Sleep problems in early childhood can be easily missed or
recognized by parents and doctors. A short and flexible screening tool (like a
questionnaire) may help the process of recognizing these children do that
corrective measures can be instituted.
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
This study was performed in United States in which
359 mother/child pairs participated.
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.
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
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
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.
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.
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.
Prevalence, Patterns, and Persistence of Sleep
Problems in the First 3 Years of Life; Kelly Byars et al; Pediatrics 2012.