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Emphasis on continuous infant sleep overnight may be driven by parental concern of risk to child mental health outcomes. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) examined whether infant sleep at 6 and 12 months postpartum predicts anxiety disorders at 2–4 years, and whether this is moderated by maternal depression, active physical comforting (APC) or maternal cognitions about infant sleep. Data included 349 women and infants. Infant sleep was measured using the Brief Infant Sleep Questionnaire and child anxiety disorders by the Preschool Age Psychiatric Assessment. The risk of developing generalised anxiety or social phobia disorders at 3–4 years was reduced by 42% (p = 0.001) and 31% (p = 0.001), respectively, for a one standard deviation increase in total sleep at 12 months. No other infant sleep outcomes were associated. Maternal depression, APC and cognitions about infant sleep did not significantly moderate these relationships. Focus may need to be on total infant sleep, rather than when sleep is achieved. Highlights: To assess whether infant sleep outcomes (i.e., frequency of nocturnal wakes; nocturnal wakefulness and total sleep per day) at 6 and 12 months predict early childhood anxiety disorders at 3–4 years of age.Maternally reported infant sleep outcomes were not associated with the risk of developing early childhood anxiety disorders at 3–4 years.It may be total infant sleep, irrespective of when sleep occurs or night waking and, independently, active physical comforting that requires further investigation. [ABSTRACT FROM AUTHOR]

Abstract Background Healthy sleep issues should provide to family within first 6 months of infant’s life. This study aimed to evaluate the effect of early sleep intervention on nighttime sleep quality. Methods Eligible infants aged 4 months ± 2 weeks were randomized to receive early sleep intervention or usual care. Data on sleep variables were obtained via parental interview at baseline and 6 months of age. Using logistic regression to analyze the efficacy of early sleep intervention. Results At baseline, 335 eligible infants were enrolled and randomized. In total, 306 participants were final analyzed: early sleep intervention group (n = 148) and the usual care group (n = 158). The early sleep intervention group had a significantly longer nighttime sleep duration and a shorter night waking duration than the usual care group (585.20 ± 80.38 min vs. 496.14 ± 87.78 min, p

Background: Healthy sleep issues should provide to family within first 6 months of infant's life. This study aimed to evaluate the effect of early sleep intervention on nighttime sleep quality. Methods: Eligible infants aged 4 months ± 2 weeks were randomized to receive early sleep intervention or usual care. Data on sleep variables were obtained via parental interview at baseline and 6 months of age. Using logistic regression to analyze the efficacy of early sleep intervention. Results: At baseline, 335 eligible infants were enrolled and randomized. In total, 306 participants were final analyzed: early sleep intervention group (n = 148) and the usual care group (n = 158). The early sleep intervention group had a significantly longer nighttime sleep duration and a shorter night waking duration than the usual care group (585.20 ± 80.38 min vs. 496.14 ± 87.78 min, p <.001 and 61.01 ± 36.38 min vs. 89.72 ± 45.54 min, p <.001). At 6 months of age, the early sleep intervention group had a longer night sleep duration (≥ 4 h/time) than the usual care group (adjusted odds ratio: 2.39, 95% confidence interval: 1.34–4.28). Conclusions: Early sleep intervention should be recommended to infants at 4 months of age as a part of well childcare to improve infant sleep quality. Trial Registration: Thai Clinical Trials Registry (thaiclinicaltrial.org). Retrospective registered TCTR20230117001 (17/01/2023). [ABSTRACT FROM AUTHOR]

Background: Parental behavior and infant sleep patterns can vary widely both within and between cultures and settings. Breastfeeding during the second half-year of infancy has been associated with frequent night waking, which is perceived as sleep problem among the Western societies. An understanding of sleeping patterns among breastfed infants during the second half-year of infancy is important in supporting continued breastfeeding. Objectives: The study aimed to investigate the sleeping patterns among breastfed infants during second half-year of infancy. Methods: This is a cross-sectional study. Three hundred and forty-two mothers of 6–12 months old breastfed infants completed the questionnaires on socio-demographic factors, breastfeeding practices, and infant sleeping patterns, which were assessed by using the Brief Infant Sleep Questionnaire (BISQ). The Cox regression model was used to assess the factors that were associated with night sleep duration whereas demographic factors and breastfeeding practices that were associated with night waking frequency were investigated using the Poisson regression model. Results: On average, the breastfed infants slept for 11 h during the night and most infants were reported to have night waking (96.8%) and were breastfed at least once at night (93.5%). In the adjusted analyses, infants in the age group 9–12 months were less likely to sleep longer compared to infants in the 6–8 months age group [HR 1.52 95% CI (1.17, 1.98)]. A one-hour increase in daytime sleep and in night wakefulness increased the likelihood of waking up at night by 19% and 24%, respectively. Infants who had been vaccinated within the last 7 days and infants who were breastfed to sleep were more likely to have a shorter nighttime sleep duration. Nighttime breastfeeding frequency was significantly associated with a 17% increase in the likelihood of night waking [IRR 1.17 95% CI (1.13, 1.22)]. Infants who slept on their parents' bed were 1.28 times more likely to wake up at night compared to infants who slept in a separate room [IRR 1.28 95% CI (1.05, 1.59)]. Infants of parents who reported that their infants' sleep was not a problem were 34% less likely to wake up compared to infants of parents who reported that their infants' sleep was a problem [IRR 0.66 95% CI (0.49, 0.87)]. Conclusions for Practice: Frequent night waking, bed sharing and night breastfeeding were common among 6–12 months old breastfed infants. Frequent night breastfeeding may lengthen an infant's nighttime sleep duration. The study findings indicate that adequate information and support should be given to breastfeeding mothers in relation to the sleeping pattern of breastfed infants in order to promote continued breastfeeding practices. Significance: Breastfeeding during the second half-year of infancy has numerous benefits for both mother and infant. Frequent night waking is known as a common phenomenon among 6–12 months old breastfed infants. However, frequent night waking among breastfed infants during this age is commonly perceived as an infant having sleep problems. This study is the first to understand parental behavior and infant sleep patterns in different cultures and settings in Norway. 6–12 months old breastfed infants still frequently waking and being breastfed during the night. Our findings add to the limited body of evidence on breastfeeding and frequent infant night waking. [ABSTRACT FROM AUTHOR]

Sally Whelan, Arlene Mannion, Azeem Madden, Fine Berger, Rachel Costello, Saeid Ghadiri, Geraldine Leader Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, IrelandCorrespondence: Sally Whelan, Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland, Tel +35 391493434, Email geraldine.leader@nuigalway.ieAbstract: Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies’ heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bi-directional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices.Keywords: autism spectrum disorder, night waking, insomnia, behavior, anxiety, bedtime resistance

The implications of the substantial individual differences in infant sleep for early brain development remain unclear. Here, we examined whether night sleep quality relates to daytime brain activity, operationalized through measures of EEG theta power and its dynamic modulation, which have been previously linked to later cognitive development. For this longitudinal study, 76 typically developing infants were studied (age: 4–14 months, 166 individual study visits) over the course of 6 months with one, two, three, or four lab visits. Habitual sleep was measured with a 7‐day sleep diary and actigraphy, and the Brief Infant Sleep Questionnaire. Twenty‐channel EEG was recorded while infants watched multiple rounds of videos of women singing nursery rhymes; oscillatory power in the theta band was extracted. Key metrics were average theta across stimuli and the slope of change in theta within the first novel movie. Both objective and subjective sleep assessment methods showed a relationship between more night waking and higher overall theta power and reduced dynamic modulation of theta over the course of the novel video stimuli. These results may indicate altered learning and consolidation in infants with more disrupted night sleep, which may have implications for cognitive development. [ABSTRACT FROM AUTHOR]

Objective/background: Night wakings are common during infancy, with variability in infant self-soothing or requiring parent involvement to fall back asleep. Reasons for variable soothing behaviors are unclear and may be influenced by early-life sleep parenting practices. The study applied a novel method using sleep actigraphy in mother-father-infant triads to quantify infant-only wake bouts (i.e., "self-soothing") and examined associations between sleep parenting practices from 6 to 24 weeks of age.Patients/methods: Mother-father-infant triads (N = 20) wore sleep monitors for 1 week at infant ages 6, 15, and 24 weeks. Data were time-matched within families to quantify infant-only wake bouts (when infants woke in the night and parents remained asleep) to be indicative of infant self-soothing. Mothers reported on sleep parenting practices (e.g., feeding to sleep, putting infants to bed while awake) using the Brief Infant Sleep Questionnaire at each age. Mixed models tested associations between parenting practices and infant-only wake bouts.Results: Most mothers (69.5%) reported typically feeding their infants to sleep at bedtime; 27.1% reported typically putting infants to bed while still awake. Parenting practices associated with a greater proportion and frequency of infant-only wake bouts included not typically feeding infants to sleep during night wakings, putting infants to bed while still awake (at 24 weeks of age), and using a greater proportion of low-, rather than high-, stimulus soothing strategies during night wakings.Conclusion: These data suggest parenting practices, such as putting infants to bed when drowsy but still awake, are important strategies for promoting infant self-soothing during night wakings. [ABSTRACT FROM AUTHOR]

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

Abstract 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.

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

Transactional models of parenting and infant sleep call attention to bidirectional associations among parenting, the biosocial environment, and infant sleep behaviors. Although night waking and bedtime fussing are normative during infancy and early childhood, they can be challenging for parents. The current study, conducted in the United States between 2003 and 2009, examined concurrent and longitudinal associations between maternal mental health and infant sleep during the first year. Concurrent associations at 6 and 12 months and longitudinal associations from 6 to 12 months were studied in a non-clinic referred sample of 171 economically and culturally diverse families. Mothers with poorer mental health reported that their infants had more night waking and bedtime distress and were more bothered by these sleep issues. Associations between infant sleep and maternal mental health were moderated by culture (Hispanic/Asian vs. other) and by stressors that included high parenting stress, more stressful life events, and low family income. Individual differences in maternal well-being may color mothers' interpretations of infants' sleep behaviors. It may be prudent to intervene to support maternal mental health when infants are referred for sleep problems.

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 Française 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. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Summary: 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). Seventy‐four 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 self‐report, 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. [ABSTRACT FROM AUTHOR]

Sleep disorders in infants and children are common and often behavioural in origin. Problems include difficulties going to sleep and/or maintaining sleep. History taking should focus on the bedtime routine, consistency of caregiver approach to settling, sleep cues and exclusion of medical problems including atopy and obstructive sleep apnoea. Management includes ascertaining parent goals, ensuring these are realistic and then offering parents a choice of evidence-based strategies, tailored to family need and capacity. Sleep diaries and parent education materials from evidence-based web sites complement the consultation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article focuses on the aspects of infant and maternal sleep after birth. It discusses infants' sleep pattern development, which is part of their circadian rhythm establishment. It mentions various factors of human milk that contribute to the circadian rhythm development in infants including melatonin, nucleosides, tryptophan.

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. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to investigate the association between sleep patterns and daytime functioning in children with insomnia. Furthermore, the role of frequency of night waking and wake time after sleep onset for daytime functioning was analyzed in the context of total sleep time and sleep onset latency. Methods: Families with children with parent-perceived sleep problems were recruited for diagnostic clarification and subsequent treatment (if indicated) at an outpatient clinic. Out of 49 families seeking help, 34 children (age 5.2–10.9years, mean 7.1years) and their parents were included in the present study. Sleep and sleep problems were assessed by a structured clinical interview according to the diagnostic criteria of the International Classification of Sleep Disorders (ICSD-II). Parents kept a sleep diary over two weeks. In addition, they answered the Child Behavior Checklist, questions concerning the daytime sleepiness of their children, as well as a structured clinical interview assessing comorbid mental disorders. Results: Reduced parent-reported total sleep time predicted more delinquent behavior and more concentration problems. Independent of total sleep time and frequency of night waking, longer parent-reported wake time after sleep onset was associated with greater daytime sleepiness, which in turn predicted more social problems. Conclusions: Besides total sleep time, wake time after sleep onset could be another important determinant for specific aspects of daytime functioning in children with insomnia. [Copyright &y& Elsevier]

Although sleep disorders such as insomnia and obstructive sleep apnea are common in both children and adults, the clinical features and treatments for these conditions differ considerably between these two populations. Whereas an adult with obstructive sleep apnea typically presents with a history of obesity, snoring, and prominent daytime somnolence, a child with the condition is more likely to present with normal body weight, tonsillar hypertrophy, and inattentiveness during school classes. The adult with suspected sleep apnea almost always undergoes a baseline polysomnogram and proceeds to treatment only if this test confirms the diagnosis, while many children with suspected sleep apnea are treated empirically with adenotonsillectomy without ever receiving a sleep study to verify the diagnosis. This article reviews sleep disorders in children, with a particular focus on age-related changes in sleep, conditions that primarily affect children, and disorders for which clinical manifestations and treatment differ substantially from the adult population. [ABSTRACT FROM AUTHOR]

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

This literature review focuses on factors found to be associated with individual differences in infant night waking. Infant night waking that requires parent intervention to assist the infant to return to sleep is of special concern to parents because of the sleep deprivation and fragmentation that they experience. Both intrinsic and extrinsic factors related to night waking are considered and strategies for reducing night waking are briefly reviewed. An integrative perspective on the causes and effects of night waking, which considers both parent-infant behavioral contingencies and developmental/transactional processes, is proposed. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Night waking is common among infants and can create sleep deficit in both parents and infants. Sleep practices are influenced by cultural variations which may affect the prevalence and associated factors of frequent night waking. Our objective was to determine whether differences in parental practices related to infant sleep are associated with frequent night waking in Thai infants. Methods: A cross-sectional survey based on interviews with parents of infants aged three months, birth weight greater than 2500g, conducted under the Prospective Cohort study of Thai Children (PCTC). Results: Of the total sample, 82.9% (3172 of 3826) of parents provided completed night waking information. The mean number (±standard deviation [SD]) of awakenings per night was 2.7±1.1, 47.3% awoke 1–2 times per night, and 46.9% awoke 3–4 times per night. The group of frequent night wakers (more than 14 night wakings per week, n =1634) was compared with the group of infrequent night wakers (n =1538). Significant and independent associations were present between frequent night waking and male gender (odds ratio [OR] of 1.5; 95% confidence interval [CI], 1.3–1.8), more than three naps per day (OR, 1.3; CI, 1.1–1.5), use of a swinging or rocking cradle (OR, 1.5; CI, 1.2–1.98), falling asleep while feeding (OR, 1.3; CI, 1.1–1.5), and breastfeeding only (OR, 1.2; CI, 1.1–1.4). No significant association was noted between frequent night waking and parental age, education, occupation, household income, type of parental response to infant’s nighttime crying, or type of diaper. Conclusion: An association with frequent night waking was demonstrated with various factors of parental practice related to infant sleep, such as number of naps, use of a swinging or rocking cradle, breastfeeding only, and falling asleep while feeding. Further documentation of these associations may be clinically important. Implementing preventive interventions may be able to reduce frequent night waking in early infancy. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

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

This study set out to examine the links between infants’ sleep–wake regulation and attachment security. Subjects were 57 healthy, Israeli infant–mother dyads. Mother–child relationship was assessed at 12 months with the Attachment Q-Set (AQS) (Waters & Deane, 1985). Sleep was measured, objectively, with an activity monitor, as well as through maternal reports. The objective sleep records were not associated with either the security or the dependency score. In contrast, mothers’ descriptions of the child''s sleep problems were associated with the child''s dependency placement. This result is in line with the premise that dependency, more than security, modulates the child''s transitions to sleep. Since temperament was implicated in both the dependency placement and in the child''s sleep pattern, a further disentangling of sleep-attachment-temperament is in order. Future studies of sleep regulation and attachment should address these constructs longitudinally, and include observational measures of attachment and of nighttime parenting, in different child-rearing contexts. [Copyright &y& Elsevier]

Aim: To evaluate a standardized sleep programme that is a two-step variation of graduated extinction, where the child is first taught to fall asleep by him/herself at bedtime (first intervention) and two weeks later also after night awakenings (second intervention). As it has been claimed that extinction procedures may be harmful to the child, this study documents both night- and daytime behaviour before and after interventions.Method: The study included a total of 95 families, with children from 4 to 45 mo of age exhibiting frequent signalled awakening episodes during the night. Sleep diaries, visual analogue scales (VAS) on daytime behaviour and the Flint Infant Security scale, completed by parents, were used as instruments. Parents also completed VAS scales and the Swedish Parenthood Stress Questionnaire scales on their own well-being.Results: All families carried out the interventions. Parents reported significant improvements in sleep quality, daytime behaviour and family well-being as early as two weeks after the first intervention. Before intervention, the sleep-disturbed children were rated as more insecure than a matched comparison group with unknown sleep behaviour. This difference was eliminated after the interventions. The more anxious the children were rated before intervention, the more they tended to benefit from it.Conclusion: If parents experience young children's night awakenings as a problem, teaching the children to fall asleep by themselves usually solves this problem quickly. According to parental ratings, family well-being and negative daytime behaviour are also improved. [ABSTRACT FROM AUTHOR]

Data on sleep behavior were gathered on 100 children with pervasive developmental disorders (PDD), ages 2–11 years, using sleep diaries, the Children's Sleep Habits Questionnaire (CSHQ), and the Parenting Events Questionnaire. Two time periods were sampled to assess short-term stability of sleep–wake patterns. Before data collection, slightly more than half of the parents, when queried, reported a sleep problem in their child. Subsequent diary and CSHQ reports confirmed more fragmented sleep in those children who were described by their parents as having a sleep problem compared to those without a designated problem. Interestingly, regardless of parental perception of problematic sleep, all children with PDD exhibited longer sleep onset times and greater fragmentation of sleep than that reported for age-matched community norms. The results demonstrate that sleep problems identified by the parent, as well as fragmentation of sleep patterns obtained from sleep diary and CSHQ data, exist in a significant proportion of children with PDD. [ABSTRACT FROM AUTHOR]