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This paper describes the longitudinal change in sleep, functional, and behavioural characteristics in a cohort of children with Down syndrome, including the effect of sleep interventions in a subset. A prospective longitudinal cohort study was undertaken in children with Down syndrome aged 3-16 years comparing (1) children referred to a tertiary sleep medicine clinic who received sleep hygiene advice and an additional sleep treatment (DSref_I) with (2) children attending the same clinic who only received sleep hygiene advice (DSref_N) and (3) children recruited from the community who, were not receiving any treatment (DScomm). Data collected included demographic and medical history information, Child Sleep Habits Questionnaire-Abbreviated (CSHQ-A), Life-Habits Questionnaire (Life-H) and Child Behaviour Checklist (CBCL) at baseline and then 6-monthly for a total of 18 months. Any sleep interventions during this time were recorded. A total of 57 children were included (DSref_I, n = 16; DSref_N, n = 25; DScomm, n = 16). At recruitment, the median CSHQ-A total score was high (>41) in all three subgroups, but highest in the DSref_I subgroup (median [interquartile range] Dsref_I score 58 [53-66] versus DSref_N score 49 [43-53], p = 0.019). Although improved, 80% of participants in the DSref_I subgroup still had a CSHQ-A total score >41 at the last assessment point. The median total Life-H and total CBCL scores were not significantly different between groups at baseline and there was no significant time, group, or interaction effect seen through the study. Over an 18-month period, sleep problems were seen to persist in children with Down syndrome. Treatment resulted in only modest improvements in sleep., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

The onset of monophasic sleep, in which napping ceases and sleep consolidates into a single night period, is a key developmental milestone of childhood. Yet to date, there is little consensus regarding the timing of cessation of napping in children. The aim of the current study is to examine global evidence regarding napping patterns in childhood, and, through meta-analysis, describe patterns of napping cessation and duration observed in children aged 0-12 y. A systematic search of all published, original research articles reporting children's napping patterns, by age, was conducted. The quality of studies was assessed, and meta-analysis of eligible studies undertaken. Risk of bias and heterogeneity of measurement was high. Current evidence indicates that less than 2.5% of children cease napping prior to age 2, while 94% cease napping by age 5. The preschool period (3-5 y; 36-60 mo) represents a particularly dynamic period in napping cessation, with large variation in rates of napping across studies evidencing potential ecological effects. Future studies should focus on understanding of the underlying mechanisms explaining individual variations in napping patterns and the extent to which patterns of napping may represent a marker of child development., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services., Design: Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016-2017., Setting: Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines., Participants: The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys., Main Outcomes and Measures: Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual's knowledge, beliefs and attitudes regarding safe sleeping practices., Results: 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room., Conclusion: Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies., Trial Registration Number: ANZCTR 12618001056280-pre-results., Competing Interests: Competing interests: SSt reports grants from Queensland Government, during the conduct of the study and has been previously commissioned by the Queensland Department of Education to develop resources and professional development programmes for the childcare sector. SSm and SI report grants from Queensland Government, during the conduct of the study; KT reports grants from Department of Education, Queensland Government, during the conduct of the study; JY reports grants from Department of Child Safety, Youth and Women and fees for professional time to consult to the Queensland Child Death Review Panel outside the submitted work. CP, AP and PB have nothing to disclose., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To examine the associations between sleep parameters and weight status in a large sample of preschool children., Design: Cross-sectional survey data from the Effective Early Educational Experiences for children (E4Kids) study were analyzed., Participants: 1111 children aged 3 to 6 years from Queensland and Victoria, Australia., Measurements: General linear modeling, with adjustment for significant control variables, assessed the impact of night sleep duration, total sleep duration, napping frequency, sleep timing (onset, offset and midpoint), and severity of sleep problems on standardized body mass index (BMI z score). General linear modeling was conducted for the total sample and then separately by sex., Results: For the total sample, there was a significant association between short sleep duration (≤10 hours) and increased BMI z score. No other sleep parameters were associated with BMI z score in this sample. Analyses by sex revealed that, among girls, there were no associations between any sleep parameter and BMI z score. However, among boys, short night sleep duration and napping frequency were both significantly associated with weight status even after adjustment for controls., Conclusion: Night sleep duration is a consistent independent predictor of body mass in young children. These results identify a complex relationship between sleep and body mass that implicates sex. Potential mechanisms that might explain sex differences warrant further investigation., (Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Policy provision for naps is typical in child care settings, but there is variability in the practices employed. One practice that might modify children's early sleep patterns is the allocation of a mandatory nap time in which all children are required to lie on their beds without alternate activity permitted. There is currently limited evidence of the effects of such practices on children's napping patterns. This study examined the association between duration of mandatory nap times and group-level napping patterns in child care settings. Observations were undertaken in a community sample of 113 preschool rooms with a scheduled nap time (N = 2,114 children). Results showed that 83.5% of child care settings implemented a mandatory nap time (range = 15-145 min) while 14.2% provided alternate activities for children throughout the nap time period. Overall, 31% of children napped during nap times. Compared to rooms with ≤ 30 min of mandatory nap time, rooms with 31-60 min and > 60 min of mandatory nap time had a two-and-a-half and fourfold increase, respectively, in the proportion of children napping. Nap onset latency did not significantly differ across groups. Among preschool children, exposure to longer mandatory nap times in child care may increase incidence of napping.

Background: Duration and quality of sleep affect child development and health. Encouragement of napping in preschool children has been suggested as a health-promoting strategy., Objectives: The aim of this study is to assess evidence regarding the effects of napping on measures of child development and health., Design: This study is a systematic review of published, original research articles of any design., Subjects: Children aged 0-5 years., Method: Electronic database search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessment of research quality was carried out following a Grading of Recommendations, Assessment, Development and Evaluations (GRADE) protocol., Results: Twenty-six articles met inclusion criteria. These were of heterogeneous quality; all had observational designs (GRADE-low). Development and health outcomes included salivary cortisol, night sleep, cognition, behaviour, obesity and accidents. The findings regarding cognition, behaviour and health impacts were inconsistent, probably because of variation in age and habitual napping status of the samples. The most consistent finding was an association between napping and later onset, shorter duration and poorer quality of night sleep, with evidence strongest beyond the age of 2 years., Limitations: Studies were not randomised. Most did not obtain data on the children's habitual napping status or the context of napping. Many were reliant on parent report rather than direct observation or physiological measurement of sleep behaviour., Conclusions: The evidence indicates that beyond the age of 2 years napping is associated with later night sleep onset and both reduced sleep quality and duration. The evidence regarding behaviour, health and cognition is less certain. There is a need for more systematic studies that use stronger designs. In preschool children presenting with sleep problems clinicians should investigate napping patterns., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: To examine the relationship between mandatory naptimes in child care and children's nighttime sleep duration, both concurrently and 12 months later once in school., Methods: A sample of 168 children (50-72 months; 55% males) attending licensed child care centers were observed across their morning and throughout their scheduled naptime. Mandatory naptime was determined as the period in which children were not permitted any alternative activity except lying on their bed. Teachers reported each child's napping in child care. Nighttime and total sleep duration was reported by parents at 2 time points, in child care and in the second semester of their first school year. General linear models were used to examine group differences in sleep duration between children experiencing 0 to 60 minutes and >60 minutes of mandatory naptime, adjusting for key confounders. Path analysis was conducted to test a mediation model in which mandatory naptime is associated with nighttime sleep duration through increased napping in child care., Results: Children who experienced >60 minutes of mandatory naptime in child care had significantly less nighttime sleep than those with 0 to 60 minutes of mandatory naptime. This difference persisted at 12-month follow-up, once children were in school. Napping in child care mediated the relationship between mandatory naptime and duration of nighttime sleep., Conclusions: Exposure to mandatory naptimes of >60 minutes in child care is associated with decreased duration of nighttime sleep that endures beyond child care attendance. Given the large number of children who attend child care, sleep practices within these settings present an important focus for child health.

The international quality-improvement agenda for Early Childhood Education (ECE) directs attention to maximising children's learning experiences. Yet routines, and particularly those relating to sleep-rest provision, are not well conceptualised as learning opportunities. Often children who no longer sleep in the daytime are required to lie down without alternative activity. Educator discourse frames these practices as 'teaching self-regulation', yet these experiences afford little opportunity for child-directed learning, and both observational and cortisol studies suggest the potential for negative learning experiences. Prior studies have examined children's emotional response and identified sleep-rest time as disliked, but have not examined children's accounts of learning. In this study, we analyse accounts of learning from 54 children (mean age = 56 months). Collectively, the children identified three learnings. Most children learned that adults regulate sleep-rest opportunities through instruction, reward, punishment and privilege. Some children reported learning coping strategies including imagination and subversion. A rare few identified learning to self-regulate. The findings identify a discrepancy between policy aspiration and educator intent, that foreground self-regulation and the "de facto" lessons children draw from their sleep-rest experiences. Our findings identify standard sleep-rest provision as sub-optimal and the imperative to view care routines, such as sleep-rest, as opportunities for learning.

Background: Early childhood education and care (ECEC) services have the potential to influence or disrupt sleep patterns given that ECEC attendance coincides with the normative transition towards napping cessation. Objective: In light of the evidence that sleep patterns in early childhood are foundational to lifelong health, this study investigated parent-educator communication about children's 24-h sleep cycles. Communication is critical in ensuring regularity and responsiveness to children's sleep behaviours, yet knowledge about if and how this happens is limited. We sought to address this gap. Method: This study draws upon survey data, both numeric and text, from 116 parents and 39 educators across 25 ECEC services in Brisbane, Australia. The type and regularity of communication strategies between ECEC educators and parents were analysed to establish frequency and demographic patterning. Qualitative analyses investigated the content of sleep-related communication between educators and parents. Results: Most educators and parents reported discussing children's sleep through in-person communication at pick-up and drop-off times. Qualitative analysis of the content of parent-educator communication identified three key themes: sleep quantity, quality and practices. Communication focused primarily on the quantity of children's sleep while attending ECEC settings, and communication about sleep quality and home practices were less frequent. Educators communicated more sleep-related information with parents than parents did with educators. Conclusions: This study highlights the need for frequent, bi-directional parent-educator communication. Providing practices which support regularity of sleep across home and ECEC settings and responding to the developmental transition toward napping cessation promotes children's sleep health.

Sleep and rest provision in early childhood education and care (ECEC) is commonly enacted as a routine -- a standard time-period during which children are required to lie down even if they do not sleep. Yet contemporary ECEC policies emphasise "responsive" pedagogical practice that includes children in decision-making and respects each child's developmental and sociocultural context as appropriate pedagogical practice. To understand current practices, analyses of numeric data and textual accounts from a survey of Australian ECEC service providers, leaders and educators (N = 247) was undertaken. Two broad challenges to enabling responsive practice and inclusion of children in decision-making were identified: (1) "Provisions" -- organisational interpretations of national policy and attendant resourcing set the structural parameters for achievement of responsive pedagogical practice. (2) "Practices" -- individual and communal demands on educators and their professional philosophy set interactional parameters. "Service leadership" played a pivotal role in determining whether sleep-rest practices were Routine (84%) or Responsive (16%). Responsive leaders were characterised by strong professional advocacy for child rights and child-focused pedagogy. They instigated professional reflection and communication strategies within their service and removed expectation that educators could undertake alternative activity while providing for children's sleep and rest.

Daytime sleep is a significant part of the daily routine for children attending early childhood education and care (ECEC) services in Australia and many other countries. The practice of sleep-time can account for a substantial portion of the day in ECEC and often involves a mandated sleep/rest period for all children, including older preschool-aged children. Yet, there is evidence that children have a reduced need for daytime sleep as they approach school entry age and that continuation of mandated sleep-time in ECEC for preschool-aged children may have a negative impact on their health, development, learning and well-being. Mandated sleep-time practices also go against current quality expectations for services to support children's agency and autonomy in ECEC. This study documents children's reports of their experiences of sleep-time in ECEC. Semi-structured interviews were conducted with 54 preschool-aged children (44-63 months) across four long day ECEC services that employed a range of sleep-time practices. Findings provide a snapshot of children's views and experiences of sleep-time and perceptions of autonomy-supportive practices. These provide a unique platform to support critical reflection on sleep-time policies and practices, with a view to continuous quality improvement in ECEC. This study forms part of a programme of work from the Sleep in Early Childhood research group. Our work examines sleep practices in ECEC, the subsequent staff, parent and child experiences and impacts on family and child learning and development outcomes.

Sleep disorders are prevalent in children with Down Syndrome (DS). However, sleep treatment is not always readily accessed by this group. This study aims to understand families' experiences of having a child with DS and sleep difficulties, and in particular, their healthcare experiences, with the goal of informing practice improvements. We conducted semi-structured interviews with 34 parents (fathers n = 4 and mothers n = 30) with open-ended questions about parents' experiences of sleep, family dynamics, and healthcare. We operationalized a reflexive Thematic Analysis. Parents normalized their experiences of having a child with DS and sleep problems. Parents acknowledged that sleep disruption has adverse and pervasive impacts on their wellbeing and family dynamics, but also found this difficult to identify as a health problem. They accepted sleep difficulties as a regular part of bringing up any child, particularly one with a disability. When they did seek treatment for their child's sleep difficulties, parents often reported encountering insensitive and inadequate care and described that, at times, healthcare professionals also normalized children's sleep difficulties, resulting in sub-optimal treatment. This included at times failure to refer to tertiary sleep medicine services when required. Parents' and healthcare professionals' normalization of sleeping difficulties denies that they are both deleterious and modifiable. Practice implications include raising healthcare professionals' awareness of the importance of proactively addressing sleep, with sensitivity to families' normalization strategies, recognizing that families may require prompting to report concerns. [ABSTRACT FROM AUTHOR]

Families of children with Down syndrome experience complex lives and needs, yet the few existing studies on these families are written in conventional academic prose that is not optimal for knowledge translation beyond academia, particularly for busy healthcare professionals. In this paper, we Depart Radically in Academic Writing (DRAW) (Mackinlay, 2022) and present data poetry and two case studies that draw upon semi-structured interviews with mothers, fathers, and siblings, who were interviewed separately about their experiences of having a child/sibling with Down syndrome. We introduce our interdisciplinary team that includes academics and clinicians to contextualise our focus on research translation. We demonstrate that writing with creative criticality (i.e. 'DRAWing') contributes an embodied and affective understanding of research participants' stories, which is largely lacking in the academic literature on families of children with Down syndrome and the sociology of health and illness field more broadly. Moreover, DRAWing can impact audiences emotionally as well as intellectually (Richardson, 2003, p. 924), which has important knowledge translation implications for both healthcare professionals and these families. DRAWing can capture healthcare professionals' attention, prompting them to critically reflect on their practices and opportunities for improving care and treatment for these families. [ABSTRACT FROM AUTHOR]

The international quality-improvement agenda for Early Childhood Education (ECE) directs attention to maximising children's learning experiences. Yet routines, and particularly those relating to sleep-rest provision, are not well conceptualised as learning opportunities. Often children who no longer sleep in the daytime are required to lie down without alternative activity. Educator discourse frames these practices as 'teaching self-regulation', yet these experiences afford little opportunity for child-directed learning, and both observational and cortisol studies suggest the potential for negative learning experiences. Prior studies have examined children's emotional response and identified sleep-rest time as disliked, but have not examined children's accounts of learning. In this study, we analyse accounts of learning from 54 children (mean age = 56 months). Collectively, the children identified three learnings. Most children learned that adults regulate sleep-rest opportunities through instruction, reward, punishment and priveledge. Some children reported learning coping strategies including imagination and subversion. A rare few identitfied learning to self-regulate. The findings identify a discrepancy between policy aspiration and educator intent, that foreground self-regulation and the de facto lessons children draw from their sleep-rest experiences. Our findings identify standard sleep-rest provision as sub-optimal and the imperative to view care routines, such as sleep-rest, as opportunities for learning. [ABSTRACT FROM AUTHOR]

Sleep and rest provision in early childhood education and care (ECEC) is commonly enacted as a routine – a standard time-period during which children are required to lie down even if they do not sleep. Yet contemporary ECEC policies emphasise responsive pedagogical practice that includes children in decision-making and respects each child's developmental and sociocultural context as appropriate pedagogical practice. To understand current practices, analyses of numeric data and textual accounts from a survey of Australian ECEC service providers, leaders and educators (N = 247) was undertaken. Two broad challenges to enabling responsive practice and inclusion of children in decision-making were identified: (1) Provisions – organisational interpretations of national policy and attendant resourcing set the structural parameters for achievement of responsive pedagogical practice. (2) Practices – individual and communal demands on educators and their professional philosophy set interactional parameters. Service leadership played a pivotal role in determining whether sleep–rest practices were Routine (84%) or Responsive (16%). Responsive leaders were characterised by strong professional advocacy for child rights and child-focused pedagogy. They instigated professional reflection and communication strategies within their service and removed expectation that educators could undertake alternative activity while providing for children's sleep and rest. [ABSTRACT FROM AUTHOR]

Light affects human health and behaviour. Research has demonstrated that children are more susceptible to the effects of light than adults, however this population remains underrepresented in the literature. This systematic review reports evidence of objectively measured light exposure on health and development outcomes in children (0–12 years old). Study (n = 59) outcomes were categorised into five thematic domains. Heterogeneity of light measurement and summarisation techniques were identified. Light's effects on melatonin and activity patterns were relatively robust, while research on sleep was sparse. Mixed findings suggest a protective effect of light on myopia, and vision improvements under cooler, brighter lighting. Increased light during the daytime was broadly associated with beneficial effects on social-emotional, cognitive, and physical health outcomes. Timing, colour, and intensity of light exposures were important in understanding health and developmental effects of light. Heterogeneity in light measurement methods limits comparability across studies and should be carefully considered. Greater understanding about the effects of light on children could inform novel approaches to support children's health, sleep, and development. • Reviews a rapidly emerging field of research into the effects of light for children's health and developmental outcomes. • Lighting exposure was linked to melatonin suppression and daily activity patterns, but sleep research remains sparse. • Increased daytime light was broadly associated with ophthalmological, psychological, and physical health outcomes. • Light measurement and summarisation methods are currently heterogenous across existing literature and research fields. [ABSTRACT FROM AUTHOR]

The timing, intensity, and duration of exposure to both artificial and natural light have acute metabolic and physiological effects in mammals. Recent research in human adults suggests exposure to moderate intensity light later in the day is concurrently associated with increased body mass; however, no studies have investigated the effect of light exposure on body mass in young children. We examined objectively measured light exposure and body mass of 48 preschool-aged children at baseline, and measured their body mass again 12 months later. At baseline, moderate intensity light exposure earlier in the day was associated with increased body mass index (BMI). Increased duration of light exposure at baseline predicted increased BMI 12-months later, even after controlling for baseline sleep duration, sleep timing, BMI, and activity. The findings identify that light exposure may be a contributor to the obesogenic environment during early childhood. [ABSTRACT FROM AUTHOR]

Night-waking is typical across infancy and early childhood, inevitably disrupting family sleep. For some children, sleep problems develop and endure throughout childhood. This systematic review focused on fathers, and synthesised the evidence pertaining to the effects of children's sleep (from birth to 12 years) on fathers' health and wellbeing. A total of 29 studies were included. Key outcomes reported for fathers were: sleep and fatigue; mental and general health; and family functioning. An association between child sleep and father's sleep was observed when child's sleep was measured via actigraphy or paternal report, but not when measured via maternal report, suggesting that mothers may not always be aware of disruptions that awaken fathers. Findings showed poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer, and less frequent than those reported for mothers in the same households. Poor child sleep was negatively associated with the quality of family relationships, both within the couple and between parent and child. Future studies seeking to understand the interplay of child sleep and family wellbeing should apply objective measurement of sleep and integrate formal measures of family dynamics into the study design. [ABSTRACT FROM AUTHOR]

The original version of the article was unfortunately published without displaying the blinded contents. [ABSTRACT FROM AUTHOR]