Prevalence, patterns, and persistence of sleep problems in the first 3 years of life

Abstract

Objective: Examine the prevalence, patterns, and persistence of parent-reported sleep problems during the first 3 years of life.

Methods: Three hundred fifty-nine mother/child pairs participated in a prospective birth cohort study. Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring.

Results: Prevalence of a parent-reported sleep problem was 10% at all assessment intervals. Night wakings and shorter sleep duration were associated with a parent-reported sleep problem during infancy and early toddlerhood (6-24 months), whereas nightmares and restless sleep emerged as associations with report of a sleep problem in later developmental periods (24-36 months). Prolonged sleep latency was associated with parent report of a sleep problem throughout the study period. In contrast, napping, sleep location, and snoring were not associated with parent-reported sleep problems. Twenty-one percent of children with sleep problems in infancy (compared with 6% of those without) had sleep problems in the third year of life.

Conclusions: Ten percent of children are reported to have a sleep problem at any given point during early childhood, and these problems persist in a significant minority of children throughout early development. Parent response to a single-item nonspecific sleep query may overlook relevant sleep behaviors and symptoms associated with clinical morbidity.

FIGURE 1

Prevalence of parent-reported sleep problems. Percent of children reported by their parent to have a sleep problem at 6, 12, 24, and 36 months of age.

FIGURE 2

Persistence of parent-reported sleep problems. Percent of children with a sleep problem at 6 months of age (open bars) versus without a sleep problem at 6 months (black bars) who went on to have a sleep problem at later time points. OR, odds ratio. Significance values from Fisher’s exact test: *P < .05, **P < .01, ***P < .001.

FIGURE 3

Persistence of parent-reported sleep problems. Percent of children with a sleep problem at 12 months of age (open bars) versus without a sleep problem at 12 months (black bars) who went on to have a sleep problem at later time points. OR, odds ratio. Significance values from Fisher’s exact test: *P < .05, **P < .01, ***P < .001.

FIGURE 4

Persistence of parent-reported sleep problems. Percent of children with a sleep problem at 24 months of age (open bars) versus without a sleep problem at 24 months (black bars) who went on to have a sleep problem at 36 months of age. OR, odds ratio. Significance values from Fisher’s exact test: *P < .05, **P < .01, ***P < .001.