Environmental Characteristics and Sleep in Two-Month-Old Infants

Abstract

The study aimed at assessing possible relationship between the quality of infant environment and maternal reported behavioural features during sleep in 2-month-old infants. It comprised 115 randomly selected, apparently healthy infants (50 boys, 65 girls) from community setting who were singletons born at term with normal birth weight in St. Petersburg in 2001-2002. Quality of infant care was estimated using the “PROCESS” (Paediatric Review of Children's Environment Support and Stimulation) inventory enabling to measure infant's developmental stimulation and organisation. Infant's behaviour during sleep was assessed using an adapted version of the Children's Sleep Habits Questionnaire (CSHQ). The babies facing more developmental stimulation and from more organised environment less often fell asleep in parents bed (P = 0.036). Infants from more organised environment were more often put to sleep at the same time at night, more often were ready to go to sleep at bedtime and less often struggled at bed; it was more common with them to have right amount of sleep and to have about a same amount of sleep each day; less often they moved a lot during sleep and woke up in sleep. These associations remained significant after adjustment has been made for each of such potential confounders as infant's gender, weight at birth and at study, gestational age, Apgar score at 1 and 5 minutes, birth order, maternal age and education, maternal marital status, infant's feeding at birth and at study, as well as to their simultaneous effects.
Lower environmental organisation and developmental stimulation may be associated with specific disadvantageous infant behavioural features during sleep. Infants with parentally reported sleep problems should be carefully considered for possible flaws in the quality of environment.

Zusammenfassung

Die Studie hatte das Ziel, mögliche Verknüpfungen zwischen dem Einfluss der Umgebung von 2 Monate alten Säuglingen sowie dem Schlafverhalten dieser Kinder (auch anhand von Berichten der Mütter) festzustellen. Dazu wurden im Einzugsgebiet der Kinderklinik in St. Petersburg in den Jahren 2001-2002 insgesamt 115 gesunde Säuglinge mit normalem Geburtsgewicht (50 Knaben, 65 Mädchen) erfasst. Die Qualität der Säuglingsbetreuung wurde mit Hilfe des Programms „PROCESS” (Paediatric Review of Children’s Environment Support and Stimulation) beurteilt; es schloss auch die gesamte Entwicklung ein. Das Schlafverhalten der Säuglinge wurde anhand des CSHQ-Fragebogens (Children’s Sleep Habits Questionnaire - Die Schlafgewohnheiten eines Kindes) ausgewertet. Säuglinge, die in einem geordneten Umfeld aufwuchsen, schliefen deutlich seltener bei den Eltern im Bett (p=0,036), schliefen öfter zur gleichen Tageszeit ein und sträubten sich weniger gegen das Einschlafen. Sie schliefen gewöhnlich stets die gleiche Zeitspanne, auch tagsüber, bewegten sich während des Schlafes weniger und wachten deshalb auch nicht auf. Diese Befunde wurden durch andere Faktoren, z. B. durch das Geschlecht des Säuglings, sein Geburtsgewicht, den Untersuchungszeitpunkt, den Apgar-Index, den Geburtsablauf, das Alter und den Bildungsstand der Mutter, die Ernährung nach der Geburt und während dieser Studienzeit, nicht beeinflusst. Mangelhafte Umweltverhältnisse bewirken auch mangelnde Impulse für die Entwicklung des Säuglings und stehen direkt nachteilig in Verbindung mit dem Schlafverhalten. Eltern, die über Schlafstörungen ihres Kindes klagen, sollten sorgfältig ihr Umfeld auf mögliche Mängel überprüfen.

Key words

Infant-behaviour - infant sleep - environmental stimulation

Schlüsselwörter

Säuglingsschlaf - Umwelteinflüsse - Säuglingsentwicklung

References

• 1 Anonimous . Early child care and self-control, compliance, and problem behavior at twenty-four and thirty-six months. The NICHD Early Child Care Research Network.  Child Dev. 1998;  69 1145-1170
• 2 Armitage P, Berry G. Statistical methods in medical research. 3rd ed. Blackwell, Oxford 1994
• 3 Bradley R H, Whiteside L, Mundfrom D J. et al . Home environment and adaptive social behavior among premature, low birth weight children: alternative models of environmental action.  J Pediatr Psychol. 1995;  20 347-362
• 4 Call J D. Extraordinary changes in behavior in an infant after a brief separation.  J Dev Behav Pediatr. 1998;  19 424-428
• 5 Casey P H, Barrett K, Bradley R H, Spiker D. Pediatric clinical assessment of mother-child interaction: concurrent and predictive validity.  J Dev Behav Pediatr. 1993;  14 313-317
• 6 Casey P H, Bradley R H, Caldwell B M, Edwards D R. Developmental intervention: a pediatric clinical review.  Pediatr Clin North Am. 1986;  33 899-923
• 7 Casey P H, Bradley R H, Nelson J Y, Whaley S A. The clinical assessment of a child's social and physical environment during health visits.  J Dev Behav Pediatr. 1988;  9 333-339
• 8 DiLalla L F, Bishop E G. Differential maternal treatment of infant twins: effects of infant behaviors.  Behav Genet. 1996;  26 535-542
• 9 Duncan G J, Brooks-Gunn J, Klebanov P K. Economic deprivation and early childhood development.  Child Dev. 1994;  65 296-318
• 10 Einspieler C. Abnormal spontaneous movements in infants with repeated sleep apnoeas.  Early Hum Dev. 1994;  36 31-48
• 11 Eisenberg L. Experience, brain, and behavior: the importance of a head start.  Pediatrics. 1999;  103 1031-1035
• 12 Fleming A S, O'Day D H, Kraemer G W. Neurobiology of mother-infant interactions: experience and central nervous system plasticity across development and generations.  Neurosci Biobehav Rev. 1999;  23 673-685
• 13 Florey C D, Leech A M, Blackhall A. Infant feeding and mental and motor development at 18 months of age in first born singletons [see comments].  Int J Epidemiol. 1995;  24 (Suppl 1) S21-S26
• 14 Fox R A, Platz D L, Bentley K S. Maternal factors related to parenting practices, developmental expectations, and perceptions of child behavior problems.  J Genet Psychol. 1995;  156 431-441
• 15 Girouard P C, Baillargeon R H, Tremblay R E. et al . Developmental pathways leading to externalizing behaviors in 5-year-olds born before 29 weeks of gestation.  J Dev Behav Pediatr. 1998;  19 244-253
• 16 Grantham-McGregor S M, Lira P I, Ashworth A. et al . The development of low birth weight term infants and the effects of the environment in northeast Brazil.  J Pediatr. 1998;  132 661-666
• 17 Hoffman H J, Hillman L S. Epidemiology of the sudden infant death syndrome: maternal, neonatal, and post-neonatal risk factors. In: Hunt CE (ed). Clinics in perinatology: apnea and SIDS. Vol. 19. Saunders, Philadelphia 1992; 717-738
• 18 Ihle W, Loffler W, Esser G. et al . The effect of life change events on cognitive and socio-emotional development in early childhood.  Z Kinder Jugendpsychiatr. 1992;  20 77-84
• 19 Kahn A, Blum D, Rebuffat E. et al . Polysomnographic studies in infants who subsequently died of sudden infant death syndrome.  Pediatrics. 1988;  82 721-727
• 20 Kahn A, Groswasser J, Franco P. et al . Sudden infant death: arousal as a survival mechanism.  Sleep Medicine. 2002;  3 S11-S14
• 21 Kahn A, Groswasser J, Sottiaux M. et al . Clinical symptoms associated with brief obstructive sleep apnea in normal infants.  Sleep. 1993;  16 409-413
• 22 Kelmanson I A. An assessment of the microsocial environment of children diagnosed as “sudden infant death” using “PROCESS” inventory.  Eur J Pediatr. 1993;  152 686-690
• 23 Kelmanson I A. An assessment of behavioural characteristics in infants who died of sudden infant death syndrome using the Early Infancy Temperament Questionnaire.  Acta Paediatr. 1996;  85 977-980
• 24 Kelmanson I A, Erman L V, Litvina S V, Adulas E I. Quality of infant care and behavioural characteristics in 2-4-month-old infants.  Pädiatr Grenzgebiete. 2002;  41 453-459
• 25 Koniak-Griffin D, Verzemnieks I. The relationship between parental ratings of child behaviors, interaction, and the home environment.  Matern Child Nurs J. 1995;  23 44-56
• 26 Kumar R, Aggarwal A K, Kaur M, Iyengar S D. Factors influencing psychosocial development of preschool children in a rural area of Haryana, India.  J Trop Pediatr. 1994;  43 324-329
• 27 Leadbeater B J, Bishop S J. Predictors of behavior problems in preschool children of inner-city Afro-American and Puerto Rican adolescent mothers.  Child Dev. 1994;  65 638-648
• 28 Levy-Shiff R, Einat G, Mogilner M B. et al . Biological and environmental correlates of developmental outcome of prematurely born infants in early adolescence.  J Pediatr Psychol. 1994;  19 63-78
• 29 Lewis M, Rosenblum L. The effect of the infant on its caregiver. John Wiley, New York 1974
• 30 Mitchell E A, Taylor B J, Ford R PK. et al . Four modifiable and other major risk factors for cot death: The New Zealand study.  J Pediatr Child Health. 1992;  28 (Suppl 1) S3-S8
• 31 Morrell J M. The role of maternal cognitions in infant sleep problems as assessed by a new instrument, the maternal cognitions about infant sleep questionnaire.  J Child Psychol Psychiatry. 1999;  40 247-258
• 32 Murray A D, Yingling J L. Competence in language at 24 months: relations with attachment security and home stimulation.  J Genet Psychol. 2000;  161 133-140
• 33 Naeye R L, Messmer J, Specht T, Merritt T A. Sudden infant death syndrome temperament before death.  J Pediatr. 1976;  88 511-515
• 34 Owens J A, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children.  Sleep. 2000;  23 1043-1051
• 35 Robson A L, Pederson D R. Predictors of individual differences in attention among low birth weight children.  J Dev Behav Pediatr. 1997;  18 13-21
• 36 Rona R J, Li L, Gulliford M C, Chinn S. Disturbed sleep: effects of sociocultural factors and illness.  Arch Dis Child. 1998;  78 20-25
• 37 Rosenblum L A, Andrews M W. Influences of environmental demand on maternal behavior and infant development.  Acta Paediatr Suppl. 1994;  397 57-63
• 38 Sameroff A J. Environmental risk factors in infancy.  Pediatrics. 1998;  102 (Suppl E) 1287-1292
• 39 St. James-Roberts I, Sleep J, Morris S. et al . Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems.  J Paediatr Child Health. 2001;  37 289-297
• 40 Thatch B T, Davies A M, Koenig J S. Pathophysiology of sudden upper airway obstruction in sleeping infants and its relevance for SIDS.  Ann NY Acad Sci. 1988;  533 314-328
• 41 Wolk S, Zeanah C H, Garcia Coll C T, Carr S. Factors affecting parents' perceptions of temperament in early infancy.  Am J Orthopsychiatry. 1992;  62 71-82