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Published on: December 18, 2013
Children's morning and evening salivary cortisol: pattern, instruction compliance and sampling confounders
N Michels1, I Sioen, T De Vriendt
1Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Nathalie.michels@ugent.be
Insights
Salivary cortisol levels in children are influenced by age and awakening time. The cortisol awakening response was observed in only half of the children, highlighting the need for standardized sampling protocols.
Area of Science:
- Endocrinology
- Pediatric Health
- Stress Research
Background:
- Salivary cortisol is a key biomarker for assessing childhood stress.
- Current research lacks consensus on reference ranges and factors influencing cortisol levels in children.
- Understanding these variations is crucial for accurate stress assessment.
Purpose of the Study:
- To establish reference concentrations for salivary cortisol in children.
- To investigate the cortisol awakening response (CAR) in a pediatric cohort.
- To identify factors influencing salivary cortisol variations, including sampling time and guideline compliance.
Main Methods:
- Salivary samples were collected from 444 Belgian children (5-11 years) over two consecutive weekdays.
- Sampling occurred at four time points: upon awakening, 30 min, 60 min later, and in the evening.
- Data on awakening time, collection times, and adherence to sampling guidelines were recorded.
Main Results:
- Reference values for salivary cortisol were established.
- Age, time compliance, and awakening time significantly impacted cortisol levels.
- A cortisol increase post-awakening (CAR) was observed in only 52.5% of children.
- Absence of CAR was associated with higher awakening times and lower post-awakening concentrations.
Conclusions:
- Accurate salivary cortisol assessment in children requires accounting for age and awakening time, and excluding extreme time deviations.
- The cortisol awakening response is not consistently observed in all children, suggesting it may not be a universal characteristic.
- Poor adherence to sampling time guidelines can influence the observed cortisol patterns and the presence of CAR.
Background/Aims:
Salivary cortisol has been widely used to assess childhood stress. Yet, there is no consensus on reference concentrations, awakening response, guideline compliance and contribution of sampling factors to the variation in children's salivary cortisol levels.
Methods:
Samples were collected from 444 Belgian children participating in the ChiBS study (5-11 years old) on two consecutive weekdays at four moments: awakening, 30 min later, 60 min later and in the evening. A checklist requested awakening time, collection hours and guideline compliance.
Results:
Reference values were determined. Mixed model analyses revealed that age, time compliance and awakening time contributed significantly to the variance in cortisol levels. In only 52.5% of the children a cortisol morning increase was observed. Participants with no morning increase showed higher awakening but lower post-awakening concentrations on that day, and the morning response showed a small negative correlation with the time lag between first and second sampling.
Conclusion:
This study emphasizes the importance of excluding extreme time deviation and correcting for age and awakening time. Appearance of a cortisol morning increase was only found in approximately half of the children, suggesting the absence of the cortisol awakening response as a general characteristic. Also, this could partially be explained by poor time compliance.
