Longitudinal analysis of predictors of sleep disturbances in the early years of life

  • Gilly Mancz

Student thesis: Doctoral Thesis


Background: There is considerable variability in early childhood regarding the consolidation of the sleep wake cycle. Furthermore, it is recognised to be impacted on by a range of biological characteristics, psychological factors and environmental issues. The complex relationship between sleep and other factors causes an ongoing uncertainty regarding what constitutes ‘normal sleep’ and what affects sleeping patterns.
Aim. This thesis has four aims: to identify the sleeping patterns of typically developing UK infants in the first two years of life; to develop a Composite Sleep Difficulties Score (CSDS) to determine clinical parameters of a sleep problem in early childhood; to determine whether parents are able to accurately identify a sleep problem in their young child; and to identify which factors are associated with poorer infant sleep and how these relationships change over time.
Design. This longitudinal population-based cohort study collected data at five time points; antenatally from the mothers enrolled in the registry, at birth and through questionnaires focused on the health and development of the infants when they were aged between 5-10 months, 11-17 months and 23-30 months.
Results. This thesis is the first study to describe normal sleeping patterns of UK infants; the sleeping patterns of young children in this community sample are similar to studies in other Western countries, with sleep measures improving over the first two years of life. A Composite Sleep Difficulties Score (CSDS) was validated at three timepoints and was found to correlate with parental perceptions of their child’s sleep. Parents in this study were accurate at identifying a sleep problem in their child at each wave of data collection. Infants and young children who were reported to have no sleep problem had sleep measures indicative of better sleep and a lower CSDS compared to those reported to have either a small sleep problem or a serious sleep problem. Furthermore, two specific measures, night wakings and nocturnal wakefulness, were significantly associated with parents reporting their young child had a serious sleep problem at each wave. Self-settling in a cot in own room, dummy use, sleeping in a cot in own room and formula feeding were associated with fewer sleep difficulties.
Conclusions. The findings of this research have implications for clinical practice. Health professionals supporting families should screen for fragmented sleep to identify young children who may benefit from sleep support and universally promote strategies encouraging infants to self-settle. This could also include supporting parents to move children into their own room at six months if appropriate,

provide information and support to parents when weaning their infant off a dummy and being aware that breastfeeding mothers may need specific advice and guidance regarding infant sleep
Date of Award27 Jul 2022
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorSuzannah Helps (Supervisor), Rebecca Stores (Supervisor) & Wendy Wigley (Supervisor)

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