β = -5.3, p = 0.057). Maternal depressive symptoms at 6-8 weeks postpartum were negatively and prospectively associated with infant nocturnal sleep duration (β = -9.35, p = 0.016), even when controlling for covariates (β = -7.32, p = 0.042). The association between maternal depressive symptoms and maternal perception of infant sleep as not a problem at all was significant at 1 year postpartum (β = -0.05, p = 0.006), although it became non-significant when controlling for appropriate covariates. No other significant associations were found. This study solely included measures derived from self-report validated questionnaires. Our findings suggest it is of utmost importance to support women with gestational diabetes mellitus as a means to reduce the detrimental impact of maternal perinatal depressive symptoms on infant sleep, given its predictive role on infant metabolic health.

To examine the sleep habits of children with cerebral palsy (CP) and use of night braces and to investigate their association with parental quality of life. The study included 114 children aged 3–6 (57 with typical development (TD) and 57 with CP). The children with CP were grouped according to the Gross Motor Function Classification System (GMFCS) and night brace use (NBU). “Children’s Sleep Habits Questionnaire-Abbreviated Form” and “Short-Form Health Survey” were used to investigate the children’s sleep habits and the parents’ quality of life, respectively. Results were compared for children with CP and TD, and for NBU and non-use (NNBU) in children with CP. All children had sleeping problems, but night waking was more prevalent among children with CP (p 0.05). The quality of life of the parents of children with CP and TD was significantly different (p

The gut microbiota harvests energy from indigestible plant polysaccharides, forming short-chain fatty acids (SCFAs) that are absorbed from the bowel. SCFAs provide energy—presumably after easily digested food components have been absorbed from the small intestine. Infant night waking is believed by many parents to be due to hunger. Our objective was to determine whether faecal SCFAs are associated with longer uninterrupted sleep in infants. Infants (n = 57) provided faecal samples for determining SCFAs (7 months of age), and questionnaire data for determining infant sleep (7 and 8 months). Linear regression determined associations between SCFAs—faecal acetate, propionate and butyrate—and sleep. For each 1% higher propionate at 7 months of age, the longest night sleep was 6 (95% CI: 1, 10) minutes longer at both 7 and 8 months. A higher proportion of total faecal SCFA as propionate was associated with longer uninterrupted infant sleep.

Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies’ heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bi-directional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices. peer-reviewed

Background Joint and limb pain is a common presenting complaint within the paediatric population, affecting 10–20% of school-age children. They are also a major reason for referral to paediatric rheumatology clinics (1). The differential diagnosis for joint pain and/or swelling can include both benign and malignant causes. Studies have found that Methods Charts of patients referred from rheumatology clinic to the haemato-oncology clinic were selected. A detailed chart review was then carried out to obtain information on clinical presentation, diagnostic work up and clinical progress of the patient. Results Case 1 CS, A 2 year and 2 months old girl who presented to paediatric rheumatology clinic with 5 month history of lower limb pain associated with a fever of 40’C. The pain progressively worsened leading to inability to walk. She had previously been treated for Idiopathic Thrombocytopenic Purpura with steroids. Initial Bone Marrow Aspiration (BMA) had ruled out leukaemia. Four months later, her condition had worsened and was referred to our facility where a peripheral blood film and flow cytometry confirmed B cell ALL. Treatment was initiated but unfortunately the patient’s condition deteriorated and eventually passed away. Case 2 NM, a 2 year and 10 months old girl presented to our paediatric rheumatology clinic with bilateral foot pain for 8 weeks. She was initially limping and progressed to inability to walk within a month. Rheumatology review in Tanzania diagnosed the patient as JIA and started on steroids. On examination, systemic findings were normal except bilateral ankle joint effusion and tenderness. An X-ray displayed bilateral transverse lucencies in the metaphyseal ends of the tibia and fibula. BMA was done and confirmed ALL. Treatment was initiated and the patient attained remission after 18 months of therapy. She remains well 2 years after completion of therapy. Case 3 NC, a 4-year-old girl, presented with multiple joint pains for 2 weeks. Pain was associated with night awakening and recurrent fevers. C-Reactive Protein (CRP) was persistently high and was treated with several courses of antibiotics. She was assessed by a haemato-oncologist with unremarkable findings. A decision was made to do a BMA and flow cytometry, which confirmed B cell ALL. Conclusion Musculoskeletal complaints are frequently the initial manifestations of acute leukaemia in childhood (60%) and should be considered in the differential diagnosis of JIA (3). Initially laboratory test results can be normal therefore it is necessary to follow these children closely and request serial tests, until there is a clearly defined diagnosis of neoplasia. Finally, malignancy should be eliminated before introduction of immunosuppressive therapy as the use of steroids may mask and delay its diagnosis (2).

Objective/Background: Poorer executive function (EF) has been implicated in the etiology of negative parenting (e.g., harsh, reactive, intrusive). EF may be affected by good or poor quality sleep, and thus sleep may be involved in negative parenting. In the current exploratory study, we investigated the additive and interactive effects of maternal EF and sleep indicators in the statistical prediction of negative parenting. Patients/Methods: A sample of 241 mothers of 2.5-year-olds (51% girls) completed questionnaires, wore wrist actigraphs for one week, and completed several EF tasks during a laboratory visit. Results/Conclusions: We found that sleep activity (e.g., nighttime waking and movements) interacted with EF in predicting negative parenting practices, such that poorer EF was linked with more negative parenting only in the context of higher levels of night waking. Sleep duration also interacted with EF, such that EF and parenting were no longer associated when sleep durations were short. The findings have implications for incorporating sleep into our understanding of maternal cognitive self-regulation and harsh parenting during early childhood development.

The Children's Sleep Habits Questionnaire (CSHQ) is widely used in clinical settings to screen for sleep problems in children aged 4–10 years. Existing studies on children in different cultures have included children across a wide age range and results have raised questions about CSHQ's psychometric quality. Our study addressed some of the limitations of existing studies by focusing on Chinese children within a much narrower age range of 4–5 years old. We tested the reliability and construct validity of the CSHQ in children living in Shanghai, China. Parents (mothers: 93%) of a random selected sample of kindergarten children aged 4–5 years (N = 171; 46.8% boys; one target child per family) from Shanghai, China provided data on their children's sleep behaviors. CFA and EFA were conducted using Mplus 7.3. Weighted least squares with mean and variance adjusted (WLSMV) were used as the estimation method in Mplus, due to the ordinal nature of item responses. Our analyses showed that, similar to most existing studies, the eight subscales of CSHQ had low internal consistency, with Cronbach's alphas ranged from .11 (Night Waking) to .62 (Daytime Sleepiness). CFA failed to confirm the 8-factor structure. EFA suggested that a six-factor structure should be extracted. Subsequent CFA with a newly identified set of items from CSHQ led to the exclusion of two uninterpretable factors, leaving four factors with 28 items: Bedtime Behaviors (α = .59), Sleep Behaviors (α = .62), Morning Wakings (α = .69), and Daytime Sleepiness (α = .67). The four factors represented some improvement to the psychometric quality of the CSHQ. Based on our findings and those from other studies, we concluded that the CSHQ should be used with great caution.

Angelman syndrome is a rare genetic syndrome, in which sleep disturbances are reported for 20-80% of individuals (Williams et al., 2006). This interview study delineated parental perceptions of sleep problems experienced by children with Angelman syndrome and the impact on parental sleep quality, health and wellbeing. The nature of desired interventions was also explored. Semi-structured interviews were completed with parents of 50 children, aged 16 months-15 years with Angelman syndrome who experienced current or historic sleep problems; predominantly night waking and settling problems. Parents were concerned by the impact of their child's sleep quality upon their own ability to function during the day. The importance of considering parental experiences was evidenced by variability in coping e.g. despite the persistence of sleep problems 20% of parents did not feel the need for any additional support. Amongst a range of types of further support desired, 27% cited further support with a behavioural intervention, and information about the trajectory of sleep problems in Angelman syndrome (18%). The results suggest that behavioural interventions supporting both children and parents in improving their sleep quality and well-being, and longitudinal research into sleep problems should be prioritised.

Sleep disturbances are common among preschool-aged children. As children's problematic sleep is commonly defined by subjective reports from parents as to how the issue affects them, we took a qualitative approach to explore the perceptions and experiences of mothers and main caregivers of preschoolers with problematic sleep. The aim was to understand their firsthand experiences.Purposive sampling was used to identify mothers of 3- to 4-year-olds whose sleep was a problem for them. Semistructured interviews were conducted with 16 mothers. The interviews were analyzed for anticipated and emergent themes, the latter generated from exploring the impact of the child's sleep problems on the mother herself.Mothers described difficulties mainly with bedtime resistance and night waking and the adverse consequences affecting siblings and partners. Predominant themes falling under the umbrella of emotional responses (e.g., resignation, guilt or shame, confusion or frustration, and defeat) and daytime functioning (e.g., exhaustion, moodiness, poorer concentration, less socializing) emerged from mothers describing the impact the child's sleep problem had on her personally.This study highlights the overwhelming impact a child's sleep problems can have on a mother both emotionally and physically, and expressions of shame and guilt suggest some mothers assume much of the responsibility for their child's sleep problem. The findings provide insight into understanding mothers' personal responses in dealing with their preschoolers' sleep that could be useful to assist health professionals in history taking and establishing a treatment plan.

Night awakening is a common concern for parents and professionals in early childhood and a risk factor for child growth and development. This study examined the concurrent and longitudinal associations of night awakening with child health and illness during the first 3 years of life.Longitudinal data from 1364 infants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used in this study. At ages 6, 15, 24, and 36 months, mothers reported on the frequency of their child's night awakening in the past week, overall health, and occurrences of illness. Information on demographic factors, including child sex and ethnicity/race, maternal education, and family income as well as child breastfeeding status was obtained at 1 month. Structural equation modeling, including latent growth curve modeling, was performed.Age-related changes in weekly frequency of night awakening and overall child health were characterized by curvilinear patterns between 6 and 36 months. Although more frequent night awakenings were associated with poorer health at 6 months, a faster decline in night awakenings was associated with a slowed health decline over time. Furthermore, more frequent night awakenings were concurrently associated with more occurrences of illness at ages 6, 15, and 24 months. The association between night awakening and illness dissipated by 36 months.Night awakening is concurrently and longitudinally associated with poorer health and more illnesses in early childhood.

Objective Infant sleep plays a critical role in normal development. Sleep problems, including sleep onset difficulties (SODs) and night waking (NW), range from 20% to 30% in infants and young children and can be persistent over time up to adulthood. Young French children seem to have longer sleep durations and less sleep troubles than their counterparts worldwide. Here, we aimed at describing infant sleep characteristics (total sleep time (TST)/24 h, NW, and SODs) and associated sleep habits in infants at age one year from the French nationwide birth cohort Etude Longitudinale Francaise depuis l’Enfance (ELFE). Methods This study included 11,783 infants with information on both sleep characteristics and sleep habits (parental presence when falling asleep, eating to fall asleep, sucking a pacifier or finger to sleep and sleep arrangement and location). Associations were studied by multinomial logistic regression analyses adjusted for familial and infant characteristics. Results Mean TST was 13 h36 min including 2 h54 min of naps; 20% of the infants had TST ≤12 h/24 h. About 46% did not present SOD or NW, 16% had frequent SODs and 22% had NW > 1 night in 2. Parental presence, feeding to fall asleep and infant sleep arrangements were frequent in infants with short sleep duration (≤12 h/24 h), NW and SODs. Non-nutritive sucking was associated with risk of NW, SOD and TST >14 h/24 h. Parental room sharing was associated with NW. Conclusion This work provides new information on infant sleep arrangements and non-nutritive sucking that should be accounted for when considering sleep behaviors. In addition, most identified sleep habits associated with poor sleep characteristics may be amenable to change.

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

The pineal gland is supra-axial endocrine gland. It is the axel that turns the four endocrine axes. Its key role is to harmonize the activity of the rhythmic function of the interior to the rhythmic demands of the exterior world. The pineal gland regulates general and seasonal adaptation responses. Within the interior, it plays protective and restorative roles. Its commonly acknowledged role of preventing night waking is in service of its restorative and reparative role, including antitumoral. The pineal gland plays a crucial role in chronobiology and cosmobiology, which explain unexpected alterations in endocrine function and health.

The aim of this study was to explore the impact of Sleep Tight, a behavioural sleep programme, on child sleep problems and family wellbeing. A service evaluation of 40 families with a child aged 0–12 years who completed Sleep Tight through Sure Start children's centres was performed. A before and after within-subjects design was used and outcomes assessed using the Sleep Disturbance Index ( Quine, 1991 ). Evidence of a statistical effect was found for settling, night waking, sleeping in parents' bed, and parents up at night. On average, children had 2.5 hours more sleep per night after the intervention. Parents reported changes in family life and child's daytime behaviour. The findings support the use of Sleep Tight as an effective, time-limited behavioural sleep programme.

The aim of the study is to examine nocturnal sleep measures of healthy and well developed pre-term infants by birth weight when they were averaged 15 corrected months and became elementary school children. Sleep measures were collected by actigraphs (Micro-mini RC, Ambulatory Monitoring Inc., New York, USA). Nocturnal sleep quality of children born as extremely low birth weight (ELBW) was significantly inferior with that of children born as very low birth weight (VLBW) at 15 corrected months [number of night waking: 6.0 (4.5 - 8.0), ELBW 8.5 (7.0 - 10.3) (Z = 2.47, p < 0.01), wake after sleep onset: VLBW 99.0 (73.0 - 115.0) min, ELBW 146.5 (94.8 - 171.3) min (Z = 2.89, p < 0.01)]. However, these measures did not show any significant differences by birth weight at second data collection period [number of night waking: VLBW 0.0 (0.0-1.0), ELBW 1.0 (0.0 - 2.5) (Z = —0.62, n.s.), wake after sleep onset: VLBW 16.0 (8.0 - 27.0) min, ELBW 15.0 (6.0 - 32.5) min (Z = 0.00, n.s.)]. It was assumed that nocturnal measures were affected by the birth weight at the age of 15 corrected months in ELBW infants, but could not predict the future sleep problems at this point.

This paper advocates for a blue comparative literature that uses the view from the sea to provide new axes for comparison. Roy Jacobsen&rsquo, s De usynlige (The Unseen, 2013) and Sarah Moss&rsquo, s Night Waking (2011) explore subsistence lives on small islands in the northern Atlantic at different moments in the past, when inhabitants were dependent on the sea for food and transport. By looking at them together, as texts linked by their engagement with the physical world of the northern Atlantic, the two novels show how marginal populations on small islands can represent a space for the imagination of the human past and future in the Anthropocene.

Background Sleep quality in early life has implications for individual and family well-being [19]. Parenting in the early months may be highly influential on infant sleep patterns and trajectories. Method This study used observational and survey data to investigate how sleeping arrangement and two types of nighttime interventions at one and three months (non-distress-initiated and distress-initiated) are associated with infants' sleep development across the first nine months. Distress-initiated interventions were identified as parents' responses to infants' distress signals whereas non-distress initiated interventions were identified as parents’ behaviors in response to non-distressed vocalizations or while infants were asleep. Results Analysis from 107 families revealed that infant night wakings decreased over time as expected. The link between early non-distress initiated interventions and rate of change in infant night wakings was significantly moderated by sleep arrangement such that solitary sleeping infants who experienced higher levels of non-distress-initiated interventions showed a less steep decline across time in infant night wakings compared to solitary infants who experienced low levels of non-distress-initiated interventions. Results also showed that higher levels of distress-initiated interventions at one and three months were associated with a steeper decrease in infant night wakings for both solitary and cosleeping infants. Notably, these findings were not replicated when parental interventions as predictors of infant sleep were examined at later points in the first year. Conclusions Results inform conceptualizations of parenting competence in infant sleep contexts during the first few months of life and how best to promote infant sleep regulation across the first year.

Introduction: Sleep is an integral part in a child’s health and development. During different stages of development, there are aberrations in normal physiology of sleep which make children more susceptible to various types of sleep problems. This study was conducted to identify sleep pattern and sleep problems in Nepalese children using Nepali translation of Brief Infant Sleep Questionnaire (BISQ) screening tool.Materials and Methods: This was a descriptive cross-sectional study. Data were collected from parents of children aged 6 to 36 months attending paediatric out-patient clinic for general health check-up from July 2013 to December 2013. Nepali translation of the BISQ was used as a screening tool for sleep problems in this study.Results: The study included 553 children (52.4% boys). Mothers completed the questionnaire in 92% of children. Mean total duration of sleep in 24 hours was 11.7 ±1.7 hours. Respondents reported sleep problem in 16.9% of children whereas 20.3% of children had sleep problems according to BISQ criteria. As per this criteria, 2.7% of children had total sleep duration less than 9 hours, 5.9% of children had total night awakening duration of more than one hour, 13.9% of children had night waking >3 times. These BISQ sleep parameters differed significantly in children with and without sleep problems (p

Introduction: Peak Expiratory Flows (PEFs) are an essential component of Asthma Action Plans (AAPs) and have been supported by International guidelines. However their utility in exacerbation prone, severe asthmatics has not been fully tested. Methods: Exacerbation-prone asthmatics on BTS steps 3-5 were followed over 6 months until a clinically confirmed exacerbation. Daily symptom score (wheeze, night waking, chest tightness and breathlessness; 1 point each), short-acting beta 2 agonist (SABA) usage and twice daily PEFs were recorded. The risk of exacerbation within 3 and 7 days following an index change in symptom score and PEF was calculated as an Odds Ratio (OR). Results: 24 participants experienced 15 exacerbations during the study. A 20% reduction in PEFR had an OR of 2.6 [95%CI 0.9,7.7] (sensitivity 50%, specificity 73%) for exacerbation within 3 days, and an OR of 2.0 [0.7, 6.1] within 7 days. However the positive predictive values (PPV) were only 7 and 13% respectively. The likelihood of an exacerbation was greater when a 30% reduction in peak flow occurred (OR 3.3 [1, 11.0], PPV 10%). A symptom score of 4 points gave an OR of 6.5 [95%CI 2.1,20.0] for an exacerbation in the following 3 days (p Conclusions: In Severe Asthma, a Symptom score has superior ability to predict exacerbations in the subsequent 3 and 7 days than drop in PEFR. This study was funded by an Asthma UK Foundation Grant

Objective The aim was to study, with a developmental approach, the longitudinal association between night-waking from age 2 to 5–6 years and behavior at age 5–6 years. Methods Within the French birth cohort study Etude sur les Determinants pre et post natals du developpement et de la sante de l'ENfant (EDEN), repeated measures of children's night-waking were collected at age 2, 3 and 5–6 through parental questionnaires and were used to model night-waking trajectories. Behavior was assessed with the “Strengths and Difficulties Questionnaire,” which provides five subscales measuring a child's conduct problems, emotional symptoms, peer relation problems, antisocial behavior, and hyperactivity/attention problems. The behavioral subscales were dichotomized at the tenth percentile. Multivariable logistic regressions, adjusted for parents' socio-economic factors, parental characteristics, and children's characteristics and sleep habits allowed us to study, in 1143 children, the association between night-waking trajectories from 2 to 5–6 years and behavior at age 5–6 years. Results The “2 to 5–6 rare night-waking” trajectory represented 78% of the included population (n = 896), and the “2 to 5–6 common night-waking” 22% (n = 247%). Children belonging to the “2 to 5–6 common night-waking trajectory” had, at age 5–6, increased risk of presenting emotional symptoms (odds ratio [OR] = 2.17, 95% CI = 1.27–3.70, p = 0.004), conduct problems (OR = 1.63, 95% CI = 1.00–2.65, p = 0.050), and hyperactivity/attention problems (OR = 1.61, 95% CI = 1.00–2.57, p = 0.049). After adjusting for baseline behavior at age two years, only the association with emotional symptoms remained significant (OR = 2.02, 95% CI = 1.15–3.55, p = 0.015). Results did not differ according to sex. Conclusion Results suggest that the persistence of night-waking difficulties in early years is positively associated with emotional symptoms, hyperactivity/inattention, and conduct problems.

This article presents a comprehensive review of the menthol cigarette dependence-related literature and results from an original analysis of the Total Exposure Study (TES), which included 1,100 menthol and 2,400 nonmenthol adult smokers. The substantial scientific evidence available related to age of first cigarette, age of regular use, single-item dependence indicators (smoking frequency, cigarettes per day, time to first cigarette, night waking to smoke), smoking duration, numerous validated and widely accepted measures of nicotine/cigarette dependence, and our analysis of the TES do not support that menthol smokers are more dependent than nonmenthol smokers or that menthol increases dependence.

Night-waking is common among preschool-aged children. Little is known about night-time parenting among parents of preschool-aged children. To explore night-waking strategy use in a community sample, 203 mothers (M age = 32 years, SD = 5.1; children's M age = 3.4 years, SD = 1.0) completed the Night-waking Strategy Scale (NSS) and measures of general parenting, agreement with night-waking strategies, and children's sleep. Children were grouped by age (2-, 3-, and 4-to-5-year-olds). Mothers endorsed using routines most frequently, followed by active comforting and rewards; limit-setting and punishment were used less often. NSS punishment and routines were significantly associated with parenting (e.g. laxness was correlated with NSS routines, rs = −.35 to .47, p

Aim: The aim of this study was to assess the relationship between breastfeeding and sleep patterns in infants from Asia-Pacific region. Methods: Parents of 10 321 infants (0–11 months) from Australia, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand and Vietnam completed an expanded version of the Brief Infant Sleep Questionnaire. Results: Overall, 4714 (45.72%) were currently being breastfed; 61.3% of those between 0 and 5 months and 36.6% of those between 6 and 11 months. Currently breastfed infants, when compared with not currently breastfed infants, had a significant increase in the number and duration of night-time wakings and less consolidated sleep. Interestingly, currently breastfed infants less than 6 months also showed longer duration of daytime sleep and obtained more sleep overall. Of note, of those who were currently breastfed, those infants who were nursed back to sleep during night, woke up more often at night (2.41 vs. 1.67 times) and had shorter continuous night-time sleep period (5.58 vs. 6.88 h; P < 0.001). There was no significant difference between breastfeeding and non-breastfeeding infants in the number of night wakings, when the nursing to sleep variable was controlled for in the analysis of variance. Conclusion: Breastfeeding is associated with reduced sleep consolidation in infants. This relationship, however, may be moderated by parenting practices of nursing to sleep and back to sleep during the night. Thus, parents of infants with night waking problems should be encouraged to limit the association between nursing and falling to sleep, to improve sleep while maintaining breastfeeding.

Mechanisms were examined to clarify relations between maternal depressive symptoms, dysfunctional cognitions, and infant night waking among 45 infants (1–24 months) and their mothers. A mother-driven mediational model was tested in which maternal depressive symptoms and dysfunctional cognitions about infant sleep predicted infant night waking via their impact on mothers’ bedtime and nighttime behavior with infants (from video). Two infant-driven mediational models were also examined, in which infant night waking predicted maternal depressive symptoms, or dysfunctional cognitions, via their impact on nighttime maternal behavior. Stronger support for the mother-driven model was obtained, which was further supported by qualitative observations from video-recordings. This study provides important insights about maternal depression’s effects on nighttime parenting, and how such parenting affects infant sleep.

The development of sleep–wake regulation occurs within the context of the infant–parent relationship. The present study investigated (1) patterns of change in night waking across infancy and attachment to parents and (2) if dependency, a characteristic of secure subgroup B4 and insecure-resistant infants, accounted for differences in night waking. Forty-six families reported on the number of infant night wakings at 7, 12, and 14 months of age. Attachment was measured at 12 (infant–mother) and 14 (infant–father) months. Findings suggest that infants with a secure (including the dependent-secure, B4) pattern of attachment with mothers decreased in the number of night wakings over time, whereas infants with an insecure-resistant pattern of attachment with mothers continued to wake at night into the second year. Attachment dependency did not account for differences in night waking. These findings are important to understanding the mechanism(s) underlying the relation between attachment and sleep–wake regulation. Copyright © 2012 John Wiley & Sons, Ltd.

Aim. The study aim was to compare changes in maternal confidence, competence, depression, anxiety and settling behaviours and children’s sleep and settling behaviours for mothers and infants (4–6 months of age) attending a Day Stay intervention at an early parenting centre in Western Australia and a community group. Background. Infant difficulties in getting to sleep and frequent night waking are concerns for parents. Techniques are available to assist parents with infants exhibiting behavioural sleep problems; however, parents often lack confidence to consistently initiate sleep interventions. Design. The study incorporated a prospective non-equivalent before-after design. Method. The conceptual framework guiding this intervention emphasised the development of parental confidence and competence through connection with practitioners to promote change. Both groups provided baseline data (time 1) and four weeks postbaseline (time 2). Recruitment occurred between July 2007–July 2009. Results. The Ngala group (n = 93) and community group (n = 85) were not equivalent for infant age and maternal parity; there were more multiparous mothers in the community group, with infants on average one week older. The Ngala group, the majority of which were primiparous women, had significantly higher levels of competence and confidence four weeks following their Day Stay visit. There were no significant differences between groups at time 2 for time to settle the infant at night, infant night waking and maternal depression and anxiety scores. Conclusions. Although both groups demonstrated an improvement in depression and anxiety scores, with decreased sleep and settling concerns, the results indicate parental inconsistency in settling approaches. Given links between inconsistent infant settling approaches and infants’ difficulty with sleep self-initiation, further exploration is warranted. Relevance to clinical practice. The conceptual framework guiding the Ngala practitioners was effective in developing confidence and competence for the sample.

Physical signs of old age may be obvious, but mental and cognitive changes require more careful observation. Changes in behavior may represent the earliest indications of medical problems, or disorders of the central nervous system, and these may be bidirectional. Cognitive dysfunction syndrome is underdiagnosed and affects a substantial portion of aged companion animals. This article describes potential treatment regimens to address age-related behavioral problems, as well as a framework for investigating differential diagnoses. Early identification of changes in behavior is essential for the adequate treatment and management of medical and behavioral problems, and for monitoring outcomes.

This paper is a systematic review on the reference values and changes in infant sleep–wake behaviour during the first 12 months of life. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Seventyfour papers were included, and the reference values and changes in sleep–wake behaviour during the first 12 months of life were identified. Sleep duration during the 24-h period, and day and sleep periods during the night decreased over the first 12 months of life. Night wakings and bedtime/sleep-onset time decreased, while the longest sleep period increased at night during the first 6 months. High discrepancy was noted between studies in the reference values of sleep–wake behaviour, while more congruence was noted regarding changes, especially those occurring in the first 6 months of life. Several methodological differences were identified between studies and may partially explain inconsistencies in the results, including the assessment of different sleep–wake behaviours, the focus on specific ages or age ranges, the use of selfreport, observational or direct measures, the recruitment of small or large representative samples, and the countries where the research was conducted. These aspects should be considered in future research and caution should be taken when generalizing results from studies with diverse methodological characteristics. Nonetheless, this review identifies normative reference values and the changes occurring in infant sleep–wake behaviour, and could inform both practitioners and researchers, helping them identify infants with sleep delays or problems., This research was supported by FEDER Funds through the Programa Operacional Factores de Competitividade - COMPETE and by National Funds through FCT - Fundacao para a Ciencia e a Tecnologia under the project: PTDC/SAU/SAP/116738/2010 and PhD grant SFRH/BD/113005/2015. This study was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Education and Science through national funds, and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653)., info:eu-repo/semantics/publishedVersion

The objective of this short-term longitudinal study was to examine the concurrent and prospective associations of infants' sleep arrangements and night waking with cortisol responses to an inoculation at 6 and 12 months, controlling for several key covariates. To our knowledge, this was the first study to concurrently and prospectively link proximity in sleep arrangements and night waking to physiological stress reactivity. A sample of 92 mother–infant dyads participated in the study when the infants were 6 and 12 months of age, although sample sizes were reduced for some analyses. Both proximal cosleeping arrangements and more frequent night wakings' were associated concurrently with an increased cortisol response to inoculations at both ages. Night waking at 6 months also was associated with a slightly increased cortisol response to inoculation at 12 months. Results aimed at exploring the direction of influence suggested that cosleeping and night waking may influence infant stress physiology rather than the reverse. Adaptive and maladaptive implications of infants' nocturnal experiences and greater stress-induced cortisol responses are discussed. Copyright © 2009 John Wiley & Sons, Ltd.

When treating infant sleep problems implementing treatment procedures at bedtime-only might be easier and more efficient than requiring parents to implement procedures throughout the night, but only if improvements at bedtime generalize to later in the night. This study investigated the immediate and generalized effect of treating bedtime settling problems and later night waking in infants and whether it was parent or child behavior that generalized. Parents recorded sleep problems of seven infants (6–20 months) who exhibited chronic sleep disturbance, then implemented a graduated checking procedure at bedtime-only (Setting 1). A multiple-baseline across-settings and participants design was employed. Immediate (in Setting 1) and any generalized effects (in Setting 2) on wakings and other changes in parent and child behavior were assessed by diary information and all-night infra-red video recordings. Clinically significant reductions in sleep problems were evident for five out of seven infants, but these were not consistently observed until parents generalized their use of the procedure throughout the night. There was no evidence that the infants generalized changes in self-soothing from bedtime to later. It is concluded that changes in infant sleep problems are unlikely to occur unless parents actually alter their management of the problems across all settings in which the problems occur. Copyright © 2008 John Wiley & Sons, Ltd.

SUMMARY An association was found in a sample of 59 healthy middle-class first-born babies between regular night-waking at one year old and pre- and perinatal events. The findings closely resemble those reported by Bernal (1973). The only measure of parental behaviour discriminating night wakers from regular sleepers was that mothers of wakers responded more rapidly to crying during daytime observations. However, this was shown to be a difference related to the child's obstetric history and the persistence of crying, and not directly to night waking. Rapid response to crying, and night waking itself, seem to be separate outcomes of a sub-optimal obstetric history. The evidence is that no aspect of parental behaviour yet examined produces night-waking children. RESUME Associations entre facteurs perinataux et reveil nocturne ulterieur Il a ete trouve un lien chez un echantillon de 59 nourrissons, premier-ne, en bonne sante, appartenant a la classe moyenne entre le reveil nocturne regulier a l'âge d'un an et les manifestations pre et peri-natales. Les donnees correspondent etroitement a celles qui ont ete rapportees par Bernal (1973). Une seule mesure de comportement parental differenciait les sujets se reveillant des dormeurs reguliers: les meres des nourrissons se reveillant repondaient plus rapidement aux pleurs durant les observations de jour. Cependant, cette attitude s'est revelee une difference liee a l'histoire obstetricale de l'enfant et a la persistance de ses pleurs, non directement au reveil nocturne. Une reponse rapide aux pleurs et le reveil nocturne paraissent des consequences independantes d'une anamnese obstetricale suboptimale. Il semble done qu'aucun aspect du comportement parental examine jusqu'a ce jour n'influence le reveil nocturne des enfants. ZUSAMMENFASSUNG Die Beziehung zwischen perinataler Anamnese und spateren nachtlichen Aufwachens Bei einer Gruppe von 59 gesunden erstgeborenen Kindern aus der Mittelklasse wurde eine Beziehung zwischen regelmassigen nachtlichen Aufwachens im Alter von einem Jahr und prae- und perinatalen Faktoren gefunden. Die Befunde entsprechen fast denen von Bernal (1973). Nur in einem Punkt elterlichen Verhaltens wurden die Kinder, die nachts aufwachen, von denen, die nachts durchschlafen, unterschieden—die Mutter der Aufwachkinder reagierten sehr viel schneller auf das Schreien wahrend der Beobachtungen am Tage. Jedoch zeigte sich, dass dieser Unterschied mit der geburtshilflichen Anamnese des Kindes und mit der Dauer seines Schreiens zusammenhing und nicht direkt mit dem nachtlichen Aufwachen. Rasche Reaktion auf Schreien und nachtliches Aufwachen scheinen unabhangige Ergebnisse einer nicht normalen geburtshilflichen Anamnese zu sein. Es wurde gefunden, dass keine bisher untersuchte Verhaltensweise von Eltern Kinder zum nachtlichen Aufwachen veranlasst. RESUMEN Asociacion entre factores perinatales e incontinencia nocturna posterior Se hallo una asociacion en una muestra de 59 lactantes sanos de clase media primerizos entre el despertar nocturno regular al ano de edad y los acontecimientos pre y perinatales. Los hallazgos son muy semejantes a los hallados por Bernal (1973). Solo un dato en el comportamiento de los padres discriminaba los que se despertaban durante la noche de los que dormian regularmente: Las madres de los que se despertaban respondian mas rapidamente al Ilanto durante las observaciones hechas durante el dia. Sin embargo se vio que esta diferencia estaba en relacion con la historia obstetrica del nino y la persistencia de su Ilanto y no directamente con su despertar nocturno. La respuesta rapida al Ilanto y el despertar nocturno parece que son dos acontecimientos separados de una historia obstetrica sub-optima. Se evidencia que ningun aspecto del comportamiento de los padres examinados produce el despertar nocturno de los ninos.

This study examined relations between infant night waking and both daytime behaviors reflective of poor behavioral and emotional regulation (intrinsic factors) and parent behaviors that may contribute to infant night waking (extrinsic factors) in 41 infants. Mothers completed questionnaires and an infant sleep and crying diary. More time awake at night was related to separation distress, frequent daytime crying, dysregulation, co-sleeping with parents, breast feeding, and being put to bed asleep. More frequent waking was related to separation distress, frequent daytime crying, co-sleeping, and breast feeding. The combination of intrinsic and extrinsic factors predicted night waking better than behaviors from one category alone. Implications for parenting are discussed.

Relations between night waking in infants and depressive symptoms in their mothers at 6 months postpartum were examined using the data from the National Institute for Child Health and Human Development Study of Early Child Care. Although more depressive symptoms were only weakly correlated with a higher frequency of infant waking, longer wake times, and more total time awake, the rate of clinically significant depression scores was about double in mothers of chronically waking infants in comparison with mothers whose infants did not awaken during the night. The value of comparing subgroups to elucidate relations identified through correlations is discussed.

Infancy and early childhood sleep–wake behaviours from current and retrospective parental reports were used to explore the relationship between sleeping arrangements and parent–child nighttime interactions at both time points. Children (N=45) from educated, middle-class families, mostly breastfed in infancy, composed a convenience sample that was recruited from a university preschool in the Northeast US. Parents responded to the Sleep Habits Inventory, a 19-item Likert-style inventory measuring sleep-related behaviours during the last week, and the Sleeping Arrangements Questionnaire, a 30-question, open-ended, short-answer-style instrument which queries both retrospective infancy and current sleep location, bedtime routine, night waking and parent–child interactions during the sleep period. Co-sleeping in early childhood was associated with sleep location in infancy (i.e. proximity to the mother's bed) during wake–sleep transitions and night feedings. Security object use during infancy was inversely related to early childhood co-sleeping (calling for the parents, night waking, poor bedtime routine and fear of the dark). Results showed that early childhood co-sleeping in this sample was reactive, i.e. associated with current parent-seeking, night waking and social contact during wake–sleep transitions. These findings suggest that co-sleeping in early childhood is related to social experiences during infancy, particularly the amount of parent social contact and security object use. Copyright © 2007 John Wiley & Sons, Ltd.

Behavioural family interventions, alone or in combination with sedative medication, have been shown to be effective treatments for infant sleep disturbance (ISD), especially night waking and crying...

OBJECTIVE. Western parents are given conflicting advice about whether to introduce a “scheduled” approach to infant care or to follow their infants' demands. Attempts to address this issue using randomized, controlled trials have been unsuccessful. This comparative study collected evidence about methods of parenting and associated infant crying and sleeping in 2 communities with substantially different approaches to infant care (London, United Kingdom, and Copenhagen, Denmark) and in a “proximal care” group, where parents planned to hold their infants ≥80% of the time between 8 am and 8 pm, breastfeed frequently, and respond rapidly to infant cries.METHODS. Validated behavior diaries were used to measure parental behavior and infant crying and night waking longitudinally at 8 to 14 days, 5 to 6 weeks, and 10 to 14 weeks of age. Feeding and sleeping practices were measured by questionnaire.RESULTS. Proximal care parents held infants for 15 to 16 hours per 24 hours and coslept with them through the night more often than other groups. London parents had 50% less physical contact with their infants than proximal care parents, including less contact when the infants were crying and when awake and settled. London parents also abandoned breastfeeding earlier than other groups. Copenhagen parents fell in between the other groups in measures of contact and care. These differences in caregiving were associated with substantial differences in several aspects of infant crying and settled behavior at night. London infants cried 50% more overall than infants in both other groups at 2 and 5 weeks of age. However, bouts of unsoothable crying occurred in all 3 of the groups, and the groups did not differ in unsoothable bouts or in colicky crying at 5 weeks of age. Proximal care infants woke and cried at night most often at 12 weeks. Compared with proximal care infants, Copenhagen infants cried as little per 24 hours, but woke and cried at night less often at 12 weeks of age.CONCLUSIONS. “Infant-demand” care and conventional Western care, as practiced by London parents, are associated with different benefits and costs. As used by proximal care and Copenhagen parents, infant demand parenting is associated with less overall crying per 24 hours. However, the proximal form of infant-demand parenting is associated with more frequent night waking and crying at 12 weeks of age. Copenhagen infants cry as little per 24 hours as proximal care infants but are settled at night like London infants at 12 weeks of age. Colicky crying bouts at 5 weeks of age are unaffected by care. The findings have implications for public health care policy. First, they add to evidence that bouts of unsoothable crying, which are common in early infancy, are not much affected by variations in parenting, providing reassurance that this aspect of infant crying is not parents' fault. Second, the findings provide information that professionals can give to parents to help them to make choices about infant care. Third, the findings support some experts' concerns that many English parents are adopting methods of care that lead to increased crying in their infants. There is a need for informed debate among professionals, policy makers, and parents about the social and cultural bases for the marked differences between London and Copenhagen parents' approach to care.

Asthma continues to cause increasing morbidity and mortality among young adults in the developing world. There is scarcity of data on the prevalence of asthma among young Nigerian adults.We studied the prevalence of asthma among students (15-35 years of age) of the Obafemi Awolowo University using a standardized questionnaire. One thousand self-administered questionnaires were distributed; 903 were retrieved and analyzed (469 males, 434 females). Symptoms indicative of asthma were cough, chest tightness at rest and on exposure to irritants, and the presence of nocturnal symptoms. Students with three or more symptoms or who had a diagnosis of asthma were considered probable asthmatics and those with one or two symptoms as suspected asthmatics. Students in any of these two categories were defined as symptomatic respondents.The 12-month prevalence of wheeze, night waking with cough, and chest tightness in the morning was 9.0% (n = 81) 9.4% (n = 85) and 8.0% (n = 72), respectively. One hundred and twenty-seven respondents (14.1%) comprising 49 males (10.4%) and 78 females (17.9%) had probable asthma. The remaining symptomatic respondents consisting of 20 males (4.3%) and 16 females (3.9%) had suspected asthma. Of these, only 32.5% (53/163) had been previously diagnosed and 22.1% were on occasional inhaled bronchodilator treatment.These results indicate a relatively high prevalence of asthma among the students. A greater proportion of them had not been diagnosed and were not receiving proper treatment.

“Craig,” a 13-year-old biracial male, presented for treatment with primary nocturnal enuresis. Historical information indicated a history of treatment failure with various psychological interventions. In the current case analysis, a “successful” intervention for the client’s presenting complaint is documented and discussed. On the basis of the client’s expressed wishes, graduated night waking was utilized as an intervention, despite the fact that he was informed of other treatments that were more likely to be successful (i.e., the urine alarm). This case highlights the importance of collaborative treatment planning, particularly with an adolescent with a history of conflicts with authority figures. Also, the case is discussed in terms of identifying markers of success that are “client-centered.”

The purpose of this study Was to investigate behavioral interventions designed to reduce sleep difficulties in four young children With developmental disorders. Positive bedtime routines and sleep restriction Were successful in eliminating bedtime disturbances and nighttime aWakenings in four children With significant sleep problems. Positive bedtime routines included activities such as taking a bath, changing into pajamas, and reading a story. Sleep restriction involved reducing the number of hours each child slept While maintaining a consistent bedtime and Wake-up time. Positive bedtime routines and sleep restriction also resulted in improved parental satisfaction With the child's behavior at bedtime, the child's sleep pattern, and the time it takes to put the child to bed at night.

Clinicians are commonly consulted by the parents of infants aged 6–24 months who are distressed by their infant's sleep disturbance. Infant sleep disturbance (ISD) presents as frequent night awakening, delays in sleep onset and co-sleeping that is not of the parents’ choice. Conflicting advice leaves parents unsure regarding management. Recent research has described treatment approaches as well as models describing the complexity of variables that appear to control ISD. In this article, we describe the learning principles underlying the development of ISD and summarize empirically validated treatments. Practitioners are advised on the importance of appropriate assessment and support, as well as on suggestions they can make about prevention.

Purpose: This study was conducted to examine the contribution of inadequate sleep and its associated factors, on behavior and cooperation of children in the dental operatory. Materials and Methods: A cross-sectional study was conducted on 100 healthy children at the time of their initial visit to the dental hospital, ranging from preschoolers to adolescents. Data acquisition was done by a questionnaire. Interview with the accompanying person was done to ask about the sleep duration, naps, and sleep habits of the child. Children's behavior during their preliminary examination was studied and categorized according to Frankl's behavior rating scale. Data were analyzed by linear regression analysis and Spearman's correlation with the aid of SPSS 16.0 software. Results: Total duration of sleep accounted for a small but significant contribution in behavioral problems of children. Significant correlation was found between duration of sleep and cooperative behavior in dental operatory (R = 0.478). However, the duration of sleep was negatively correlated to the number of siblings and socioeconomic status of the family. Conclusion: Children who had shorter total sleep duration had increased behavioral problems in dental operatory.