Infant sleep and early parental sleep-related cognitions predict sleep
in pre-school children
, Lee Shaashua
Ben-Gurion University of the Negev, Tel-Aviv University, Israel
Received 8 April 2011
Received in revised form 28 June 2011
Accepted 1 July 2011
Available online 3 December 2011
Objective: To investigate early predictors of sleep patterns in pre-school age children. Speciﬁcally, we
were interested in exploring whether infant sleep patterns and parenting factors assessed at 12 months
would predict sleep in four year-old children.
Methods: This was a follow-up study of a home-based longitudinal study, exploring the links between
parental cognitions and children’s sleep. The present study included 71 families (boys 58%) and focused
on data collected when children were 12 months and four years old. Sleep at both time points was
assessed for four weekdays by actigraphy and parental reports.
Results: Statistically signiﬁcant zero-order correlations were found between early sleep patterns, mater-
nal cognitions, and soothing behaviors at 12 months, and sleep patterns at four years. Multiple regression
analysis revealed that 12 months maternal cognitions reﬂecting difﬁculties with limiting parental night-
time involvement were a statistically signiﬁcant predictor of fragmented child’s sleep and of parental
bedtime involvement at four years. More objective infant night-wakings at 12 months predicted lower
sleep efﬁciency at four years.
Conclusions: Both early sleep patterns and maternal sleep-related cognitions during infancy are signiﬁ-
cant predictors of sleep quality of pre-school children. These ﬁndings are clinically meaningful as they
suggest that improving infant sleep and addressing early parental beliefs and perceptions regarding
infant sleep may help in preventing sleep problems of pre-school children.
Ó 2011 Elsevier B.V. All rights reserved.
Sleep plays an important role in child development. Research
suggests that childhood sleep disturbances are associated with var-
ious negative outcomes, including disrupted cognitive functioning,
poor emotional regulation, and behavioral problems [1–5]. There-
fore, understanding the origins of childhood sleep problems has
theoretical and clinical importance.
Sleep problems are very prevalent during the ﬁrst years of life,
ranging between 20% and 30% of children . The most common
complaints parents present to pediatric health-care professionals
are related to sleep onset difﬁculties and frequent and prolonged
night-wakings requiring parental attention [6–8]. Studies in pre-
school and school age children suggest a decline in the prevalence
of parental reported night-waking problems in comparison to in-
fancy [9,10]. However, actigraphy based studies demonstrate that
night-wakings continue to be very frequent [11,12]. Although
non-signaled night-wakings may not be considered problematic
by parents because they are not aware of them, the clinical impor-
tance of fragmented sleep (including non-signaled awakening), has
been demonstrated in studies showing it to be associated with
poor neurobehavioral functioning and behavior problems in
school-age children . In addition, other sleep problems, such
as bedtime resistance and nighttime-fears, seem to become com-
mon during the pre-school years [13–15]. Overall, the prevalence
of sleep problems in pre-school children is estimated to range be-
tween 14% and 37%, [13,16–19] although it is important to note
that there are no widely accepted criteria for diagnosing sleep
problems in this age group. Thus, these estimations are based on
different diagnostic criteria and measurement tools .
Research on the etiology of sleep problems has focused mainly
on infancy. The transactional model postulates that there are ongo-
ing bi-directional links between intrinsic infant factors (e.g., matu-
ration, temperament), parenting factors (e.g., parental cognitions,
soothing behaviors), and infant sleep . Furthermore, the model
suggests that parental sleep-related cognitions may inﬂuence par-
ent–infant interactions around bedtime, which, in turn, affect
infant sleep patterns. On the other hand, infants with a tendency
towards more frequent night-wakings may inﬂuence their parents
beliefs about infant sleep and then their nighttime soothing
1389-9457/$ - see front matter Ó 2011 Elsevier B.V. All rights reserved.
Corresponding author. Address: Ben-Gurion University of the Negev, Beer-
Sheva 84105, Israel. Tel.: +1 972 8 6472759.
E-mail address: email@example.com (L. Tikotzky).
Sleep Medicine 13 (2012) 185–192
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journal homepage: www.elsevier.com/locate/sleep