Elsevier

Sleep Medicine Reviews

Volume 13, Issue 5, October 2009, Pages 355-361
Sleep Medicine Reviews

Clinical Review
Risk factors and consequences of early childhood dyssomnias: New perspectives

https://doi.org/10.1016/j.smrv.2008.12.001Get rights and content

Summary

Dyssomnias are largely under-diagnosed in infants and toddlers. This literature review proposes an integrative model based on empirical data on determinants and consequences of sleep disturbances occurring in early life. This model proposes that parental behaviors that impede the child's autonomy toward sleep periods are primary grounds for the development of dyssomnias, e.g., parental presence until the child falls asleep, and putting an already sleeping child to bed. The model also indicates the serious potential consequences of a modest but chronic loss of sleep in childhood. At least three developmental domains could be directly affected: behavioral/social competence, cognitive performance, and physical condition. Thus, children with short nocturnal sleep duration before age 3.5 years show increased risk of high hyperactivity–impulsivity scores and low cognitive performance at 6 years compared to children who sleep 11 h per night, after controlling for potentially confounding variables. Moreover, persistent short sleep duration in early infancy increased the risk of suffering of obesity at 6 years of age, after controlling for potentially confounding variables. Finally, the importance of allowing the child to sleep at least 10 h per night in early childhood is stressed, as the National Sleep Foundation Poll suggests, for optimal child development.

Introduction

Although sleep plays an important role in many areas of child development, including health, mood, cognition and academic performance,*1, *2 longitudinal studies of normal sleep and sleep problems in early childhood have been conducted only recently. This literature review summarizes the results derived from the current knowledge on potential determinants and consequences of sleep disturbances occurring in early life. A model supported by empirical data is presented, with recommendations for clinicians and parents coping with sleep problems in young children.

Section snippets

Sleep duration and consolidation

Normally, full-term babies sleep around 16–18 h per day at birth, interrupted by waking periods. Total sleep duration declines as children grow up: 13–14 h at 6 months and 10–11 h at 6 years.3 This reduction results largely from the decreasing number and duration of naps. Conversely, waking periods gradually increase during the daytime. Daytime sleep becomes well-defined naps: 2–3 naps per day until age 6 months (3.5 h total), followed by 2 naps per day at around 9–12 months, and finally, 1 nap in

Definitions and prevalence

Dyssomnias are defined in the DSM-IV22 as a group of disorders characterized by difficulty in initiating or maintaining sleep. Dyssomnias are largely under-diagnosed in infants and toddlers.22 A recent study23 has recommended standard criteria to diagnose 2 categories of sleep problems in early childhood: 1) frequent nocturnal awakenings, defined as >2 signaled awakenings/night in 1–2-year-old children and >1 signaled awakening/night in children 2 years old and older), and 2) sleep onset

Consequences of short sleep duration

Do sleep problems have negative consequences on the child's development? Poor sleepers go to bed 1 h later on average, and therefore sleep 1 h less than good sleepers.42 As the child grows up, it becomes imperative to assess the relationship between nocturnal sleep duration and the potential consequences for development.

An integrative model of the risk factors and consequences of dyssomnias

A theoretical model of infant sleep regulation integrating multiple environmental systems was developed in 1993.32 A revised model based on empirical data is proposed here (see Fig. 1).

It relies heavily on a series of analyses*2, *41, *67, 70 performed on a representative sample of children born in the province of Quebec (Canada) in 1997–1998 studied prospectively and longitudinally. This study allowed investigating several spheres of child development simultaneously in order to distinguish

Conclusions

This review stresses the importance of allowing young children to sleep at least 10 h per night, as suggested by the National Sleep Foundation Poll71 for optimal general childhood development. It would be important to more accurately determine the minimum required sleep duration threshold in early childhood. We should keep in mind that the required sleep duration may show inter-individual variation (short- and long-sleepers). To avoid childhood dyssomnias, one recommendation to parents is to

Acknowledgements

This research was supported by a postdoctoral fellowship (E. Touchette) from the Canadian Institutes of Health Research.

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