Search

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.

This paper reports on a study of the prevalence and social correlates of dyssomnias, features associated with obstructive sleep apnoea, and parasomnias in primary school children aged 4-12. Head teachers of schools selected randomly from lists of local primary and special schools were contacted by telephone and asked to distribute a questionnaire package to the parents of all pupils aged 4-12 years. In all, 890 parents of children from mainstream schools and 300 from special schools were approached. The response rates were 64.7% and 60%, respectively. The results showed that significantly higher proportions of children in special schools than in mainstream schools presented four of the five dyssomnias investigated and all of the features associated with obstructive sleep apnoea. In contrast, only two of the seven parasomnias were presented by higher proportions of the children in special schools. Age and gender differences for the two groups of children are presented. Finally, multiple correlations were computed between a range of child, family, and environmental characteristics and the three problems most frequently reported: frequency of settling problems; sleeping in the parents' bed; and night waking. The findings are discussed with reference to other studies of children's sleep problems, and the implications for treatment are considered.

OBJECTIVE: To assess the efficacy of treatment of settling problems and night waking in young children. DESIGN: A systematic review of randomized controlled trials of interventions. SETTING: Electronic bibliographic databases and references on identified papers, hand searches, and personal contact with specialists. SUBJECTS: Children aged 5 years or younger who had established settling problems or night waking. INTERVENTIONS: Interventions had to be described and a placebo, waiting list, or another intervention needed to have been used as a comparison. Interventions comprised drug trials or nondrug trials. Main outcome measures Number of wakes at night, time to settle, or number of nights in which these problems occurred. RESULTS: Drugs seemed to be effective in treating night waking in the short term, but long-term efficacy was questionable. In contrast, specific behavioral interventions showed both short-term efficacy and possible longer term effects for dealing with settling problems and night walking. CONCLUSIONS: Given the prevalence and persistence of childhood sleep problems and the effects they can have no children and families, treatments that offer long-lasting benefits are more appealing, and these are likely to be behavioral interventions.

The relationships between aspects of parenting and infants' sleep patterns were studied longitudinally with 81 mother-child pairs. Mothers' parenting orientation at 6 months was defined using the Facilitator-Regulator distinction. When the infants were 12 months old, mother and child participated in a laboratory-based developmental assessment which involved a brief separation episode. Upon reunion, mothers reported on their concerns during separation; they also described their child's sleep. It was found that high maternal separation anxiety was related to night waking. In addition, night waking was more frequent among first born babies of Facilitators compared with Regulators. How maternal separation anxiety and care-giving orientation regulate aspects of the child's sleep awaits further explanation.

Bedtime resistance and night waking are common sleep problems throughout childhood, especially in the early years. These sleep problems may lead to difficulties in neurobehavioral functioning, but most research into childhood sleep problems has not emphasized the importance of the developmental context in which disruptions in neurobehavioral and daytime functioning occur. We review the development of sleep as well as executive functioning (EF) in childhood and suggest that EF may be particularly vulnerable to the effects of these common childhood sleep problems because of its prolonged course of maturation. Behavioral problems associated with common sleep problems suggest poor self-regulation in the context of sleep loss, and developing EF skills play important roles in self-regulation. A research agenda that considers a developmental approach to sleep and sleep problems in the context of childhood EF performance is outlined to promote future research in this area. Citation: Turnbull K; Reid GJ; Morton JB. Behavioral sleep problems and their potential impact on developing executive function in children. SLEEP 2013;36(7):1077-1084.

A parents’ questionnaire was used to assess sleep disorders (night waking, settling problems) in 265 visually impaired and 67 nondisabled 10‐ to 72‐month‐olds. Results showed that multiple handicapped blind children (n=57), blind children with no additional impairments (n=56), and multiple handicapped partially sighted children (n=71) more frequently had difficulties in falling asleep (more than once a week) and in sleeping through the night (night waking more than once per week and taking more than 5‐10 minutes to get back to sleep) than nonhandicapped children (n=67), whereas the frequency of sleep disorders (night waking, settling problems) in partially sighted children with no additional neurological or physical impairments (n=81) did not differ from that of nonhandicapped controls. The results indicated relationships between sleep disorders and the regularity of children's daily routines and activities in the evening before going to bed, as well as the children's sleeping habits.

The co-morbidity of crying, feeding and sleeping problems at 5 months of age was investigated in a representative sample of 432 infants in South Germany. A crying, sleeping or feeding problem was reported in 32.7% of these infants by their parents and a further 14.6% had two or more of these problems. Little co-morbidity between crying and feeding problems was found. There were moderate to strong associations between crying and sleeping behaviours. Feeding problems showed little relationship to sleeping behaviour, but feeding type and frequency of feeds were related to night waking. Breastfed infants woke much more often at night. Crying and feeding problems at 5 months were poor predictors of sleeping behaviour at 20 or 56 months of age. Later sleeping behaviour was best predicted by infant sleeping behaviour. At 56 months, maternal distress due to sleeping and co-sleeping practices was predicted by maternal distress due to crying and feeding practices at 5 months of age. The predictions were significant but generally weak to modest in strength. Future studies on the consequences of crying or feeding problems should take into account patterns of co-morbidity. So-called ‘post-colicky’ sleep problems are not due to increased crying per se but rather appear to be the consequence of associated infant sleeping problems and parental caretaking patterns for dealing with night waking in infancy.

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.

Publisher Summary Bedtime problems and night waking, typically involve inappropriate sleep associations and/or limit-setting problems, in young children (ages 6 months to 5 years). Frequent night wakings are the hallmark symptom of behavioral insomnia of childhood–sleep onset association type (BIC–SOA), typically seen in children older than 6 months. BIC–SOA is caused by negative sleep associations that interfere with falling asleep at bedtime and returning to sleep independently throughout the night. BIC–limit-setting type is typically manifested as avoidance of bedtime, frequent requests after lights out, as well as refusal to get into bed, to stay in bed, or to participate in the bedtime routine. Finally, BIC–combined type occurs when a child has features of both SOA and limit-setting subtypes, often with difficulties limit setting leading to the development of negative sleep associations. Bedtime problems and night waking are highly prevalent with studies indicating that 20–30 percent of young children experience these sleep problems. Such problems can result in significant sleep loss in young children, which can impact all aspects of a child's well being and daytime functioning. In addition to the impact on the child, these sleep problems also negatively impact families, with sleep problems placing a significant burden on parents and the parent–child relationship.

Publisher Summary A number of components of bedtime fading with response cost may increase the efficacy of treatment. Treatment capitalizes on the biological components of sleep. Bedtime fading with response cost is indicated for children with or without a developmental disability between the ages of 3 and 18 years. Sleep disturbances are relatively common in children, and may persist and become increasingly problematic if left untreated. In fact, sleep problems may persist for 3 years or more in 84 percent of individuals who initially show symptoms of sleep disturbance. Parents may need to monitor their child during night waking, especially if the child engages in problem behavior during this period of time. Consequently, sleep problems may affect the whole family, and parents may feel irritable during the day due to chronic sleep deprivation.

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.

Chapter 8 outlines night waking, and presents intervention options to manage the problem. Family resistance is discussed, along with steps for graduated extinction, sleep restriction, and scheduled awakening.

Chapter 9 discusses night waking interventions, reviewing progress and modifications that can be made to each intervention approach to manage remaining night waking issues.

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.

An infant and child sleep survey questionnaire was performed in a well-baby clinic to investigate parent-reported sleep problems in the children. A total of 506 children aged 0–6 years were enrolled and divided into five age groups. The results contain important clinical implications, as follows: (i) frequent night waking is observed in 37.5% of the children; (ii) more than 70% of the children take 30 min or longer to fall asleep; (iii) illness interferes with sleep at night in 35.0% of the children; (iv) caregivers’ perceptions of sleep problems is very common (64.2%); (v) the children sleep for a total of between 11.5 and 15.4 h; (vi) they go to sleep between the hours of 21.00 and 22.00 hours; (vii) they wake between 07.00 and 09.00 hours and (viii) the frequency of sleep problems is related to their age, and problems are more prevalent in the going to bed schedule, night waking, and daytime sleepiness. We conclude that sleep problems of infants and young children are very common in northern Taiwan, and the data analysis of sleep problems may provide valuable information to medical personnel and parents in the clinical evaluation and management of sleep problems.

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.

SUMMARY A variety of epidemiological sleep parameters was evaluated in 574 Finnish schoolchildren (age 7 to 17 years) and in their parents (454 mothers and 390 fathers). Three questionnaire forms were set, one for the pupil and two for his/her parents including information of sleep habits, disorders, and social background of the pupil and his/her family. The pupils were grouped by age (two preadolescent groups: 7.1–9.3 y and 9.4–13 y, adolescents 13.1–17.1 y) and sex. It was found that bedtime was more often after 22.00 hours among adolescents than preadolescents both at weekends and on weekdays. At weekends the wake-up time was later in adolescents than preadolescents but on weekdays it was opposite in boys. On weekdays girls went earlier to bed than boys and woke up earlier than boys. Total sleep durations both on weekdays and at weekends were longer in preadolescent than in adolescent groups, and longer during weekend nights than on weekday nights in all groups. Girls experienced more dreaming and night waking, but boys snored more. Daytime sleepiness patterns were more common in adolescents than in preadolescents. Children who experienced daytime sleepiness more often had fathers with daily sleep urges. An association was found between age and sleep habits and some daytime sleepiness patterns; adolescents went to bed later and slept less, and had more problems with alertness during daytime than preadolescents. Some differences were also found between boys and girls. The daytime sleepiness of pupils correlated with the same symptom in fathers.

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.

Editor—I was disappointed to see that once again children with sleep disorders are being lumped into a homogeneous group of children with “behavioural” problems, then “studied” without using polysomnography. I think it's presumptuous and dangerous to think that every child who has trouble sleeping has a behavioural problem. Few physicians are aware that breathing difficulty can cause night waking and bedtime resistance, and it is because of studies like that of Ramchandani et al.1 Doctors don't look for sleep disorders properly, don't know much about them, and are told repeatedly that behavioural treatments are the appropriate treatment. This is wrong unless we can guarantee that the children have behavioural problems. A study looking at obese children using polysomnography diagnosed unsuspected obstructive sleep apnoea in 75% of the children studied—meaning the physicians examining the children picked up only 1 in 4 cases. It therefore seems a big leap of faith not to be doing polysomnography more often. Some of the children waking at night could have upper airways resistance syndrome, which can also cause sleep problems. Most doctors can barely take a proper history for sleep disorders, let alone diagnose a subtle case of upper airways resistance syndrome causing repeated night waking or bedtime resistance. Studies like that of Ramchandani et al certainly don't help because they take the emphasis away from finding a “real physiological” problem and on to stress behavioural modification. Before we continue to send physicians out to behaviourally modify breathing difficulties or other subtle causes of sleep disorders that can mimic behavioural problems, we need to do polysomnography on these children.

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.

In industrial societies around 20% of children aged 1 to 3 years wake at night and cry enough to wake their parents. We suggest that instead of regarding this common behavior as pathological we might consider whether it is, or could once have been, an adaptive response. We suggest that one outcome of this behavior, plausibly adaptive, would be delaying the conception of the next sibling. This could happen if night wakers would, given the chance, suckle more often at night than nonworkers, which in turn would delay the return of ovulation. The delay would be of greater advantage to vulnerable children whose survivorship would be most threatened by the arrival of the next sibling. This suggestion is compared to the view that sleeping apart from parents is an abnormal situation to which we cannot expect all children to adapt.

Regular waking at night is one of the most common problems encountered by parents of young children. In a family counselling programme in Auckland, a night-waking programme has been used with 208 children referred during a two year period. The programme involved organized bed-time routines, procedures for settling the child and non-reward of crying, calling out and getting out of bed. Programme introduction was followed by daily phone calls to parents in which appropriate parent behaviours were prompted and reinforced. Further face to face sessions were held after one week and then if needed. Parent reports show high rates of parent implementation of procedures and rapid change of child sleep behaviour with improvements being maintained at follow up. In a survey of 48 of the parents, positive changes in the daytime behaviour of children were reported as coinciding with improved sleep habits. Also there was an absence of negative side effects, and generally, parent satisfaction with the programme was high.

Factors determining the introduction of solid food into an infant's diet were studied in an urban sample of breastfeeding mothers. The time at which a mother intended to introduce solid food was found to be a reliable predictor of actual age of introduction, p < 0.01. However, infant birth weight also significantly improved the prediction of weaning age. When asked, 75 per cent of the mothers reported that they had introduced solid food as a response to an observed change in the infants' behaviour. Behavioural changes most frequently reported were those of too frequent feeding or a return of night waking. It was concluded that subcultural factors might place constraints upon the timing of the introduction of solids, but that infant behaviour which is perceived as signalling nutritional need could override cultural constraints.

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%).

Children’s temperaments contribute significantly to their interactions with their environments. Sometimes this happens in stressful ways that result in problems in their health or development. Although the quality of the interaction is generally more important than either the temperament or the environment alone, some temperament patterns seem more likely than others to lead to these problems in the child. For example, the “difficult child” syndrome appears to predispose to a variety of behavioral dysfunctions in diverse caretaking settings, while the characteristics of high activity or low sensory threshold seem to do so only under certain circumstances.

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.

The objective was to study the longitudinal associations between inattention/hyperactivity symptoms and night-waking in preschool-years, in light of their joint evolution. Within the French birth-cohort study EDEN, repeated measures of 1342 children’s night-waking and inattention/hyperactivity symptoms were collected at age 2, 3 and 5–6 through questionnaires. Trajectories were computed using group-based modeling. Logistic regressions, adjusted for confounding factors, were used to measure the association between trajectories and to determine risk factors for belonging to the identified joint trajectories. Two night-waking trajectories were observed, 20% of the children had a trajectory of “common night-waking”, and 80% a trajectory of “rare night-waking”. The children were distributed in three inattention/hyperactivity trajectories, a low (47%), medium (40%) and high one (13%). Both night-waking and inattention/hyperactivity trajectories showed persistence of difficulties in preschool years. The risk of presenting a high inattention/hyperactivity trajectory compared to a low one was of 4.19[2.68–6.53] for common night-wakers, compared to rare night-wakers. Factors associated with joint trajectories were parent’s education level and history of childhood behavioral problems, and the child’s gender, night-sleep duration and collective care at 2 years of age. Results suggest that children presenting behavioral difficulties would benefit from a systematic investigation of their sleep quality and conversely.

To test the hypothesis that infant night waking is an adaptation to increase interbirth intervals (IBIs) (i.e., the time between a mother’s consecutive births) by exhausting the mother, we made an initial attempt at investigating whether maternal sleep disturbance is associated with longer IBIs. We also explored whether postpartum depression symptoms mediated the association between maternal sleep disturbance and IBI length. We used retrospective self-reports from 729 mothers living in Finland. We conducted structural regressions separately for the mother’s two first children at two different age intervals (0–1 and 1–3 years). Infant night waking was associated with maternal sleep disturbance (β = .78–.84) and maternal sleep disturbance was associated with postpartum depression symptoms (β = .69–.81). Postpartum depression symptoms were also associated with longer IBIs for the first child (β = .23–.28). This result supports the notion that postpartum depression in and of itself could be viewed as adaptive for the offspring’s fitness, and not just as an unintentional byproduct of the mother’s sleep disturbance. Contrary to our prediction, maternal sleep disturbance was, however, associated with shorter IBIs for the first child (β = −.22 to −.30) when including postpartum depression symptoms in the model. We discuss the potential role of social support as an explanation for this unexpected result.