Parents often complain about bedtime rituals and children waking at night. A new report, however, reveals parents who don’t sleep well may actually be misreporting poor sleep in their children.
Parents who lose sleep are more likely to misreport sleep problems in their children, according to a new report published in Pediatrics.
The study, conducted in Finland, involved 100 children aged between 2 and 6 years. Data were collected from parent questionnaires and sleep diaries about the child’s sleep quality, and children were fitted with actigraphs to measure their nighttime movement and estimate periods of sleep for 1 week. Parents were also tested using the Jenkins’ sleep scale and other questionnaires about their own sleep patterns.
Of the 100 children who participated successfully in the study, there was no significant association between the quality of the child’s sleep and what parents were reporting. However, high levels of parental sleeping problems were associated with more frequently reporting children’s sleeping problems, according to the report.
“Parents who report sleeping difficulties of their own also reported more sleep related problems in their offspring. They experienced their children as having more difficulties initiating and maintaining sleep, more sleep-wake transition difficulties, and more excessive somnolence than did parents who slept better,” the report states. “This association could not be explained by the children’s sleeping problems as identified with an objective measure, namely the actigraph. Child’s age, gender, number of siblings, existence of chronic illnesses or medication, or the existence of current medication also did not attenuate the association.”
Previous research has shown similar results, according to the report, with loss of sleep in parents causing attention bias towards negative events.
“These observations explain why parents who sleep poorly notice and remember their children’s bed resistance and night waking so well,” the authors note. “Hence, in the clinical field, it is of paramount importance to aim interventions in a child’s sleeping difficulties toward the wellbeing of the whole family instead of only the child. The diagnostic measures should consider not only the sleeping habits of the child but also parental aspects. Tired parents can unconsciously exaggerate their child’s sleeping difficulties, which could lead to misplaced interventions.”
Hanni Rönnlund, MD, one of the authors of the study, says the report serves as a reminder to complete a full assessment when presented with sleep problems, including asking parents about their own sleep.
“A child’s sleeping problems can become a huge burden to the entire family and poor parental sleep quality can make the situation feel even worse. Consequently, if the parents are able to avoid tiredness eg, by taking naps while relatives, friends or other family members look after the child, the child’s sleeping problems might not cause as much anxiety and be easier to handle,” Rönnlund says. “When treating children’s sleeping problems physicians should ask about parental sleep quality and if needed, also refer the parent to treatment for their sleeping problems.”
The National Sleep Foundation (NSF) offers recommendations on sleep durations by age, ranging from 14 to 17 hours per day for infants aged under 3 months to 9 to 11 hours per day for school age children. Adults should get 7 to 9 hours of sleep per day, according to the NSF.
The NSF says children generally sleep better when parents establish rules, limit technology, and set a good example for sleep hygiene. Parents reported to NSF in a 2014 poll that their children often got about an hour less sleep than the parents thought they needed on school nights, but 72% also reported allowing children to have at least 1 electronic device in their rooms at night.
“Children who leave electronic devices on at night get less sleep on school nights than other children do, according to parents’ estimates-a difference of up to nearly one hour on average per night,” according to NSF. “Parents also have a more negative view of the quality of their child’s sleep if the child leaves electronics on while sleeping than if not.”
Parents also report that late night homework and school activities negatively affect both their child’s and their own sleep quality. Rules at bedtime can help, and most parents say they enforce at least 1 rule for bedtime, such as setting bedtimes or limiting caffeinated beverages or television time before bed.
However parents have to set a good example, says NSF, and 65% of children whose parents had an electronic device in their room also had 1 in theirs. On the other hand, only 24% of children whose parents left electronics out of the bedroom had their own devices in their rooms.
Setting rules and establishing good routines as a family are crucial, says NSF, which estimates that two-thirds of children experience sleep problems and parents lose an average of 200 hours of sleep each year as a result of children’s nighttime awakenings.
Carol L Rosen, MD, medical director of Pediatric Sleep Services in the Division of Pediatric Pulmonology and Sleep Medicine at University Hospitals Rainbow Babies & Children's Hospital, J S Rube Endowed Chair in Pediatric Sleep Medicine, and professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland Ohio, says 25% of parents don’t like something about the way their children sleep.
The first thing pediatricians must ask, she says, is what it is specifically that concerns the parents about their child’s sleeping; how does it affect their child; and ask the parents their thoughts on possible causes (family stress, school problems, changes at home, physical changes).
While she would not comment specifically on the new study from Finland, Rosen says it is important to get a full snapshot of the child’s behavior and the family’s routines in assessing reported sleep problems. She recommends using the BEARS screening tool to evaluate bedtimes, excessive sleepiness, arousal, regular schedules, and snoring or sleep apnea.
“I think a lot of pediatricians are familiar with that BEARS screening for sleep disorders,” Rosen says. “Parents do certainly see some challenging behaviors during the day and they often will attribute that to something about the child’s sleep. A simple thing pediatricians can do is to really get a snapshot of the weekdays and weekends; what time to they get into bed; what time do they fall asleep; and what time do they wake up? Filling in that little box, for the weekdays and weekends is a just absolute wealth of information.”
Pediatricians should also evaluate whether children have a good opportunity to sleep. Do they have time to nap during the day? Are there things going on in the household at night that challenge bedtime routines?
“All of those schedule irregularities are really a big problem for children aged 2 to 6 years,” she says, adding that children’s bedtime routines should shift by no more than 2 hours from weekdays to weekends.
For children with true sleeping problems in the presence of proper bedtime routines and sleep hygiene, Rosen says pediatricians should assess for physical causes, such as snoring or restless leg syndrome and consider a referral to a sleep specialist.
Medical reasons for sleep disturbances may include parasomnia, sleep apnea, movement disorders, and more. Rosen says in conducting thorough sleep assessments, she often uses actigraphs, as in the study, as a “truth buster.”
“Sometimes parents report stuff and it doesn’t make sense,” Rosen says. “I find it very difficult to always know from the parent report what’s going on. Sometimes parents are exactly right, and sometimes not at all. It’s very useful to have black and white data logs to go through.”
Parents who are seeking medications to help their children sleep usually raise a red flag, Rosen says, besides the fact that there are no US Food and Drug Administration-approved medications for sleep disturbances in children. Some pharmacotherapies may be used in rare cases where atypical development is to blame, she says.
Pediatricians should begin by having parents review bedtime routines and completing a 2-week sleep log. She also encourages pediatricians to remind parents that it is not normal for children to sleep soundly all night, but rather to wake 5 or 6 times each night between rapid eye movement cycles. Pediatricians should counsel parents about how to determine if their child is truly awake, and when to intervene.
“If children get in the habit of waking up or parents get involved, then they don’t know how to go back to sleep,” she says. It can also be helpful for parents to take videos of unusual behaviors during nighttime wakings, Rosen adds.