Quality of Preterm Infants’ Night Sleep: and Online Community-Based Survey of Maternal Factors and Perceptions of Infants’ Nighttime Awakenings and Sleep Problems

  • Authors

    • Reem Ali Jordan University of Science and Technology
    • Wendy Hall University of British Columbia
    • Fay Warnock University of British Columbia
    • Sabrina Wong University of British Columbia
    • Pam Ratner University of British Columbia
    2014-06-25
    https://doi.org/10.14419/ijans.v3i2.2412

  • Background: Between one-quarter and one-third of infants aged six months to five years have sleeping problems.  Infants' night sleep patterns, in particular problematic night waking with crying, are a common concern for parents.  Many factors can influence the development of infants’ night sleep patterns and sleep problems, including parental interaction.

    Objectives: To examine the associations between premature infants’ nighttime awakening, mothers’ reports of sleep problem severity, and maternal factors, including mothers’ styles of attachment and behaviors used to settle their infants to sleep.

    Method: The cross sectional survey study used a web-based questionnaire to collect data from a community-based sample of 105 mothers of singleton premature infants aged 5-6 months (corrected age) across a number of English speaking countries. The main outcome measures were mothers’ perceptions of infants’ nighttime awakenings (frequency and duration) and presence of infant sleep problems.

    Results: Of the 55% of mothers who reported that their infants had sleep problems, 17% described the problem as serious.  The majority of infants woke 2.1 times per night for an average of 45.7 minutes per night.     Mothers’ style of attachment and personal history of sleep problems predicted the duration of the infants’ nighttime awakening, whereas maternal active physical comforting predicted the frequency of nighttime awakenings.

    Conclusions: The findings can guide healthcare providers to screen mothers for an anxious style of attachment, perceptions of infant sleep problems, and use of active physical comforting strategies for bedtime settling when assessing premature infants’ sleep problems.

     

    Keywords: Maternal Attachment, Nighttime Awakenings, Premature Infant, Settling Strategies, Sleep Problem

  • References

    1. Alexander, R. Feeney, J., Hohaus, L., & Noller, P. (2001). At-tachment style and coping resources as predictors of coping strategies in the transition to parenthood. Personal Relationships, 8, 137- 152.
    2. Als, H. (1982). Toward a synactive theory of development: Promise for the assessment and support of infant individuality. Infant Mental Health Journal, 3, 229-243.
    3. Armitage, R., Flynn, H., Hoffmann, R., Vazquez, D., Lopez, J., & Marcus, S. (2009). Early developmental changes in sleep in infants: The impact of maternal depression. Sleep, 32, 693-696.
    4. Bayer, J.K., Hiscock, H., Hampton, A., & Wake, M. (2007). Sleep problems in young infants and maternal mental and physical health. Journal of Paediatric and Child Health, 43, 66–73.
    5. Benoit, D., Zeanah, C. H., Boucher, C., & Minde, K. K. (1992). Sleep disorders in early childhood: Association with insecure maternal attachment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 86-93.
    6. Byles, J., Byrne, C., Boyle, M., & Offord, D. (1988). Ontario Child Health Study: Reliability and validity of the general functioning subscale of the McMaster Family Assessment Device. Family Process, 27, 97-104.
    7. Dunn, J. F., Plomin, R., & Daniels, D. (1986). Consistency and change in mothers' behavior toward young siblings. Child Development, 57, 348-356
    8. Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171-180.
    9. Feeney, J. A. (2003). Adult attachment, involvement in infant care, and adjustment to new parenthood. Journal of Systemic Therapies, 22, 16-30.
    10. Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman (Eds.), Attachment in adults: Clinical and developmental perspectives (pp. 128-152). New York: Guilford Press.
    11. Feldman, R., & Eidelman, A. I. (2006). Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants. Pediatrics, 118, e869-e878. DOI: 10.1542/peds.2005-2040.
    12. Fiese, B. H., winter, M. A., Sliwinski, M., & Anber, R. D. (2007). Nighttime waking in children with asthma: An exploratory study of daily fluctuations in family climate. Journal of Family Psychology, 21, 95-103.
    13. Forcada-Guex, M., Pierrehumbert, B., Borghini, A., Moessinger, A., & Muller-Nix, C. (2006). Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months. Pediatrics, 118, e107-e114. DOI: 10.1542/peds.2005-1145.
    14. France, K. G., & Blampied, N. M. (1999). Infant sleep disturbance: Description of a problem behavior process. Sleep Medicine Reviews, 3, 265-280.
    15. Georgiades, K., Boyle, M. H., Jenkins, J. M., Sanford, M., & Lipman, E. (2008). A multilevel analysis of whole family functioning using the McMaster family assessment device. Journal of Family Psychology, 22, 344-354.
    16. Goodlin-Jones, B. L., Burnham, M. M., Gaylor, E. E., & Anders, T. F. (2001). Night waking, sleep-wake organization and self-soothing in the first year of life. Journal of Developmental and Behavioral Pediatrics, 22, 226-233.
    17. Hall, W., Saunders, R. A., Clauson, M., Carty, E. M., & Janssen, P. A. (2006). Effects of an intervention aimed at re-ducing night waking and signaling in 6- to 12-month-old infants. Behavioral Sleep Medicine, 4, 242–261.
    18. Henderson, J. M. T., France, K. G., & Blampied, N. M. (2011). The consolidation of infants' nocturnal sleep across the first year of life. Sleep Medicine Reviews, 15, 211-220.
    19. Hiscock, H., Canterford, L., Ukoumunne, O. C., & Wake, M. (2007). Adverse associations of sleep problems in Australian preschoolers: National population study. Pediatrics, 119, 86-93.
    20. Hiscock, H., Bayer, J.K., Hampton, A., Ukoumunne, O.C., & Wake, M. (2008). Long-term mother and child mental health effects of a population-based infant sleep intervention: Cluster-randomized, controlled trial. Pediatrics, 122, 621–627.
    21. Holditch-Davis, D. (2010). Development of sleep and sleep problems in preterm infants. In R. E. Tremblay, M. Boivin, & R. deV Peters (Eds.), Encyclopedia on early childhood development (pp. 1-8) [online]. Montreal, PQ: Centre of Excellence for Early Childhood Development. Available at: http://www.child-encyclopedia.com/pages/PDF/Holditch-DavisANGxp3.pdf. (Accessed 31 December 2010).
    22. Huber, P. J. (1981). Robust statistics. New York: Wiley.
    23. Johnson, J. L., Ratner, P. A., Bottorff, J. L., Hall, W., & Dahinten, S. (2000). Preventing smoking relapse in postpartum women. Nursing Research, 49, 44-52.
    24. Lam, P., Hiscock, H., & Wake, M. (2003). Outcomes of infant sleep problems: A longitudinal study of sleep, behavior, and maternal well-being. Pediatrics, 111, e203-e207. DOI: 10.1542/peds.111.3.e203.
    25. Loutzenhiser, L., Ahlquist, A., & Hoffman, J. (2011). Infant and maternal factors associated with maternal perceptions of infant sleep problems. Journal of Reproductive and Infant Psychology, 29, 460-471.
    26. Magai, C., Hunziker, J., Mesias, W., & Culver, L. C. (2000). Adult attachment styles and emotional biases. International Journal of Behavioral Development, 24, 301-309.
    27. Meltzer, L. J., & Mindell, J. A. (2007). Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: A pilot study. Journal of Family Psychology, 21, 67-73.
    28. Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29, 1263-1276.
    29. Morrell, J., & Cortina-Borja, M. (2002). The developmental change in strategies parents employ to settle young children to sleep, and their relationship to infant sleeping problems, as assessed by a new questionnaire: The Parental Interactive Bedtime Behaviour Scale. Infant and Child Devel-opment, 11, 17-41.
    30. Morrell, J. M., & Steele, H. (2003). The role of attachment security, temperament, maternal perception and care-giving behavior in persistent infant sleeping problems. Infant Mental Health Journal, 24, 447-468.
    31. Muller-Nix, C., Forcada-Guex, M., Pierrehumbert, B., Jaunin, L., Borghini, A., & Ansermet, F. (2004). Prematurity, maternal stress and mother-child interactions. Early Human Development, 79, 145-158.
    32. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
    33. Ramos, K. D., Youngclarke, D., & Anderson, J.E. (2007). Parental perceptions of sleep problems among co-sleeping and solitary sleeping children. Infant and Child Development, 16, 417-431.
    34. Sadeh, A. (2004). A brief screening questionnaire for infant sleep problems: Validation and findings for an internet sample. Pediatrics, 113, e570- e577.
    35. Sadeh, A., Mindell, J. A., Luedtke, K., & Wiegand, B. (2009). Sleep and sleep ecology in the first 3 years: A web-based study. Journal of Sleep Research, 18, 60-73.
    36. Scher, A. (2001). Attachment and sleep: A study of night waking in 12-month-old infants. Developmental Psychobiology, 38, 274-284.
    37. Shaha, P. E., Robbinsh, N., Coelhob, R. B., & Poehlmannc, J. (2013). The paradox of prematurity: The behavioral vulnerability of late preterm infants and the cognitive susceptibility of very preterm infants at 36 months post-term. Infant Behavior & Development, 36, 50– 62.
    38. Sigman, M., Cohen, S. E., Beckwith, L., & Parmelee, A. H. (1981). Social and familial influences on the development of preterm infants. Journal of Pediatric Psychology, 6, 1-13.
    39. Simola, P., Liukkonen, K., Pitkaranta, A., Pirinen, T., & Aronen, E. T. (2012). Psychosocial and somatic outcomes of sleep problems in children: a 4-year follow-up study. Child: care, health and development, 40, 60-67.
    40. Stephens, T., & Graham, D. F. (Eds.). (1993). Canada's health promotion survey 1990 (Tech. Rep.). Ottawa: Health and Welfare Canada.
    41. Taveras, E. M., Rifas-Shiman, S. L., Oken, E., Gunderson, E. P., & Gillman, M. W. (2008). Short-sleep duration in infancy and risk of childhood overweight. Archives of Pediatric and Adolescent Medicine, 162, 305-311.
    42. Taylor, N., Donovan, W., & Leavitt, L. (2008). Consistency in infant sleeping arrangements and mother-infant interaction. Infant Mental Health Journal, 29, 77–94.
    43. Teti, D. M., & Crosby, B. (2012). Maternal Depressive Symptoms, Dysfunctional Cognitions, and Infant Night .Waking: The Role of Maternal Nighttime Behavior. Child Development, 83, 939–953
    44. Touchette, E., Petit, D., Paquet, J., Boivin, M., Japel, C., Tremblay, R. E., & Montplaisir, J. Y. (2005). Factors associated with fragmented sleep at night across early childhood. Archives of Pediatrics & Adolescent Medicine, 159, 242-249.
    45. Touchette, E., Cote, S. M., Petit, D., Liu, X., Boivin, M., Falissard, B., et al. (2009). Short nighttime sleep-duration and hyperactivity trajectories in early childhood. Pediatrics, 124, e985–993. DOI: 10.1542/peds.2008-2005.

  • Downloads

  • How to Cite

    Ali, R., Hall, W., Warnock, F., Wong, S., & Ratner, P. (2014). Quality of Preterm Infants’ Night Sleep: and Online Community-Based Survey of Maternal Factors and Perceptions of Infants’ Nighttime Awakenings and Sleep Problems. International Journal of Advanced Nursing Studies, 3(2), 59-64. https://doi.org/10.14419/ijans.v3i2.2412