Night waking during the first three years of life: links to health and illness

Background:One of themost common parental concerns reported to pediatric practice is difficulties in the initiation and maintenance of sleep among infants. At 6 months, frequent nighttime awakening after the onset of sleep is associated with poorer health in infants (Weinraub et al., 2012). At 12 months, infants with mild eczema had more frequent night waking and infants with severe eczema had shortened sleep time when compared to normal infants (Anuntaseree et al., 2012). This study was further to examine the relationship between infants’ night waking and their health and illness from 6 to 36 months. Purpose: Using an archived longitudinal dataset, this study investigated developmental changes in infants’ nighttime sleep awakenings and their associations with health and illness in the first 3 years of life. Methods:A total of 1364 healthy infants and their parents were originally recruited from 10 hospitals across the US to participate in a longitudinal study investigating early care and development known as NICHD SECCYD. As part of this larger study, sleep and health data were collected when the children were 6, 15, 24, and 36 months old. At each age, mothers were asked to report the number of nights and the times per night of their child’s night waking in the past week. Infants were identified with sleep problemswhenwaking at night and eliciting the parent’s attention at least 3 times a week (Zuckerman, 1987). Mothers also reported on their child’s overall health (1 = poor health to 4 = excellent health) and the occurrences of respiratory illnesses, ear infections, and/or intestinal illnesses in the past 3 months. The occurrences of illnesses were summed to create an index of child illness (score range = 0–3). Results: The prevalence rates of night waking (70.4%, 66.9%, 64.4%, and 62.1%) and infants with sleep problems (17.2%, 13.4%, 11.8%, and 9.5%) decreasedwith age. Latent growth curve modeling analysis was applied to examine the change patterns in weekly and nightly frequency of infant night waking over time and their associations with infants’ health and illness over time. With age, a decreased pattern was found for both weekly and nightly frequency of night waking. Decline in weekly frequency was characterized by a nonlinear patterna fast decline from 6 (M= 4.11 nights) to 15 (M= 3.20 nights) and a slowed reduction from 15 to 24 (M= 2.95 nights) and to 36 (M= 2.77 nights) months. By contrast, a gradual, linear decline was found for the nightly frequency (1.61, 1.49, 1.39, and 1.34 times). Poorer health and more illnesses were significantly associated with more frequent weekly and nightly nighttime awakenings. At all ages, infants identifiedwith sleep problems had poorer health and more illnesses as compared to those without. Conclusion(s): The decline in infants’ night waking appears to reflect sleep consolidation in thefirst 3 years. Sleep disturbance as indexed by night waking may compromise health in early childhood. Implications: Study results are expected to provide relevant information for interventions. Physical therapists need to consider the role of sleep in health among infants when conducting interventions.