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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.

BACKGROUND Teaching caregivers to respond to normal infant night awakenings in ways other than feeding is a common obesity prevention effort. Models can simulate caregiver feeding behavior while controlling for variables that are difficult to manipulate or measure in real life. METHODS We developed a virtual infant model representing an infant with an embedded metabolism and his/her daily sleep, awakenings, and feeds from their caregiver each day as the infant aged from 6 to 12 months (recommended age to introduce solids). We then simulated different night feeding interventions and their impact on infant body mass index (BMI). RESULTS Reducing the likelihood of feeding during normal night wakings from 79% to 50% to 10% lowered infant BMI from the 84th to the 75th to the 62nd percentile by 12 months, respectively, among caregivers who did not adaptively feed (e.g., adjust portion sizes of solid foods with infant growth). Among caregivers who adaptively feed, all scenarios resulted in relatively stable BMI percentiles, and progressively reducing feeding probability by 10% each month showed the least fluctuations. CONCLUSIONS Reducing night feeding has the potential to impact infant BMI, (e.g., 10% lower probability can reduce BMI by 20 percentile points) especially among caregivers who do not adaptively feed. IMPACT Teaching caregivers to respond to infant night waking with other soothing behaviors besides feeding has the potential to reduce infant BMI. When reducing the likelihood of feeding during night wakings from 79% to 50% to 10%, infants dropped from the 84th BMI percentile to the 75th to the 62nd by 12 months, respectively, among caregivers who do not adaptively feed. Night-feeding interventions have a greater impact when caregivers do not adaptively feed their infant based on their growth compared to caregivers who do adaptively feed. Night-feeding interventions should be one of the several tools in a multi-component intervention for childhood obesity prevention.

Objective To investigate the association between night waking frequency in 3- to 4-month-old infants and mothers' response to them. Design Cross-sectional survey. Sample We examined 663 mothers of infants aged 3-5 months who attended regular health checks for 4 months at 7 public health centres in Japan between September 2006 and March 2007. Measurements Mother-reported questionnaires were used, measuring the frequency of infants' night waking and four types of responses by mothers. Using multiple regression, the association between number of wakings and each response was evaluated adjusting for covariates, that is mother's (e.g. feelings of worry and bed-sharing) and infant's (e.g. age and sex) demographic variables. Results The number of wakings was related to "immediately feeding and/or checking diapers" (β = 0.16, p = .002).This response to infants' night waking may be associated with night waking frequency. Conclusion Modifying caregiver responses to infants' night waking by reducing immediate feeding or diaper checks could improve infants' night waking frequency.

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.

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.

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.

Objective: Crying and unsettled behavior in infancy is common. Prolonged disturbed infant sleep can have significant negative effects on the development of the child, and on the psychological well-being of the mother. Compared to studies examining the effects of behavioral sleep programs such as extinctionbased techniques in infants over 6 months of age, fewer studies have looked at such strategies in infants under 6 months of age. The aim of this article is to summarize the literature examining the effects of behavioral techniques on infant sleep outcomes in the first 6 months of life and provide evidence based recommendations for the management of infant sleep disturbance. Method: An electronic search of the literature was performed to identify studies which examined the effects of a behavioral intervention aimed at improving sleep in infants under 6 months of age. Results: Eleven studies were identified, of which 8 demonstrated improvements in infant sleep outcomes subsequent to the implementation of an educational behavioral program. Conclusion: Education directed to parents about the use of simple, prescriptive, behavioral techniques is effective in improving infant sleep. Long term follow-up studies have failed to find any negative effects on the child, either from a psychological or physical perspective. Refereed/Peer-reviewed

OBJECTIVE: Coffee and other caffeinated beverages are commonly consumed in pregnancy. In adults, caffeine may interfere with sleep onset and have a dose-response effect similar to those seen during insomnia. In infancy, nighttime waking is a common event. With this study, we aimed to investigate if maternal caffeine consumption during pregnancy and lactation leads to frequent nocturnal awakening among infants at 3 months of age. METHODS: All children born in the city of Pelotas, Brazil, during 2004 were enrolled on a cohort study. Mothers were interviewed at delivery and after 3 months to obtain information on caffeine drinking consumption, sociodemographic, reproductive, and behavioral characteristics. Infant sleeping pattern in the previous 15 days was obtained from a subsample. Night waking was defined as an episode of infant arousal that woke the parents during nighttime. Multivariable analysis was performed by using Poisson regression. RESULTS: The subsample included 885 of the 4231 infants born in 2004. All but 1 mother consumed caffeine in pregnancy. Nearly 20% were heavy consumers (≥300 mg/day) during pregnancy and 14.3% at 3 months postpartum. Prevalence of frequent nighttime awakeners (>3 episodes per night) was 13.8% (95% confidence interval: 11.5%–16.0%). The highest prevalence ratio was observed among breastfed infants from mothers consuming ≥300 mg/day during the whole pregnancy and in the postpartum period (1.65; 95% confidence interval: 0.86–3.17) but at a nonsignificant level. CONCLUSIONS: Caffeine consumption during pregnancy and by nursing mothers seems not to have consequences on sleep of infants at the age of 3 months.

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

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.

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.

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.

AimTo determine whether levels of daytime physical activity are associated with sleep duration and night waking in children assessed using accelerometry, and if these associations change over time.Methods24-hour accelerometry data were obtained from 234 children at 3, 5 and 7 years of age for at least 5 days at each time. Sleep duration was estimated using the Sadeh algorithm. Time spent in sedentary, light and moderate-vigorous (MVPA) activity was established using published cut-points. Appropriate statistical techniques were utilised to account for the closed nature of the data (24-hour periods).ResultsTime spent asleep was related more to sedentary or light activity and not to MVPA. The most active (95th percentile) children spent 55-84 fewer minutes asleep and 16-19 more minutes awake at night compared to the least active (5th percentile) children. Children with later bedtimes slept less at night (30-40 minutes) and undertook more sedentary (10-15 minutes) but also more light (18-23 minutes) activity during the day. However, no differences in MVPA were apparent according to bedtime. Children slept slightly less on weekend nights (11 minutes) compared with week-nights, but only at 3 years of age. Most relationships were broadly similar at 3, 5 and 7 years of age.ConclusionChildren who are more physically active during the day have shorter total sleep time and are more awake at night than less active children. The protective effect of sleep on obesity does not appear to be mediated by increased physical activity.

Item does not contain fulltext Objective: Night wakings are common in infancy. Although a link between infant night wakings and attachment to the primary caregiver has been previously proposed, empirical support is limited so far. The aim of this longitudinal study was to examine the early history of night waking in infants who were later classified as securely or insecurely (avoidantly, resistantly, or disorganized) attached. Methods: Participants in the study were 193 infants and their mothers. Information on infant night wakings was collected with the use of daily sleep diaries for the first 6 months of life and again for 2 weeks at 12 months of age. Infant-mother attachment was assessed using the Strange Situation (Ainsworth et al, Patterns of Attachment: A Psychological Study of the Strange Situation. New York: Hillsdale; 1978) when the infants were 12 months of age. Results: Longitudinal regression analyses showed that, after controlling for many covariates, infants with an insecure-resistant attachment at 12 months of age awoke more during the night in their first 6 months of life than the other infants. Furthermore, infants with different attachment classifications developed different patterns of night wakings over the first 6 months, with the insecure-avoidant infants waking the least toward the end of the 6 months. Hierarchical multiple regression analyses showed no associations between attachment and night wakings at 12 months of age. Conclusion: This study is the first in showing that attachment at 12 months of age is related to infant night waking patterns in the first 6 months of life. Patterns of infant night wakings early in life apparently reflect the emerging attachment relationship. 19 p.

Sleep problems are very prevalent during infancy. The most common problems are those related to night wakings and sleep-disordered breathing (SDB). Most common night waking problems do not have identified physiologic etiology. Their causes appear to be behavioral or developmental by nature, and they usually respond well to behavioral interventions. SDB may result from a variety of anatomic and neurologic factors and is associated with a variety of medical and developmental disorders. Because of the high prevalence of sleep problems during infancy, their persistence, their potential adverse developmental effects, and the positive treatment outcomes, pediatricians should serve as the primary address for screening and referral to proper assessment and treatment.

Summary A longitudinal study of the development of sleep patterns addressed the issue of continuity and change in night waking in the course of the first year. Mothers of 118 infants, who took part in a follow-up study of normal babies, completed a sleep questionnaire at 3, 6, 9 and 12 months. Regular night waking was a common characteristic throughout the first year (46% at 3 months, 39%, 58% and 55% respectively at 6, 9 and 12 months). The number of awakenings per night was a function of age. Following a decline in the number of interruptions from 3 to 6 months, an increase in night waking at age 9 months was recorded. Although the methodology does not lend itself to an objective validation of the changes in sleep–wake states, nor is it suitable for causal explanations, it is, nevertheless, important to note this profile. The increase in night waking towards the end of the first year coincides with significant socio-emotional advances which characterize this developmental stage.

The sleeping patterns of 874 infants aged 1-12 months were recorded by parents over a 6 day period. The most striking feature of the results was the wide range in total hours slept by infants of the same age, for example, the average total sleeping time per 24 h period for 4 month old infants was 14.8 h with a range of 11.0-19.3 h. Furthermore, over the 6 day period, individual infants showed wide variations in their sleeping times with a range as great as 12 h. Despite these wide variations, several clear trends emerged: from 1 to 8 months, a decrease with age of the average number of hours slept per 24 h period; and from 8 to 12 months, and a continuing shift towards a dominance of night over day sleep. The frequency of night wakings was, on average, 77%, a finding that contrasted sharply with parental perception of frequency of night waking; the transition from bassinet/carrycot to cot was most common between 3 and 4 months of age; 25% of babies slept with the light on, 9% used a dummy, and 37% sucked their fingers; first-born infants woke significantly less often at night than those with one or more sibling. These results provide an important comparative data set on the sleep patterns of infants.

This quasi-experimental one-group pre- and posttest pilot study evaluated an intervention aimed at reducing night waking and signaling for infants between 6 and 12 months of age. Thirty-nine healthy infants and their parents were recruited. Thirty-five infants completed the intervention and data collection. Both parents participated in a group teaching session with telephone follow-up for 2 weeks. Actigraphy and sleep diary data were collected at baseline and 6 and 16 weeks postintervention. We hypothesized a decrease in length and number of infant waking and crying periods and an increase in longest night sleep and nap time. Following the intervention, infants had significantly reduced length of night crying and number of wakes and longer night sleep periods. The intervention warrants evaluation with a randomized controlled design.

For the purpose of evaluating the association between health problems and sleep disturbances as part of a community survey of sleep patterns in childhood, a questionnaire was administered to 752 mothers of children between the ages of 4 months and 4 years, and to the nurses at their regular baby clinics. The questionnaire covered the areas of past and present sleep and settling behaviour, as well as health history and demographic data. The study group consisted of 66 (8.9%) children who had either chronic medical problems, or history of an illness requiring hospitalisation. Regular night waking was reported in 35% and 34% of the group with and without history of illness, respectively. The mean number of interrupted nights per week was similar in both groups and so were the sleep problems perceived by the mothers. We conclude that in this age group the results do not support an association between health problems and prolonged sleep disturbances.

Sleep regulation was examined from a mother–child relational perspective. Although the link between sleep and attachment has been previously discussed, empirical support is rather limited. This report, which is a part of a longitudinal investigation of sleep in infancy, examines the association between the child's sleep pattern and mother–infant attachment in 94 mother–infant dyads. At 12 months each dyad participated in the Strange Situation procedure; 77% were securely attached. Mothers' description of the infant's fussiness was not found to predict the attachment pattern, but was associated with the sleep habits. It was found that 55% of the secure and 60% of the ambivalent children were described as night wakers. To a sub-group of 37 infants, a sleep monitor (actigraph) was provided for two nights' recordings. The frequency of the objective awakenings was higher than what mothers reported but similar for the secure and insecure infants. The findings confirm that night waking at the end of the first year is a common developmental phenomenon. Among this group of non-risk infants, sleep characteristics were only marginally associated with the quality of the child's attachment relationship. © 2001 John Wiley & Sons, Inc. Dev Psychobiol 38: 274–285, 2001

A study of 100 young children referred to a Crying Baby Clinic for repeated waking at night yielded a less than expected incidence of “easy” temperaments and a greater number of “difficult” temperaments in the children.

A statistical study was made of reported night-waking in a national cohort of British 5-year-olds in order to explore long-term associations with physical, behavioural and mental development. After adjusting for the most likely confounders, reported night-waking al five was found to be linked at 10 years of age to certain chronic medical conditions and some symptoms of emotional distress. No convincing relationships existed between night-waking at five and selected measures of later physical development or intellectual ability.

Summary.-A retrospective follow-up study of 68 adolescents treated for night waking when infants or toddlers showed that 82% of them were described by their parents as currently sleeping "well," and only two continued to experience a nightwaking ddficulty. Night waking is one of the most common behavior problems exhibited by infants and toddlers. Estimates of night waking are 30% of infants 6 to 14 months of age and slightly less for toddlers ages 15 to 27 months (Bernal, 1973; Rchman, 1981). Persistent night walung by a child can have serious adverse effects on the physical and psychological health of the child and parents. Fortunately, behavioral interventions have been effective in reducing or eluninating the night walungs in the majority of the children (Schaefer, 1987; Schaefer & Petronko, 1987), and the improvements tend to be stable over a 6-mo. period (Schaefer, 1990). Parents of infants who wake at night often express the concern that this behavior foreshadows sleep disturbances later in Me. The purpose of the present study was to examine whether chddren who displayed night walung during early childhood continued to experience sleep difficulty as teenagers. Method.-The subjects were 170 children treated by the author during 1986 to 1988 at Fairleigh Dickmson University's Crying Baby Clinic. The children were all Euro-Americans from middle- to upper-middle class backgrounds. They were between the ages of 6 mo. and 3 yr. (mean age of 18 mo.) at referral for night wakmg. Of the san~ple, 56% were boys. All of the children met the standard definition of night walung: child awakened and cried for more than a few minutes and disturbed his parents, and these awakenings occurred three or more times weekly for at least four consecutive weeks (Moore & Ucko, 1957; Richrnan, 1981). In January 2000, the parents of these children were mailed a brief questionnaire which contained three questions: How well is your child currently sleeping (well, fair, poorly); Does your child have any sleep ddficulty or unusual sleep pattern (describe); and Has your child ever been diagnosed with a physical or mental health problem?

A national sample of 1500 mothers of 1-year-old children received a postal questionnaire concerned with the sleeping patterns of their children. The response rate was 69%. Seventeen per cent of mothers reported that their 1-year-old presented a moderate or severe sleep problem and 26% said their child woke at night on at least five nights a week. While these two measures correlated, 10% of those who reported their infant woke on at least five nights a week did not consider this to be a problem. Neither sex of infant, social class, method of infant feeding or numbers of house moves were associated with sleep problems. The pattern of results strongly suggest an association between night waking and other sleeping difficulties and stress for mothers. This was indicated by the association we found with complaints about housing, overcrowding, more negative attitudes toward motherhood, lower assessments of maternal well-being, lack of practical support from partners, the use of more negative adjectives to describe their baby and more frequent feelings of being dominated by their baby. While these associations may be explained by the stresses of living with a night-waking baby, it is also likely that a mother who is feeling somewhat depressed and negative toward her baby is more likely to see night waking as significant and as a problem. There were class differences in how parents coped with a shortage of space. Middle-class parents were more likely to put a baby in with a sibling while working class parents more often had the baby in their own room. Middle-class parents were more likely to leave a night-waking baby to cry.

The crying, feeding and sleeping patterns of 270 infants 0-12 months old were studied using a 24-hour schedule included in a questionnaire given to mothers visiting four well-baby clinics in Finland in 1987-88. Of these infants 78 were under 3, 84 were 3-5, 65 were 6-8 and 43 were over 9 months old. The results showed that the infants less than 3 months old slept on average 15.2 hours per day, whereas those over 9 months slept 13.4 hours. The sleeping periods were longer at night. Continuous night-time sleep for at least 6 hours was noted in 35% of the infants under 3 months old and the proportion increased to 72% by the age of 9-12 months. The youngest infants were fed on average 6-7 times per day at 2- to 3-hour intervals in the daytime and at 4- to 6-hour intervals at night. The number of feedings decreased slightly with age. The average total crying time decreased from 1.6 hours per day for the youngest group to 1.1 hours for the 9-12 months old. At the time of the study, 23 mothers felt the need for help because of excessive crying or night waking. The help needed ranged from information about colic and child care, help with housework or the baby and encouragement. Of the mothers who needed help, a significantly higher proportion had a first-born baby compared with those not in need of help. There were also significant differences in the mothers' perception of the cry and feelings towards it.

Night waking and crying are very common in infancy and can cause problems for parents and families. This study surveyed 218 healthy Korean infants from 3 months to 2 years old to determine their night waking and crying patterns. On average, 83% awoke and 28% cried more than once per night. Ninety-eight percent of the babies slept with a member of the family. Infants with transitional objects or nighttime habits (e.g., finger sucking, touching and/or playing with mother's or own hair, touching a part of mother's or own body) cried more frequently. In terms of the maternal response toward the crying babies, most of the mothers used traditional methods, such as patting/holding, feeding, changing diapers. Only one mother ignored the crying baby, and none used medication, delayed response, or white noise. Sixteen percent of the mothers indicated that their babies' crying constituted a problem for them. J Dev Behav Pediatr 13:326–330, 1992 Index terms: night waking, crying, Korean infants.

Parents report two common problems about their child's sleep in the early years of life. The first is difficulty in getting the child to go to bed, although subsequently he sleeps on through the night. The second is the problem of the child who goes to bed but then wakes during the night. The two, of course, often co-exist, but I am going to concentrate on the second problem, which is usually the more serious. By night waking I mean not only that the child wakes?everybody wakes up at night?but that the child wakes and then wakes up the family.

Parental reports of night waking and sleep patterns were obtained for 141 normal 4- to 8-month-old infants from middle-class families. A group of infants was identified who had a past history of colic and who were perceived to have a current night waking “problem”. These infants awoke more often than other infants and also had significantly briefer total sleep duration. Night waking was described as a problem in infant boys more often than in infant girls. A second group of infants who awoke frequently was reported to snore or mouth breathe when asleep. This group of infants did not have a past history of colic, was not perceived to have a night waking problem, and was not overly represented by boys. Ordinal position, father's education level, gender, and method of feeding did not affect reported sleep patterns.

Among 320 low birthweight infants seen at nine months post term those using a soft object, thumb, or fingers as comforter were significantly less likely to wake at night (9/96, 9%) than those with no comforter or using a dummy (66/224, 29%). Dummy users were as likely to wake (27/93, 29%) as those without a comforter (39/131, 30%).

In a randomly selected series of 60 infants in a single private practice, 15 (25 per cent) had the sleep disturbance of night waking between 6 and 12 months of age. There was a significant correlation (p

Sleep problems, such as night waking and bedtime struggles, occur in 20% to 30% of toddlers and preschool-aged children. The management of disturbing sleep behavior is optimized by understanding the physiology of sleep, developmental considerations, and the care-giving environment. Recent research indicates the availability of a variety of effective interventions other than letting children "cry it out." A sleep record is an invaluable tool in designing and implementing an individualized treatment program. Such a program often entails using behavioral techniques in conjunction with understanding normal sleep patterns, parental responses that inadvertently reinforce an undesired sleep behavior, temperamental characteristics of the child, separation and autonomy issues, and parental anxieties. The studies reviewed suggest that effectve intervention is feasible within the constraints of pediatric practice.

Regular night waking of young children is one of the most common problems encountered by parents. This study compared a standardized night waking programme that involved organized bedtime routines, procedures for settling the child and for the handling of crying, calling out and getting out of bed, with a group which received written information only and a waiting list control group. The children receiving the standard programme and those receiving written information only showed significant improvement over children in the waiting list group. This result supports the use of written parent instructions with or without therapist support.

Questionnaires about infant sleep patterns were sent by mail to a random sample of the families of 1,158 1− to 2-year-olds. Returned questionnaires (67%) indicated that 20% of the children woke five or more times a week. Characteristics of 55 children with severe waking problems and their families were compared with 30 nonwaking controls. The wakers more commonly had other behavior and temperamental difficulties, irritability in the early months, and an adverse perinatal history. Their families had more stress and their mothers were more likely to have psychiatric symptoms. The role of various factors in the genesis and maintenance of sleep disruptions is discussed.

SUMMARY Sleep problems had developed at one year in 24 of a sample of 77 babies studied in Cambridge, England. The problem babies slept for shorter periods and woke regularly. There was no relationship between sleep problems and sex, birth order or social class. There was a suggestion that the development of sleep problems might be related to length of labour and the state of the baby at delivery. The problem group were more wakeful and irritable during the first 10 days of life. At 8, 14, 20 and 30 weeks, the problem group showed a continuing pattern of shorter sleep bouts at night. The role of parental handling in the development of sleep problems is discussed; while there was no pattern of care common to all mothers of the problem infants, the majority were very responsive. There was no evidence that feeding when the infant awoke at night was related to the problem of waking. ZUSAMMENFASSUNG Nachtliches Erwachen in den ersten 14 Lebensmonaten Bei einer Gruppe von Sauglingen, die in Cambridge, England, beobachtet wurden, gab es bei 24 Kindern im Alter von 1 Jahr Schlafstorungen. Das Problem bestand in verkurzten Schlafperioden und regelmasigem Aufwachen. Es gab keine Zusammenhange zwischen den Schlafstorungen und dem Geschlecht, der Stellung in der Geschwisterreihe oder der sozialen Schicht. Es wurde vermutet, das eine Beziehung zwischen Schlafstorungen und der Geburtsdauer sowie dem Zustand des Babies bei der Geburt bestand. Ferner war die schlafgestorte Gruppe wahrend der ersten 10 Lebenstage haufiger wach und leichter erregbar. Mit 8, 14, 20 und 30 Wochen zeigte die Problemgruppe eine zunehmende Verkurzung der nachtlichen Schlafperioden. Die Rolle der elterlichen Fursorge im Zusammenhang mit der Entwicklung von Schlafstorungen wurde diskutiert, jedoch wurde bei Muttern mit Problemkiadern keine gemeinsame Eigenheit festgestellt; die Mehrheit war sehr temperamentvoll. Es ergab sich kein Anhalt fur die Annahme, das das Futtern der Kinder wahrend des nachtlichen Aufwachens in Zusammenhang mit den Schlafstorungen stehen konnte. RESUMEN Despertar nocturno en los primeros 14 meses de vida Problemas del sueno se desarrollaron al ano de edad en 24 de una muestra de 77 ninos estudiados en Cambridge (Inglaterra). Los ninos problema dormian durante periodos mas cortos y despertaban regularmente. No habia relacion entre los problemas del sueno o el sexo, orden de nacimiento o clase social. Se sugirio que el desarrollo de problemas del sueno podria estar relacionado con la duracion del parto y el estado del nino en el mismo, ya que el grupo problema se despertaba mas y era mas irritable durante los 10 primeros dias de la vida. A las 8, 14, 20 y 30 semanas el grupo problema mostraba un esquema continuo de pequenos periodos de sueno durante la noche. Se discute el papel de los padres en el desarrollo de problemas del sueno, no habiendo un esquema comun de cuidados en las madres de los ninos problema siendo la mayoria muy responsables. No habia evidencia de que el alimentar al nino al despertarse durante la noche, tuviera relacion con el problema del despertar.