Sleep Patterns - Problems, Prevalence and Persistence in First Three Years of Life
Sleep is essential for daily functioning, sleep related issues are routinely addressed through anticipatory guidance in pediatric settings. However, research indicates that pediatric sleep problems may go undetected during routine clinical care. Although there is no gold standard for sleep assessment during infancy and early childhood, a study confirms the importance of focused screening for sleep problems during infancy and early childhood that goes further than merely asking if the child has problems sleeping.
This study was performed in United States in which 359 mother/child pairs participated.Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring.
The sample was 64% white participants and 31% African American participants. In the 6- months survey point, the overall rate of parent-reported sleep problems and behaviors around sleep maintenance did not significantly differ by race or family income at any time point. However, there was differential attrition over time among African Americans and those in the lowest education and income groups. Those from lower-income families were reported to have longer sleep onset latency, shorter overall sleep duration, less independent sleep, and more snoring than were white children and those fromhigher-income families.
Reported napping/daytime sleep, vocalization/restlessness, and nightmares/night terrors differed by race or family income at only one time point. Nightmares/ night terrors and restlessness/ vocalization were significantly associated with parent report of a sleep problem from 12 to 36 months of age.
While the presence of a nonspecific sleep problem was reported by roughly 10% of parents at each time point, parent report of a sleep problem was significantly associated with snoring only at 12 months and with the location of a child's sleep only at 24 months. Parent report of a sleep problem was significantly associated with longer sleep onset latency across all age ranges, as well as poorer sleep maintenance and shorter sleep duration at 6 to 24months but less strongly at 36 months.
21% to 35% of those who were reported to have a sleep problem during infancy showed persistent sleep problems 1 to 2 1/2 years later. Night waking and shorter sleep duration were perceived as sleep problems by 6 months of age and then remained particular concerns for parents through 2 years of age. Also, across all time points, the majority of children (62.5%-81.9%) were sleeping in their own bed.
Parents did not seem to associate snoring with sleep problems as a result snoring could be completely overlooked during well-child visits, despite its known risk for morbidity. It is noteworthy that the failure of a parent to recognize and report problems related to these domains could lead to errors in clinical decision making. Like sampling error may have influenced prevalence estimates of sleep problems. All sleep measures were based on parent-report. Since there is no single validated instrument for assessing sleep problems in children aged 6 to 36 months, the data was pooled from 2 independent sleep questionnaires. Sleep problem and behavioral domains that were the focus of this study are culturally defined to varying degrees; study did not propose nor examine potential mechanisms underlying sleep problems.
Parent interpretation and report of a sleep problem during early childhood may be inconsistent with clinical criteria for diagnosing pediatric sleep disorders, especially when assessed via a nonspecific query. To clarify parental concerns about sleep during early development and ensure that clinically relevant sleep issues are not overlooked, it is recommended that sleep problems be screened by using a flexible family-centered approach while addressing specific sleep behaviors and symptoms that have known clinical significance.
Reference: Prevalence, Patterns, and Persistence of Sleep Problems in the First 3 Years of Life; Kelly Byars et al; Pediatrics 2012.