Want to learn more about infant and childhood sleep? While most of the research can only be accessed through a paid subscription, some is available without restriction. These open access articles reflect a portion of the growing body of knowledge on pediatric sleep.
Sleep Totals/ Sleep-Wake Development
Acebo, C., Sadeh, A., Seifer, R., Tzischinsky, O., Hafer, A., & Carskadon, M. A. (2005). Sleep/wake patterns derived from activity monitoring and maternal report for healthy 1- to 5-year-old children. Sleep, 28(12), 1568–77.
A landmark cross-sectional study of 169 healthy children, with sleep objectively measured by use of activity monitors–as well as recorded in daily diaries by mothers.
Anders, T. F., & Keener, M. (1985). Developmental course of nighttime sleep-wake patterns in full-term and premature infants during the first year of life. I. Sleep, 8(3), 173–92.
Thomas Anders’ work is foundational to our understanding of the development of consolidated sleep in infancy. He is credited with coining the phrase “self-soothing.”
Blair, P. S., Humphreys, J. S., Gringras, P., Taheri, S., Scott, N., Emond, A., … Fleming, P. J. (2012). Childhood sleep duration and associated demographic characteristics in an English cohort. Sleep, 35(3), 353–60.
A longitudinal study of roughly 14,000 English babies born in the early 1990’s, whose sleep patterns were followed from birth to age 11.
Bruni, O., Baumgartner, E., Sette, S., Ancona, M., Caso, G., Di Cosimo, M. E., … Ferri, R. (2014). Longitudinal study of sleep behavior in normal infants during the first year of life. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 10(10), 1119–27.
The sleep development during the first year of life for 704 Italian infants.
Burnham, M. M., Goodlin-Jones, B. L., Gaylor, E. E., & Anders, T. F. (2002). Nighttime sleep-wake patterns and self-soothing from birth to one year of age : a longitudinal intervention study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 43(6), 713–725.
In tandem with the Goodlin-Jones article below, this article focus on the same 80 infants, with an intervention to see if using a knotted t-shirt worn by the mother helped infants learn to self-soothe.
Goodlin-Jones, B. L., Burnham, M. M., Gaylor, E. E., Anders, T. F., Lin, G. G., & Scott, J. G. (2001). Night Waking, Sleep-Wake Organization, and Self-Soothing in the First Year of Life. Journal of Developmental and Behavioral Pediatrics : JDBP, 22(4), 226–233.
Video tracking of the sleep-wake development of 80 infants, with particular regard to what distinguishes the sleepers who become self-soothers.
Mindell, J. A., Composto, J., Lee, C., Bhullar, B., & Walters, R. (2014). Development of infant and toddler sleep patterns from real world data on a mobile app. Sleep, 37(June), A312.
The data from 841 children ages 0-35 months is presented, as collected over the span of 19 months from an iOS app, Johnson’s Bedtime Baby Sleep.
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(1), 60–73.
Just over 5,000 parents of children 0-3 years using the website BabyCenter.com filled out a questionnaire regarding sleep habits. Examines typical development and factors influencing sleep.
Weinraub, M., Bender, R. H., Friedman, S. L., Susman, E. J., Knoke, B., Bradley, R., … Williams, J. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age. Developmental Psychology. Weinraub, Marsha: Department of Psychology (265-66), Temple University, 656 Weiss Hall, 1701 N. 13th St., Philadelphia, PA, US, 19122, firstname.lastname@example.org: American Psychological Association.
Longitudinal study of 1,200 infants, focusing on what separates the “Sleepers” from the “Transitional Sleepers.”
Crosby, B., LeBourgeois, M. K., & Harsh, J. (2005). Racial differences in reported napping and nocturnal sleep in 2- to 8-year-old children. Pediatrics, 115(1 Suppl), 225–32.
What effect does race have on sleep development? Is it genetic or cultural? This study of 1043 children found that black children are much more likely to continue napping beyond the age of 3 as compared to white children.
Kurth, S., Lassonde, J. M., Pierpoint, L. A., Rusterholz, T., Jenni, O. G., McClain, I. J., … LeBourgeois, M. K. (2016). Development of nap neurophysiology: preliminary insights into sleep regulation in early childhood. Journal of Sleep Research, 25(6), 646–654.
The ability to fall asleep during the day, the length of the nap, plus the proportion of the nap spent in deep sleep, changes as children get older. 8 healthy children were assessed at three age points using EEG to track the maturational changes occurring in regards to napping.
Lampl, M., & Johnson, M. L. (2011). Infant growth in length follows prolonged sleep and increased naps. Sleep, 34(5), 641–50.
Parents often think of growth spurts happening in relation to increased eating. Growth hormone is released primarily during deep sleep, making increased sleep an integral part of growth spurts.
Nakagawa, M., Ohta, H., Nagaoki, Y., Shimabukuro, R., Asaka, Y., Takahashi, N., … Yoda, H. (2016). Daytime nap controls toddlers’ nighttime sleep. Scientific Reports, 6(1), 27246.
Both the length of the nap and the timing of the nap influence night sleep in 1.5 year old children. Naps ending later, and those that are longer in length, result in shorter night sleep.
Weissbluth, M. (1995). Naps in Children: 6 Months-7 Years. Sleep, 18(2), 82–87.
Prior to publishing his well-known book, Healthy Sleep Habits, Happy Child, Weissbluth surveyed the parents of infants in his practice in regard to typical nap length and frequency. His work here provided an initial point of reference for typical nap development.
Adachi, Y., Sato, C., Nishino, N., Ohryoji, F., Hayama, J., & Yamagami, T. (2009). A brief parental education for shaping sleep habits in 4-month-old infants. Clinical Medicine & Research, 7(3), 85–92.
Japanese mothers of 4-month old infants were given a 10-minute educational training and a 20-page booklet on creating healthy sleep habits as a means of preventing infant sleep problems.
Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitham, J., Williams, A. S., … Kennaway, D. J. (2016). Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics, 137(6), e20151486.
A study that received significant media attention when the authors found no evidence of stress or long-term attachment issues as a result of graduated extinction sleep training.
Hall, W. A., Hutton, E., Brant, R. F., Collet, J. P., Gregg, K., Saunders, R., … Wooldridge, J. (2015). A randomized controlled trial of an intervention for infants’ behavioral sleep problems. BMC Pediatrics, 15, 181.
Just over 100 parent/infant intervention pairs and 100 parent/infant control pairs, all infants 6-8 months of age, participated in a randomized controlled trial of graduated extinction sleep training.
Hiscock, H., & Wake, M. (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ (Clinical Research Ed.), 324(7345), 1062–5.
156 mothers of infants 6-12 months with parent-defined severe sleep problems were randomized to either educational intervention or control. Parents implemented either graduated extinction or “camping out,” where they stayed with the infant and gradually faded out their presence at bedtime.
Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., Sadeh, A., & American Academy of Sleep Medicine. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263–1276.
The American Academy of Sleep Medicine’s commissioned review of 52 studies on behavioral treatment of sleep problems in young children.
Blampied, N. M., & France, K. G. (1993). A behavioral model of infant sleep disturbance. Journal of Applied Behavior Analysis, 26(4), 477–92.
An in-depth analysis of the behavioral psychology of sleep, and how parental behavior can potentially reinforce natural awakening in young children.
Byars, K. C., Yolton, K., Rausch, J., Lanphear, B., & Beebe, D. W. (2012). Prevalence, Patterns, and Persistence of Sleep Problems in the First 3 Years of Life. PEDIATRICS, 129(2), e276–e284.
Parents commonly believe that children will outgrow their sleep struggles. Although most sleep problems can be resolved using behavioral interventions, when left untreated, 21% of infants with sleep problems in this study continued to have difficulty sleeping at 36 months of age.
Eckerberg, B. (2004). Treatment of sleep problems in families with young children: effects of treatment on family well-being. Acta Paediatrica, 93(1), 126–134.
What are the effects of sleep training? Evidence here shows that teaching a child to fall asleep independently resolves night waking, and improves family well-being as well as negative daytime behavior.
France, K. G., & Blampied, N. M. (1999). REVIEW ARTICLE: Infant sleep disturbance: Description of a problem behaviour process. Sleep Medicine Reviews, 3(4), 265-280.
Analysis of how sleep problems develop.
Lam, P., Hiscock, H., & Wake, M. (2003). Outcomes of Infant Sleep Problems: A Longitudinal Study of Sleep, Behavior, and Maternal Well-Being. PEDIATRICS, 111(3), e203–e207.
Families with ongoing child sleep problems are more likely to experience difficult behavior in their child with a sleep problem, and mothers are more likely to experience depression as a result of lost sleep.
Sadeh, A., & Anders, T. F. (1993). Infant sleep problems : Origins , assessment , intervention. Infant Mental Health Journal, 14(1), 17-34.
Two of the pioneers of pediatric sleep research proposed what has become a foundational model of the dynamic, bidirectional nature of the origin of infant sleep problems.
Vriend, J., & Corkum, P. (2011). Clinical management of behavioral insomnia of childhood. Psychology Research and Behavior Management, 4, 69–79.
Sleep problems in infants and children are clinically referred to as behavioral insomnia of childhood (BIC). This article outlines what is known about the prevalence and treatment of BIC.
Circadian Rhythms/ Timing of Sleep
Akacem, L. D., Wright, K. P., & LeBourgeois, M. K. (2016). Bedtime and evening light exposure influence circadian timing in preschool-age children: A field study. Neurobiology of Sleep and Circadian Rhythms, 1(2), 27–31.
Parent-selected bedtime and the amount of light a child is exposed to in the 2 hours before bedtime play a significant role in a child’s sleep.
Burgess, H. J., & Eastman, C. I. (2004). Early versus late bedtimes phase shift the human dim light melatonin rhythm despite a fixed morning lights on time. Neuroscience Letters, 356(2), 115–8.
A late bedtime delays the release of melatonin, even when wake time and morning light exposure stays the same.
Gooley, J. J., Chamberlain, K., Smith, K. A., Khalsa, S. B. S., Rajaratnam, S. M. W., Van Reen, E., … Lockley, S. W. (2011). Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. Journal of Clinical Endocrinology and Metabolism, 96(3), E463-72.
Artificial light before bed has a significant effect on our sleep.
Kelly, Y., Kelly, J., & Sacker, A. (2013). Changes in Bedtime Schedules and Behavioral Difficulties in 7 Year Old Children. PEDIATRICS, 132(5), e1184–e1193.
Evidence of the long-term effect that a regular versus variable bedtime has on children. Sleep loss is cumulative; frequently delayed bedtimes lead to a greater incidence of problem behavior. However, children with late and/or irregular bedtimes are also more likely to come from disadvantaged homes.
Lodemore, M., Petersen, S. A., & Wailoo, M. P. (1991). Development of night time temperature rhythms over the first six months of life. Archives of Disease in Childhood, 66(4), 521–524.
A baby’s ability to sleep for longer stretches of time at night without eating is directly related to the development of a regular body temperature rhythm.
Randler, C., Faßl, C., & Kalb, N. (2017). From Lark to Owl: developmental changes in morningness-eveningness from newborns to early adulthood. Scientific Reports, 7, 45874.
Young children are naturally wired to wake early and go to bed early.
Simpkin, C. T., Jenni, O. G., Carskadon, M. A., Wright, K. P., Akacem, L. D., Garlo, K. G., & LeBourgeois, M. K. (2014). Chronotype is Associated with the Timing of the Circadian Clock and Sleep in Toddlers. Journal of Sleep Research, 23(4), 397–405.
Most toddlers in this study of 48 children aged 30-36 months were rated as “definitely morning types,” while none were rated as “definitely evening types” in an assessment of chronotype.
Waterhouse, J., Fukuda, Y., Morita, T., Ancoli-Israel, S., Ayalon, L., Salzman, C., … Rigaud, A. (2012). Daily rhythms of the sleep-wake cycle. Journal of Physiological Anthropology, 31(1), 5.
The sleep/wake cycle is regulated by a 2-process model: sleep pressure and circadian rhythm. Body temperature rises and falls as set by the body’s internal clock. Morningness/eveningness (chronotype) changes with age. Our ability to sleep and to be alert is both commonplace and astounding; beautifully simple yet so complex.
Werner, H., LeBourgeois, M. K., Geiger, A., & Jenni, O. G. (2009). Assessment of Chronotype in Four-to-Eleven-Year-Old Children: Reliability and Validity of the Children’s Chronotype Questionnaire (CCTQ). Chronobiology International, 26(5), 992–1014.
Chronotype can be assessed in children, showing a range of reliably measurable differences in sleep timing and duration.
Wright, K. P., McHill, A. W., Birks, B. R., Griffin, B. R., Rusterholz, T., Chinoy, E. D., … Duncan, W. C. (2013). Entrainment of the human circadian clock to the natural light-dark cycle. Current Biology : CB, 23(16), 1554–8.
Lack of strong light exposure during the day combined with artificial light in the evening causes a delay in the body’s circadian timing–exaggerating a night owl tendency. When exposed to only natural lighting, the body’s internal clock synchronizes to sunrise and sunset.
Wright, K. P., Lowry, C. A., & LeBourgeois, M. K. (2012). Circadian and wakefulness-sleep modulation of cognition in humans. Frontiers in Molecular Neuroscience, 5, 50.
Cognitive functions follow a circadian rhythm. Your ability to think clearly depends on a regular, full night of rest in alignment with your body’s natural rhythms.
How Parenting Influences Sleep
Mindell, J. A., Sadeh, A., Kohyama, J., & How, T. H. (2010). Parental behaviors and sleep outcomes in infants and toddlers: a cross-cultural comparison. Sleep Medicine, 11(4), 393–9.
An impressive study of nearly 30,000 children 0-36 months from 17 countries across the globe. Parental behavior explains a significant degree of the difference seen in the sleep of young children.
Philbrook, L. E., & Teti, D. M. (2016). Bidirectional associations between bedtime parenting and infant sleep: Parenting quality, parenting practices, and their interaction. Journal of Family Psychology, 30(4), 431–441.
“Higher maternal emotional availability (EA) in combination with less close contact at bedtime was associated with more infant sleep across the night on average, and higher EA in combination with fewer arousing bedtime activities predicted more rapid increases in infant sleep with age.”
Pyper, E., Harrington, D., & Manson, H. (2017). Do parents’ support behaviours predict whether or not their children get sufficient sleep? A cross-sectional study. BMC Public Health, 17(1), 432.
Children get more sleep when bedtime and bedtime rules (e.g., no electronics in the bedroom) are enforced rather than merely encouraged.
Sadeh, A., Flint-Ofir, E., Tirosh, T., & Tikotzky, L. (2007). Infant sleep and parental sleep-related cognitions. Journal of Family Psychology, 21(1), 74–87.
Parents of children with sleep problems display a harder time setting limits for their children than do parents of children without sleep problems.
St James-Roberts, I., Roberts, M., Hovish, K., & Owen, C. (2017). Video evidence that parenting methods predict which infants develop long night-time sleep periods by three months of age. Primary Health Care Research & Development, In press.
Among breastfed infants, those whose parents consistently implemented a 1-minute interval between baby waking at night and feeding developed long stretches of sleep at night at a much higher percentage than among babies who were fed immediately on waking.
Teti, D. M., Kim, B., Mayer, G., & Countermine, M. (2010). Maternal emotional availability at bedtime predicts infant sleep quality. Journal of Family Psychology, 24(3), 307–315.
“These findings demonstrate that parents’ emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality.”
Tikotzky, L., Sadeh, A., & Glickman-Gavrieli, T. (2011). Infant Sleep and Paternal Involvement in Infant Caregiving During the First 6 Months of Life. Journal of Pediatric Psychology, 36(1), 36–46.
“A higher involvement of fathers in overall infant care predicted and was associated with fewer infant night-wakings and with shorter total sleep time after controlling for breastfeeding.”
Sleep in Children With Autism and/or ADHD
Papadopoulos, N., Sciberras, E., Hiscock, H., Mulraney, M., McGillivray, J., & Rinehart, N. (2015). The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder. Journal of Attention Disorders.
Sleep problems are much more common in children with ADHD and autism. An intervention focusing on sleep hygiene and behavioral strategies was significantly effective in improving sleep for these children.
Van der Heijden, K. B., Stoffelsen, R. J., Popma, A., & Swaab, H. (2018). Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls. European Child & Adolescent Psychiatry, 27(1), 99–111.
“In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in typically developing children both factors are important. Clinical implications are discussed.”
Co-Sleeping (Bed sharing or room sharing)
Mao, A., Burnham, M. M., Goodlin-Jones, B. L., Gaylor, E. E., & Anders, T. F. (2004). A Comparison of the Sleep-Wake Patterns of Cosleeping and Solitary-Sleeping Infants. Child Psychiatry & Human Development, 35(2), 95–105.
“Infants who cosleep, at least through 15 months of age, will awaken more frequently but for less duration during the night. That is, they awakened more often, but for shorter durations than solitary sleepers. Contrary to previous reports, the cosleeping infants did not spend the majority of the night face to face with their mothers.”
Paul, I. M., Hohman, E. E., Loken, E., Savage, J. S., Anzman-Frasca, S., Carper, P., … Birch, L. L. (2017). Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study. PEDIATRICS, 140(1).
In a widely-publicized study, longer duration of infant-parent room sharing predicts shorter sleep length, poorer sleep consolidation, and an increased likelihood of unsafe sleep arrangements. This stands at odds with the American Academy of Pediatrics’ recommendation for infant-parent room sharing for the first 6-12 months of baby’s life as protective against SIDS.
Teti, D. M., Shimizu, M., Crosby, B., & Kim, B.-R. (2016). Sleep arrangements, parent-infant sleep during the first year, and family functioning. Developmental Psychology, 52(8), 1169–81.
“Compared with families whose infants were solitary sleepers by 6 months, persistent cosleeping was associated with sleep disruption in mothers but not in infants, although mothers in persistent cosleeping arrangements reported that their infants had more frequent night awakenings. Persistent cosleeping was also associated with mother reports of marital and coparenting distress, and lower maternal emotional availability with infants at bedtime (from home observations). Persistent cosleeping appeared to be a marker of, though not necessarily a cause of, heightened family stress.”
Malkiel, S., Eisenstadt, M., & Pollak, U. (2017). Say a prayer for the safe cutting of a child’s teeth: The folklore of teething. Journal of Paediatrics and Child Health, 53, 1145–1148.
Amber teething necklaces today; pendants made from the tooth of a male viper back then.
Massignan, C., Cardoso, M., Porporatti, A. L., Aydinoz, S., Canto, G. D. L., Mezzomo, L. A. M., & Bolan, M. (2016). Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis. Pediatrics, 137(3).
Babies who are teething have swollen gums, they’re cranky, and they drool a lot. Most other symptoms–particularly the belief that teething correlates with a rise in temperature–are unfounded.
Ramos-Jorge, J., Pordeus, I. A., Ramos-Jorge, M. L., & Paiva, S. M. (2011). Prospective Longitudinal Study of Signs and Symptoms Associated With Primary Tooth Eruption. Pediatrics, 128(3), 471–476.
11 dentists made daily visits to 47 Brazilian babies over a period of 8 months to track the signs and symptoms of teething. “Irritability, increased salivation, runny nose, loss of appetite, diarrhea, rash, and sleep disturbance were associated with primary tooth eruption. Results of this study support the concept that the occurrence of sever signs and symptoms, such as fever, could not be attributed to teething.”