Short-term prospective study of sleep disturbances in 5-8-year-old children

The course and psychological correlates of disturbed sleep during middle childhood were investigated using parents' responses to questionnaires. Five specified sleep disturbances were explored in 614 5-8-y-old children, at baseline and at follow-up, 14 +/- 3 mo later. Difficulties falling asleep, in 6.2% of the children at baseline, persisted in 47.4% of the cases at follow-up; night-waking, in 18.6% at baseline, persisted in 45.5%; snoring, in 9.4% at baseline, persisted in 60%; nightmares, in 4.4% at baseline, persisted in 29.6%, and bedwetting, in 6% at baseline, persisted in 46%. Moreover, children with difficulties falling asleep at baseline frequently displayed bedtime resistance and shorter sleep at follow-up, while night-waking at baseline was related to co-sleeping at follow-up. Snoring at baseline was associated with a trend towards restless sleep at follow-up. Nightmares at baseline were related to several other sleep complaints as well as to behavioural difficulties during daytime at follow-up. Bedwetting at baseline was associated with tendencies towards hyperactivity at follow-up. Separate analyses of cases of persisting sleep disturbances showed that persisting difficulties falling asleep were associated with a need to remedy sleep problems, while persisting nightmares were strongly related to reports suggesting behavioural and emotional problems. Conclusion: During middle childhood, difficulties falling asleep, night-waking, snoring, nightmares or bedwetting commonly persist over the course of a year. Persistent nightmares frequently indicate significant psychological problems in affected children.     

Tinnitus in 7-year-old children

The prevalence of tinnitus in children with normal hearing has been reported to be between 6% and 36% and much higher in children with hearing loss. The aim of the present study was to perform an epidemiological, cross-sectional study, on the prevalence of tinnitus in 7-year-old school children ( n=964) and to statistically analyse the relation of tinnitus to gender, noise exposure, intratympanic pressure and hearing parameters. Tinnitus was reported by 12% of the children and in contrast to other reports, hearing parameters, did not correlate to the prevalence of tinnitus and no gender differences were found. Noise induced tinnitus was reported in 2.5% of the children. CONCLUSION: persistent tinnitus in children may have similar causes to that in adults.     

Micturition habits and incontinence in 7-year-old Swedish school entrants

The prevalence of incontinence in children has been extensively studied, but knowledge of other bladder symptoms is lacking in a healthy child population. The micturition habits of 3556 7-year-old school entrants were surveyed by a questionnaire supplemented by telephone interviews. One or more symptoms of a disturbed bladder function was reported in 26%, but most of these had moderate urgency as a sign of incomplete voluntary bladder control. Isolated bedwetting occurred in 2.8% of the girls and 7.0% of the boys, whereas nocturnal incontinence combined with daytime wetting was equally common in both sexes, 2.3% and 2.0% respectively. Diurnal incontinence was reported in 6.0% of the girls and 3.8% of the boys and was usually combined with other symptoms. The frequency of micturition in children without symptoms of bladder disturbance and with no previous urinary tract infection was 3–7 times per day.     

Potentially harmful sleep habits of 3-year-old children in Japan

To examine the sleep habits of 3-year-old children, we questioned guardians during a routine health examination for 3-year-old children at a public health center. According to the 1105 questionnaires analyzed, the proportion of children who fell asleep at 10 p.m. or later was 49.6%. The nocturnal sleep onset time was significantly correlated with the wake-up time in the morning and was significantly negatively correlated with the nocturnal sleep duration. The average daily total sleep duration (nocturnal sleep duration + nap duration) of regular nap-takers showed a significant negative correlation with the nocturnal sleep onset time. The average values for height, weight, and body mass index (BMI) were not correlated with the nocturnal sleep onset time. Children who went to sleep later got less sleep than those who went to sleep earlier. Because sleep debt has a harmful impact on older children and adults, late sleep onset may have adverse health consequences in young children.     

Sleep architecture in healthy 5-year-old preschool children: associations between sleep schedule and quality variables

Aim: Although disturbed sleep quality such as night awakenings and difficulties in falling asleep are common symptoms during sleep in preschool children, relationships between sleep quality and sleep schedule are mostly unknown. This study aimed to evaluate the relationships between sleep schedule and quality variables in preschool children. Methods: Sleep‐wake patterns of 48 healthy 5‐year‐old children were assessed over 7 consecutive days using actigraphy. Results: Children with longer sleep latency had a lower sleep quality, a later bedtime, a later sleep onset time, a shorter nocturnal sleep period and a longer daytime nap. Children with a longer nocturnal sleep period on weekends compared with weekdays had longer sleep latency and a later sleep onset time on weekdays, resulting in a lower sleep quality on weekends. An irregular bedtime on weekdays was associated with a later sleep onset time and a shorter sleep period on weekends. Conclusion: Sleep quality and schedule were linked with each other, whiche may explain why sleep problems tend to aggregate and form a wider syndrome of disturbed sleep even in young children. Strategies solely targeting the improvement of sleep quantity may not promote ideal sleep; simultaneous considerations for the sleep rhythm and quality may be required.     

Sleep in middle childhood — A longitudinal study of sleep problems in a large sample of Dunedin children aged 5-9 years

Complaints of sleeping difficulties in a large group of New Zealand children were studied prospectively over four years from 5 to 9 years of age. No association was found between sleeping difficulties and the sex, intelligence, or educational attainments of the child. Mothers who described their child as anxious or who were poor sleepers themselves, tended to report sleeping problems in their child more frequently. There was no association between sleeping problems and teacher ratings of behaviour problems. Children who reported sleep problems also tended to report other problems. There was low agreement between parents and children. Only 0.3% of the total sample had a problem which persisted over the whole period.     

Thermal detection thresholds in 5-year-old preterm born children; IQ does matter

Background

Experiencing pain at newborn age may have consequences on one's somatosensory perception later in life. Children's perception for cold and warm stimuli may be determined with the Thermal Sensory Analyzer (TSA) device by two different methods.

Aim

This pilot study in 5-year-old children born preterm aimed at establishing whether the TSA method of limits, which is dependent of reaction time, and the method of levels, which is independent of reaction time, would yield different cold and warm detection thresholds. The second aim was to establish possible associations between intellectual ability and the detection thresholds obtained with either method.

Study design

A convenience sample was drawn from the participants in an ongoing 5-year follow-up study of a randomized controlled trial on effects of morphine during mechanical ventilation.

Methods

Thresholds were assessed using both methods and statistically compared. Possible associations between the child's intelligence quotient (IQ) and threshold levels were analyzed.

Results

The method of levels yielded more sensitive thresholds than did the method of limits, i.e. mean (SD) cold detection thresholds: 30.3 (1.4) versus 28.4 (1.7) (Cohen's d = 1.2, P = 0.001) and warm detection thresholds; 33.9 (1.9) versus 35.6 (2.1) (Cohen's d = 0.8, P = 0.04). IQ was statistically significantly associated only with the detection thresholds obtained with the method of limits (cold: r = 0.64, warm: r = − 0.52).

Discussion

The TSA method of levels, is to be preferred over the method of limits in 5-year-old preterm born children, as it establishes more sensitive detection thresholds and is independent of IQ.     

The Conners' 10-item scale: findings in a total population of Swedish 10–11-year-old children

Aim: To present normative data for the Swedish version of the Conners' 10-item scale, to validate the scale by comparing children with and without attention deficit/hyperactivity disorder (ADHD), to explore the factor structure of this scale and to investigate behavioural characteristics and gender differences among 10- to 11-year-old children, as rated by parents and teachers respectively.
Methods: Parents and teachers rated 509 10- to 11-year-old children (261 boys and 248 girls) from a population-based cohort in a Swedish municipality.
Results: The Conners' 10-item scale discriminated very well between children with and without ADHD. Confirmatory factor analyses confirmed a two-dimensional structure of the scale with items measuring restless/impulsive behaviour in one factor and items measuring emotional lability in another. An ANOVA revealed that parents and teachers reported different behavioural characteristics in boys as compared to girls.
Conclusion: The Conners' 10-item scale is a valid screening instrument for identification of ADHD. The two subscales can be used separately, in addition to the total score, to get a more detailed picture of the child's behaviour. Parents and teachers pay attention to different aspects of problem behaviour in boys and girls. The less disruptive behaviour of girls needs to be highlighted.     

Parent perceptions of child sleep: a study of 10,000 Swedish children

Aim: To gather normative data on parent‐reported child sleep and investigate what influences it. Methods: Subjective sleep report data on night wakings, sleep quality, bedtime and risetime were gathered from parents of around 10 000 children from birth to age 5 in a cohort questionnaire study. The data were analysed for trends, and sleep measures were compared with background factors such as child temperament, foreign origin, family situation, parents' age and education and night feedings. Results: The population trends were towards improved sleep with increasing age. Individual sleep patterns show some stability. Reports of frequent night wakings and low sleep quality (LSQ) were strongly associated with each other within and between the age groups (odds ratio [OR] 2.8–60.2, p < 0.001). Perception of poor child sleep was influenced by child temperament at ages 1 and 3 (OR 2.2–4.4, p < 0.001), foreign origin at age 1 (OR 2.1–2.3, p < 0.001), and to some extent, parents' age and education at ages 1–3 (OR 1.4–2.1, p < 0.05 or stronger), but not by single parent status or infant night feedings. Reporting multiple or unspecific causes of night wakings was associated with reporting LSQ (OR 1.8–4.7, p < 0.05 or stronger). Conclusion: With increasing age, fewer wakings, improved sleep quality and a more uniform sleep schedule seem normal. However, frequent wakings and low quality sleep at early ages seem surprisingly stable. A difficult temperament and foreign origin were associated with lower quality sleep and more frequent wakings in early ages, whereas being a single parent was not. Finally, night feeding does not seem to condition children to frequent wakings.     

The development and adjustment of 7-year-old children adopted in infancy

The present study (N = 159) provides evidence of an increased risk for behavior problems of infant-placed 7-year-old internationally, transracially adopted children in the Netherlands. However, parents reported more behavior problems for adopted boys than for adopted girls. Notably, about 30% of the adopted children were classified as clinical on the CBCL scale for total problems, which is a much larger percentage than the 10% found in the normative population. It was suggested that these results could be explained by the operation of multiple risk factors before and after adoption placement, e.g. the child's genetic disposition, pre-natal and pre-adoption care, or the child's cognitive understanding of adoption in middle childhood. Also, results suggest that maternal sensitive responsiveness in adoptive families declines in the transition from early to middle childhood. In contrast to the home setting, the adopted children showed favorable behavioral and socioemotional adjustment at school, while their academic achievement and intelligence were in the normal range or above average. In particular Korean children had high IQs: 31% of these children obtained an intelligence score above 120. It was suggested that adoptive parents seem to offer their children sufficient or even more than average cognitive stimulation. Furthermore, adopted girls scored higher in optimal ego-control, social competence, and peer group popularity than nonadopted girls from the general population: 30% of the adopted girls were rated as popular by their classmates, which compares favorably to the 13% found in the general school population.     

Oxygen-uptake efficiency slope in healthy 7- to 18-year-old children

The aim of this article was to assess the oxygen-uptake efficiency slope (OUES) throughout the age span of 7 to 18 years. One hundred fourteen healthy children (58 boys and 56 girls) exercised on a treadmill by means of a modified Balke protocol. The OUES grew in a nonlinear pattern with age, and it appeared to be significantly higher in boys than in girls. There was a very strong correlation between OUES and VO2peak (r = .92), and there was a small difference between the values of OUES calculated for different exercise intensities. Stepwise-regression analysis outlined body surface area (BSA) and sex as main determinants of OUES. OUES is an objective measure of exercise capacity that does not require a maximal effort but is considerably dependent on anthropometric variables and necessitates the generation of appropriate reference values.     

Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children

Edlund B, Hallqvist G, Sjödén P-O. Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children. Acta Pædiatr 1994;83:572–7. Stockholm. ISSN 0803–5253
All students in grades 5 and 8 of three randomly chosen schools in Uppsala ( n = 236) were eligible, and 197 participated. The survey included a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a demographic and dieting questionnaire. In total, 47% of the children (girls 70%, boys 25%) wanted to be thinner and 25% had tried to lose weight. In the 5th grade, 49% of the girls reported that they wanted to be thinner and in the 8th grade 83%. Fifty-three percent of the girls in the 8th grade reported that they had tried to lose weight; 36% admitted that they felt too fat but only 5% reported that other people found them too fat. The methods used were caloric restriction and exercise. Compared with US data, the Swedish students dieted less often and showed lower ChEAT scores. Compared with earlier data, our results show that weight concerns begin at an earlier age among Swedish children today.     

Cardiac allograft vasculopathy in children — treatment challenges

Cardiomyopathy in children accounts for greater than 50% of the cases of end-stage cardiac disease leading to heart transplantation in children. While early survival is excellent, late survival is limited with an average graft half-life of approximately 15 years in children. Cardiac allograft vasculopathy is a not uncommon complication of transplantation and is the leading cause of late graft loss and retransplantation in pediatric populations. Studies of the United Network of Organ Sharing database and the Pediatric Heart Transplant Study group report rates of coronary vasculopathy that increase from 5% at 2 years to 35% at 10 years. Coronary artery vasculopathy is a complex process caused by both immune mediated endothelial dysfunction and vascular changes as well as typical cardiovascular risk factors. Unfortunately, despite vigilant surveillance protocols, new onset graft dysfunction and sudden cardiac death can be the presenting symptoms of new disease. In recent years multiple medical and adjuvant therapies have been studied in relation to potential management to minimize this disease process. Further research and collaborative multi-center trials will be the most effective means of developing strategies for the prevention and treatment of coronary vasculopathy in pediatric heart transplant patients.