"We're doing the best job we can": maternal experiences of facilitators and barriers to preschoolers sleeping well in Aotearoa/New Zealand

Maternal depressive symptoms in and beyond the perinatal period: associations with infant and preschooler sleep

STUDY OBJECTIVES

(1) To describe sleep in infancy and early childhood among children born to mothers with and without clinically significant depressive symptoms, and (2) to explore the relationships between maternal depressive symptoms and sleep patterns and problems during infancy and early childhood.

METHODS

Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study. Data were collected in pregnancy (T1), 12 weeks postpartum (T2), and 3 years post-birth (T3). Participants were 262 Māori and 594 non-Māori mother-child dyads. Chi-square and independent t-tests measured bivariate associations between maternal mood (T1, T2, and T3) and child sleep characteristics (T2 and T3). Binary logistic regression models examined longitudinal and concurrent associations between maternal depressive symptoms and infant and preschooler sleep. Adjusted models accounted for key socio-demographic variables, as well as infant sleep variables in preschooler models.

RESULTS

Bivariate associations were found between prior and concurrent depressive symptomology and many of the infant and preschooler sleep outcomes. In adjusted models, prenatal depressive symptoms remained independently associated with shorter-than-recommended sleep durations in preschoolers. In these models, concurrent depression was also associated with night waking, night LSRSP, and perceived sleep problems at 12 weeks postpartum, and CSHQ-determined and perceived sleep problems at 3 years post-birth.

CONCLUSIONS

Longitudinal and cross-sectional associations were found between maternal depressive symptoms and child sleep. Sleep appears to be one pathway by which maternal depression confers risk for suboptimal child health outcomes. Findings support the need for earlier and better maternal mental health services.

The measurement of young children's nocturnal sleep health and the development of the Perception of Infant and Toddler Sleep Scale (PoITSS) in Aotearoa New Zealand whānau (families)

OBJECTIVES

To modify an existing questionnaire Brief Infant Sleep Questionnaire - Revised (BISQ-R) to ensure that it is suitable to measure nocturnal sleep health in a diverse sample of young children from Aotearoa New Zealand whānau (families), and to develop a "Perception of Infant and Toddler Sleep Scale" (PoITSS) to use as a primary outcome measurement in an upcoming trial.

METHODS

Items from the BISQ-R were adapted for use among ethnically diverse whānau, and tested online with caregivers of 0-2 year old children. A PoITSS score was generated by scaling the responses from three of the questionnaire items to create a value between 0 (very poor) and 10 (very good). Caregivers provided qualitative feedback about the ease of interpreting and answering questionnaire items.

RESULTS

Caregivers of 957 children (35% Māori, 12% Pacific) completed the questionnaire. Few differences in children's nocturnal sleep were observed by demographic characteristics. The mean PoITSS score was 6.9 (SD 2.3) and was slightly higher among Māori children (mean difference 0.4, 95% CI 0.1, 0.7). Test-retest indicated good reliability (ICC=0.81). While the majority (86%) of caregivers did not find it difficult to answer any of the items which formed the PoITSS, qualitative feedback indicated that simple modifications to some items would help ensure that they would be well understood by most caregivers.

CONCLUSIONS

Items from the BISQ-R were successfully adapted, and the PoITSS scale was shown to be appropriate, for use in ethnically diverse Aotearoa New Zealand whānau with young children.

Trying to Do What's Best: Maternal Perspectives About Toddler Sleep Health Among an Underresourced Sample of Mothers With Diverse Racial and Ethnic Identities

INTRODUCTION

This study describes mothers' knowledge, attitudes, beliefs, and practices about their toddler's sleep health among an underresourced sample of mothers with diverse racial and ethnic identities.

METHOD

This was a descriptive qualitative study with 16 mothers and their 12- to 36-month-old child. Mothers completed a semistructured, audio-recorded interview about their toddler's sleep health. Data were analyzed using inductive content analysis on the basis of established methods.

RESULTS

Mothers self-identified as 18.8% Black, 43.8% White, 12.5% multiracial, 25.0% other race, and 37.5% Hispanic. Of the mothers, 80.0% reported a past year household income of ≤ $40,000. A core construct, "Trying to do What's Best," emerged from the interview data, and this construct included three domains: Getting Good Sleep, Getting Thrown Off, and Rolling With It.

DISCUSSION

Findings support future strengths-based and multilevel sleep health-promoting interventions.

Moe Kura: a longitudinal study of mother and child sleep and well-being in Aotearoa New Zealand

Moe Kura is a longitudinal study focused on the role of sleep in the health and well-being of mothers and children in Aotearoa New Zealand (NZ). The leadership, design and conduct of the study is informed by Kaupapa Māori research principles and is positioned within a broader rights-based approach to health, recognising that inequities in health must be identified and understood to improve the health of wāhine Māori and tamariki. In late pregnancy 418 Māori women and 768 non-Māori women were recruited and data collected at four waves (35-37 weeks gestation, 4-6 weeks postpartum, 11-13 weeks postpartum and when the Moe Kura child was 3-4 years of age) with linkage to birth records and national administrative datasets and associated qualitative research. Findings demonstrate substantial inequities in sleep health, infant and maternal health, and maternal employment between Māori and non-Māori, along with the important role of sleep in perinatal health and maternal mental health outcomes. The research philosophy that underpins the study, the primary focus on women, and the detailed measurement of sleep during the childbearing years has provided new and important findings that contribute to intervention development and health policy for women and children in NZ.

Sleep timing and sleep problems of preschoolers in Aotearoa/New Zealand: relationships with ethnicity and socioeconomic position

OBJECTIVES

To provide descriptive sleep data and explore sleep inequities, we investigated maternal reports of when and how well Māori (Indigenous) and non-Māori preschoolers sleep, and examined relationships between ethnicity (child and maternal), socioeconomic position (SEP) and sleep timing and problems of 3-4 year old children in Aotearoa/New Zealand (NZ).

METHODS

This study involved cross-sectional analysis of data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand longitudinal study. Log-binomial regression models were used to investigate associations between child and maternal demographic variables and preschooler bedtimes, social jetlag and maternally-reported sleep problems. Child models included child ethnicity, child gender, area- and individual-level deprivation. Maternal models included maternal ethnicity, maternal age, area- and individual-level deprivation.

RESULTS

340 Māori and 570 non-Māori preschoolers and their mothers participated. Māori preschoolers had later average bedtimes and wake times than non-Māori preschoolers. Ethnicity and area-level deprivation were independently associated with later bedtimes. Ethnicity was associated with social jetlag and sleep problems, independent of SEP. Individual-level deprivation was associated with problems falling asleep. Preschoolers of Māori mothers in least deprived areas were more likely to have problems falling asleep than preschoolers of non-Māori mothers in least deprived areas.

CONCLUSIONS

Research is needed to understand what sleep timing differences mean for preschoolers' wellbeing in NZ. Fundamental causes of social and economic disadvantage experienced by Indigenous children and mothers and by families who hold low SEP must be addressed, in order to eliminate sleep health inequities in early childhood.