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Outcomes of infant sleep problems: a longitudinal study of sleep, behavior, and maternal well-being
Peiyoong Lam1, Harriet Hiscock, Melissa Wake
1Centre for Community Child Health, Royal Children's Hospital, Parkville, Australia.
Insights
Infant sleep problems often persist or recur into the preschool years, linked to increased child behavior issues and maternal depression. These factors appear to be consequences, not causes, of sleep difficulties.
Area of Science:
- Pediatric Sleep Medicine
- Developmental Psychology
- Maternal Mental Health
Background:
- Infant sleep problems are a common concern for parents.
- Previous research indicates a need to understand the long-term trajectory of these issues.
- Community-based studies are crucial for understanding generalizable sleep patterns.
Purpose of the Study:
- To determine the prevalence of recurring, persistent, and resolving infant sleep problems in 3-4 year olds.
- To identify early predictors of persistent or recurring sleep problems.
- To explore comorbidities associated with ongoing sleep difficulties in preschool children.
Main Methods:
- A follow-up survey of mothers whose infants (8-10 months) participated in a sleep intervention trial.
- Assessment of current child sleep problems using standardized maternal questionnaires.
- Measurement of maternal well-being (Edinburgh Postnatal Depression Scale) and child behavior (Child Behavior Check List).
Main Results:
- 32% of children had current sleep problems, with 12% persistent and 19% recurring.
- Children with sleep problems were more likely to be nursed to sleep and exhibited higher scores for aggressive and somatic behaviors.
- Mothers of children with sleep problems reported higher depression scores and marital difficulties.
Conclusions:
- Infant sleep problems frequently persist or recur into the preschool years.
- These ongoing sleep issues are associated with increased child behavioral problems and maternal depressive symptoms.
- Maternal depression appears to be a consequence, rather than a cause, of persistent childhood sleep problems.
Objectives:
In a community sample of children aged 3 to 4 years with previous infant sleep problems, we aimed to 1) establish proportions with recurring, persisting, and resolving sleep problems; 2) identify early predictors of later sleep problems; and 3) identify comorbidities of persistent or recurrent sleep problems at age 3 to 4 years.
Methods:
A follow-up community survey was conducted of mothers of children aged 3 to 4 years who had, as 8- to 10-month-old infants with identified sleep problems, participated in a community-based, randomized, controlled trial of a brief sleep intervention from 3 middle-class local government areas in Melbourne, Australia. Infant sleep problems (standardized maternal questionnaire), maternal well-being (Edinburgh Postnatal Depression Scale), child behavior problems (Child Behavior Check List for ages 1.5 to 5 years), marital satisfaction (Dyadic Adjustment Scale), and family functioning (General Functioning Scale, McMaster Family Assessment Device) were measured.
Results:
Seventy-three percent (114 of 156) of mothers responded, 36 (32%) of whom reported a current problem with their child's sleep. Current sleep problems were similar regardless of infant sleep intervention. Twelve percent (14 of 114) reported that their child's sleep problem had persisted, and 19% (21 of 113) reported that it had recurred. Children with current sleep problems were more likely still to be nursed to sleep by an adult and had slightly higher mean scores on Child Behavior Check List subscales for Aggressive Behavior (54 vs 52) and Somatic Problems (55 vs 53). Their mothers had higher Edinburgh Postnatal Depression Scale scores (median: 8 vs 5) and more difficulties with their partner undermining the management of their child. However, early depression did not predict current sleep problems. Families of children with sleep problems were functioning as well as those without sleep problems.
Conclusions:
Persistence or recurrence of infant sleep problems in the preschool years is common and is associated with slightly higher child behavior problems and maternal depression scores. Results suggest that depressive symptoms are a result rather than cause of sleep problems. Despite this, families of children with sleep problems are functioning well.