Factors associated with fragmented sleep at night across early childhood

Objective: To identify the factors most strongly associated with sleeping less than 6 consecutive hours at night for children aged 5, 17, and 29 months. Design, Setting, and Participants: A randomized survey design used a representative sample of infants born in 1997-1998 in the Canadian province of Quebec. Data were collected by questionnaires and interviews. Interviews were scheduled at home with the mothers. The number of consecutive hours slept at night by 1741 children aged 5, 17, and 29 months was assessed from parental reports. Factors associated with fragmented sleep were investigated for each age in a cross-sectional design. Results: At 5 months of age, 23.5% of children did not sleep 6 consecutive hours. Of the children who did not sleep 6 consecutive hours at night at 5 months or 17 months of age, 32.9% were still not sleeping 6 consecutive hours at night at 29 months of age. The factor most strongly associated with not sleeping at least 6 consecutive hours per night at 5 months of age was feeding the child after an awakening. Parental presence until sleep onset was the factor most strongly associated with not sleeping at least 6 consecutive hours per night at 17 months and 29 months of age. Conclusions: Sleep consolidation evolves rapidly in early childhood. Parental behaviors at bedtime and in response to a nocturnal awakening are highly associated with the child's sleep consolidation. The effects are probably bidirectional and probably create a long-term problem. Early interventions could possibly break the cycle.