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Muller J, Guse T, Ntozini A. Parental experiences of subjective well-being in the context of infant sleep problems. J Reprod Infant Psychol 2024; 42:540-549. [PMID: 36047577 DOI: 10.1080/02646838.2022.2115471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study explored parental experiences of subjective well-being in the context of infant sleep problems. BACKGROUND Although quantitative research has highlighted the deleterious impact of infant sleep problems for parental well-being broadly, little is known about subjective experiences of well-being specifically. METHOD This retrospective qualitative study formed part of a larger multiphase project. Ten parents who approached a sleep consultancy for assistance with infant sleep problems participated in the study. Data was collected through in-depth interviews and results were analysed thematically. RESULTS Two key themes were identified: (1) the negative influences of insufficient sleep on parental subjective well-being, and (2) the indirect influence of infant sleep problems on parental subjective well-being. Participants highlighted the direct influence of insufficient sleep on their life satisfaction, affect and mood. Further, through its impact on infant well-being and behaviour, and the loss of free time, infant sleep problems indirectly negatively influenced parental subjective well-being. As a result, life satisfaction and affect was deleteriously influenced. CONCLUSION Parental subjective well-being may be deleteriously influenced by infant sleep problems, both directly through insufficient sleep and indirectly through the impact of infant sleep problems.
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Affiliation(s)
- Jacomien Muller
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | - Tharina Guse
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | - Anathi Ntozini
- Department of Psychology, University of Pretoria, Pretoria, South Africa
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2
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Tarsha MS, Narvaez D. Humanity's evolved nest and its relation to cardiac vagal regulation in the first years of life. Early Hum Dev 2024; 193:106033. [PMID: 38744000 DOI: 10.1016/j.earlhumdev.2024.106033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The Evolved Developmental Niche (EDN) is a millions-year-old developmental system that matches the maturational schedule of the offspring, optimizing health. Every animal has a developmental niche. AIMS Humanity has fallen away from providing its EDN. Does it matter? STUDY DESIGN Several components of humanity's EDN were reviewed (breastfeeding, positive touch, allomothers, responsive care, free play) in relation to cardiac vagal nerve regulation, a signal of healthy development. Focal subjects were young children. OUTCOME MEASURES A review of research on the selected EDN components in relation to vagal nerve function was performed. Data were available for all but the allomother component, which is typically not measured by western researchers, although allomothers provide EDN components alongside parents. RESULTS Apart from the lack of research on allomother effects, all these EDN components have been shown to influence cardiac vagal regulation in young children. CONCLUSIONS Converging evidence suggests that providing the EDN in early life may not only support aspects of a child's primal health system, but bolster capacities for social health and wellness, the cornerstone of a positive life trajectory.
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Affiliation(s)
- Mary S Tarsha
- Department of Psychology and the Kroc Institute for International Peace Research, University of Notre Dame, United States of America
| | - Darcia Narvaez
- Department of Psychology and the Kroc Institute for International Peace Research, University of Notre Dame, United States of America.
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3
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Tsai SY, Lee WT, Lee CC, Jeng SF, Weng WC. Five-year follow-up of a clinic-based sleep intervention for paediatric epilepsy: A randomized clinical trial. J Sleep Res 2024; 33:e14059. [PMID: 37770048 DOI: 10.1111/jsr.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5-year follow-up of a clinic-based sleep intervention study that randomized 100 toddlers and preschool-age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long-term benefits of a clinic-based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow-up was 9.55 years. Thirty-eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5-year follow-up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5-year follow-up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic-based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool-age children with epilepsy had long-lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring.
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
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Lecuelle F, Leslie W, Gustin MP, Franco P, Putois B. Treatment for behavioral insomnia in young children with neurotypical development under 6 years of age: A systematic review. Sleep Med Rev 2024; 74:101909. [PMID: 38394890 DOI: 10.1016/j.smrv.2024.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
This literature review examines all treatments for behavioral insomnia in children under 6 years of age to determine which treatments have empirically demonstrated efficacy. Following PRISMA guidelines, three databases were investigated (Pubmed, Cochrane and Psychinfo) to select randomized controlled trials (RCTs) which assess treatments for behavioral insomnia in children under 6 years of age, all with neurotypical development. A total of 908 articles met the search criteria. 21 articles were selected and analyzed in their entirety for a total of 2363 children (ranging from 2 months to 6 years of age). Based on these studies, treatment of behavioral insomnia in young children under 6 years of age is primarily based on behavioral therapy. There is no evidence that pharmacological treatments are effective in the long term for neurotypical children. This review highlights the lack of RCTs in this field: new RCTs should be carried out among young children to refine and optimize the therapeutic approach and to address the risk of therapeutic abuse through the use of non-scientifically validated methods.
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Affiliation(s)
- Florian Lecuelle
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France.
| | | | - Marie-Paule Gustin
- Institute of Pharmaceutic and Biological Sciences, University Claude Bernard Lyon 1, Villeurbanne, France; Emerging Pathogens Laboratory-Fondation Merieux, International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France
| | - Patricia Franco
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France
| | - Benjamin Putois
- Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France
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5
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Kahn M, Barnett N, Gradisar M. Behavioral infant sleep interventions: helping parents and clinicians make scientifically informed decisions. J Pediatr 2023; 261:113334. [PMID: 36720381 DOI: 10.1016/j.jpeds.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Michal Kahn
- School of Psychological Sciences Tel Aviv University Tel Aviv, Israel
| | | | - Michael Gradisar
- Wink Sleep Pty Ltd Adelaide South Australia, Australia; Sleep Cycle AB Gothenburg, Sweden
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Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
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Whittall H, Gradisar M, Fitton J, Pillion M, Kahn M. Can cry tolerance be increased in mothers of infants with sleep problems, and why does it matter? A quasi-experimental study. Sleep Med 2023; 107:64-71. [PMID: 37121221 DOI: 10.1016/j.sleep.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Abstract
STUDY OBJECTIVES Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance. METHODS This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6-24 months, mothers of poor sleeping infants aged 6-24 months, and good sleeping women aged 23-40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects. RESULTS We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05). CONCLUSIONS This demonstrates that cry tolerance can be increased using emotion regulation strategies, such as distraction via music or gaming, and reappraisal. This has clinical implications for families implementing behavioural sleep interventions.
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Affiliation(s)
- Hannah Whittall
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia.
| | | | - Josh Fitton
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Michal Kahn
- Tel Aviv University, School of Psychological Sciences, Israel
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Kahn M, Barnett N, Gradisar M. Implementation of Behavioral Interventions for Infant Sleep Problems in Real-World Settings. J Pediatr 2023; 255:137-146.e2. [PMID: 36375604 DOI: 10.1016/j.jpeds.2022.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare the real-world frequency, timing, duration, difficulty, and helpfulness of 3 infant Behavioral Sleep Intervention (BSI) approaches: Unmodified Extinction, Modified Extinction, and Parental Presence and to examine the effectiveness and safety of these approaches by comparing infant sleep, parent sleep, daytime sleepiness, depression, and parent-infant bonding between parents who had and had not implemented these interventions. STUDY DESIGN Participants were 2090 parents (75% mothers, 79% White/Caucasian) of US infants (49% girls) aged 3-18 months (M = 9.1, SD = 4.1). Parents completed online questionnaires regarding their infant's sleep, their own sleep, daytime sleepiness, depression levels, and parent-infant bonding. Infant sleep was assessed via objective-albeit exploratory-autovideosomnography data obtained from the 14 days prior to survey completion. RESULTS Sixty-four percent of parents reported implementing BSIs. The average age at intervention was 5.3 months (SD = 2.6). Unmodified and Modified Extinction were rated as significantly more difficult to implement compared with Parental Presence but also as more helpful, shorter, and quicker to show improvements. Infant nighttime sleep was longer and more consolidated in the Unmodified and Modified Extinction groups compared with the Parental Presence and non-BSI groups. No differences were found between BSI groups in parent sleep, sleepiness, depression, or parent-infant bonding. CONCLUSIONS Implementation of BSIs outside clinical settings is pervasive and occurs earlier than generally recommended. Unmodified and Modified Extinction were associated with longer and more consolidated infant sleep. Despite concerns regarding the potential harm of BSIs, implementation of these approaches was not linked with negative outcomes, providing additional evidence for their safety and effectiveness.
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Affiliation(s)
- Michal Kahn
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.
| | | | - Michael Gradisar
- Wink Sleep Pty Ltd, Adelaide, South Australia, Australia; Sleep Cycle AB, Gothenburg, Sweden
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9
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Honaker SM, Chung A. Infant Behavioral Sleep Intervention in Black Families. JAMA Netw Open 2023; 6:e236286. [PMID: 37000455 DOI: 10.1001/jamanetworkopen.2023.6286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Alicia Chung
- Center for Early Childhood Health and Development, Department of Population Health, New York University Grossman School of Medicine, New York
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Ohmura N, Okuma L, Truzzi A, Shinozuka K, Saito A, Yokota S, Bizzego A, Miyazawa E, Shimizu M, Esposito G, Kuroda KO. A method to soothe and promote sleep in crying infants utilizing the transport response. Curr Biol 2022; 32:4521-4529.e4. [PMID: 36103877 DOI: 10.1016/j.cub.2022.08.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
Approximately 20%-30% of infants cry excessively and exhibit sleep difficulties for no apparent reason, causing parental stress and even triggering impulsive child maltreatment in a small number of cases.1-8 While several sleep training methods or parental education programs may provide long-term improvement of infant cry and sleep problems, there is yet to be a conclusive recommendation for on-site behavioral interventions.9-13 Previously we have reported that brief carrying of infants transiently reduces infant cry via the transport response, a coordinated set of vagal activation and behavioral calming conserved in altricial mammals.14-18 In this study, we disentangled complex infant responses to maternal holding and transport by combining subsecond-scale, event-locked physiological analyses with dynamic mother-infant interactions. Infant cry was attenuated either by maternal carrying or by reciprocal motion provided by a moving cot, but not by maternal holding. Five-minute carrying promoted sleep for crying infants even in the daytime when these infants were usually awake, but not for non-crying infants. Maternal laydown of sleeping infants into a cot exerted bimodal effects, either interrupting or deepening the infants' sleep. During laydown, sleeping infants were alerted most consistently by the initiation of maternal detachment, then calmed after the completion of maternal detachment in a successful laydown. Finally, the sleep outcome after laydown was associated with the sleep duration before the laydown onset. These data propose a "5-min carrying, 5- to 8- min sitting" scheme for attending to infant cry and sleep difficulties, which should be further substantiated in future studies. VIDEO ABSTRACT.
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Affiliation(s)
- Nami Ohmura
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan
| | - Lana Okuma
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan; Laboratory for Human Cognition and Learning, RIKEN Center for Brain Science, Saitama 351-0198, Japan
| | - Anna Truzzi
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan; Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy; Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Kazutaka Shinozuka
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan
| | - Atsuko Saito
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan; Department of Psychology, Sophia University, Tokyo 102-8554, Japan
| | - Susumu Yokota
- Department of Clinical Laboratory, Saitama Prefectural Cardiovascular and Respiratory Center, Saitama 360-0197, Japan
| | - Andrea Bizzego
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Eri Miyazawa
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan
| | - Masaki Shimizu
- Division of Neonatology, Saitama Prefectural Children's Medical Center, Saitama 330-8777, Japan
| | - Gianluca Esposito
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan; Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy.
| | - Kumi O Kuroda
- Laboratory for Affiliative Social Behavior, RIKEN Center for Brain Science, Saitama 351-0198, Japan.
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Gronski M. Occupational Therapy Interventions to Support Sleep in Children From Birth to Age 5 Years. Am J Occup Ther 2022; 76:23909. [PMID: 36125512 DOI: 10.5014/ajot.2022.049552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. This Evidence Connection article provides a case report of a young child receiving early intervention services. I describe the occupational therapy evaluation and intervention processes for supporting this child's sleep routines in the home and early childhood education settings. A systematic review on this topic was published in the March/April 2020 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Early Childhood: Birth-Age 5 Years. Each article in this series summarizes the evidence from published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.
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Affiliation(s)
- Meredith Gronski
- Meredith Gronski, OTD, OTR/L, CLA, FAOTA, is Associate Professor and Chair, Department of Occupational Therapy, Methodist University, Fayetteville, NC;
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Bruni O, DelRosso LM, Mogavero MP, Angriman M, Ferri R. Chronic insomnia of early childhood: Phenotypes and pathophysiology. Neurosci Biobehav Rev 2022; 137:104653. [PMID: 35398115 DOI: 10.1016/j.neubiorev.2022.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
This paper aims to review the limitations of the current classification of insomnia of early childhood and propose a new conceptual model allowing a better understanding of its pathophysiology. Our hypothesis is that chronic insomnia of childhood has different phenotypical expressions, associated to different pathophysiological mechanisms. Based on a long-lasting experience in evaluating a very large number of children with specific insomnia symptoms (nocturnal awakenings, difficulty in falling asleep, nocturnal restlessness, early morning awakenings) and on published data, we hypothesize that different phenotypes of insomnia might exist with different therapeutic implications. We describe three phenotypes of insomnia in early childhood: a) insomnia with motor restlessness; b) insomnia characterized without difficulties in falling asleep but with long-lasting early morning awakenings; c) insomnia with multiple night awakenings and falling asleep difficulty. This type of categorization might have important implications for treatment, based on the different hypothetical neurotransmitter dysfunctions. The early identification of a phenotype of insomnia might guide to specific behavioral and/or pharmacological interventions with the aim to prevent chronic insomnia.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi 78, Rome 00185, Italy.
| | - Lourdes M DelRosso
- Pulmonary and Sleep Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA 98105, USA.
| | - Maria P Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Via Salvatore Maugeri 10, 27100 Pavia, Italy.
| | - Marco Angriman
- Child Neurology and Neurorehabilitation Unit, Bolzano Hospital, Via Guncina 54, 39100 Bolzano, Italy.
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute, IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy.
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13
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Cassels T, Rosier JG. The Effectiveness of Sleep Training: Fact or Fiction? CLINICAL LACTATION 2022. [DOI: 10.1891/cl-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IntroductionIn Western cultures, parents often view infant sleep as problematic. Family, friends, and doctors may advise parents to “sleep train” assuming it is safe and effective, without considering its possible side effects, including its impact on breastfeeding. Unfortunately, it may reduce night feeds and result in earlier supplementation or weaning. The larger question is whether sleep training is worth the risk (i.e., does it improve infant sleep?). Our goal was to examine the data on the effectiveness of sleep training interventions on infant/toddler sleep.MethodsPubMed and Google Scholar were searched for specific terms to identify articles that included behavioral sleep interventions and objective measures of sleep pre-and postntervention. Two objective infant sleep measures were examined: Night wakings and total sleep duration. Articles were then reviewed for evidence of the effectiveness of these interventions to reduce night wakings and increase total sleep duration.ResultsFive articles were identified that met the criteria for inclusion. Overall, there was no evidence that sleep training improves infant sleep.Applications for PracticeThe claim that sleep training is effective in changing infant sleep is not warranted. Given the potential side effects on breastfeeding, parents should be cautioned about engaging these behavioral sleep interventions if they have breastfeeding goals they want to achieve.
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Quante M, McGee GW, Yu X, von Ash T, Luo M, Kaplan ER, Rueschman M, Haneuse S, Davison KK, Redline S, Taveras EM. Associations of sleep-related behaviors and the sleep environment at infant age one month with sleep patterns in infants five months later. Sleep Med 2022; 94:31-37. [DOI: 10.1016/j.sleep.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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15
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Schoch SF, Castro-Mejía JL, Krych L, Leng B, Kot W, Kohler M, Huber R, Rogler G, Biedermann L, Walser JC, Nielsen DS, Kurth S. From Alpha Diversity to Zzz: Interactions among sleep, the brain, and gut microbiota in the first year of life. Prog Neurobiol 2021; 209:102208. [PMID: 34923049 DOI: 10.1016/j.pneurobio.2021.102208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
Sleep disorders have been linked to alterations of gut microbiota composition in adult humans and animal models, but it is unclear how this link develops. With longitudinal assessments in 162 healthy infants, we present a so far unrecognized sleep-brain-gut interrelationship. First, we report a link between sleep habits and gut microbiota: daytime sleep is associated with bacterial diversity, and nighttime sleep fragmentation and variability link with bacterial maturity and enterotype. Second, we demonstrate a sleep-brain-gut link: bacterial diversity and enterotype are associated with sleep neurophysiology. Third, we show that the sleep-brain-gut link is relevant in development: sleep habits and bacterial markers predict behavioral-developmental outcomes. Our results demonstrate the dynamic interplay between sleep, gut microbiota, and the maturation of brain and behavior during infancy, which aligns with the lately emerging concept of a sleep-brain-gut axis. Importantly, sleep and gut microbiota represent promising health targets since both can be modified non-invasively. As many adult diseases root in early childhood, leveraging protective factors of adequate sleep and age-appropriate gut microbiota in infancy could constitute a health promoting factor across the entire human lifespan.
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Affiliation(s)
- S F Schoch
- Department of PulmonOlogy, University Hospital Zurich, Zurich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | | | - L Krych
- Department of Food Science, University of Copenhagen, Denmark
| | - B Leng
- Department of Food Science, University of Copenhagen, Denmark
| | - W Kot
- Department of Plant and Environmental Sciences, University of Copenhagen, Denmark
| | - M Kohler
- Department of PulmonOlogy, University Hospital Zurich, Zurich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - R Huber
- Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - G Rogler
- Department for Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - L Biedermann
- Department for Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - J C Walser
- Genetic Diversity Center, ETH Zurich, Zurich, Switzerland
| | - D S Nielsen
- Department of Food Science, University of Copenhagen, Denmark
| | - S Kurth
- Department of PulmonOlogy, University Hospital Zurich, Zurich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland; Department of Psychology, University of Fribourg, Fribourg, Switzerland.
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Early regulatory problems and parenting: life-long risk, vulnerability or susceptibility for attention, internalizing and externalizing outcomes? Eur Child Adolesc Psychiatry 2021; 30:1523-1531. [PMID: 32888096 DOI: 10.1007/s00787-020-01632-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems, RPs) predict increased risk for self-regulation difficulties. Sensitive parenting may protect children from trajectories of dysregulation. Considering self-regulation from a life-course perspective, are children with early multiple and/or persistent RPs affected similarly by parenting as those without (main effects model, ME), or are they more vulnerable (diathesis-stress, DIA-S), or more susceptible (differential susceptibility theory, DST) to variations in sensitive parenting at age 6 years? Participants (N = 302) were studied prospectively from birth to 28 years. RPs were assessed from 5 to 56 months. Sensitive parenting was observed at 6 years. Attention regulation was observed at 8 and 28 years. Internalizing and externalizing problems were rated by parents at 8 years, and by adults at 28 years. Confirmatory-comparative modelling tested whether associations of sensitive parenting with outcomes at 8 and 28 years among individuals with early multiple and/or persistent RPs (n = 74) versus those without (n = 228) were best explained by ME, DIA-S, or DST models. Best fitting models differed according to age at assessment. For childhood attention regulation, the statistically parsimonious DIA-S provided the best fit to the data. At age 28, two additive main effects (ME, RP group and sensitive parenting) fit best. DIA-S and ME explained internalizing and externalizing problems. Using a comprehensive life-span approach, DIA-S and ME models but not DST explained how early RPs and sensitive parenting predicted attention, internalizing, and externalizing outcomes. Individuals with early RPs are vulnerable to insensitive parenting.
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Abstract
OBJECTIVE The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment. METHOD This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months. RESULTS Parental use of "cry out" as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment. CONCLUSION When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.
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Honaker SM, Mindell JA, Slaven JE, Schwichtenberg AJ. Implementation of Infant Behavioral Sleep Intervention in a Diverse Sample of Mothers. Behav Sleep Med 2021; 19:547-561. [PMID: 32954835 DOI: 10.1080/15402002.2020.1817745] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE/BACKGROUND Behavioral Sleep Interventions (BSI) is an efficacious class of treatment approaches for infant sleep disturbance. Little is known about BSI implementation in the real world. Objectives were to a) examine the prevalence of BSI implementation and related factors in a diverse sample of US mothers; b) assess racial-ethnic group differences; and c) examine predictors of BSI implementation. PARTICIPANTS Participants included mothers (n= 353) with an infant (6-18 months) from one of the three racial-ethnic groups: White Hispanic (n= 113), White non-Hispanic (n= 122), Black non-Hispanic (n= 118). METHODS Respondents completed an online survey assessing BSI implementation, familiarity, barriers, sleep knowledge, cognitions, and sleep patterns. RESULTS Approximately one-third (36%) of the sample endorsed BSI implementation and 59% reported BSI familiarity. Black non-Hispanic mothers were more likely to report stopping a BSI prior to completion (OR = 4.92, p <.05) and more likely to hear about BSI from a health-care professional (OR = 1.32, p <.05) compared to White non-Hispanic mothers. Racial-ethnic group differences were identified for a variety of sleep practices, including bedsharing, independent sleep onset, and score on a validated measure of problematic sleep. No racial-ethnic group differences were found in BSI implementation, cognitions, or barriers. BSI implementation was predicted by BSI familiarity, more maternal education, and cognitions around infant self-soothing. CONCLUSIONS Differential BSI implementation does not appear to be a major driver of sleep disparities, although Black non-Hispanic mothers who decide to implement BSI do report notably lower completion rates. Future studies should examine alternative mechanisms of sleep disparities as well as strategies to promote sleep health in diverse families.
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Affiliation(s)
| | - Jodi A Mindell
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James E Slaven
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - A J Schwichtenberg
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana
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Kahn M, Livne-Karp E, Juda-Hanael M, Omer H, Tikotzky L, Anders TF, Sadeh A. Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions. J Clin Sleep Med 2021; 16:1275-1283. [PMID: 32279703 DOI: 10.5664/jcsm.8488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors. METHODS Participants were 91 infants aged 9-18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale. RESULTS Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions. CONCLUSIONS Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study's findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Interventions for sleep problems in early childhood; URL: https://clinicaltrials.gov/ct2/show/NCT01489215;Identifier: NCT01489215.
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Affiliation(s)
- Michal Kahn
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Efrat Livne-Karp
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | | | - Haim Omer
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
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20
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Whittall H, Kahn M, Pillion M, Gradisar M. Parents matter: barriers and solutions when implementing behavioural sleep interventions for infant sleep problems. Sleep Med 2021; 84:244-252. [PMID: 34182352 DOI: 10.1016/j.sleep.2021.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Behavioural sleep interventions (eg, extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep.
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Affiliation(s)
- Hannah Whittall
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia.
| | - Michal Kahn
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Michael Gradisar
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
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21
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Kang EK, Kim SS. Behavioral insomnia in infants and young children. Clin Exp Pediatr 2021; 64:111-116. [PMID: 32683806 PMCID: PMC7940085 DOI: 10.3345/cep.2020.00052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022] Open
Abstract
In infants and young children, bedtime problems and night waking are common and the main presentations of insomnia. Poor sleep may critically impact the daytime functioning and mood of the child and their caregivers. A comprehensive sleep history, a sleep diary/log, and the BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) sleep screen are useful for diagnosing sleep problems in young children. Behavioral therapies for this type of insomnia include extinction, bedtime fading with positive routines, and scheduled awakening. Previous studies of behavioral interventions for young children showed significant improvements in sleep-onset latency, night waking frequency, and night waking duration. Parent education about their child's sleep, bedtime routines, and sleep hygiene is essential for treatment.
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Affiliation(s)
- Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seung Soo Kim
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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22
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Patan MJ, Kennedy DO, Husberg C, Hustvedt SO, Calder PC, Middleton B, Khan J, Forster J, Jackson PA. Differential Effects of DHA- and EPA-Rich Oils on Sleep in Healthy Young Adults: A Randomized Controlled Trial. Nutrients 2021; 13:nu13010248. [PMID: 33467135 PMCID: PMC7830450 DOI: 10.3390/nu13010248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022] Open
Abstract
Emerging evidence suggests that adequate intake of omega-3 polyunsaturated fatty acids (n-3 PUFAs), which include docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), might be associated with better sleep quality. N-3 PUFAs, which must be acquired from dietary sources, are typically consumed at suboptimal levels in Western diets. Therefore, the current placebo-controlled, double-blind, randomized trial, investigated the effects of an oil rich in either DHA or EPA on sleep quality in healthy adults who habitually consumed low amounts of oily fish. Eighty-four participants aged 25-49 years completed the 26-week intervention trial. Compared to placebo, improvements in actigraphy sleep efficiency (p = 0.030) and latency (p = 0.026) were observed following the DHA-rich oil. However, these participants also reported feeling less energetic compared to the placebo (p = 0.041), and less rested (p = 0.017), and there was a trend towards feeling less ready to perform (p = 0.075) than those given EPA-rich oil. A trend towards improved sleep efficiency was identified in the EPA-rich group compared to placebo (p = 0.087), along with a significant decrease in both total time in bed (p = 0.032) and total sleep time (p = 0.019) compared to the DHA-rich oil. No significant effects of either treatment were identified for urinary excretion of the major melatonin metabolite 6-sulfatoxymelatonin. This study was the first to demonstrate some positive effects of dietary supplementation with n-3 PUFAs in healthy adult normal sleepers, and provides novel evidence showing the differential effects of n-3 PUFA supplements rich in either DHA or EPA. Further investigation into the mechanisms underpinning these observations including the effects of n-3 PUFAs on sleep architecture are required.
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Affiliation(s)
- Michael J. Patan
- Brain, Performance and Nutrition Research Centre, Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.J.P.); (D.O.K.); (J.K.); (J.F.)
| | - David O. Kennedy
- Brain, Performance and Nutrition Research Centre, Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.J.P.); (D.O.K.); (J.K.); (J.F.)
| | | | | | - Philip C. Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- National Institute of Health Research Southampton Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
| | - Benita Middleton
- Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
| | - Julie Khan
- Brain, Performance and Nutrition Research Centre, Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.J.P.); (D.O.K.); (J.K.); (J.F.)
| | - Joanne Forster
- Brain, Performance and Nutrition Research Centre, Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.J.P.); (D.O.K.); (J.K.); (J.F.)
| | - Philippa A. Jackson
- Brain, Performance and Nutrition Research Centre, Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.J.P.); (D.O.K.); (J.K.); (J.F.)
- Correspondence: ; Tel.: +44-(0)-191-227-4468
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23
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Schnatschmidt M, Cattarius B, Schneider B, Jud A, Schlarb AA. Wie ist die Lage in Einrichtungen für frühkindliche Regulationsstörungen in Deutschland? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2021. [DOI: 10.1026/1616-3443/a000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Frühkindliche Regulationsprobleme stehen in Verbindung mit Schlafproblemen und unsicherem Elternverhalten. Störungsspezifische Behandlungsansätze sind vielfältig und unterscheiden sich deutlich hinsichtlich Qualität und Evidenzgrad. Fragestellung: Häufigkeiten von Schlafproblemen, elterliche Unsicherheiten, therapeutisch / beraterische Grundorientierungen und Konzepte werden erfasst und Unterschiede zwischen Einrichtungsarten untersucht. Methode: Die Umfrage wurde mit interdisziplinären Experten entwickelt. Eine deutschlandweite Datenbank (622 Einrichtungen) mit einer finalen Stichprobe von N = 160 wurde erstellt. Ergebnisse: Schlafprobleme gelten als häufigster Anmeldegrund (59 %), unsicheres Erziehungsverhalten als mehrheitlich relevant (66 %). Über 16 Behandlungskonzepte werden angewandt; je nach Einrichtungsart eher systemische ( d = 0.5), körperorientierte ( d = 0.5) oder somatisch-medizinische ( d = 0.7) Verfahren. Schlussfolgerung: Die schlafspezifische Expertise der Fachkräfte sollte gesichert sowie Transparenz und Überprüfbarkeit von Qualitätsstandards weiterentwickelt werden.
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Affiliation(s)
- Marisa Schnatschmidt
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
| | - Barbara Cattarius
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
| | - Barbara Schneider
- Zentrum für Neuropädiatrie und Schlafmedizin, Kinderkrankenhaus St. Marien, Landshut
| | - Andreas Jud
- Kinder- und Jugendpsychiatrie / Psychotherapie, Universitätsklinikum Ulm
- Soziale Arbeit, Hochschule Luzern, Luzern, Schweiz
| | - Angelika A. Schlarb
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
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24
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Bilgin A, Wolke D. Parental use of 'cry it out' in infants: no adverse effects on attachment and behavioural development at 18 months. J Child Psychol Psychiatry 2020; 61:1184-1193. [PMID: 32155677 DOI: 10.1111/jcpp.13223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leaving infant to cry it out has been the subject of discussion among researchers and parents. Nevertheless, there is paucity of empirical research investigating the association between leaving infant to cry it out and consequent crying duration and frequency, mother-infant attachment and behavioural development. METHODS The sample with complete longitudinal data comprised 178 infants and their caretakers. Parental use of 'leaving infant to cry out' and cry duration were assessed with maternal report at term, 3, 6 and 18 months, and frequency of crying was assessed at term, 3 and 18 months of age. Attachment was measured at 18 months using the strange situation procedure. Behavioural development of the infant was assessed with two observational measures and a parent-report questionnaire at 18 months. RESULTS The use of 'leaving infant to crying' was rare at term and increased over the next 18 months. 'Leaving infants to cry it out' at term was associated with a decrease in crying frequency at 3 months. Furthermore, leaving infants to cry it out a few times at term and often at 3 months was associated with shorter fuss/cry duration at 18 months of age. No adverse impacts of leaving infants to cry it out in the first 6 months on infant-mother attachment and behavioural development at 18 months were found. CONCLUSIONS Contemporary practice of some parents in the United Kingdom to occasionally or often 'leaving infant to cry it out' during the first 6 months was not associated with adverse behavioural development and attachment at 18 months. Increased use of 'leaving to cry it out' with age may indicate differential responding by parents related to infant self-regulation.
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Affiliation(s)
- Ayten Bilgin
- Department of Psychology, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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25
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Kuhn BR, LaBrot ZC, Ford R, Roane BM. Promoting Independent Sleep Onset in Young Children: Examination of the Excuse Me Drill. Behav Sleep Med 2020; 18:730-745. [PMID: 31621416 DOI: 10.1080/15402002.2019.1674852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There is compelling evidence to support behavioral interventions as the first-line approach for bedtime resistance in young children. Among the behavioral treatment options, extinction ("cry it out") has the most extensive empirical support and tends to produce the most rapid gains. There are well known problems with the use of extinction, however, including side effects (extinction burst, spontaneous recovery) and poor acceptance, not to mention that extinction fails to teach children appropriate replacement behaviors (what "to do"). This study introduces a new behavioral sleep intervention, the Excuse Me Drill, designed to address some of the limitations of extinction. The EMD was formally evaluated for the first time using a multiple-baseline research design across four participants with sleep disturbance.Participants: Participants included four children who were clinically referred to outpatient pediatric psychology clinics for the treatment of behavioral insomnia of childhood, and included one 2-year-old female, two 7-year-old females, and one 7-year-old male. All participants had a history of dependent sleep onset at bedtime (i.e., parents remained in the child's bedroom upon sleep onset). Methods: A non-concurrent multiple baseline design across participants was used to experimentally evaluate the effectiveness of the EMD. During baseline, parents collected data on independent sleep onset and disruptive bedtime behaviors, but conducted the bedtime routine as usual. Immediately following baseline, parents implemented the EMD protocol until data indicated that children were consistently initiating sleep independently. Follow-up data were collected to determine the extent to which children continued to initiate sleep independently at bedtime in absence of the EMD. Results: Outcomes were promising as the EMD successfully taught all four children to initiate sleep independently and produced notable decreases in disruptive bedtime behavior. Results were maintained at follow-up for three of four participants. In addition, parents rated the EMD to be a socially acceptable procedure for their children. Conclusions: Results of this study indicate that the EMD was effective in promoting independent sleep onset and reducing disruptive bedtime behavior that maintained over time. The EMD should be considered to be a viable alternative to traditional extinction procedures for pediatric sleep disturbance. Implications for practice, limitations, and direction for future research are discussed.
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Affiliation(s)
- Brett R Kuhn
- Department of Psychology, University of Nebraska Medical Center/Munroe-Meyer Institute , Omaha, NE
| | - Zachary C LaBrot
- Department of Psychology, University of Nebraska Medical Center/Munroe-Meyer Institute , Omaha, NE
| | - Ryan Ford
- Tidal Integrated Health, NOVA Behavioral Healthcare Corporation , Golsboro
| | - Brandy M Roane
- Department of Physiology and Anatomy, University of North Texas Health Science Center , Fort Worth, TX
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Vasileva ES, Anisimov GV, Kalashnikova TP. [Current approaches to the diagnosis and treatment of behavioral insomnia in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:62-67. [PMID: 33076647 DOI: 10.17116/jnevro202012009262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Behavioral insomnia is the most common sleep disorder in young children. It significantly reduces the quality of parent's life and is one of the common complaints to a pediatrician or neurologist. The basis treatment of childhood insomnia is behavioral therapy, which includes sleep hygiene, age-appropriate daily routine and sleep associations, stable bedtime routines, positive reinforcement, bedtime fading, scheduled awakenings. Although a systematic ignoring («crying it out») is effective and widely used in behavioral therapy, it has low compliance and its safety is insufficiently studied. Therefore, a systematic ignoring is not a priority method of behavioral therapy and should not be used in children under 6 months of age. Behavioral therapy of childhood insomnia is complemented by psychological and informational support from parents, and in some cases, drug therapy. Prevention includes education of expectant parents on baby sleep hygiene.
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Affiliation(s)
- E S Vasileva
- The first medical and pedagogical center «Lingua Bona», Perm, Russia
| | - G V Anisimov
- The first medical and pedagogical center «Lingua Bona», Perm, Russia
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27
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Clark GF, Kingsley KL. Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years. Am J Occup Ther 2020; 74:7403397010p1-7403397010p42. [PMID: 32365324 DOI: 10.5014/ajot.2020.743001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth-5 yr. OBJECTIVE Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social-emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. METHOD Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). RESULTS A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. CONCLUSION and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social-emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. WHAT THIS ARTICLE ADDS This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.
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Affiliation(s)
- Gloria Frolek Clark
- Gloria Frolek Clark, PhD, OTR/L, BCP, FAOTA, is an occupational therapist in private practice, Adel, Iowa;
| | - Karrie L Kingsley
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Reuter A, Silfverdal S, Lindblom K, Hjern A. A systematic review of prevention and treatment of infant behavioural sleep problems. Acta Paediatr 2020; 109:1717-1732. [PMID: 31965638 DOI: 10.1111/apa.15182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 01/08/2023]
Abstract
AIM The aim of this review was to evaluate the evidence for interventions for behavioural sleep problem in infants. METHODS Systematic review based on a search in MEDLINE, Web of Science and PsychINFO in December 2017 for articles published in English during 2007-2017 about preventive and treatment interventions for sleep problems in infants. The review included controlled trials and meta-analyses with at least 20 infants in study groups assessed according to the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS Out of 476 original articles assessed for eligibility, 12 studies were included in the synthesis. Interventions with behavioural, educational and massage strategies were evaluated. No intervention was evaluated in more than one trial. Five interventions with behavioural methods for establishing consistent routines or controlled crying showed modest short-term effects, while the evidence for elements of education was inconsistent. Studies of massage were of poor quality. Knowledge gaps were identified regarding interventions in cross-cultural context, involving fathers, in children below six months of age, in high-risk populations and consequences of interventions that include extinction. CONCLUSION Some support for short-term effects of behavioural treatment strategies was found, but more studies are needed to establish evidence.
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Affiliation(s)
- Antonia Reuter
- Child and Youth Healthcare Region Västra Götaland Gothenburg Sweden
| | - Sven‐Arne Silfverdal
- Clinical Sciences, Pediatrics Umeå University Umeå Sweden
- Centre for Mother and Child Health Care Umeå Sweden
| | | | - Anders Hjern
- Sachs’ Children and Youth hospital Stockholm Sweden
- Department of Medicine Clinical Epidemiology Unit Karolinska Institutet Stockholm Sweden
- CHESS, Centre for Health Equity Studies Stockholm University and Karolinska Institutet Stockholm Sweden
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29
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Gronski M, Doherty M. Interventions Within the Scope of Occupational Therapy Practice to Improve Activities of Daily Living, Rest, and Sleep for Children Ages 0-5 Years and Their Families: A Systematic Review. Am J Occup Ther 2020; 74:7402180010p1-7402180010p33. [PMID: 32204772 DOI: 10.5014/ajot.2020.039545] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Research studies supporting occupational therapy interventions to address feeding, toileting, and sleep can be applied to practice in early intervention and preschool settings to improve the outcomes of young children and their families. OBJECTIVE To examine the effectiveness of interventions within the scope of occupational therapy practice to improve activities of daily living, rest, and sleep for children ages 0-5 yr and their families. DATA SOURCES Five databases (MEDLINE, PsycINFO, CINAHL, OTseeker, ERIC) and Evidence-Based Medicine Reviews, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, and Database of Abstracts of Reviews of Effectiveness were searched for studies published between January 2000 and March 2017. STUDY SELECTION AND DATA COLLECTION Inclusion criteria were Levels I-III evidence, being within occupational therapy's scope of practice, including participants with a mean age younger than 6 yr, and addressing self-care, activities of daily living, and rest and sleep. FINDINGS Forty articles were appraised, and three themes emerged: interventions to address feeding and eating, interventions to address toileting, and interventions to address rest and sleep. Additional subthemes of behavioral approaches, parent and caregiver education, and contextual intervention were revealed. CONCLUSIONS AND RELEVANCE Occupational therapy practitioners should consider the use of interventions with moderate or strong evidence as described in this review. Limitations include risk of bias and limited evidence for several interventions. WHAT THIS ARTICLE ADDS This article provides a broader perspective on evidence-based practice by examining studies within the scope of occupational therapy practice published outside of current occupational therapy publications. The review includes studies from nutrition, nursing, and psychology, which address interdisciplinary care, family coaching and education, and behavioral approaches within the professional scope of occupational therapy to improve the functional performance, routines, and quality of life for young children and their caregivers.
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Affiliation(s)
- Meredith Gronski
- Meredith Gronski, OTD, OTR/L, CLA, is Assistant Professor and Chair, Department of Occupational Therapy, Methodist University, Fayetteville, NC;
| | - Meghan Doherty
- Meghan Doherty, OTD, OTR/L, is Assistant Professor, Department of Occupational Science and Occupational Therapy, Saint Louis University, St. Louis, MO
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Williams KE, Howard SJ. Proximal and distal predictors of self-regulatory change in children aged 4 to 7 years. BMC Pediatr 2020; 20:226. [PMID: 32423394 PMCID: PMC7236486 DOI: 10.1186/s12887-020-02133-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023] Open
Abstract
Background Growth in early self-regulation skills has been linked to positive health, wellbeing, and achievement trajectories across the lifespan. While individual studies have documented specific influences on self-regulation competencies in early childhood, few have modelled a comprehensive range of predictors of self-regulation change across health, development, and environment simultaneously. This study aimed to examine the concurrent associations among a range of proximal and distal influences on change in children’s self-regulation skills over 2 years from age 4–5 years. Methods Data from the Longitudinal Study of Australian Children (N = 4983) were used in a structural equation model, predicting a multi-source composite measure of self-regulation at each of 4–5 years and 6–7 years. By controlling for earlier self-regulation and covariates, the model examined the relative contributions of a comprehensive range of variables to self-regulation change including health, development, educational, home environment, time-use, and neighbourhood characteristics. Results The significant predictors of children’s self-regulation growth across 4 to 7 years were fewer behavioural sleep problems, higher gross motor and pre-academic skills, lower levels of maternal and paternal angry parenting, and lower levels of financial hardship. There were also marginal effects for high-quality home learning environments and child-educator relationships. Conclusion Findings suggest that if we are to successfully foster children’s self-regulation skills, interventionists would do well to operate not only on children’s current capacities but also key aspects of their surrounding context.
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Affiliation(s)
- Kate E Williams
- School of Early Childhood & Inclusive Education, Faculty of Education, Queensland University of Technology, QUT, Level 4 E Block, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Steven J Howard
- Early Start, School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
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Blunden S, Dawson D. Behavioural sleep interventions in infants: Plan B - Combining models of responsiveness to increase parental choice. J Paediatr Child Health 2020; 56:675-679. [PMID: 32073200 DOI: 10.1111/jpc.14818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/20/2020] [Accepted: 02/02/2020] [Indexed: 11/27/2022]
Abstract
In families with infants between the ages of 6 and 18 months, sleep disruption can be significant, often putting parents at risk of a range of negative psychological and psychosocial consequences. Commonly prescribed sleep interventions typically involve 'extinction' methods, which require parents to completely or periodically ignore their infant's overnight cries. These methods can be effective in many, but not all cases. For over 40 years 30-40% of parents have consistently reported difficulty ignoring their child. For this group, ignoring their child is behaviourally and/or ideologically difficult with attrition often leading to a perceived sense of failure. For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviourally or ideologically challenging. In this paper we propose an integrated, less polarised approach to infant behavioural sleep interventions that better caters to those who have difficulty with extinction methods - our so-called 'Plan B'. This approach potentially resolves the often opposing ideological and theoretical perspectives of extinction versus responsiveness into a practical, complementary and pragmatic treatment framework. Recommendations on how best to implement Plan B are also presented. In our view, Plan B could provide practitioners with a logically integrated well-targeted suite of clinical interventions that could potentially improve compliance, reduce attrition and ultimately benefit the sleep and well-being of all infants and their parents, especially those who struggle with traditional extinction methodologies.
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Affiliation(s)
- Sarah Blunden
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
| | - Drew Dawson
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
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Répression des pleurs comme traumatismes relationnels précoces. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2020.100139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The human need for sleep is universal and unquestioned; however, humans vary in their sleep needs according to age, individual differences, as well as cultural and social norms and practices. Therefore, what is “normal” in infant sleep and the development of sleep architecture in humans is highly dependent on biological and sociocultural variables as well as socially constructed assumptions about what infant sleep “should” look like. This paper uses a multidisciplinary approach to review papers from fields including pediatrics, anthropology, psychology, medicine, and sociology to understand “normal” infant sleep. Because human culture and behavioral practice changes much more quickly than evolved human biology, and because human evolutionary history occurred in the context of breastfeeding and cosleeping, new work in the field of infant sleep architecture development would benefit from a multidisciplinary approach. To come to a consensus about what is “normal” infant sleep, researchers must agree on underlying basic assumptions of infant sleep from which to ask question and interpret findings.
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Affiliation(s)
- Elaine S. Barry
- Human Development and Family Studies, Penn State Fayette, The Eberly Campus, Lemont Furnace, PA, USA
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Abstract
Adequate sleep in infancy and beyond is important for development; however, many children are not sleeping the recommended amount. During the first few years of childhood, infants are frequently seen in the pediatric office for well-visits and a myriad of other concerns, including sleep difficulties. As such, pediatricians should be adequately prepared to address these concerns. This article aims to provide clinicians with a basic knowledge of sleep physiology, sleep patterns and development, and current guidelines and options available for parents to address these issues. [Pediatr Ann. 2020;49(3):e101-e105.].
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Behavioral interventions for pediatric insomnia: one treatment may not fit all. Sleep 2019; 43:5611128. [DOI: 10.1093/sleep/zsz268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/01/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study Objectives
Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems.
Methods
Ninety-one infants aged 9–18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up.
Results
Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change significantly following treatment. Infant separation anxiety moderated treatment efficacy, with greater benefit for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention.
Conclusions
This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants.
Clinical Trial Registration
NCT01489215.
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Wolke D. Persistence of infant crying, sleeping and feeding problems: need for prevention. Arch Dis Child 2019; 104:1022-1023. [PMID: 31401560 DOI: 10.1136/archdischild-2019-317578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Dieter Wolke
- Department of Psychology and Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
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Williams RC, Biscaro A, Clinton J. Relationships matter: How clinicians can support positive parenting in the early years. Paediatr Child Health 2019; 24:340-357. [PMID: 31379438 DOI: 10.1093/pch/pxz063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/08/2019] [Indexed: 11/14/2022] Open
Abstract
A secure attachment relationship with at least one healthy adult is essential for a child to develop optimal coping abilities. Primary care providers like paediatricians and family physicians can help by supporting parents in practice settings. Every clinician encounter is an opportunity to ask parents about children's relationships and their behaviour, daily routines, and overall family function. This statement, which focuses on children aged 0 to 6 years, describes basic principles in support of positive parenting and recommends in-office practices to promote secure parent-child relationships, engage families and build trust with parents. Crying, sleep, and difficult behaviours are described as opportunities for clinicians to provide anticipatory, responsive guidance to parents.
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Affiliation(s)
- Robin C Williams
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario
| | - Anne Biscaro
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario
| | - Jean Clinton
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario
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Williams RC, Biscaro A, Clinton J. L’importance des relations : comment les cliniciens peuvent soutenir des pratiques parentales positives pendant la petite enfance. Paediatr Child Health 2019; 24:348-357. [PMCID: PMC6656952 DOI: 10.1093/pch/pxz064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/08/2019] [Indexed: 10/28/2023] Open
Abstract
Il est essentiel que l’enfant forme des liens d’attachement stables avec au moins un adulte en bonne santé pour développer des capacités d’adaptation optimales. Les professionnels de la santé de première ligne, tels que les pédiatres et les médecins de famille, peuvent y contribuer en soutenant les parents dans leur milieu de pratique. Le clinicien peut profiter de chaque rencontre pour s’informer auprès des parents des relations et des comportements des enfants, des habitudes quotidiennes et du fonctionnement global de la famille. Le présent document de principes, qui porte sur les enfants de 0 à six ans, décrit les principes de base pour soutenir des pratiques parentales positives et recommande des pratiques en cabinet pour promouvoir des relations parents-enfant stables, mobiliser les familles et établir un climat de confiance avec les parents. Les pleurs, le sommeil et les comportements difficiles sont décrits comme des occasions pour le clinicien de donner des conseils préventifs et réceptifs aux besoins des parents.
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Affiliation(s)
- Robin C Williams
- Société canadienne de pédiatrie, groupe de travail de la petite enfance, Ottawa (Ontario)
| | - Anne Biscaro
- Société canadienne de pédiatrie, groupe de travail de la petite enfance, Ottawa (Ontario)
| | - Jean Clinton
- Société canadienne de pédiatrie, groupe de travail de la petite enfance, Ottawa (Ontario)
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McLuckie A, Landers AL, Curran JA, Cann R, Carrese DH, Nolan A, Corrigan K, Carrey NJ. A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties. Syst Rev 2019; 8:183. [PMID: 31337424 PMCID: PMC6651971 DOI: 10.1186/s13643-019-1043-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Infant mental health has emerged as a unique area of practice and research distinguished from child and youth sub-specialties by its advocacy for a relational practice framework with an emphasis on parents/caregivers being integral to assessment, treatment, and prevention initiatives. A diverse array of initiatives offered across a broad spectrum of delivery methods is available to clinicians. However, to date, a large-scale mapping of the research evidence regarding these interventions has yet to be completed to help inform clinician's decisions regarding the best approaches for their clients. To address this knowledge gap, this study aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0-5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes. METHOD A scoping review methodology was used to conduct a large-scale mapping of the intervention research pertaining to infants and preschoolers (0-5) at risk for socio-emotional difficulties. We searched MEDLINE, PsycINFO, EMBASE, Web of Science, The Cochrane Library, CINAHL, LILACS, ProQuest Nursing & Allied Health Source, World Cat, and ClinicalTrials.gov , from inception to December 31, 2012. We extracted information regarding publication date, geographical location, study design, level of risk, population, key intervention mechanism, and outcome measures. RESULTS We identified 533 potential studies from 1233 title and abstracts after the first round of screening. Full text article review in the second round of screening resulted in a total of 162 included articles for the final analysis. Results indicated that over 50% of interventions evaluated were randomized controlled trials conducted in Westernized countries. Most studies could be subdivided by level of risk within a preventative public health framework including universal, selected, indicated, and direct treatment for children formally diagnosed with a mental disorder. Risk factors experienced by children and their families were heterogeneously defined and numerous outcome measures across included studies. The results of this study are limited to the last search date of 2012. CONCLUSIONS Key intervention mechanisms spanned a range of approaches including parenting groups, dyadic, in-home, cognitive-behavioral therapy, and day care-based interventions. The findings are discussed in terms of implications for broad trends and gaps in research and policy for this population.
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Affiliation(s)
| | - Ashley L Landers
- Department of Human Development, Virginia Polytechnic Institute & State University, 7054 Haycock Road, Falls Church, VA, 22043, USA.
| | | | | | - Domenica H Carrese
- Department of Human Development, Virginia Polytechnic Institute & State University, 7054 Haycock Road, Falls Church, VA, 22043, USA
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Hatch B, Galland BC, Gray AR, Taylor RW, Sayers R, Lawrence J, Taylor B. Consistent use of bedtime parenting strategies mediates the effects of sleep education on child sleep: secondary findings from an early-life randomized controlled trial. Sleep Health 2019; 5:433-443. [PMID: 31122876 DOI: 10.1016/j.sleh.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/04/2019] [Accepted: 03/08/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Using data from a randomized controlled trial, this study investigated whether parent's consistent use of recommended bedtime strategies with infants was a mediating mechanism for improved child sleep. METHODS Expectant mothers were allocated to 4 groups: usual care (Control); additional support regarding Food, (physical) Activity, and Breastfeeding (FAB); advice on infant sleep through 1 group educational session during the antenatal period and 1 home visit when the child was 3 weeks of age (Sleep), or both FAB and Sleep interventions (Combination). An index relating to parent's consistent use of strategies to encourage infant sleep self-settling was developed from data collected when infants were 4 and 6 months of age. Child sleep self-control was measured at 3.5 years of age through a behavior rating scale. Child overnight sleep duration was measured using accelerometers at 1, 2, 3.5, and 5 years of age. Analyses examined whether any association between intervention group and child sleep self-control or sleep duration was mediated by consistent use of bedtime strategies at 4 and 6 months. RESULTS Compared to Controls, Sleep group parents had significantly higher odds of using more intervention strategies consistently (1.63; 95% confidence interval [CI] 1.14-2.33), as did Combination group parents (1.45; 95% CI 1.01-2.07). Consistent strategy use was significantly associated with a decrease in child bedtime behavioral difficulties (0.97; 95% CI 0.95-0.98) and increased sleep duration (0.152; SE = 0.017). Sleep group assignment reduced child sleep self-control difficulties and improved sleep duration indirectly via parent's consistent use of bedtime strategies. DISCUSSION Consistent use of appropriate bedtime strategies in infancy is an important factor that influences child sleep self-control in later development.
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Affiliation(s)
- Burt Hatch
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago.
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago
| | - Andrew R Gray
- Biostatistics Unit, Dunedin School of Medicine, University of Otago
| | | | - Rachel Sayers
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago
| | - Julie Lawrence
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago
| | - Barry Taylor
- Dean's Department, Dunedin School of Medicine, University of Otago.
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Hall WA, Biletchi J, Hunter DL, Lemay S, Ou C, Rempel L. Dissemination of evidence based interventions for pediatric sleep disorders - The Niagara project: process and outcomes. Sleep Med X 2019; 1:100001. [PMID: 33870160 PMCID: PMC8041121 DOI: 10.1016/j.sleepx.2019.100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 01/30/2023] Open
Abstract
Background/objective This paper describes evidence-based strategies for the dissemination of empirically supported interventions for infant behavioral sleep problems. Methods To identify parents' needs, a survey sampled 1022 parents in the Niagara region about use of health resources, tracking occurred of public health nurses' consultations with parents about infant sleep, and nurses obtained sleep workshop evaluation data from 18 parents. A focus group with 10 participants, a survey of Niagara Region Public Health and Emergency Services (NRPH&ES) employees, and consultations with external stakeholders identified gaps in parents' and infants' care and public health nurses' training needs. We developed solutions by creating evidence-based tools and a program for parents and public health nurses. We implemented and disseminated information via sharing tools on the NRPH&ES website, and workshops for community agencies and public health nurses. Results Seventy childhood educators, support workers, and social and public health professionals attended our community workshop. Twenty-three public health nurses attended our training workshop. In guided discussion, nurses evaluated the workshop as addressing gaps in knowledge and enhancing NRPH&ES interventions to manage infants' behavioral sleep problems. Fifteen parents attended a sleep workshop pilot, with seven parents indicating a preference for follow-up telephone support. Fifty individuals attended our oral presentation at the Ontario Public Health Convention. Conclusions For next directions, community and other public health agencies want access to our tools and program components. We received a research grant to design, implement, and evaluate sharing tools and program components with community agencies (daycares and childcare centres). Behavioral sleep problems are common during infancy. Parents identify problems but have limited access to evidence-based care. Public health nurses can provide evidence-based support to families. Public health nurses can offer community agencies evidence-based resources.
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Affiliation(s)
- Wendy A Hall
- University of British Columbia School of Nursing, T. 201, 2211 Wesbrook Mall, V6T 2B5, Vancouver, British Columbia, Canada
| | - Jeff Biletchi
- Niagara College, 100 Niagara College Boulevard, Welland, Ontario, L3C 7L3, Canada
| | - Debbie L Hunter
- Niagara Region Public Health and Emergency Services, Sir Isaac Brock Way, Campbell East, Thorold, L2V 0A2, Ontario, Canada
| | - Stephanie Lemay
- Niagara Region Public Health and Emergency Services, Sir Isaac Brock Way, Campbell East, Thorold, L2V 0A2, Ontario, Canada
| | - Christine Ou
- University of British Columbia School of Nursing, T. 201, 2211 Wesbrook Mall, V6T 2B5, Vancouver, British Columbia, Canada
| | - Lynn Rempel
- Brock University, 1812 Sir Isaac Brock Way, St. Catharines, L2S 3A1, Ontario, Canada
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Abstract
Persistent, inconsolable crying in young infants is common, distressing but usually benign. This selective review examines perceptions and perceived origins of this phenomenon in babies where serious pathology has been excluded. Adult brains have evolved to become hypersensitive to infant cries. Babies respond to parental stress by crying more, thus setting up a vicious cycle. Most treatments appear to work largely through a placebo effect. The imperative for healthcare professionals is to reduce parental anxiety by offering reassurance and support.
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Hill CM, Everitt H. Assessment and initial management of suspected behavioural insomnia in pre-adolescent children. BMJ 2018; 363:k3797. [PMID: 30327294 DOI: 10.1136/bmj.k3797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Catherine M Hill
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Southampton Children's Hospital, Southampton, UK
| | - Hazel Everitt
- Division of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK
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Bindt C. Exzessives Säuglingsschreien, persistierende Unruhe und Bindungsentwicklung: Plädoyer für einen erweiterten Blick. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schlarb AA. [Therapy of insomnia and nightmares in childhood and adolescence]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:383-391. [PMID: 30141741 DOI: 10.1024/1422-4917/a000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Therapy of insomnia and nightmares in childhood and adolescence Abstract. Sleep problems and sleep disorders have a high prevalence in childhood and adolescence. Normally, such conditions persist and often become chronic. Daytime impairments are widespread with concentration deficits, mental problems, and also a higher suicide risk. Therefore, early and effective interventions are necessary. As symptoms change with age, therapy should be adjusted accordingly. Various strategies for infants and toddlers, schoolchildren, and adolescents will be named. In addition, evidence of these therapy strategies will be shown. All in all, more randomized controlled studies addressing children and adolescents are needed. Furthermore, studies with children and adolescents suffering from comorbid disorders or mental disorders and sleep problems should be conducted.
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Affiliation(s)
- Angelika A Schlarb
- 1 Abteilung für Psychologie, Fakultät für Psychologie und Sportwissenschaft, Bielefeld
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Maute M, Perren S. IGNORING CHILDREN'S BEDTIME CRYING: THE POWER OF WESTERN-ORIENTED BELIEFS. Infant Ment Health J 2018; 39:220-230. [PMID: 29489022 DOI: 10.1002/imhj.21700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ignoring children's bedtime crying (ICBC) is an issue that polarizes parents as well as pediatricians. While most studies have focused on the effectiveness of sleep interventions, no study has yet questioned which parents use ICBC. Parents often find children's sleep difficulties to be very challenging, but factors such as the influence of Western approaches to infant care, stress, and sensitivity have not been analyzed in terms of ICBC. A sample of 586 parents completed a questionnaire to investigate the relationships between parental factors and the method of ICBC. Data were analyzed using structural equation modeling. Latent variables were used to measure parental stress (Parental Stress Scale; J.O. Berry & W.H. Jones, 1995), sensitivity (Situation-Reaction-Questionnaire; Y. Hänggi, K. Schweinberger, N. Gugger, & M. Perrez, 2010), Western-oriented parental beliefs (Rigidity), and children's temperament (Parenting Stress Index; H. Tröster & R.R. Abidin). ICBC was used by 32.6% (n = 191) of parents in this study. Parents' Western-oriented beliefs predicted ICBC. Attitudes such as feeding a child on a time schedule and not carrying it out to prevent dependence were associated with letting the child cry to fall asleep. Low-sensitivity parents as well as parents of children with a difficult temperament used ICBC more frequently. Path analysis shows that parental stress did not predict ICBC. The results suggest that ICBC has become part of Western childrearing tradition.
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Affiliation(s)
| | - Sonja Perren
- University of Konstanz and Thurgau University of Teacher Education
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Langevin R, Hébert M, Guidi E, Bernard-Bonnin AC, Allard-Dansereau C. Sleep problems over a year in sexually abused preschoolers. Paediatr Child Health 2018; 22:273-276. [PMID: 29479233 DOI: 10.1093/pch/pxx077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives The aim of the present study was to explore sleep problems in sexually abused preschoolers over a year. Methods The sample consisted of 224 abused children and 83 nonabused children aged 3 to 6 years old at enrolment into the study (T1), and 85 abused children and 73 nonabused children at the second evaluation, approximately 1 year later (T2). Sleep problems were assessed using parental reports on the Child Behavior Checklist - Preschool Version. Results Multivariate analysis of covariance revealed that sexually abused preschoolers presented higher scores of sleep problems than nonabused children on all items related to sleep problems at T1. Results from a regression analysis revealed that sexual abuse remained associated with higher levels of sleep problems after controlling for sociodemographical variables. At T2, abused preschoolers still presented more sleep problems than nonabused children on all but one of the sleep items. Results from a repeated measure one-way analysis of covariance revealed that abused preschoolers presented higher total sleep scores at both measurement times. Time was not associated with levels of sleep problems and sleep problems did not evolve differently for abused and nonabused children. Conclusions Sexually abused preschoolers are at risk of presenting with sleep problems. These results are worrisome given the negative impacts of sleep problems on child development. Research and clinical implications are discussed.
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Affiliation(s)
- Rachel Langevin
- Département de sexologie, Université du Québec à Montréal, Montréal, Québec
| | - Martine Hébert
- Département de sexologie, Université du Québec à Montréal, Montréal, Québec
| | - Elisa Guidi
- Dipartimento di Ingegneria dell'Informazione, University of Florence, Firenze, Italy
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Abstract
PURPOSE OF REVIEW This article provides an overview of the clinical features, diagnosis, and treatment of insomnia, restless legs syndrome, periodic limb movements of sleep, parasomnias, narcolepsy, and sleep-related breathing disorders among children and adolescents. RECENT FINDINGS Pediatric presentations of sleep disorders differ from adult presentations, making diagnosis challenging. Specific clinical syndromes, such as cataplexy in children with narcolepsy type 1, can have an altogether different presentation compared to adult-onset symptoms, contributing to diagnostic delays and potential misdiagnoses. More broadly, research shows strong associations between sleep and daytime cognition, mood, and behavior among children with and without neurologic conditions and thus suggests a need to identify and treat sleep problems to optimize daytime functioning. SUMMARY Addressing sleep problems in children with neurologic conditions and neurodevelopmental disorders improves quality of life for patients and their families and, in many cases, reduces neurologic disease burden.
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The Art of Parenting at Night. MCN Am J Matern Child Nurs 2017; 42:359. [PMID: 29049061 DOI: 10.1097/nmc.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Abstract
Sleep problems in infants and young children are common and often underdiagnosed. The potential negative outcomes that chronic disrupted sleep can have on a child's daytime functioning, as well as the adverse impact it can have on the family, are well known. There is considerable evidence to support the use of behavioral interventions to treat childhood insomnia. These strategies not only produce reliable and durable positive changes in sleep in most young children, but may also improve child and family well-being without negative effects on a child's social-emotional development. This article serves as a guide to help the pediatric provider identify, evaluate, and treat insomnia in infants and young children. [Pediatr Ann. 2017;46(9):e321-e326.].
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