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Changes in children's sleep domains between 2 and 3 years of age: the Ulm SPATZ Health Study
Stefanie Braig1, Michael S Urschitz2, Dietrich Rothenbacher1
1Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Insights
Toddler sleep habits show minor overall changes between ages two and three, but individual children experience significant variations. Analyzing specific sleep behaviors is crucial for understanding child health.
Area of Science:
- Pediatric Health
- Sleep Medicine
- Developmental Psychology
Background:
- Growing interest in the link between sleep and child health.
- Limited reference values and longitudinal data on toddler sleep habits exist.
Purpose of the Study:
- Describe parent-reported sleep habits in toddlers (2-3 years old).
- Analyze intra-individual changes in sleep habits over time.
- Utilize data from the Ulm SPATZ Health Study.
Main Methods:
- Longitudinal data collection using the German Children's Sleep Habits Questionnaire (CSHQ-DE).
- Follow-ups at two and three years in a birth cohort (N=615).
- Descriptive statistics and sign tests for intra-individual differences.
Main Results:
- Minimal sample-averaged changes in total and subscale CSHQ scores (max Cohen's d=0.39).
- Significant intra-individual variations and opposing trends within subscales (e.g., bedtime resistance improved, sleep duration shortened).
- Sleep anxiety items showed mixed trends, with 'Afraid of sleeping in the dark' worsening in ~20% of children.
Conclusions:
- Provides initial descriptive data on toddler sleep habits.
- Highlights the importance of age- and item-specific analyses due to masked intra-individual changes.
- Suggests that aggregated data may obscure critical developmental shifts in sleep.
Objective:
There is growing interest in the link between sleep habits and child health but reference values specific to toddlers as well as longitudinal data on sleep are scarce. We aimed to describe parent-reported child sleep habits and their intra-individual changes in two- to three-year-olds using data from a regional birth cohort study.
Methods:
In the Ulm SPATZ Health Study, a birth cohort study conducted at Ulm, Southern Germany, with baseline examination from April 2012 to May 2013, the German version of the Children's Sleep Habits Questionnaire (CSHQ-DE) was used longitudinally at follow-ups at two and three years (N = 615 children). Descriptive statistics including intra-individual differences between three- and two-year scores were reported, the latter using the sign test.
Results:
The sample-averaged total and subscale CSHQ scores differed only slightly between two and three years (max. Cohen's d = 0.39). Intra-individual comparisons of the CSHQ subscales or single items revealed congruent but also opposing changes in items belonging to the same subscale. Whereas items on bedtime resistance generally improved, sleep duration shortened with older age. With regard to sleep anxiety, we found worsening in the item 'Afraid of sleeping in the dark' in about one-fifth of our children whereas other items on this CSHQ subscale showed an opposing trend with age. A similar opposing trend was detected within the subscale on night wakings.
Conclusion:
Our data provide initial descriptive information on sleep habits in toddlers. The high intra-individual changes, partly in opposing directions which may be masked by aggregation, indicate a need for age- and item-specific analyses.