A Missed Opportunity? Meal Provision in Early Childhood Education and Care Services in the Context of Socioeconomic Disadvantage.

OBJECTIVES: Early childhood education and care (ECEC) services are attended by most children before school entry, reaching many living in circumstances of poverty and providing opportunity to support their nutrition. In this study, we examine the extent to which this opportunity is being met, comparing two common types of service provision: centre- versus family- provided food. METHODS: Intensive in-situ observations were undertaken across 10 ECEC services in highly disadvantaged Australian communities. All meals provided to children aged 3.5-5 years across an ECEC day (N = 48), of which 11% were experiencing severe food insecurity, were photographed and analysed to assess nutritional adequacy with reference to national dietary standards. RESULTS: Meals provided did not meet national dietary recommendations for quality or quantity. Nutrition was least adequate in services with policies of family-provided food. These services were also those that served families experiencing the highest levels of severe food insecurity (29%). CONCLUSIONS: In the absence of policies for the provision of food in ECEC, services are not realising their potential to support child nutrition in the context of poverty presenting increased risk to lifetime trajectories of health and wellbeing. System level policy interventions are required to facilitate equitable access to nutritious food and attendant life chances.

Longitudinal change in sleep, functional, and behavioural characteristics in a cohort of children with Down syndrome.

This paper describes the longitudinal change in sleep, functional, and behavioural characteristics in a cohort of children with Down syndrome, including the effect of sleep interventions in a subset. A prospective longitudinal cohort study was undertaken in children with Down syndrome aged 3-16 years comparing (1) children referred to a tertiary sleep medicine clinic who received sleep hygiene advice and an additional sleep treatment (DSref_I) with (2) children attending the same clinic who only received sleep hygiene advice (DSref_N) and (3) children recruited from the community who, were not receiving any treatment (DScomm). Data collected included demographic and medical history information, Child Sleep Habits Questionnaire-Abbreviated (CSHQ-A), Life-Habits Questionnaire (Life-H) and Child Behaviour Checklist (CBCL) at baseline and then 6-monthly for a total of 18 months. Any sleep interventions during this time were recorded. A total of 57 children were included (DSref_I, n = 16; DSref_N, n = 25; DScomm, n = 16). At recruitment, the median CSHQ-A total score was high (>41) in all three subgroups, but highest in the DSref_I subgroup (median [interquartile range] Dsref_I score 58 [53-66] versus DSref_N score 49 [43-53], p = 0.019). Although improved, 80% of participants in the DSref_I subgroup still had a CSHQ-A total score >41 at the last assessment point. The median total Life-H and total CBCL scores were not significantly different between groups at baseline and there was no significant time, group, or interaction effect seen through the study. Over an 18-month period, sleep problems were seen to persist in children with Down syndrome. Treatment resulted in only modest improvements in sleep.

Parents' Experiences of Having a Child with Down Syndrome and Sleep Difficulties.

OBJECTIVES: Sleep disorders are prevalent in children with Down Syndrome (DS). However, sleep treatment is not always readily accessed by this group. This study aims to understand families' experiences of having a child with DS and sleep difficulties, and in particular, their healthcare experiences, with the goal of informing practice improvements. METHODS: We conducted semi-structured interviews with 34 parents (fathers n = 4 and mothers n = 30) with open-ended questions about parents' experiences of sleep, family dynamics, and healthcare. We operationalized a reflexive Thematic Analysis. RESULTS: Parents normalized their experiences of having a child with DS and sleep problems. Parents acknowledged that sleep disruption has adverse and pervasive impacts on their wellbeing and family dynamics, but also found this difficult to identify as a health problem. They accepted sleep difficulties as a regular part of bringing up any child, particularly one with a disability. When they did seek treatment for their child's sleep difficulties, parents often reported encountering insensitive and inadequate care and described that, at times, healthcare professionals also normalized children's sleep difficulties, resulting in sub-optimal treatment. This included at times failure to refer to tertiary sleep medicine services when required. CONCLUSIONS: Parents' and healthcare professionals' normalization of sleeping difficulties denies that they are both deleterious and modifiable. Practice implications include raising healthcare professionals' awareness of the importance of proactively addressing sleep, with sensitivity to families' normalization strategies, recognizing that families may require prompting to report concerns.

Mealtimes in the context of poverty: Comparison of ECEC services providing food and those requiring food provided from home.

BACKGROUND: In developed economies, most children attend Early Childhood Education and Care (ECEC) services before school entry, many from early life and across long days. For this reason, ECEC services present significant potential to provide food environments that positively influence eating behaviours and food preferences with attendant effect on life course trajectories of health and wellbeing. Yet there is evidence that feeding practices that limit optimal ongoing nutrition, such as pressure and restriction, are amplified in ECEC services serving disadvantaged communities. We sought to identify underlying explanatory mechanisms through observation of children's feeding experiences and educator explanations comparing, family-provided and service-provided meals. METHOD: This study used qualitative analyses of educator interviews and observation records from 55 mealtimes in 10 ECEC services: 5 providing food and 5 requiring family food provision. RESULTS: High levels of concern drove educator's controlling feeding practices at mealtimes but presented differently across meal provision modes. In centres that provided food, educators' concern focused on food variety, manifesting in pressure to 'try' foods. In centres requiring family-provided food, concern focused on nutrition quantity and quality and manifested as control of order of food consumption and pacing of intake to ensure food lasted across the day. Interview data suggested that conflict aversion limited optimal nutrition. In centres providing food, this was seen in menus that prioritized child food preferences. In centres requiring family meal provision, conflict aversion was seen as reticence to discuss lunchbox contents with families. CONCLUSION: The findings direct attention to public health intervention. Currently, ECEC face significant barriers to realizing their potential to support child nutrition and establish positive life course trajectories of nutrition. To do so requires targeted supports that enable sufficient supply and quality of food in the context of poverty.

Emotional quality of early education programs improves language learning: A within-child across context design.

Observational studies comparing child outcomes in early care and education classrooms of differing quality are often confounded by between-child differences. A within-child design, tracking children across contexts, can identify the effects of quality with less confounding. An analysis of Australian children (N = 1128, mean age 5 years, 48% female, 2.9% Indigenous, ethnicity data unavailable) tracked across pre-K, K, and year 1 (2010-2012) was conducted to assess how changes in observed quality (Classroom Assessment Scoring System) were associated with changes in cognitive development (Woodcock-Johnson III). Thresholds of quality were also investigated. Increases in Emotional Support were associated with improved language development (ß = 0.54, 95% CI [0.1-0.99], approximating 2.6 weeks development). Results highlight that emotional quality is an integral and potent component of early learning.

Associations between food provision and feeding practices in socially disadvantaged childcare centres.

Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.

A comparison of maternal feeding responses to child fussy eating in low-income food secure and food insecure households.

Children learn to like a wide variety of healthy foods through exposure in their early feeding environment. While some children may reject foods during this learning process, parents may perceive persistent refusal as 'fussy' or 'picky' eating. Low-income parents may provide fussy children with a narrow range of foods that they will like and accept to avoid food and economic waste; inadvertently limiting children's exposure to a variety of healthy foods. This 'risk aversion' to food rejection may be particularly salient in food insecure households where resources are further constrained. We aimed to examine if food insecurity modifies the relationship between child fussy eating and parents' food provision and feeding with respect to exposure to a variety of healthy foods. Australian mothers residing in a low-income community (N = 260) completed a cross-sectional survey on their preschool-aged child's 'food fussiness', household food insecurity and food exposure practices. Food exposure practices included the home availability of fruit and vegetables, and children's tasting of a variety of fruit and vegetables (food provision); and whether parents prepared alternative meals for their child (feeding). Mothers reporting food insecurity (11%) were less likely to have fruit frequently available in the home compared to mothers reporting food security. Food insecurity moderated the relationship between fussy eating and food exposure practices insofar that food secure mothers were more likely to prepare alternative meals for fussier children. Family resources and child fussy eating behaviours are identified as important contextual factors in food provision and feeding. Findings from the current study suggest that health professionals, researchers and policymakers tailor interventions to consider both the needs of families and child eating characteristics.

Mandatory Nap Times and Group Napping Patterns in Child Care: An Observational Study.

Policy provision for naps is typical in child care settings, but there is variability in the practices employed. One practice that might modify children's early sleep patterns is the allocation of a mandatory nap time in which all children are required to lie on their beds without alternate activity permitted. There is currently limited evidence of the effects of such practices on children's napping patterns. This study examined the association between duration of mandatory nap times and group-level napping patterns in child care settings. Observations were undertaken in a community sample of 113 preschool rooms with a scheduled nap time (N = 2,114 children). Results showed that 83.5% of child care settings implemented a mandatory nap time (range = 15-145 min) while 14.2% provided alternate activities for children throughout the nap time period. Overall, 31% of children napped during nap times. Compared to rooms with ≤ 30 min of mandatory nap time, rooms with 31-60 min and > 60 min of mandatory nap time had a two-and-a-half and fourfold increase, respectively, in the proportion of children napping. Nap onset latency did not significantly differ across groups. Among preschool children, exposure to longer mandatory nap times in child care may increase incidence of napping.

Do twins differ from single-born children on rates of behavioral difficulty in early childhood? A study of sibling relationship risk factors.

The hypothesis that twinning raises risk for behavioral difficulties in childhood is persistent, yet there is limited and inconsistent empirical evidence. Simple mean comparison without control for confounders provides data on prevalence rates but cannot provide knowledge about risk or etiology. To assess the effect of twin relationship on behavior, comparison of patterns of association with single-born siblings may be informative. Analyses of data from an Australian sample of twins and single-born children (N = 305, mean age 4 years 9 months, and a follow-up 12 months later) were undertaken. The outcome measure was the Strengths and Difficulties Questionnaire. Predictor and control measures were obtained from parent report on the sibling/co-twin relationship behavior, family demographics, and obstetric history. We assessed difference between twins and single-born children in two respects: (a) mean behavioral difficulties, and (b) patterns of association between sibling relationship and behavioral difficulties, controlling for confounders. Results showed no differences in mean levels of behavioral difficulties between twins and single-born siblings identifying the importance of statistical control for family and obstetric adversity. Differences in patterns of association were found; for twin children, conflict in their co-twin relationship predicted externalizing behaviors, while for single-born children conflict predicted internalizing behaviors. The findings of mean differences between twin and single-born children in social background, but not in behavioral difficulties, underscore the necessity of statistical control to identify risk associated with twinning compared with risk associated with family and obstetric background factors.

Exploring the Relationship Between Age at Nap Cessation and Social-Emotional Functioning in Children.

OBJECTIVE: The objective of this study was to examine variations in age at nap cessation and identify whether there is an association with social-emotional functioning (SEF) as measured by internalizing/externalizing behavior, child temperament, and social skills in a sample of early childhood education and care-attending children. METHODS: The sample comprised 1117 children from the Australian Effectiveness Early Educational Experiences for Children longitudinal early childhood study. We used children's age at nap cessation as retrospectively recalled by caregivers in 2011 or 2013 when children were between ages 2 and 7 years. Each child's SEF was reported by a caregiver using the Strengths and Difficulties Questionnaire, the Short Temperament Scale for Children, and the Social Skills Inventory Scale. Associations between children's age of nap cessation and SEF were tested using linear regressions. RESULTS: The children's age at nap cessation ranged from 6 months to 6 years. For each additional year of napping, children's total , conduct , externalizing , and peer behavior problems decreased by 0.39 (95% confidence interval [CI], -0.70 to -0.09), 0.11 (95% CI, -0.21 to -0.01), 0.11 (95% CI, -0.51 to -0.06), and 0.11 (95% CI, -0.20 to -0.02) units on the Strengths and Difficulties Questionnaire scale, respectively. No further significant associations were found. CONCLUSION: This is the first study reporting the age range of nap cessation and its associations with social-emotional functioning. Our findings demonstrate earlier cessation ages in Australian children attending Early Childhood Education and Care programs than previously reported and a small association with externalizing and peer problems.

Sleep deprivation and recovery: Endurance racing as a novel model.

The aim of this study was to investigate sleep-wake behavior and gain insights into perceived impairment (sleep, fatigue, and cognitive function) of athletes competing in two international multi-day adventure races. Twenty-four athletes took part across two independent adventure races: Queensland, Australia and Alaska, USA. Individual sleep periods were determined via actigraphy, and racers self-reported their perceived sleep disturbances, sleep impairment, fatigue and cognitive function. Each of these indices was calculated for pre-, during- and post-race periods. Sleep was severely restricted during the race period compared to pre-race (Queensland, 7:46 [0:29] vs. 2:50 [1:01]; Alaska, 7:39 [0:58] vs. 2:45 [2:05]; mean [SD], hh:mm). As a result, there was a large cumulative sleep debt at race completion, which was not 'reversed' in the post-race period (up to 1 week). The deterioration in all four self-reported scales of perceived impairment during the race period was largely restored in the post-race period. This is the first study to document objective sleep-wake behaviors and subjective impairment of adventure racers, in the context of two geographically diverse, multi-day, international adventure races. Measures of sleep deprivation indicate that sleep debt was extreme and did not recover to pre-race levels within 1 week following each race. Despite this objective debt continuing, perceived impairment returned to pre-race levels quickly post-race. Therefore, further examination of actual and perceived sleep recovery is warranted. Adventure racing presents a unique scenario to examine sleep, performance and recovery.

Early Childhood Screen Use Contexts and Cognitive and Psychosocial Outcomes: A Systematic Review and Meta-analysis.

Importance: The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development. Objective: To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes. Data Sources: PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023. Study Selection: A total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included. Data Extraction and Synthesis: All studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized. Main Outcomes and Measures: Screen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence). Results: Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, -0.16; 95% CI, -0.24 to -0.08) and background television (n = 8; k = 18; r, -0.10; 95% CI, -0.18 to -0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, -0.04; 95% CI, -0.07 to -0.01), age-inappropriate content (n = 9; k = 36; r, -0.11; 95% CI, -0.17 to -0.04), and caregiver screen use during routines (n = 6; k = 14; r, -0.11; 95% CI, -0.20 to -0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25). Conclusions and Relevance: Findings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

Communicating the complex lives of families that include a child with Down syndrome.

Families of children with Down syndrome experience complex lives and needs, yet the few existing studies on these families are written in conventional academic prose that is not optimal for knowledge translation beyond academia, particularly for busy healthcare professionals. In this paper, we Depart Radically in Academic Writing (DRAW) (Mackinlay, 2022) and present data poetry and two case studies that draw upon semi-structured interviews with mothers, fathers, and siblings, who were interviewed separately about their experiences of having a child/sibling with Down syndrome. We introduce our interdisciplinary team that includes academics and clinicians to contextualise our focus on research translation. We demonstrate that writing with creative criticality (i.e. 'DRAWing') contributes an embodied and affective understanding of research participants' stories, which is largely lacking in the academic literature on families of children with Down syndrome and the sociology of health and illness field more broadly. Moreover, DRAWing can impact audiences emotionally as well as intellectually (Richardson, 2003, p. 924), which has important knowledge translation implications for both healthcare professionals and these families. DRAWing can capture healthcare professionals' attention, prompting them to critically reflect on their practices and opportunities for improving care and treatment for these families.

Siblings' experiences of sleep disruption in families with a child with Down syndrome.

OBJECTIVE: Adverse effects of sleep disruption are identified in parents who live with a child with Down Syndrome (DS), yet there is no research on siblings' experiences. This study addresses this knowledge gap. DESIGN: A qualitative research study using semi-structured interviews to understand the experiences of siblings of a child with DS and sleep difficulties from the perspectives of parents and siblings. PARTICIPANTS: Eleven siblings aged 5-15 years old, and 11 parents, from 8 families with a child with DS in Australia. METHODS: Semi-structured sibling interviews explored what it was like to have a sibling with DS and sleep difficulties; the participant's own sleep; how their sleep affected how they felt during the day; how sleep impacted their family; and advice that they would give to other siblings. Parent interviews included similar topics; here we report on excerpts in which parents reference siblings. Interviews were audio recorded, transcribed verbatim, and analyzed using a reflexive thematic analysis. RESULTS: Siblings and parents acknowledge sleep disruption for siblings; yet sleep disruption is normalized, viewed with acceptance and inevitability. Siblings report adverse effects from sleep disruption, view sleep in a relational way, and cope with sleep disruption. Parents can underestimate siblings' sleep disruption and are uncertain whether siblings' symptoms result from sleep disruption or other causes. CONCLUSIONS: Siblings of a child with DS experience sleep disruption and may be at risk of developing long-term health problems without focused support.

Children's sleep and fathers' health and wellbeing: A systematic review.

Night-waking is typical across infancy and early childhood, inevitably disrupting family sleep. For some children, sleep problems develop and endure throughout childhood. This systematic review focused on fathers, and synthesised the evidence pertaining to the effects of children's sleep (from birth to 12 years) on fathers' health and wellbeing. A total of 29 studies were included. Key outcomes reported for fathers were: sleep and fatigue; mental and general health; and family functioning. An association between child sleep and father's sleep was observed when child's sleep was measured via actigraphy or paternal report, but not when measured via maternal report, suggesting that mothers may not always be aware of disruptions that awaken fathers. Findings showed poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer, and less frequent than those reported for mothers in the same households. Poor child sleep was negatively associated with the quality of family relationships, both within the couple and between parent and child. Future studies seeking to understand the interplay of child sleep and family wellbeing should apply objective measurement of sleep and integrate formal measures of family dynamics into the study design.

Meal provision in early childhood education and care programs: Association with geographic disadvantage, social disadvantage, cost, and market competition in an Australian population.

BACKGROUND: Across developed economies, most children attend early childhood education and care (ECEC) programs attending up to 10,000 h prior to school. These programs present significant opportunity for public health nutrition interventions through provision of healthy food. We sought to identify whether this opportunity is being taken through analysis of population data from Queensland, Australia. Specifically, we asked if meal provision occurs in locations where risk of food insecurity is high and how economic functioning of ECEC services is associated with meal provision. METHODS: Of ECEC services in Queensland, (N = 1623) administrative data on meal provision (2020) was available for 947 ECEC services (58.4% of cohort). We assessed the association of meal provision in these services with area indices of social disadvantage (geographic location, social disadvantage, proportion of child developmental vulnerability) and ECEC service economic functioning (fee structure, market competition). FINDINGS: ECEC services in remote and rural communities were less likely to provide meals. A similar but weaker trend was evident in socio-economically disadvantaged metropolitan communities. In these locations market competition increased likelihood of meal provision but without fee increase. INTERPRETATION: The competitive market works contrary to the potential for ECEC services to support child nutrition and promote public health. Children living in disadvantaged communities, where food insecurity is inevitably higher, are less likely to have meals provided by their ECEC service. Market competition increases the likelihood of meal provision, yet in disadvantaged communities, parents' ability to pay constrains fees that can be charged raising concern about food quality and effects on quality of provision more broadly. Systemic public supports to enable high quality food provision without compromising other aspects of quality, particularly in the most disadvantaged communities, should be a public health priority.

Conflict, closeness and comfort: the inter-twin relationship as a risk factor for behavioral difficulties.

BACKGROUND: There is currently little evidence concerning the impact of the inter-twin relationship on behavioral outcomes and yet the twin relationship is frequently hypothesized to be a unique source of psychopathology in twins. The current study asked whether the inter-twin relationship is a predictor of behavioral difficulties and whether there are zygosity differences in this relationship. METHOD: An Australian sample of same sex twins (N = 356, 164 MZ and 192 DZ) was studied in the year prior to school (Time 1) and again in first year of school (Time 2). Associations between twin-relationship and behavior problems were examined via path-analysis, and Satorra-Bentler chi-square difference tests were used to compare twins across zygosity. RESULTS: Results show that both conflict and lower levels of warmth at Time 1 were predictive of hyperactivity and conduct disorder at Time 2, but they were not associated with emotional difficulties or peer problems. While DZ twins shared less warmth than MZ twins, there were no differences in behavior problems. CONCLUSION: Conflict and lower levels of warmth in the inter-twin relationship are associated with hyperactivity and conduct disorder and may serve as important considerations when making decisions regarding class separation at entry to school.

Many naps, one nap, none: A systematic review and meta-analysis of napping patterns in children 0-12 years.

The onset of monophasic sleep, in which napping ceases and sleep consolidates into a single night period, is a key developmental milestone of childhood. Yet to date, there is little consensus regarding the timing of cessation of napping in children. The aim of the current study is to examine global evidence regarding napping patterns in childhood, and, through meta-analysis, describe patterns of napping cessation and duration observed in children aged 0-12 y. A systematic search of all published, original research articles reporting children's napping patterns, by age, was conducted. The quality of studies was assessed, and meta-analysis of eligible studies undertaken. Risk of bias and heterogeneity of measurement was high. Current evidence indicates that less than 2.5% of children cease napping prior to age 2, while 94% cease napping by age 5. The preschool period (3-5 y; 36-60 mo) represents a particularly dynamic period in napping cessation, with large variation in rates of napping across studies evidencing potential ecological effects. Future studies should focus on understanding of the underlying mechanisms explaining individual variations in napping patterns and the extent to which patterns of napping may represent a marker of child development.

Observed compliance with safe sleeping guidelines in licensed childcare services.

OBJECTIVE: To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services. DESIGN: Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016-2017. SETTING: Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines. PARTICIPANTS: The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys. MAIN OUTCOMES AND MEASURES: Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual's knowledge, beliefs and attitudes regarding safe sleeping practices. RESULTS: 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room. CONCLUSION: Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies. TRIAL REGISTRATION NUMBER: ANZCTR 12618001056280-pre-results.

Correlates of naptime behaviors in preschool aged children.

Purpose: Major changes in the timing, duration, and function of sleep occur during childhood. These changes include the transition from habitual napping to infrequent napping. This transition is likely to reflect, at least in part, neurocognitive development. This study sought to identify factors that discriminate between four groups of children with different teacher-reported responses to naptime in childcare: those who nap (nappers), sometimes nap (transitioners), do not nap (resters), and neither nap, nor lie still (problem nappers). Methods: Standardized observations of sleep and sleep behaviors, daytime behaviors across a number of domains, and direct neurocognitive assessment of 158 preschool aged children (aged 49-72 months; 54% male) attending childcare centers in Queensland (QLD), Australia, were adopted as part of a large longitudinal study of early childhood, the Effective Early Education Experiences (E4Kids) study. Discriminant function analysis was used to examine how age, parent education, nighttime sleep duration, cognitive functioning, behavior problems, and temperament differentiated the four groups. Results: Three discriminant functions were identified and defined as maturation (strong loadings of nighttime sleep duration, cognitive function, and age), socioeconomic status (parental education), and behavioral problems (externalizing behavior, temperament, and internalizing behavior). These functions accounted for 62.9%, 32.6%, and 4.5% of the between-groups variance, respectively. Children defined as nappers (n=44) had significantly shorter duration of nighttime sleep, were younger, and had lower cognitive functioning scores than did other groups. Problem nappers, (n=25) were more likely to have parents with lower levels of education than did transitioners (n=41). Standard behavior and temperament measures did not significantly differentiate the groups. Conclusion: The findings support an interaction between cognitive development, sleep behaviors, and the individual needs and circumstances of children. Further research in this area could make a strong contribution to theory and practice in early childhood education, and a strong contribution to understanding of children's development.