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.     

One‐year longitudinal study found a bidirectional relationship between physical activity and sleep disturbance in teenage Estonian girls

Aim

Studies have shown that physical activity (PA) declines during adolescence, especially among girls. We examined the relationship between changes in PA and sleep disturbance over the school year, including any bidirectional relationship between these two factors.

Methods

This longitudinal study focused on teenage girls who had a mean age of 13.2 ± 0.2 years at baseline and were drawn from five randomly selected schools in the city of Tartu, Estonia. Sleep disturbance and PA were subjectively assessed using the self‐reported 3‐Day Physical Activity Recall and the Insomnia Severity Index, at four intervals throughout the school year. Latent growth curve analyses were used to evaluate longitudinal and bidirectional associations between PA and sleep disturbance.

Results

Assessments were carried out at three‐monthly intervals from September 2015 to June 2016. Sleep disturbance increased and PA decreased over the school year. At baseline, higher PA was related to lower sleep disturbance. Changes in PA corresponded with changes in sleep disturbance. A negative bidirectional relationship between sleep disturbance and PA over time was also found.

Conclusion

These results suggest that increasing PA may be an effective strategy for improving the quality of sleep in girls during early adolescence.     

Childhood emotional and behavioural problems: A comparison of children's reports with reports from parents and teachers

Abstract Paediatricians are often asked to assess children with emotional and behavioural problems and are faced with the dilemma that reports about the children's behaviour obtained from the children, and from their parents and teachers, may differ. This study compares the number of childhood emotional and behavioural problems reported by children living in the community, with the number of problems reported by their parents and teachers. When describing both internalizing and externalizing problems, the children consistently reported that they had more problems than were reported by either their parents or teachers. This pattern was particularly evident with reports from older female children who reported many more internalizing problems than were reported by their parents and teachers. Possible reasons for the differences between reports from children and the other informants are discussed.     

A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.     

Comparing sleep measures of infants derived from parental reports in sleep diaries and acceleration sensors

Aim: Comparing sleep measures of infants derived from two data collection methods, acceleration sensors and sleep diaries, and identify the clinical application for each data collection method. Methods: The participants were 52 pairs of infants and mothers. Infant sleep measures were obtained through the actigraphs (Micro‐mini RC, Ambulatory Monitoring Inc., Ardsley, NY, USA) and sleep diaries for over a period of 7 days. Results: The results showed that the concordance in sleep measures derived from two methods showed decreases in the following order: sleep offset time [r = 0.91 (p = 0.00)], sleep onset time r = 0.89 (p = 0.00), nocturnal sleep duration [r = 0.75 (p = 0.00)], the number of night wakings [r = 0.46 (p < 0.01)] and WASO [r = 0.34 (p < 0.05)]. It was revealed that the accuracy of sleep diary records was affected by the sleeping place and varied throughout the study period. Conclusion: It was confirmed that the sleep measures indicating sleep schedule reported from the sleep diaries had high concordances compared with the data from the actigraphs. Using the sleep diary was recommended to understand behaviours when focusing on infant’s daily rhythms. In terms of accuracy and stability of recording throughout the study period, understanding sleep quality and independence of sleeping places, the choice of actigraph was recommended.     

Severe sleep problems among infants in a normal population in Sweden: prevalence, severity and correlates

The aim of this study was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2518 infants aged 6-18 mo. Correlates to severe sleep problems were sought. The families were approached using a questionnaire and 83% responded. Data from the collection procedure point to a non-selective dropout. Sixteen percent of the parents reported their children as having moderate or severe difficulties in falling asleep at night (sleep refusal, bedtime struggles) and 30% reported frequent night waking. Almost all (93%) of the parents had sought help at the Child Health Centre (CHC), but only 48% were satisfied with the support and advice they got. Severe sleep problems as defined by the ICSD (International Classification of Sleep Disorders, 1990) were found in 129 of the children (6.2%), who were studied in detail, with the rest of the population as controls. Severe sleep problems were found to be correlated with parental worries and anxiety concerning infant health (although the children were reported as being as healthy as the controls), infant feeding problems and intensive parental interventional behaviour (especially feeding) during the evening and night. A common factor of insecurity in the parental role is suggested.     

Cross-sectional study on the sleep status and risk factors for sleep problems in infants and young children in Jilin Province北大核心CSCD

目的 了解吉林省婴幼儿睡眠状况及睡眠问题发生的危险因素。 方法 选取吉林省8个地级市和1个自治州的1 080例0~3岁的健康婴幼儿作为研究对象。采用自制调查问卷收集研究对象的一般资料,采用简明婴幼儿睡眠问卷了解婴幼儿睡眠情况,并应用多因素logistic回归分析探讨睡眠问题发生的危险因素。 结果 婴幼儿睡眠问题的总检出率为38.24%（413/1 080）。4~11月龄、12~24月龄、25~36月龄组睡眠总时长均高于推荐睡眠总时长（P<0.05）。多因素logistic回归分析显示,足月出生、主要监护人文化程度较高、白天活动强度较大是婴幼儿睡眠问题的保护因素（P<0.05）,而服用维生素D频次较低、夜间喂养频繁和母亲打鼾是睡眠问题发生的危险因素（P<0.05）。 结论 吉林省4月龄以上婴幼儿睡眠总时长均高于推荐睡眠总时长,但睡眠问题发生率较高。睡眠问题的发生与多种因素有关;加强对早产儿的随访,对主要监护人进行婴幼儿睡眠知识宣教,坚持规律地补充维生素D,有利于减少婴幼儿睡眠问题的发生。     

Very early predictors of conduct problems and crime: results from a national cohort study

Background: Longitudinal research has produced a wealth of knowledge about individual, family, and social predictors of crime. However, nearly all studies have started after children are age 5, and little is known about earlier risk factors. Methods: The 1970 British Cohort Study is a prospective population survey of more than 16,000 children born in 1970. Pregnancy, birth, child, parent, and socioeconomic characteristics were measured from medical records, parent interviews, and child assessments at birth and age 5. Conduct problems were reported by parents at age 10, and criminal convictions were self‐reported by study members at ages 30–34. Results: Early (up to age 5) psychosocial risk factors were strong predictors of conduct problems and criminal conviction. Among pregnancy and birth measures, only prenatal maternal smoking was strongly predictive. Risk factors were similar for girls and boys. Additive risk scores predicted antisocial behaviour quite strongly. Conclusions: Risk factors from pregnancy to age 5 are quite strong predictors of conduct problems and crime. New risk assessment tools could be developed to identify young children at high risk for later antisocial behaviour.     

The link between sleep problems in infancy and early childhood and attention problems at 5 and 14 years: Evidence from a birth cohort study

Background

Little research has examined the associations between early sleep problems and attention problems over several developmental periods.

Aims

To examine whether sleep problems in infancy and early childhood are independently related to attention difficulty at 5 and 14 years, and to the continuity of attention difficulties from 5 to 14 years.

Study design

The study was a prospective, population-based birth cohort study.

Subjects

7223 women who delivered a live, singleton child between 1981 and 1983 were recruited at the first antenatal visit. Of these, 4204 had complete information on all key measures.

Outcome measures

Attention problems were assessed with items from the Child Behaviour Checklist (CBCL) and were classified as adolescent onset (i.e. problems at 14 but not at 5); early remitter (problems at 5, no problem at 14); and persistent (i.e. at both 5 and 14).

Results

At 6 months, sleep problems ‘sometimes’ were associated with the early remitter group in boys. For sleep problems between 2 and 4 years of age, findings were generally similar for boys and girls with strong associations with adolescent attention. Sleep problems ‘often’ were independently associated with early remitter and persistent attention problems, and ‘sometimes’ with early remitter and adolescent onset attention problems.

Conclusions

Sleep problems in early childhood are an indicator of subsequent attention problems that may persist into adolescence. Whether these associations are causal requires further research, however their presence provides an opportunity for early intervention and monitoring.     

上海市1～6岁儿童睡眠状况的流行病学研究

目的：了解上海市学有儿童的睡眠状况及其相关因素。方法：1999年8月－9月间在上海市5个行政区随机抽取1812名1－6岁儿童,由专人负责对其家长进行儿童家族社会环境与睡眠健康问卷调查。结果：上海市2岁组和3 组儿童的平均睡眠时间分别为11．78h和11．65h,均明显低于国外同龄儿童的平均睡眠时间需要量13h和12h。2－5岁各年龄儿童夜间睡眠所占的比例也明显低于相应标准。睡眠障碍的发生率为46．975。明显高于国外0．2％－10％的标准。其中梦游的发生率为1．93％,梦呓的发生率为24．83％,鼾症的发生率为16．84％,磨牙的发生率为19．00％、大于5岁的儿童遗尿的发生率为4．29％,梦魇及夜惊的发生率为12．14％,影响儿童睡眠时间的主要因素有抚关人的睡觉时间,孩子的脾气暴躁、与父母同睡等,而睡眠障碍发生的主要危险因素有父母中有睡眠障碍的存在、孩子脾气暴躁、经常更换抚养人、父亲情绪低落等。结论：目前上海地区儿童睡眠状况令人担扰,具体表现在睡眠时间普遍不足,睡眠障碍发生率较高。     

Predictors and protective factors for adolescent Internet victimization: results from a 2008 nationwide Danish youth survey

Aim: To examine the rate of Internet victimization in a nationally representative sample of adolescents aged 14–17 and to analyze predictors and protective factors for victimization. Methods: Data were collected for 3707 pupils in Danish schools in 2008, using a multimedia computer‐based self‐interviewing programme. Family characteristics, alcohol and drug abuse, exposure to physical/sexual abuse, emotional problems, social conduct and own risky Internet behaviour were included in the analyses. Results:  Any online victimization was reported by 27% of the adolescents, most frequently a rumour spread online (9% of boys and 15% of girls) and sexual solicitation (5% of boys and 16% of girls). Parental surveillance of adolescents’ Internet use significantly reduced their risk of online victimization. Roughly half of the adolescents had met Internet acquaintances face to face, with few instances resulting in forced sex (five boys and nine girls). Female gender, parental physical violence, previous exposure to sexual abuse, alcohol abuse in the family, self‐reported emotional problems and antisocial behaviour and high Internet use were all weakly and risky online behaviour strongly associated with online victimization. Conclusions: Danish adolescents are generally aware of the principles of ‘safe chatting’; however, online harassment is relatively frequent, but offline victimization based on Internet acquaintances is rare.     

Cultural issues in children's sleep: a model for clinical practice

Sleep is a human behavior that is driven by biological mechanisms, but also shaped and interpreted by cultural values and beliefs. The large diversity among societies and cultures may indicate that one "optimal cultural standard" for children's sleep behavior does not exist. In pediatric care, the interplay between children's biological as well as socioemotional needs and the cultural norms should be carefully considered and evaluated in the context of sleep complaints and behavioral functioning. Recognizing the culture in which children and their families live may eventually lead to better compliance and higher success rates of treatment interventions.     

Heritability of attention problems in children: longitudinal results from a study of twins, age 3 to 12

BACKGROUND: Twin studies of childhood behavior problems support the conclusion that individual differences in impulsivity, hyperactivity, and inattention are largely due to genetic influences. Non-genetic variation is due to environmental influences that are unique to the individual, and possibly to rater contrast effects. In the present longitudinal twin study, we report on the size of genetic and environmental effects on individual differences in attention problems at ages 3, 7, 10 and 12 years. METHODS: Mothers were asked to complete the CBCL for their twin offspring when the children were 3 (n = 11,938), 7 (n = 10,657), 10 (n = 6,192), and 12 years old (n = 3,124). We focus on the Overactivity (OA) scale in the Child Behavior Checklist (CBCL/2-3), and on the Attention Problem (AP) scale of the CBCL/4-18. The data were analyzed using longitudinal structural equation modeling. RESULTS: Broad heritability of OA and AP is estimated at nearly 75%, at each age. A contrast effect was observed at age 3 only. The results revealed less stability of OA at age 3 to AP at age 7 (r = .40), compared to the stability from AP at age 7 and beyond (r = .70). Genetic effects explained between 76% and 92% of the covariance between OA and AP. CONCLUSIONS: OA and AP are highly heritable at all ages in both genders. The same set of genes appears to be expressed in boys and girls. The size of genetic and environmental contributions remains the same across the ages studied. Stability in OA and AP is accounted for by genetic influences. Children who do not display OA or AP at a given age are unlikely to develop these problems at a subsequent age.