An epidemiologic longitudinal study of sleeping problems and feeding experience of preterm and term children in southern Finland: Comparison with a southern German population sample

doi:10.1016/S0022-3476(98)70224-0

The Journal of Pediatrics

Volume 133, Issue 2, August 1998, Pages 224-231

https://doi.org/10.1016/S0022-3476(98)70224-0 Get rights and content

Abstract

Objective: To determine the influence of breast-feeding on the prevalence and persistence of sleeping problems in southern Finland (SF) and southern Germany (SG). Design: Prospective binational population study of infants admitted to special care units (SCUs) in geographically defined areas in SF and SG. Subjects: In SF, the number of SCU infants was 1057 (very preterm, 47; preterm, 258; term, 752); 485 term infants were control subjects. In SG, the number of SCU infants was 4427 (very preterm, 284; preterm, 1419; term, 2724). Main outcome measure: Parent reports of child sleeping problems at 5, 20, and 56 months of age. Results: Night waking at 5 months of age was less frequent for SCU very preterm (25.5%), preterm (40.6%), and term infants (48%) than for term control subjects (56.7% to 59.9%) in SF. No differences in sleeping behavior according to gestation were found at 20 and 56 months. Sleeping problems were greater in SF infants (25.5% to 48%) than in SG infants (15.1% to 19.1%) at 5 months of age and were explained by a higher rate of breast-feeding in SF. Breast-feeding had no long-term effects on night waking or on co-sleeping in SF. In contrast, breast-fed infants continued to wake more often in SG. Conclusions: Breast-feeding rather than gestational age is strongly related to night waking. More support for dealing with night waking might prevent early termination of breast-feeding. (J Pediatr 1998;133:224-31)

Section snippets

The Cohort

All infants born alive in a geographically defined region, Uusima (southern Finland), during the period from March 1, 1985, to March, 31, 1986, and who required admission to 1 of the 5 SCUs in this region within the first 10 days of life composed the target sample. The region of SF has approximately 1.14 million inhabitants and 7 obstetric units; 15,671 births were registered during the study period. Altogether, 1536 children (9.8% of all births) met the inclusion criterion (referred to

Biologic Background Data

The average GA in the three index groups (very preterm, preterm, and term) was 28.9 ± 2.1 weeks, 34.7 ± 1.3 weeks, and 39.4 ± 1.5 weeks (P < .001). The birth weights were 1360 g (±387), 2451 g (±595), and 3515 g (±628), respectively (P < .001). In 12.8% of the very preterm, 13.2% of the preterm, and 3.6% of the term infants, the births were multiple(P < .001). The initial hospitalization period of the very preterm infants was 63.2 ± 37.6 days; of the preterm infants, 12.6 ± 16.6 days; and of

Prematurity and Nighttime Sleeping

We did not find differences in night waking, falling-asleep problems, or co-sleeping between very preterm, preterm, and term infants at 20 months and 56 months of age, in line with previous studies.1, 8, 9, 10 Fewer SF preterm and very preterm infants regularly awoke at night at 5 months of age, and the parents were less distressed by their infants’ sleeping patterns.

Infants with more medical complications and a high risk of having neurodevelopmental disorders have fewer sleeping problems than

Acknowledgements

Thanks are due to the participating hospitals in the Uusima region of Finland, as follows: University Children’s Hospital, Helsinki (Prof. J. Perheentupa); University Maternity Hospital I, Helsinki (Prof. M. Seppälä); University Maternity Hospital II, Helsinki (Prof. O. Ylikorkala); City Helsinki Maternity Hospital (Prof. T. Luukkainen); Hospital Jorvi (Dr P. Kuitunen); District Hospital Länsi-Uusimaa (Dr M. v. Flittner); and Disctrict Hospital Porvoo (Dr C.-H. Strahlman). We are grateful to

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Early childhood multiple or persistent regulatory problems and diurnal salivary cortisol in young adulthood
2024, Psychoneuroendocrinology
Early childhood multiple or persistent regulatory problems (RPs; crying, sleeping, or feeding problems) have been associated with a risk of behavioural problems in young adulthood. It has been suggested that this may be due to the possible influence of early RPs on the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. However, associations between early RPs and HPA-axis activity in young adulthood remain unexplored. Thus, the aim of the current study was to investigate whether early childhood multiple or persistent RPs are associated with diurnal salivary cortisol in young adulthood.
At the ages of 5, 20 and 56 months, RPs of 308 children from the Arvo Ylppö Longitudinal Study were assessed via standardized parental interviews and neurological assessments. Multiple RPs were defined as two or three RPs at the age of 5 months and persistent RPs as at least one RP at 5, 20 and 56 months. At the mean age of 25.4 years (SD= 0.6), the participants donated saliva samples for cortisol at awakening, 15 and 30 min thereafter, 10:30 am, at noon, 5:30 pm, and at bedtime during one day. We used mixed model regressions, and generalized linear models for testing the associations, controlling for important covariates.
Of the 308 children, 61 (19.8%) had multiple or persistent RPs in early childhood: 38 had multiple, and 27 had persistent RPs. Persistent RPs were associated with significantly higher cortisol peak and output in the waking period, and cortisol awakening response. On the other hand, multiple RPs were not associated with salivary cortisol.
Children displaying persistent RPs throughout early childhood show, over two decades later, increased HPA axis activity in response to awakening stress. This may be one physiological mechanism linking early childhood RPs to adulthood behavioural outcomes.
App-based intervention for parents of children with crying, sleeping, and feeding problems: Usability, usefulness and implications for improvement
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There is a lack of evidence-based app guidance for parents of children with crying, sleeping, and feeding problems who are often highly burdened and not likely to seek professional help. A new psychoeducational app for parents providing scientifically sound information via text and videos, a diary function, selfcare strategies, a chat forum and a regional directory of specialized counseling centers may serve as a low-threshold intervention for this target group.
We investigated how parents perceived the app in terms of the following: (1) overall impression and usability, (2) feedback on specific app functions regarding usefulness and (3) possible future improvements.
Our clinical sample of N = 137 parents of children aged from 0 to 24 months was recruited from a cry baby outpatient clinic in Southern Germany between 2019 and 2022. A convergent parallel mixed methods design was used to collect and analyse cross-sectional data on app evaluation. After app use within the framework of a clinical trial, parents filled in an app evaluation questionnaire.
Most participants used the app at least once a week (86, 62.8 %) over an average period of 19.06 days (SD = 15.00). Participants rated overall impression and usability as good, and the informational texts, expert videos and regional register of counseling centers as appealing and useful. The diary function and chat forum were found to be helpful in theory, but improvements in implementation were requested, such as a timer function for the diary entry. Regarding future functionality, parents posed several suggestions such as the option to contact counseling centers directly via app, and the inclusion of the profile of their partners.
Positive ratings of overall impression, usability, and specific app functions are important prerequisites for the app to be effective. App-based guidance for this target group should include easy-to-use information. The app is intended to serve as a secondary preventive low-threshold offer and to complement professional counseling.
Do preterm babies sleep differently than their peers? Sleep characteristics and their associations with maternal depression and parenting stress
2022, Sleep Medicine
The findings regarding the association between prematurity, sleep problems, and maternal psychological well-being are mixed. This study examined preterm- and term-born infants’ sleep patterns, ecology, and problems, in addition to the associations of these patterns with maternal parenting stress and depressive symptomatology.
In total, 84 mothers of infants between 6 and 17 months of corrected age, in which 40 were preterm infants and 44 were healthy full-term infants, participated in the study. Children's sleep was evaluated by the Brief Infant Sleep Questionnaire. Maternal depressive symptoms were screened by the Edinburgh Postnatal Depression Scale. Maternal parenting stress was measured via the Parenting Stress Index-Short Form.
In preterm infants, lower total and nocturnal sleep duration and later falling asleep time were identified compared to term infants. Regarding sleep ecology, the percentages of poor sleepers, mother's perception of child's and her own sleep problems were similar in both groups. While the most common method of falling asleep was ‘rocking the baby’ in the preterm group, it was ‘breastfeeding’ in the term group. In both groups, the maternal perception of sleep problems positively predicted maternal parenting stress. Lastly, compared to good sleepers, higher maternal parenting stress, higher maternal perception of mother's and child's sleep problems, and lower infants' age were identified among poor sleepers.
Despite many similarities in the sleep characteristics of preterm and term infants, several differences in sleep patterns and sleep ecology of preterm infants were identified. Since the maternal perception of sleep problems was found to predict parenting stress, guidance on infant sleep is suggested to support families.
Sleep patterns, problems, and ecology in young children born preterm and full-term and their mothers
2021, Sleep Medicine
Previous studies of sleep patterns and problems in preterm infants compared to full-term infants have yielded mixed results, with little known about sleep ecology. The aims of this study were to compare sleep patterns, sleep problems, and sleep ecology across developmental stages (birth to 36 months) in preterm (3 or more weeks early) infants and toddlers to those born full-term, in addition to their mothers’ sleep.
Mothers of 834 young children in Brazil (ages 0–35.9 months), half preterm and half full-term (matched for sex and chronological age), completed the Brief Infant Sleep Questionnaire and the Pittsburgh Sleep Quality Index.
Across the entire sample, preterm and full-term infants were similar for most sleep parameters, including sleep onset latency, number and duration of night awakenings, and sleep duration, as well as sleep ecology parameters, including falling asleep independently and sleep location. However, preterm infants were more likely to be held to initiate sleep, given a bottle to resume sleep after waking, and less likely to be breastfed to resume sleep after waking. Mothers of preterm infants, however, were more likely to report a parent-perceived sleep problem, although maternal-perceived confidence in managing child sleep and bedtime difficulty were similar. Finally, maternal sleep parameters were similar between groups.
Overall, these results indicate that sleep patterns, sleep problems, and sleep ecology among preterm infants and toddlers and their mothers are largely similar to those of full-term infants and toddlers and their mothers, even within the first few months.
Comparison of sleep problems between term and preterm born preschool children
2020, Sleep Medicine
Sleep disorders are common problems among all age groups. If sleep problems detected in childhood are not resolved successfully, they become sleep disorders and a chronic state. In this study, we aimed to compare sleep problems between preterm-born and term-born preschool-age children.
In the cross-sectional study, children were grouped according to whether they were born preterm or at term. The preterm group included 137 children aged four to six years. The control group comprised 145 age-matched term-born preschool children. The prenatal, natal, demographical, and clinical characteristics of preterm- and term-born preschool-age children were compared. The Children's Sleep Habits Questionnaire (CSHQ) was used to identify sleep problems. The total score and subscores of the CSHQ were compared between the groups.
The percentage of gastroesophageal reflux (GER) symptoms and obstructive sleep apnea (OSA) symptoms were significantly higher in the preterm group. According to the cutoff point of the CSHQ, 97 children in the preterm group (70.8%) and 88 children in the control group (60.7%) had a sleep disorder. The total score of the CSHQ was significantly higher in the preterm group compared with the control group; however, the scores of the subscales were similar between the groups. In the regression analysis, a significant association was found between being born preterm and having sleep disorder (β = 0.308, OR = 1.36, p = 0.04).
Our study reported a high percentage of sleep problems in preterm-born preschool children. We suggest that prematurity is associated with sleep problems even if the etiology of sleep problems is heterogeneous. Symptoms regarding GER and OAS should be investigated, and precautions, such as prohibiting maternal cigarette smoking, should be taken in preterm infants.
Maternal early pregnancy body mass index and diurnal salivary cortisol in young adult offspring
2019, Psychoneuroendocrinology
Citation Excerpt :
Further, as also lower levels of BMI have been shown to be associated with lower HPA axis activity in a general population (Kumari et al., 2010), we tested if the associations between maternal early pregnancy BMI and offspring diurnal salivary cortisol were non-linear. Participants come from the Arvo Ylppö Longitudinal Study (AYLS) (Heinonen et al., 2008; Riegel et al., 1995; Wolke et al., 1998) They were recruited from a total of 15,311 deliveries in the seven maternity hospitals in the county of Uusimaa, Finland between March 15, 1985 and March 14, 1986. The sample comprised 2193 infants (1193 boys).
Background Maternal early pregnancy overweight (body mass index [BMI] 25.0–29.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) are associated with mental and physical health adversities in the offspring. Prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been put forward as one of the mechanisms that may play pathophysiological role. However, evidence linking maternal overweight and obesity with offspring HPA-axis activity is scarce. We studied if maternal early pregnancy BMI is associated with diurnal salivary cortisol, a marker of HPA-axis activity, in young adult offspring.
Methods At a mean age of 25.3 (standard deviation [SD) = 0.6) years, 653 Arvo Ylppö Longitudinal Study participants collected saliva samples for cortisol analyses, at awakening, 15 and 30 min thereafter, 10:30AM, 12:00PM, 5:30PM and at bedtime. Maternal BMI was calculated from weight and height verified by a measurement in the first antenatal clinic visit before 12 weeks of gestation derived from healthcare records.
Results Per each one kg/m² higher maternal early pregnancy BMI offspring diurnal average salivary cortisol was -1.4% (95% CI:-2.6, -0.2, p_FDR = 0.033) lower, at awakening it was -2.4% (95% CI:-4.0, -0.7, p_FDR = 0.025) lower and the morning average salivary cortisol was -2.0% (95% CI:-3.4, -0.5, p_FDR=0.017) lower. These associations were independent of the offspring’s own young adulthood BMI, and other important covariates.
Conclusion Our findings show that young adult offspring born to mothers with higher early pregnancy BMI show lower average levels of diurnal cortisol, especially in the morning. Whether these findings reflect prenatal programming of the offspring HPA-axis activity warrants further investigation.

View all citing articles on Scopus

^☆: From the University of Hertfordshire, Department of Psychology, Hatfield, Great Britain; the University of Munich Children’s Hospital, Bavarian-Finnish Longitudinal Study, Munich, Germany; and the University of Helsinki Children’s Hospital, Helsinki, Finland.

^☆☆: Supported by the Bundesministerium für Forschung und Technik (Federal Goverment of Germany, Ministry of Science and Technology) program grants PKE 4 and JUG 14 (FKZ’s 0706224, 0706564, and 01EP9504) to Drs Riegel, Wolke, and Ohrt.

^★: Reprint requests: Dieter Wolke, PhD, Professor, University of Hertfordshire, Faculty of Health and Human Sciences, Department of Psychology, College Lane, Great Britain–Hatfield AL10 9AB.

^★★: 0022-3476/98/$5.00 + 0 9/21/89698

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An epidemiologic longitudinal study of sleeping problems and feeding experience of preterm and term children in southern Finland: Comparison with a southern German population sample☆,☆☆,★,★★

Abstract

Section snippets

The Cohort

Biologic Background Data

Prematurity and Nighttime Sleeping

Acknowledgements

Lancet

Developmental course of nighttime sleep-wake patterns in full-term and premature infants during the first year of life

Sleep

Development of sleep-wake patterns and non-rapid eye movement sleep stages during the first six months of life in normal infants

Pediatrics

Development of the sleep and wakefulness rhythm in preterm infants discharged from a neonatal care unit

Pediatr Res

Environmental neonatology [annotation]

Arch Dis Child

Effect of night and day on preterm infants in a newborn nursery: randomised trial

BMJ

The cognitive outcome of very preterm infants may be poorer than often reported: an empirical investigation of how methodological issues make a big difference

Eur J Pediatr

Sleep

The incidence of sleeping problems in preterm and term infants discharged from special neonatal care units: an epidemiological longitudinal study

J Child Psychol Psychiatry

Sleep behavior of preterm children at three years of age

Dev Med Child Neurol

Feeding and sleeping problems

Maternal perception of the sleep patterns of premature infants at seven months corrected age compared to full-term infants

Infant Mental Health Journal

Development of cicardian sleep-wake rhythms in preterm and full-term infants

Pediatr Res

Sleep/wake patterns of breast-fed infants in the first 2 years of life

Pediatrics

Co-morbidity of crying and feeding problems with sleeping problems in infancy: concurrent and predictive associations

Early Development and Parenting