Maternal beliefs and cognitions about naps in infants and toddlers.

Infant and toddler sleep affects family functioning and maternal mental health and well-being. However, little is known about parental perceptions regarding child daytime sleep. The current study aimed to determine maternal beliefs and cognitions of child naps, assessing how naps impact perceived child and maternal functioning. Mothers of 465 infants and toddlers (4-36mos; M = 18.5mos) in the United States completed an online questionnaire addressing those aims, including maternal perception of naps after napping cessation. Most mothers agreed that naps were important (98%). Over two-thirds wanted to change something about their child's naps and one-quarter reported that naps were problematic. About half wished their child fell asleep faster/easier for naps, and one-third wished they napped longer. Few reported that child naps were more trouble than they were worth (4%). Most mothers believed that when their child naps well their child is in a better mood (97%), more easy-going (96%), has fewer tantrums (89%), and listens better (84%, toddlers). Finally, most mothers believed that their child's naps were important for their own day (94%), improved their own mood (87%) made them feel calmer (90%), and enabled them to nap (51%), do more in the house (92%), complete work (87%), spend time with others (78%), and spend time doing things for themselves (80%).   Conclusion: Considering most mothers believed their child's naps were important for their child and themselves, yet many wanted to change something about those naps and/or thought naps were problematic, intervention development is warranted focusing on daytime sleep issues to improve both child and family functioning. What is Known: • Although maternal perceptions of overnight sleep in young children has been well studied, little is known about beliefs and cognitions regarding daytime sleep. What is New: • Mothers of infants and toddlers believe naps are beneficial for their child and are important for child mood, behavior, and sleep. • Mothers find child naps valuable for themselves, allowing time for other activities.

Sleep Problems, Cumulative Risks, and Psychological Functioning in Early Childhood.

BACKGROUND: Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes. METHODS: 205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created. RESULTS: Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns. CONCLUSIONS: Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.

Screening for Problematic Sleep in a Diverse Sample of Infants.

OBJECTIVE: To examine screening strategies for identifying problematic sleep in a diverse sample of infants. METHODS: Parents of infants (5-19 months; N = 3,271) presenting for a primary care visit responded to five screening items and the Infant Sleep Questionnaire (ISQ), a validated measure of problematic infant sleep. If parents responded affirmatively to any screening item, primary care providers received a prompt to evaluate. For each of the screening questions, we examined differences in item endorsement and criterion related validity with the ISQ. Using conceptual composites of night waking and sleep difficulty, prevalence, criterion-related validity, and concurrent demographic correlates were analyzed. RESULTS: Infants were primarily of Black race (50.1%) or Hispanic ethnicity (31.7%), with the majority (63.3%) living in economically distressed communities. Rates of problematic sleep ranged from 7.4%, for a single item assessing parental perception of an infant having a sleep problem, to 74.0%, for a single item assessing night wakings requiring adult intervention. Items assessing sleep difficulty had high (95.0-97.8%) agreement with the ISQ in identifying infants without problematic sleep, but low agreement (24.9-34.0%) in identifying those with problematic sleep. The opposite was true for items assessing night waking, which identified 91.0-94.6% of those with sleep problems but only 31.8-46.9% of those without. CONCLUSIONS: Screening strategies for identifying problematic infant sleep yielded highly variable prevalence rates and associated factors, depending on whether the strategy emphasized parent-perceived sleep difficulty or night wakings. The strategy that is most appropriate will depend on the system's goals.

Thermal Comfort Intervention for Hot-flash Related Insomnia Symptoms in Perimenopausal and Postmenopausal-aged Women: An Exploratory Study.

Objective/Background: To examine a novel intervention for nighttime thermal comfort and sleep of perimenopausal- and postmenopausal-aged women who experience hot flashes and insomnia symptoms. Participants: Thirty-nine women (ages 45-58, M = 52.1 years) with sleep-disrupting hot flashes and insomnia symptoms. Methods: This was a 4-week randomized cross-over study. The intervention included 2 weeks of nighttime use of a warming/cooling device worn on the wrist and was compared to a 2-week baseline period (no device). All participants completed questionnaires at the end of each 2-week period, including the Insomnia Severity Index, the PROMIS Sleep Disturbance and Sleep-Related Impairment scales, Epworth Sleepiness Scale, and the Hot Flash Related Daily Interference Scale. Results: The intervention resulted in a reduction in sleep onset latency, as well as an increase in nighttime sleep. There was a significant improvement of scores on the Insomnia Severity Index, PROMIS Sleep Disturbance and Sleep-Related Impairment scales, and the Epworth Sleepiness Scale. Significantly fewer women reported that hot flashes interfered with their sleep (90% vs 70%) and more perceived control over the degree of sleep disruption due to nighttime hot flashes while using the device (5% vs 49%). The majority reported a positive experience, with two-thirds reporting that the device improved their thermal comfort and ability to return to sleep after a night waking. Conclusions: Overall, a thermal comfort intervention may offer sleep benefits for women who experience disruptive nighttime hot flashes, particularly in terms of falling asleep at bedtime and subjective perception of control over nighttime hot flash sleep interference.

Implementation of Infant Behavioral Sleep Intervention in a Diverse Sample of Mothers.

OBJECTIVE/BACKGROUND: Behavioral Sleep Interventions (BSI) is an efficacious class of treatment approaches for infant sleep disturbance. Little is known about BSI implementation in the real world. Objectives were to a) examine the prevalence of BSI implementation and related factors in a diverse sample of US mothers; b) assess racial-ethnic group differences; and c) examine predictors of BSI implementation. PARTICIPANTS: Participants included mothers (n= 353) with an infant (6-18 months) from one of the three racial-ethnic groups: White Hispanic (n= 113), White non-Hispanic (n= 122), Black non-Hispanic (n= 118). METHODS: Respondents completed an online survey assessing BSI implementation, familiarity, barriers, sleep knowledge, cognitions, and sleep patterns. RESULTS: Approximately one-third (36%) of the sample endorsed BSI implementation and 59% reported BSI familiarity. Black non-Hispanic mothers were more likely to report stopping a BSI prior to completion (OR = 4.92, p <.05) and more likely to hear about BSI from a health-care professional (OR = 1.32, p <.05) compared to White non-Hispanic mothers. Racial-ethnic group differences were identified for a variety of sleep practices, including bedsharing, independent sleep onset, and score on a validated measure of problematic sleep. No racial-ethnic group differences were found in BSI implementation, cognitions, or barriers. BSI implementation was predicted by BSI familiarity, more maternal education, and cognitions around infant self-soothing. CONCLUSIONS: Differential BSI implementation does not appear to be a major driver of sleep disparities, although Black non-Hispanic mothers who decide to implement BSI do report notably lower completion rates. Future studies should examine alternative mechanisms of sleep disparities as well as strategies to promote sleep health in diverse families.

Development and Validation of the Pediatric Sleep Practices Questionnaire: A Self-Report Measure for Youth Ages 8-17 Years.

Objective: To develop and evaluate the validity of a self-report measure of sleep practices for youth 8-17 years. Methods: Following recommended guidelines for the development of patient reported outcomes (PROs), sleep practice concepts were identified through expert (n = 8) and child (n = 28) concept elicitation interviews and a systematic literature review. Items were developed based on these concepts and tested in cognitive interviews with children (n = 32). Psychometric analyses were applied to item response data collected from a diverse sample of youth 8-17 years (n = 307). Construct validity was evaluated through tests of associations between sleep practices and sleep disturbance and sleep-related impairment. Finally, clinical validity of the tool was assessed by comparing scores of youth with and without a parent-identified sleep problem. Results: The final Pediatric Sleep Practices Questionnaire (PSPQ) included 15 items that were used to identify 5 sleep practices: sleep timing, sleep routines and consistency, technology use before bedtime, sleep environment, and the need for parental presence to fall asleep. A confirmatory factor analysis supported the hypothesized structure (all factor loadings ≥ 0.72) and PSPQ indices were significantly associated with self-reported sleep disturbances and sleep-related impairment. Finally, children with parent-reported sleep problems had shorter sleep opportunity, later bedtimes, greater need for parental presence, poorer bedtime routines, and more technology use than children without parent-reported sleep problems. Conclusions: The PSPQ was developed using best-practice PRO development methodology. The PSPQ can be used in clinical settings and for research assessment to capture modifiable sleep practices that may promote or interfere with healthy sleep.

Longitudinal sleep problem trajectories are associated with multiple impairments in child well-being.

BACKGROUND: This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well-being at ages 10-11 years. METHODS: Data were from the first six waves of the Longitudinal Study of Australian Children - Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver-reported, teacher-reported and child-completed tasks were used to index child well-being outcomes at ages 10-11 years including emotional/behavioural functioning (internalizing and externalizing symptoms; self-control), health-related quality of life, cognitive skills and academic achievement. RESULTS: Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life, although effects were smaller than the other sleep trajectories. CONCLUSIONS: The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being.

Early Childhood Sleep Intervention in Urban Primary Care: Caregiver and Clinician Perspectives.

BACKGROUND: Despite significant income-related disparities in pediatric sleep, few early childhood sleep interventions have been tailored for or tested with families of lower socio-economic status (SES). This qualitative study assessed caregiver and clinician perspectives to inform adaptation and implementation of evidence-based behavioral sleep interventions in urban primary care with families who are predominantly of lower SES. METHODS: Semi-structured interviews were conducted with (a) 23 caregivers (96% mothers; 83% Black; 65% ≤125% U.S. poverty level) of toddlers and preschoolers with insomnia or insufficient sleep and (b) 22 urban primary care clinicians (physicians, nurse practitioners, social workers, and psychologists; 87% female; 73% White). Guided by the Consolidated Framework for Implementation Research, the interview guide assessed multilevel factors across five domains related to intervention implementation. Qualitative data were analyzed using an integrated approach to identify thematic patterns across participants and domains. RESULTS: Patterns of convergence and divergence in stakeholder perspectives emerged across themes. Participants agreed upon the importance of child sleep and intervention barriers (family work schedules; household and neighborhood factors). Perspectives aligned on intervention (flexibility; collaborative and empowering care) and implementation (caregiver-to-caregiver support and use of technology) facilitators. Clinicians identified many family barriers to treatment engagement, but caregivers perceived few barriers. Clinicians also raised healthcare setting factors that could support (integrated care) or hinder (space and resources) implementation. CONCLUSIONS: Findings point to adaptations to evidence-based early childhood sleep intervention that may be necessary for effective implementation in urban primary care. Such adaptations could potentially reduce significant pediatric sleep-related health disparities.

Sleep Problem Trajectories and Cumulative Socio-Ecological Risks: Birth to School-Age.

OBJECTIVES: To evaluate whether there are distinct childhood sleep problem trajectories from birth to 10-11 years and to assess associations with cumulative socio-ecological risks (child, family, context). STUDY DESIGN: Participants were 5107 children from the Longitudinal Study of Australian Children-Birth Cohort. At birth, cumulative risk indexes were generated for birth, parenting, family, socioeconomic, and neighborhood risks. Parent-reported child sleep problems were assessed biennially from ages 0-1 to 10-11 years. Sleep problem trajectories were derived using latent class analysis. Multivariable logistic regression was used to examine associations with risk indexes. RESULTS: Five distinct trajectories emerged: persistent sleep problems through middle childhood (7.7%), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%), and no sleep problems (51.9%). Cumulative mother- and father-reported family risks (distress; marital/relational hostility) were linked to nearly all of the trajectories, whereas father- and mother-reported parenting risks were associated with fewer trajectories. Birth risks were associated with increased middle childhood sleep problems. Neighborhood risks were not associated with any trajectories. Socioeconomic risks were linked to mild and persistent sleep problem trajectories. Cumulative risk indexes were most associated with increased middle childhood sleep problems. CONCLUSIONS: This study identified distinct longitudinal sleep problem trajectories, suggesting the need for continuous sleep screening over development. Cumulative risks assessed at birth-primarily maternal and paternal family risks-predicted these trajectories, especially for the sleep problems in middle childhood trajectory. Preventive interventions targeting modifiable factors, particularly caregiver distress and marital/relational hostility, could benefit child sleep.

Real-World Implementation of Infant Behavioral Sleep Interventions: Results of a Parental Survey.

OBJECTIVE: To describe parental practices implementing behavioral sleep intervention (BSI) outside a clinical setting. STUDY DESIGN: Parents (n = 652), recruited through a Facebook group designed as a peer support group for parents using BSI, completed an online survey about their experience using BSI with their infant or toddler. RESULTS: On average, parents implemented BSI when their infant was 5.6 (±2.77) months. Parents most often used modified (49.5%) or unmodified extinction (34.9%), with fewer using a parental presence approach (15.6%). Regardless of BSI type, more parents endorsed "a great deal of stress" during the first night (42.2%) than 1 week later (5.2%). The duration of infant crying was typically greatest the first night (reported by 45%; M = 43 minutes) and was significantly reduced after 1 week (M = 8.54 minutes). Successful implementation of BSI on the first attempt was reported by 83%, with a median and mode of 7 days until completion (79% by 2 weeks). Regardless of BSI type, after intervention parents reported their infant had less difficulty falling asleep, fewer night awakenings, and were more likely to sleep in their room and/or in their own crib/bed. CONCLUSIONS: The majority of parents report successfully implementing BSI, with significantly reduced infant crying by the end of 1 week and success within 2 weeks. Few differences were found between behavioral approaches.

A Survey of Practicing Sleep Coaches.

BACKGROUND: Sleep coaches are individuals of various backgrounds who offer services to families struggling with behavioral childhood sleep problems. We conducted a survey of coaches to further elucidate scope of practice, practice patterns, geographic distribution, education, training, and beliefs regarding qualification requirements. METHODS: A Web-based survey was completed by 142 individuals who identified as a sleep coach. RESULTS: Coaches were distributed across 17 countries and 5 continents. Overall, 65% of coaches served clients in countries beyond their home country. Within the United States, coaches were generally located in more affluent and well-educated zip codes near large metropolitan centers, 91% served clients beyond their home state, and 56% served clients internationally. Educational background varied across coaches (12% high school degree, 51% bachelor's degree, 32% master's degree, 2% doctoral degree, 1.5% JD degree). Few coaches (20%) were or had been licensed health care providers or carried malpractice insurance (38%). Coaches usually provided services for children < 4 months of age to about 6 years of age, and were much less likely to provide services for children with comorbid neurodevelopmental (32%) or significant medical disorders (19%). Coaches reported an average of 3 new and 6 total clients per week and working 20 hr per week on average. Most coaches (76%) felt that a formal sleep coach training program was the most important qualification for practice. CONCLUSIONS: These results highlight a diversity of background, training, and geographical distribution of sleep coaches, and may help inform discussions regarding guidelines for training and credentialing of sleep coaches.

Sleep and Social-Emotional Development in Infants and Toddlers.

The aim of this study was to examine the cross-sectional and longitudinal relationships among variables related to sleep patterns and both social-emotional problems (i.e., internalizing, externalizing, and dysregulation) and healthy social development (i.e., social competence). Assessments were completed at 6, 12, and 18 months across 5 cohorts of children for a total of 117 mother-child dyads. Mothers completed the Brief Infant Sleep Questionnaire at 6, 12, and 18 months, as well as the Infant Toddler Social Emotional Assessment at 12 and 18 months. Later bedtimes and less total sleep across the 24-hr period predicted higher internalizing problem scores, which includes indices of depression/withdrawal, general anxiety, separation distress, and inhibition. In contrast, sleep fragmentation was minimally associated with decreased social competence but not with any negative social-emotional outcomes. These results indicate that sleep patterns, primarily later bedtimes and less total sleep, appear to be associated with and predictive of social-emotional problem areas, namely, internalizing issues, in infants and toddlers. These findings add to the growing literature on the role of sleep in early social-emotional development and suggest that sleep schedule and duration should be addressed in clinical assessment and interventions for infant sleep.

Development of infant and toddler sleep patterns: real-world data from a mobile application.

The aim of this study was to investigate the development of infant and toddler sleep patterns. Data were collected on 841 children (aged from birth to 36 months) via a free, publicly available, commercially sponsored iPhone app. Analyses were conducted on caregiver recordings of 156 989 sleep sessions across a 19-month period. Detailed visualizations of the development of sleep across the first 3 years of life are presented. In the first 3 months, sleep sessions primarily lasted less than 3.5 h throughout the day. Between 3 and 7 months old, sleep consolidated into two naps of about 1.5 h in length and a night-time sleep session of about 10.5 h. Across age groups, a negative relationship was observed between the start of bedtime and the length of the night-time sleep session (i.e. later bedtime is associated with a shorter night-time sleep period). The length of daytime sleep sessions (naps) varied with age, decreasing between 1 and 5 months old, and then increasing monotonically through 28 months. Morning wake time was observed to be invariant in children aged 5-36 months. Sleep patterns are ever-changing across the first few years with wide individual variability. Sleep patterns start to develop more clearly at 5-6 months, when longer night-time sleep duration begins and sleep consolidation occurs. Daytime sleep patterns appeared to become more consistent and consolidated later in age than night-time sleep. Finally, there is greater variability in bedtimes than wake times, with bedtimes having a greater influence on night-time sleep duration.

Initial Validation of the Sleep Disturbances in Pediatric Cancer Model.

OBJECTIVE : The current study evaluates content validity of the Sleep Disturbance in Pediatric Cancer (SDPC) model using qualitative and quantitative stakeholder input. METHODS : Parents of children (aged: 3-12 years) with acute lymphoblastic leukemia (n = 20) and medical providers (n = 6) participated in semi-structured interviews about child sleep during cancer treatment. They also rated SDPC model component importance on a 0-4 scale and selected the most relevant sleep-related intervention targets. RESULTS : Qualitatively, parents and providers endorsed that changes in the child's psychosocial, environmental, and biological processes affect sleep. Stakeholders rated most model components (parent: 32 of 40; provider: 39 of 41) as important (>2) to child sleep. Parents were most interested in interventions targeting difficulty falling asleep and providers selected irregular sleep habits/scheduling, though groups did not differ significantly. CONCLUSIONS : Stakeholders supported SDPC content validity. The model will inform subsequent measure and intervention development focusing on biological and behavioral factors most salient to sleep disturbances in pediatric cancer.

Sleep Differences by Race in Preschool Children: The Roles of Parenting Behaviors and Socioeconomic Status.

BACKGROUND AND OBJECTIVE: This study aimed to examine whether socioeconomic variables (SES) and parenting behaviors mediate differences in sleep problems between Black and White preschool-aged children. METHOD: Parents of 191 preschool-aged children (53% male; 77% White) completed questionnaires regarding SES and sleep behaviors. Parenting behaviors and SES were analyzed as mediators of differences in sleep problems between Black and White children. RESULTS: Parent behaviors related to bedtime routine and independence mediated the relationship between race and parent-reported bedtime difficulty, parent confidence managing sleep, and sleep onset latency. SES mediated the relationship between race and sleep onset latency. CONCLUSIONS: Sleep differences between Black and White preschool children were primarily mediated by parent behaviors rather than socioeconomic variables. Results may reflect differences in cultural practices and provide important information for treatment and parent-directed intervention regarding improving sleep in young children.

Pacifier Use, Finger Sucking, and Infant Sleep.

Few studies to date have investigated the relationship between pacifier use or finger sucking and infant sleep. One hundred and four mothers of infants (ages 0-11 months) completed the Brief Infant Sleep Questionnaire (BISQ). Infants who engaged in finger sucking had fewer night wakings and longer stretches of nighttime sleep, although less daytime sleep. There were no significant differences in sleep patterns between pacifier users and infants who did not engage in nonnutritive sucking. Furthermore, no significant differences were found across groups for sleep ecology, including parental involvement at bedtime and following night wakings. Finally, infants were consistently able to retrieve their pacifiers independently by 7 months of age, although this did not appear to be associated with sleep outcomes. Results suggest that when parents are deciding whether to give their infant a pacifier, sleep may not be a critical factor. In contrast, parents of finger and thumb suckers should be reassured that this nonnutritive sucking is beneficial to sleep, at least in the first year of life.

"It's Not All About My Baby's Sleep": A Qualitative Study of Factors Influencing Low-Income African American Mothers' Sleep Quality.

Low-income African American mothers are at particular risk for poor postpartum sleep. This study sought to understand facilitators and barriers that exist to getting a good night's sleep among these high-risk mothers. Semistructured interviews with 18 low-income African Americans (3-6 months postpartum) were conducted. Most mothers described their own sleep quality to be poor, despite the fact that their babies' sleep improved substantially from the newborn period. Mothers kept themselves awake due to their own internal worry and anxiety, along with external factors that were largely independent of babies' sleep, including work and school commitments and the home environment. For the few mothers with good sleep quality, time management and family support were strong facilitators. Findings lay the groundwork for sleep improvement interventions.

Sleep Patterns among South Korean Infants and Toddlers: Global Comparison.

The purpose of this study was to examine sleep patterns in a large sample of infants and toddlers (ages birth to 36 months) in Korea, and to compare sleep patterns, sleep problems, sleep ecology, and parental behaviors to global sleep data on young children in both predominantly Asian (P-A) and predominantly Caucasian (P-C) countries/regions. We additionally examined parent and child demographic information, parental behaviors, and aspects of the sleep ecology as predictors of sleep patterns among infants and toddlers in Korea. Parents/caregivers of 1,036 Korean infants and toddlers completed an expanded, internet-based version of the brief infant sleep questionnaire. Consistent with other studies of sleep in early childhood, sleep/wake patterns became increasingly consolidated with older child age for the Korea sample. Compared to both P-A and P-C infants and toddlers, children in Korea had the latest bedtimes, shortest total sleep and daytime sleep durations, and the least frequent rates of napping. Even though half of parents perceive their children's sleep problematic, parental perceptions of severe child sleep problems were the lowest. Within Korea, breastfeeding and bottle-feeding at sleep resumption were associated with increased nocturnal awakenings. Evening television viewing was associated with later bedtimes, which may have implications for sleep hygiene recommendations in clinical practice. The current study provides important information about sleep/wake patterns, parental behaviors, and aspects of the sleep ecology for infants and toddlers for physicians to support healthy sleep in Korea.

Relationship Between Child and Maternal Sleep: A Developmental and Cross-Cultural Comparison.

The aim of this study was to assess the relationship between young children's sleep and maternal sleep from both a developmental and a cross-cultural perspective. Mothers of 10,085 young children completed the Brief Infant/Child Sleep Questionnaire and the Pittsburgh Sleep Quality Index. Overall, there were significant relationships between maternal and child sleep for bedtime, waketime, number of night wakings, and total nighttime sleep time across ages and cultures, although these relationships were stronger with younger children than preschool-aged children. Mothers report that their child's sleep pattern significantly impacts their sleep and daytime function, and they do not feel confident in managing their child's sleep pattern. Thus, interventions to improve children's sleep and develop good sleep habits, especially in early childhood, are likely to improve the quality of life of the whole family.

Parental Concerns About Infant and Toddler Sleep Assessed by a Mobile App.

The aim of this study was to assess the primary concerns of parents/caregivers regarding their young child's sleep. A total of 1,287 consecutive sleep-related questions were analyzed from submissions to an Ask the Expert section of a publicly available iPhone-based application for sleep in young children. Questions regarding infants were most likely to be submitted (53.9%), followed by newborns (23.76%) and toddlers (17.8%), with an average age of 10.94 months. The primary concerns regarded night wakings, sleep schedules, and bedtime problems, accounting for almost 85% of all questions. Results align with common concerns noted in epidemiological studies. Understanding the types of concerns for which parents seek advice is beneficial in the continued development of resources for caregivers.