learning to sleep through the night: … learning to sleep through the night: solution or strain for...

A R T I C L E

LEARNING TO SLEEP THROUGH THE NIGHT: SOLUTION

OR STRAIN FOR MOTHERS AND YOUNG CHILDREN?

GARY R. GERMO, WENDY A. GOLDBERG, AND MERET A. KELLERUniversity of California-Irvine

ABSTRACT: Is the process of helping infants and young children learn to sleep through the night a solution tofamily sleep problems or does it exacerbate matters for mother and child? Retrospective and current accountsfrom a nonclinical, convenience sample of 102 mothers of preschool-aged children provided informationon sleep issues from early infancy through preschool age. Child, mother, and parenting characteristics,along with family sleep arrangements, were differentially related to the age at which children learned tosleep through the night and to the extent of difficulty that characterized this experience. Mothers whoindicated more difficulty as their children learned to sleep through the night also reported more depressivesymptoms and more strain in the mother–child relationship. Later age at sleeping through the night wasmore common among early bedsharers, but timing of sleeping through the night was not associated withpreschool children’s reported independence in several nonsleep domains. Sleep arrangements and theimportance placed on sleeping through the night were the strongest contributors to variance explained inwhether children learned to sleep through the night during infancy or toddlerhood. When advising parentsabout sleep interventions, practitioners should seek to understand whether families’ parenting values fittheir nighttime sleep practices.

RESUMEN: ¿Representa el proceso de ayudar a los infantes y ninos pequenos a aprender a dormir durantetoda la noche una solucion para los problemas de dormir de la familia o exacerba las cosas para la madre y elnino? Recuentos retrospectivos y presentes, provenientes de un grupo muestra no clınico y de conveniencia,de 102 madres de ninos de edad preescolar, proveyeron informacion sobre asuntos relacionados con eldormir desde la primera infancia hasta la edad preescolar. El nino, la madre y las caracterısticas de lacrianza, junto con las costumbres familiares de dormir fueron relacionados diferencialmente con la edada la cual los ninos aprendieron a dormir toda la noche y al alcance de la dificultad que caracterizaba estaexperiencia. Las madres que indicaron que habıa mas dificultad a medida que sus hijos aprendıan a dormirtoda la noche tambien reportaron mas sıntomas depresivos y mas tension en la relacion entre madre e hijo.Una edad mayor para dormir toda la noche resulto mas comun entre los que iban a la cama temprano,pero el tiempo de dormir toda la noche no se asocio con la reportada independencia de los ninos en edadpreescolar en varios dominios que no correspondıan al dormir. Los arreglos para dormir y la importanciapuesta en el dormir toda la noche fueron los mas fuertes contribuyentes a la variedad explicada en cuantoa si los ninos aprendieron a dormir toda la noche durante la ninez o durante la primera etapa de la infancia.Cuando se aconseja a los padres acerca de las intervenciones en cuanto al dormir, los especialistas deben

Direct correspondence to: Wendy A. Goldberg, Department of Psychology and Social Behavior, 3381 SocialEcology II, University of California-Irvine, Irvine, CA 92697; e-mail: [email protected].

INFANT MENTAL HEALTH JOURNAL, Vol. 30(3), 223–244 (2009)C© 2009 Michigan Association for Infant Mental HealthPublished online in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/imhj.20212

223

224 • G.R. Germo, W.A. Goldberg, and M.A. Keller

buscar la manera de comprender si los valores de crianza de las familias se adaptan a sus practicas dedormir en la noche.

RESUME: Le processus qui consiste a aider les nourrissons et les jeunes enfants a apprendre a dormirpendant toute la nuit une solution aux problemes de sommeil de la famille ou cela exacerbe-t-il les chosesentra la mere et l’enfant ? Des compte-rendus retrospectifs et actuels d’un echantillon pratique, non-clinique, de 102 meres d’enfants d’age pre-scolaire a offert des informations sur les problemes de sommeildans la petite enfant precoce jusqu’a l’age prescolaire. L’enfant, la mere, les caracteristiques de parentages,ainsi que les arrangements de sommeil des famille, etaient lies differentiellement a l’age auquel les enfantsavaient appris a dormir pendant toute la nuit et au degre de difficulte qui avait caracterise cette experience.Les meres qui ont indique le plus de difficulte alors que leurs enfants apprenaient a dormir a travers toutela nuit ont aussi fait etat de plus de symptomes depressifs et plus de tension dans la relation mere-enfant.Les enfants partageant tres tot le lit pendant toute la nuit dormaient pendant toute la nuit plus tard, mais lemoment ou l’enfant commencait a dormir pendant toute la nuit n’etait pas lie a l’independance rapporteedes enfants d’age prescolaires dans plusieurs domaines n’etant pas lies au sommeil. Les arrangements dusommeil et l’importance accordee a dormir pendant toute la nuit sont les facteurs de contribution les plusforts a la variance expliquee pour si oui ou non les enfants ont appris a dormir pendant toute la nuit durant latoute petite enfance ou la petite enfance. Lorsqu’ils conseillent les parents sur les interventions en matierede sommeil, les professionnels devraient chercher a comprendre si les valeurs de parentage des famillescorrespondent a leurs pratiques de sommeil nocture.

ZUSAMMENFASSUNG: Stellt der Prozess, Babys und kleinen Kinder beim Durchschlafen zu helfen, eineLosung familiarer Schlafprobleme dar oder verschlimmert dieser die Muster zwischen Mutter und Kind?Retrospektive und aktuelle Zugange einer nicht-medizinischen, angemessenen Stichprobe von 102 Mutternmit Kindern im Vorschulalter lieferten Informationen zum Thema Schlafen ab der fruhen Kindheit bisins Vorschulalter. Kindliche, mutterliche und elterlichen Charakteristiken bezuglich Schlafarrangementswurden differentiell in Beziehung zum Alter, in dem Kinder Durchschlafen lernen und zum Ausmaßder Schwierigkeiten mit Erfahrungen bezuglich Schlagen gesetzt. Mutter die großere Schwierigkeitenanzeigten, wahrend ihre Kinder Durchschlafen lernten, berichteten auch uber mehr depressive Symptomeund uber mehr Anstrengungen in der Eltern-Kind Beziehung. Das Durchschlafen war bei Kindern, diefruh das Bett teilten, mit einem hoheren Altern verbunden, aber der Zeitpunkt des Durchschlafens stand inkeinem Zusammenhang mit von Vorschulkindern berichteten Unabhangigkeit in verschiedenen Bereichen,die nicht mit Schlafen in Verbindung stehen. Schlafarrangements und die Wichtigkeit der Schlafpositionwaren die starksten Anzeichen der Veranderung bezuglich des Erlernens des Durchschlafens in der fruhenKindheit und der Kleinkindzeit. Bei Empfehlungen fur Eltern uber Schlafinterventionen, sollten Praktikerversuchen zu verstehen, ob die familiaren elterlichen Werte mit deren nachtlichen Schlafgewohnheitenzusammenpassen.

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

Sleeping Through the Night • 225

* * *

The first months of parenthood are notorious for sleepless nights; for many parents, theensuing months continue the pattern of sleep interruptions due to their infants’ night wakings.Infants who are not “self-soothers” often signal for parental intervention to help them return tosleep (Mindell, 1997; Sadeh & Anders, 1993). Cumulative sleep interruptions lead some parentsto seek professional assistance for suggestions on how to deal with their child’s “sleepingproblem” (Middlemiss, 2004). But do night wakings that involve parental attention invariablyconstitute a sleep problem for children and parents? In many parts of the world, especially wheresharing the parents’ bed or bedroom is a culturally valued and routine practice, night waking isa normative and expected infant behavior and often does not present itself as problematic (e.g.,Keller & Goldberg, 2004; Lee, 1992, Ramos, Youngclarke, & Anderson, 2007). Alternatively,infant night wakings often pose problems for many families in North America and NorthernEurope, where the expectation is for infants and young children to sleep on their own, apart fromtheir parents. For these families, does the process of helping the child learn to sleep throughthe night invariably present a solution to the family sleep situation and family well-being orinstead contribute to difficulties in family functioning? The current study aims to address thesequestions.

Even in cultures where the expectation is that infants learn to sleep alone, night wakingis normative during the first few months. For instance, Mindell (1997) reported that two thirdsof 1-month-old infants wake more than once per night, unable to return to sleep on their own.Night wakings can be problematic after the first few months of infancy, especially when parentalresponses are necessitated (Eckerberg, 2004; Mindell, 1997). By the time infants reach 6 monthsof age (often the recommended age for sleeping through the night), approximately 15% ofinfants in the United States awaken at night, but this figure may jump to 40% later in the firstyear (Mindell, 1997). Part of normative development in toddlerhood includes nighttime fearsand separation anxiety, which also can be a source of night wakings (American Academy ofPediatrics, 1999; Mindell, 1997; Weissbluth, 1987).

Several studies have reported that mothers who breastfeed tend to have infants who wakenfrequently at night (Elias, Nicolson, Bora, & Johnston, 1986; Paret, 1983). Infants’ crying andwaking during the night have been associated with early termination of breastfeeding (Bloom,Goldbloom, Robinson, & Stevens, 1982). These studies have pointed to a link between modeand duration of feeding and frequency of night waking.

Another issue studied in relation to infant sleep has been temperament. Linkages are ex-pected between infant sleep–wake states and temperament since both are partially endogenousto infants and may reflect similar aspects of biological organization (Halpern, Anders, GarciaColl, & Hua, 1994). Indeed, significant associations between temperament and sleep problemshave emerged using maternal report measures of infant temperament both cross-sectionally (e.g.,Keener, Zeanah, & Anders, 1989; Shaefer, 1990) and longitudinally (Morrell & Steele, 2003).



Fussy-difficult infants may trigger more active comfort strategies on the part of parents, whichin turn perpetuate night wakings (Morrell & Steele, 2003). Infants who have an easy tempera-ment display fewer sleep problems, including fewer night wakings, than do those with difficulttemperaments (Anders, 1994; Sadeh & Anders, 1993).

Although many studies have relied on maternal reports for their measure of infant tem-perament, maternal well-being can influence how mothers perceive their child’s behavior, withmore depressed mothers, for example, rating their children as more difficult (e.g., Halpern, et al.,1994; Morrell & Steele, 2003). Therefore, some sleep researchers have suggested that objectivemeasures of infant/child temperament are preferred (Morrell & Steele, 2003; Scher, Tirosh, &Lavie, 1998). Halpern et al. (1994) included both maternal report and nonmaternal observerbehavioral ratings of infant temperament at 3 months and assessed infants’ sleep–wake statesat 3 weeks and at 3 months. Results have indicated that observer ratings of certain aspects ofinfant temperament, such as irritability, inhibition, and sociability, were associated with infants’sleep–wake states at 3 weeks or at 3 months. There was little support for associations betweenmaternal report of infant temperament and infants’ sleep–wake states at either time point. Relat-edly, neither maternal report nor observer behavioral report of infant temperament was associatedwith the frequency of mothers’ nighttime interventions. Thus, the extent of confluence betweeninfant temperament and infant sleep can be minimal, and when it does occur, it seems confinedto certain aspects of temperament and sometimes depends on maternal well-being and whethermaternal reports or observer ratings of temperament are used.

Sleep issues such as night wakings beyond early infancy are often assumed to be sleepproblems in much of the North American and Northern European literature, without empiricalverification. Parents’ perceptions of what constitutes “sleeping problems” may diverge fromexperts’ definitions (Middlemiss, 2004). Some parents do not interpret night wakings as prob-lematic but rather as expected, normative, and not highly disruptive. Parents with this view tendto be co-sleepers who prefer having their children in close proximity at night (Keller & Goldberg,2004; Lee, 1992; Ramos et al., 2007). Such close physical nighttime proximity can reduce theextent to which parents need to rouse to tend to the child’s wakings. Parents of infants who sleepalone in a separate room (i.e., solitary sleepers) initially may have less interrupted sleep becauseit takes more intense signaling from their children to wake them. However, when awakened bytheir children’s signals, having to go into a different room to tend to their distressed infants maybe quite disruptive to the parents’ sleep, making them more likely to define these wakings as“problems” (Middlemiss, 2004).

For some families, infant night wakings present a major source of frustration and contributeto maternal depression and stress. In these cases especially, professional assistance may berequired to handle these problems. Parents’ lack of sleep due to night wakings may in turnimpact their well-being as well as their abilities to parent effectively in the daytime (Paulson,Dauber, & Leiferman, 2006). For clinically sleep-disordered children, in which families areexperiencing severe sleep disruptions, sleep interventions may quickly and effectively resolvefamily stress. Results of a study by Hiscock and Wake (2002) found that depressive symptomsof mothers of 2- and 4-month-old infants decreased significantly after a sleep intervention wasinstituted. In another study in which sleep problems were severe (Thome & Skuladottir, 2005),parents were treated for distress at the same time their infants were being treated in a hospitalfor their sleeping problems. After the treatment, 83% of mothers and fathers had reduceddepressive symptoms. Other research has indicated that children with severe sleep problemsfeel better following implementation of a systematic sleep intervention. A Swedish study of



95 families with “sleep-disturbed” young children found children more secure and less anxiousfollowing a sleep intervention based on the graduated extinction method; parents also reportedthat children’s problematic daytime behavior and family well-being were improved after theintervention (Eckerberg, 2004). These studies have indicated that children’s sleep problems areintertwined with child and parental well-being, and all family members seem to benefit fromtreatment when situations are extreme.

However, not all sleep interventions are equally effective, and some methods are moredemanding and taxing for families than are other methods. For example, methods that requireparents to listen to their unattended children cry themselves to sleep may be particularly stressful(Johnson, 1991). Many parents are unwilling to use this type of intervention while others maytry to implement and then abandon it because they find it too difficult to listen to their child cry(France, Henderson, & Hudson, 1996; Rickert & Johnson, 1988). Unsuccessful attempts to usethis method may result in an increase in waking and signaling at night (Messer, 1993; Rickert &Johnson, 1988). Following a period of not waking, some infants spontaneously resume signalingat night (Mindell, 1997; Rickert & Johnson, 1988), which may cause parents to again beginattending to their signals, and reinstitute sleep-training procedures. Such a cycle may lead to anincrease in family stress.

In summary, past research has indicated that families who perceive night wakings as prob-lematic may experience difficulties in family functioning and in individual well-being. On theother hand, families who do not perceive night wakings as problematic may not be as adverselyaffected by these nighttime episodes. Therefore, an important and related issue is the value thatfamilies place on their children sleeping through the night. Family sleep experiences are a com-plex and integral part of family life, and are embedded in a larger system that includes parentingvalues and child characteristics (Latz, Wolf, & Lozoff, 1999; Okami, Weisner, & Olmstead,2002; Rothrauff, Middlemiss, & Jacobson, 2004). The focus of the present study is to addressthese sleep issues in a nonclinical sample of parents of young children.

THE CURRENT STUDY

Although prior literature has investigated improved family well-being and functioning as aresult of successful child sleep interventions, very little is known about the potential difficultycaused by the sleep- through-the-night experience itself, and the potential negative impact ofsleep interventions on the parent–child relationship and maternal well-being. In addition, lessis known about the combined influence of parental values, expectations, and actual practices asthey relate to parent–child relationships and individual well-being. The primary objective of thisstudy was to provide empirical data on families’ experiences of their children learning to sleepthrough the night. We sought to identify the individual and parental correlates associated withthe age at which a child learns to sleep through the night, the difficulty of the child’s experienceduring this process, the importance that mothers place on sleeping through the night, and howtheir difficulties from this experience bear on quality of parenting and the well-being of familymembers. Family sleep arrangements were examined in relation to mothers’ reports about therelative difficulty of their child learning to sleep through the night. Family sleep arrangementsincluded solitary sleepers, wherein children slept in their own bed/crib and own room duringthe first year and beyond, early bedsharers, in which children shared the parental bed during thefirst year and beyond, early roomsharers, which included young children who typically slept in



the parents’ room but not the parents’ bed, and reactive bedsharers, which referred to childrenwho returned to bedsharing after an extended period of solitary sleeping.

METHODS

Participants

Data were obtained from a convenience sample of 102 mothers of preschool-aged childrenbetween 36 and 69 months of age (M = 54.9, SD = 8.3); 53% of the infants were female (n = 54),and 70% were either only children or first-born children (n = 72). Most children (87.1%) werebreastfed and were weaned from the breast, on average, by 13.8 months (SD = 11.4). Mothers’ages ranged from 22 to 49 years (M = 36.7, SD = 5.4). In terms of ethnicity, 58 mothers (56.9%)were of European descent, 18 (17.6%) were Asian or Asian American, 18 (17.6%) were fromother ethnic groups (Middle Eastern, Latino, and mixed heritage), and 8 (7.9%) did not indicatetheir ethnicity. Mothers had a relatively high level of education: Seventy-six percent of mothersin the sample held at least a four-year college degree. Most mothers were married (83%).The modal income ranged from $100,000 to $140,000. Fifty-two percent of the mothers wereemployed outside the home (31% part-time; 21% full-time).

Procedure

A convenience sample of mothers was recruited from area preschools and daycare centers.Recruitment began by mailing an invitation describing the study and requesting the mother’sparticipation. Mothers who participated in the study returned the questionnaire and the consentform in a sealed envelope. Participant anonymity and confidentiality were maintained.

Measures

Sleep Arrangements and Family Sleep Practices . The Sleep Practices Questionnaire (SPQ;Germo, Chang, Keller, & Goldberg, 2007; Keller & Goldberg, 2004) was the primary tool usedto obtain information about family sleep and sleep-related issues starting in infancy and endingwith preschool age. The questionnaire elicited information on the child’s sleep location overtime, maternal attitudes toward bedsharing and solitary sleeping, partner’s support for sleeparrangements, and behaviors and attitudes relevant to the experience of children’s sleepingthrough the night.

Child’s sleep arrangements were identified by asking mothers where their child usually sleptat 6, 12, 24, and 36 months of age. The four options for sleep location where child slept were(a) in their own room all night, (b) in a bassinet/crib in the parents’ room all night, (c) in theparents’ bed all night, or (d) in parents’ bed for part of the night and in own bassinet/crib/bedfor part of the night.

Classification into one of four sleep-arrangement groups was determined by the pattern ofresponses to the sleep-location items from infancy to preschool age. Solitary sleepers (n = 31)were classified as children who slept in a separate room from their parents prior to 12 months ofage (with the majority of solitary sleepers in their own room by 6 months) and continued thatarrangement into their toddler and preschool years. Early bedsharers (n = 48) were children whoslept in their parents’ bed for part or all of the night during the first year, and usually continued



this arrangement at least into the second year. Early roomsharers (n = 11) were children who,during the first year, usually slept in their parents’ bedroom, but not in their parents’ bed. Manyearly roomsharers continued this arrangement at least into the second year. Reactive bedsharers(n = 12) began sharing their parents’ bed after a substantial period of solitary sleeping. Althoughthere was some heterogeneity in their sleep location during early infancy, reactive bedsharershad an extended period of solitary sleeping followed by an extended period of sharing theirparents’ bed for part or all of the night during the second or third year.

Attitudes Toward Sleep Arrangements . The 16-item Keller and Goldberg (2004) AttitudesToward Sleep Arrangements Scale was used in this study. Two subscales previously have beenidentified and were used in the current study: Attitudes Toward Bedsharing (seven items; e.g.,“Bedsharing is a great way to meet a child’s needs”) and Attitudes toward solitary sleeping(nine items; e.g., “Having six-month-olds sleep alone is a great way to encourage their inde-pendence”). The response scale options ranged from 1 (strongly disagree) to 6 (strongly agree).In the current sample, internal consistency for the two subscales was strong (α = .88 and .91,respectively), and the subscales were negatively intercorrelated (r = −.75).

Sleeping Through the Night. Four variables were used to assess aspects of children’s sleepingthrough the night: (a) child’s age at first sleeping through the night, (b) child’s reported difficultyin learning to sleep through the night, (3) importance that the mother placed on helping her childsleep through the night, and (4) mother’s difficulty in helping her child sleep through the night.Mothers responded to a single-item question asking the age at which the child started to sleepthrough the night. Children who were not yet sleeping through the night were assigned a scoreof 1 month greater than the highest age reported for children who were sleeping through thenight, which was a score of 55 months. This method kept the children who were not yet sleepingthrough the night distinguishable from the rest of the sample and avoided the problem of outliersdistorting the distribution. Children’s perceived difficulty in learning to sleep through the nightwas assessed using a one-item question on which mothers rated on a scale of 1 (not at all aproblem) to 7 (definitely a problem) the extent to which their children had difficulty learninghow to sleep through the night by themselves. Mothers’ values about their children’s sleepingthrough the night were measured using a one-item question asking the importance of helpingher child learn to sleep through the night prior to 12 months of age. Responses were scoredon a scale ranging from 0 (no, not important) to 1 (somewhat) to 2 (yes, very important). Acomposite, mean score was computed for the following two items: the extent to which mothershad difficulty listening to their children cry when trying to get them to learn to sleep throughthe night, and the degree of difficulty that mothers experienced when using their method ofhelping their children sleep through the night (each on a 7-point scale). Scores for the variable“maternal difficulty in helping child sleep through the night” ranged from 1 (not at all difficult)to 7 (extremely difficult). Varied methods were reported by mothers and included: their child“crying it out,” the Ferber method, nursing, use of a pacifier, rubbing their child’s back, andsinging lullabies.

Age of weaning. The child’s age of weaning from the breast was determined using a one-item question that asked how old the child was when he or she stopped nursing. Children whonever breastfed were assigned a code of “0” months.



Child temperament. Maternal recall of child’s temperament at 12 months of age was as-sessed using the Pictorial Assessment of Temperament (PAT): Toddler Version (Clarke-Stewart,Fitzpatrick, Allhusen, & Goldberg, 2000). The PAT yields a single, continuous score of temper-ament difficulty (using a mean score for the 10 items, with scores ranging from 1 to 3). Higherscores reflected a more “difficult” child, with the construct of difficulty including negative mood,lack of approach to strangers, slow adaptability to change, and high intensity of emotional ex-pression (Carey & McDevitt, 1978). In the present study, 9 of the 10 items were used. Theitem that concerned infant sleep behavior (i.e., naps) was eliminated to avoid confounding themeasurement of temperament with the assessments of sleep-related behaviors. Internal consis-tency for the nine-item scale was α = .61. The measure has established reliability and validityand has been shown to work well both as a current and retrospective account of temperament(Clarke-Stewart et al., 2000). Prior validation of retrospective accounts of temperament (Bates,Pettit, Dodge, & Ridge, 1998; Clarke-Stewart et al., 2000) and the stability of temperament overtime (Buss & Plomin, 1975; Rothbart, Derryberry, & Hershey, 1999) supported our use of aretrospective index of infant temperament.

Children’s independence. A subscale of the Maturity Demands Scale (Greenberger &Goldberg, 1989) was used to measure the attainment of mature behavior in preschool-agedchildren in the domains of self-reliance in daily living skills and social independence. A Likert-type response format was used, with the six-item scale ranging from 1 (never) to 7 (always).Sample items included “get dressed without adult help,” “make friends among children of similarage without adult help,” and “entertain himself or herself for short periods of time with a bookor toy.” Cronbach’s α for this scale was .74. Further psychometric information is provided inGreenberger and Goldberg (1989).

Maternal well-being. Maternal depressive symptoms were measured by the Center forEpidemiologic Studies Depression Scale (CES-D; Radloff, 1977). A 4-point response scale wasused, and a mean score was computed, with higher scores indicating more depressive symptoms.This scale had high internal consistency, α = .90.

Parenting commitment. This 17-item scale assessed the degree to which parenting wasconsidered central to oneself, salience of parenting in relation to other activities, and motivationto be successful at parenting (see Greenberger & Goldberg, 1989). Responses ranged from 1(disagree very strongly) to 6 (agree very strongly). Sample items included: “I cannot imagine asatisfying life without children,” and “being a parent allows me to express some of the traits andvalues I most prize in myself.” Cronbach’s α for this scale was .64. Further information aboutreliability and validity can be found in Greenberger and Goldberg (1989).

Maternal autonomy support and control. Maternal autonomy support was assessed usingthe Autonomy subscale of the Parental Attitudes Toward Childrearing (PACR; Easterbrooks &Goldberg, 1984) and the Harsh Control subscale of the Parental Control Scale (Greenberger& Goldberg, 1989; Greenberger, O’Neil, & Nagel, 1994); psychometric data can be found inthese sources. Sample items included: “I respect my child’s opinions and encourage him/her toexpress them” and “the most important thing I am teaching my child is to respect authority”(reverse- coded). The combined scale included 14-items in a Likert response format (1 = stronglydisagree; 7 = strongly agree). Higher mean scores reflected greater maternal autonomy supportfor the child, and lower scores indicated greater maternal harsh and controlling behaviors towardthe child. Cronbach’s α for this scale was .76.



Mother–child closeness. The Child–Parent Relationship Scale (CPRS; Pianta, 1995) wasused to assess the extent to which the mother feels a warm relationship with her child. The shortversion of the CPRS includes 13 items with two subscales (Warmth and Conflict). Sample itemsincluded: “I share an affectionate, warm relationship with my child” (Warmth subscale) and“My child and I always seem to be struggling with each other” (Conflict subscale). Responsesranged from 1 (definitely does not apply) to 5 (definitely applies). Cronbach’s α for the 13-itemscale was .77 and higher scores indicated greater closeness.

Data Analysis

Bivariate correlations were conducted initially to examine associations among study variables.Analysis of covariance (ANCOVA), controlling for significant demographic variables whenapplicable, was used to assess the relation between family sleep arrangements and the majorchild sleep variables. ANCOVA also was utilized to examine the interaction between mothers’difficulty in helping their child sleep through the night and the importance that mothers’ placedon attaining this goal in relation to the age that their child began sleeping through the night. Forthe latter analysis, mothers were categorized into groups based on the importance attached tosleeping through the night (“not at all important,” “very important”); respondents who reported“somewhat important” (n = 17) were omitted from this analysis. The continuous variable of“age at which children began sleeping through the night” was dichotomized for this analysisto reflect sleeping through the night in infancy (by 12 months) or in toddlerhood and beyond(17 months or later); 6 children whose ages fell between 13 and 17 months were omitted. Thus, weproduced four distinct groups on two dimensions (important or not; infancy or toddlerhood): notimportant/infancy (n = 9), not important/toddlerhood and later (n = 30), very important/infancy(n = 29), and very important/toddlerhood and later (n = 13). Finally, using a logistic regression,we examined the relative contributions of the major study variables in explaining whetherchildren began sleeping through the night by 12 months (0) or later than 12 months (1).

RESULTS

In the analyses conducted to examine associations between the demographic variables and themain sleep-through-the-night variables, two significant correlations were found. As shown inTable 1, older mothers reported less difficulty with their child learning to sleep through the night,and mothers with more children in the home reported that their preschool child experienced lessdifficulty learning to sleep through the night than did mothers with fewer children in the home.No significant associations were found between the sleep-through-the-night variables and thedemographic variables of annual household income, mothers’ employment status, and mothers’level of education, rs = −.16 to .05, n.s. No significant ethnic differences were apparent for anyof the sleep-through-the-night variables, F(3, 90) = 2.56, n.s.

Several of the sleep-through-the-night variables were significantly intercorrelated (seeTable 1). Not unexpectedly, the importance that mothers placed on helping their children sleepthrough the night by 12 months was inversely related to the age at which children started sleepingthrough the night. Children who reportedly experienced greater difficulty in learning to sleepthrough the night started sleeping through the night at a later age compared to children who didnot experience as much difficulty. Mothers who reported that their children experienced greater



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41∗∗

∗.2

0†−.

06.1

3−.

25∗

.08

−.08

−.02

−.27

∗∗

7.In

depe

nden

ce–

−.22

∗.1

0−.

15.2

6∗∗

−.03

.11

−.03

.10

(Con

tinu

ed)



TAB

LE1.

Con

tinue

d

12

34

56

78

910

1112

1314

15

Pare

ntin

gVa

riab

les

8.M

ater

nald

epre

ssiv

esy

mpt

oms

–−.

26∗∗

−.24

∗−.

47∗∗

∗.1

8†−.

15−.

18†

−.13

9.Pa

rent

ing

com

mitm

ent

–.3

1∗∗

.26∗

∗−.

13.2

5∗∗

−.14

.04

10.M

ater

nals

uppo

rtof

child

’sau

tono

my

–.3

0∗∗

−.46

∗∗∗

.41∗

∗∗.1

4−.

11

11.M

othe

r–ch

ildcl

osen

ess

–−.

15.1

7†.2

6∗∗

.06

12.S

olita

rysl

eep

attit

udes

–−.

75∗∗

∗−.

23∗

−.12

13.B

edsh

arin

gsl

eep

attit

udes

–.2

8∗∗

.06

14.M

ater

nala

ge–

.15

15.N

o.of

child

ren

inho

me

–

Not

e.n’

s=98

–102

.† p

<.1

0.∗ p

<.0

5.∗∗

p<

.01.

∗∗∗ p

≤.0

01.



difficulty in learning to sleep through the night also reported greater personal difficulty withthis experience. In addition, positive associations were found between mothers’ retrospectiveaccounts of the value that they placed on their children sleeping through the night by 12 monthsof age and mothers’ own level of difficulty in getting their children to learn to sleep through thenight.

Children in this sample learned to sleep through the night at varying ages: 45.1% (n = 46)learned by 12 months; another 14.7% (n = 15) learned during the second year; 17.6% (n = 18)slept through the night beginning in their third year; 6.9% (n = 7) learned during the preschoolyears, but before 4 1

2 years of age; and the remaining 15.7% (n = 16) were not sleeping throughthe night at preschool age. For the 86 children who had learned to sleep through the night, themean age for this achievement was 17.2 months (SD = 14.9).

Sleep Arrangements, Attitudes Toward Sleep Arrangements, and Sleeping Through the Night

Results from an analysis of variance indicated that the age (in months) that children learned tosleep through the night varied by type of sleep arrangement, such that early bedsharers did so alater age compared to other sleep-arrangement groups (see Table 2). In addition, the value thatmothers attached to children’s sleeping through the night varied by type of sleep arrangement:Mothers of early bedsharing children placed significantly less importance on their childrenlearning to sleep through the night by 12 months of age compared to mothers of children in allother sleep arrangements. However, children’s difficulty in learning to sleep through the night,as reported by their mothers, did not differ by sleep-arrangement group (see Table 2). Mothers’reports of their own difficulty in helping their child learn to sleep through the night differedby family sleep arrangements, with mothers of early solitary sleepers significantly more likelyto report difficulty during the period their children were learning to sleep through the nightcompared to mothers of early bedsharers (see Table 2).

Mothers’ attitudes toward sleep arrangements were associated in the expected directionwith the sleep-through-the-night variables (see Table 1). Specifically, mothers who held morefavorable views about solitary sleeping felt that it was important that their children sleep throughthe night by 12 months and indicated greater difficulty with getting their children to sleepthrough the night. Similarly, mothers who favored solitary sleeping also reported an earlier ageat which their children started sleeping through the night. Conversely, mothers who held morefavorable bedsharing views felt it was less important that their children sleep through the nightby 12 months and reported less difficulty with the sleep-through-the-night experience. Relatedly,mothers who favored bedsharing also had children who learned to sleep through the night at alater age.

Given these significant correlations, we next examined whether mothers’ difficulty in helpingtheir children learn to sleep through the night differed by the value they placed on having theirchildren achieve this behavior and the actual age at which their child learned to sleep through thenight. Using ANCOVA, controlling for maternal age, mothers’ recall of personal difficulty withchildren’s sleep varied significantly by the importance and timing of sleeping through the night,F(3, 76) = 3.84, p < .05 (see Figure 1). Mothers in the very important/infancy group reportedexperiencing more difficulty helping their children learn to sleep through the night compared tomothers who did not feel it was important to have their children learn to sleep through the nightby 12 months and whose children began sleeping through the night during or after toddlerhood.



TAB

LE2.

Ana

lyse

sof

Vari

ance

and

Cov

aria

nce

for

Slee

p-T

hrou

gh-t

he-N

ight

Vari

able

sby

Slee

p-A

rran

gem

entG

roup

,Con

trol

ling

for

Num

ber

ofC

hild

ren

orM

ater

nalA

ge

Slee

p-A

rran

gem

entG

roup

s

Solit

ary

Rea

ctiv

eE

arly

Ear

lySl

eepe

rsB

edsh

arer

sB

edsh

arer

sR

oom

shar

ers

(n=

31)

(n=

12)

(n=

48)

(n=

11)

Bon

ferr

oni

M(S

D)

M(S

D)

M(S

D)

M(S

D)

FC

ontr

asts

Age

child

slep

tthr

ough

the

nigh

t11

.55

(13.

37)

15.8

3(1

8.78

)33

.58

(18.

57)

18.0

9(1

5.32

)F

(3,9

8)=

12.1

3∗∗∗

EB

<SS

,∗∗∗

RB

,∗∗ E

R*

Chi

ld’s

diffi

culty

with

slee

ping

2.65

(2.0

6)3.

50(2

.54)

3.15

(2.2

0)3.

00(2

.28)

F(3

,97)

=0.

39th

roug

hth

eni

ghta

Impo

rtan

ceof

slee

ping

thro

ugh

nigh

t1.

58(0

.76)

1.58

(0.5

1)0.

43(0

.74)

1.45

(0.8

2)F

(3,9

6)=

19.5

6∗∗∗

EB

<SS

,RB

,ER

∗∗∗

by12

mon

ths

Mot

hers

’di

fficu

ltyw

ithch

ild’s

slee

ping

3.59

(1.8

3)3.

31(2

.10)

2.11

(1.5

2)2.

21(1

.74)

F(3

,97)

=6.

10∗∗

∗E

B<

SS∗∗

thro

ugh

the

nigh

tb

SS=

solit

ary

slee

pers

;RB

=re

activ

ebe

dsha

rer;

EB

=ea

rly

beds

hare

rs;E

R=

earl

yro

omsh

arer

.a co

ntro

lled

for

num

ber

ofch

ildre

nin

the

hom

e;bco

ntro

lled

for

mot

her’

sag

e.∗∗

p<

.01.

∗∗∗ p

≤.0

01.



0

0.5

1

1.5

2

2.5

3

3.5

Not Important Not Important Very Important Very Important

Infancy Toddlerhood Infancy Todderhood

Mat

ern

al D

iffi

cult

y

*

FIGURE 1. Mothers’ recall of difficulty with child sleep by age of child and importance placed on sleeping through thenight, F(3, 76) = 3.84, p < .05. *p < .05; Bonferroni post hoc test.

Child Characteristics and Sleeping Through the Night

Several child characteristics were examined in relation to the sleep-through-the-night variables:gender, age at weaning from the breast, infant temperament, and child’s independence in socialarenas and in daily living skills at preschool age. There were no significant gender differencesfor any of the sleep-through-the-night variables, ts = −1.12 to .56, n.s. Children who were atan older age when weaned also reportedly began sleeping through the night at a later age (seeTable 1). A later age at weaning from the breast also was associated with mothers assigning lessimportance to their children learning to sleep through the night by 12 months. Children whowere recalled to be more temperamentally difficult during infancy reportedly experienced moretrouble learning to sleep through the night. There were no other associations between mothers’recall of infant temperament and the sleep-through-the-night variables. Child’s independence(i.e., their self-reliance in daily living skills and social independence at preschool age) was notsignificantly correlated with the age at which the child learned to sleep through the night orwith their difficulty in learning to sleep through the night. In addition, there were no significantcorrelations between child’s independence at preschool age and the importance mothers’ placedon having their child learn to sleep through the night by 12 months or with mothers’ difficultygetting their child to sleep through the night (see Table 1).

Parenting, Maternal Well-Being, and Sleeping Through the Night

Mothers who reported a higher commitment to the parenting role also reported a later age whentheir children slept through the night (see Table 1). Mothers who reported greater support of



TABLE 3. Logistic Regression Predicting Whether Child Learned to Sleep Through the Night DuringInfancy or Toddlerhood

Coefficient Odds Ratio (95% confidence interval)

Age at weaning from breast 0.01 0.99 (0.94–1.04)Attitudes toward bedsharing −0.31 1.36 (0.73–2.54)Bedsharers versus all others 1.85 0.16∗∗ (0.05–0.54)Child’s difficulty in learning to sleep through the night 0.05 0.96 (0.77–1.19)Importance of child sleeping through night by 12 months −0.75 2.11∗ (1.09–4.10)Parenting commitment 0.62 0.54 (0.18–1.57)Constant 2.14Cox–Snell R2 = .25

∗p < .05. ∗∗p < .01.

their children’s autonomy also reportedly placed less value on their children sleeping throughthe night by 12 months of age. Mothers who reported more feelings of warmth and closenessand less conflict toward their preschool-aged children also recalled less difficulty in gettingthem to sleep through the night. Mothers who reported more depressive symptoms currentlyalso described having had greater difficulty with their children’s experience of learning tosleep though the night. Maternal level of depressive symptoms was marginally related in thepredicted direction to mothers’ recall of infant temperament, r = .20, p < .06. There were noother significant associations between the maternal measures and the sleep-through-the-nightvariables (see Table 1).

To further examine the relative importance of the major maternal and child characteristicson whether the child began sleeping through the night during the first year, a logistic regressionanalysis was conducted. Independent variables included were age at weaning, attitudes towardbedsharing, sleep arrangements, child’s difficulty with sleeping through the night, importanceof child sleeping through the night by 12 months, and parenting commitment. The value ofthe Hosmer—Lemeshow goodness-of-fit statistic and the corresponding nonsignificant p valuecomputed from the chi-square distribution indicates that the model fits well (see Table 3). TheCox–Snell R2 for the model was .25, which indicated a moderate amount of explained variance.Significant independent contributions were made by sleep arrangements and the importance thatmothers placed on their child sleeping through the night by 12 months. Bedsharing mothers weremore likely to have children who began sleeping through the night after the first year. Motherswho attached greater importance to their children sleeping through the night by 12 monthsindeed had children who began to sleep through the night during infancy.

DISCUSSION

A substantial body of research has examined the detrimental effects of sleep problems forfamilies, the effectiveness of various types of sleep interventions, and subsequent improvementsto family functioning once night wakings that had been highly disruptive to family life wereeliminated. However, very little empirical work has focused on parental perceptions of theprocess of getting children to sleep through the night and parents’ perspectives as to whether it isimportant that their infants learn to sleep through the night at an early age. This study examined



these and other aspects of early sleep issues in relation to parental and child functioning in anonclinical sample. These issues were examined in families who were bedsharers as well as infamilies of children who were early solitary sleepers. Findings from the present study providea valuable, albeit retrospective, account of families’ experiences of having their child learn tosleep through the night.

Findings from our study indicate that preschool children’s independence in several domainswas not associated with their level of difficulty with early sleep experiences. Despite pediatric andparental concerns about the possible detrimental implications for children’s development if theyare unable to sleep independently, there were no significant differences between children wholearned to sleep through the night at an early as opposed to a later age with respect to their levelof independence in social and daily living domains at preschool age, as reported by mothers.This finding, along with other research (Keller & Goldberg, 2004), illustrates that children’sindependence should not be treated as a monolithic category. The lack of independence in thesleep domain does not appear to generalize to independence in other domains. The results of thisstudy suggest that compared to their counterparts who learned to sleep through the night at anearly age, children who learned to sleep through the night at a later age did not differ in nonsleepdomains of independence as preschoolers. With regard to the study’s other major findings,the associations between sleep-through-the- night variables and our classifications of children’ssleep locations from infancy through preschool age (i.e., solitary sleepers, early bedsharers, earlyroomsharers, reactive bedsharers) proved to be the strongest in our dataset, in terms of varianceexplained, and persisted when controlling for maternal age and number of children. We foundthat a sizable number of mothers reported that their children slept through the night at an earlyage, which is in accord with the prescription of many Western child-sleep experts. Mothers ofsolitary sleepers valued an earlier age of sleeping through the night and, in actual practice, didhave children who slept through the night at an earlier age; however, the achievement did seemto come at some cost, as mothers who placed greater value on their children sleeping through thenight early (during infancy) also reported greater personal difficulty during this period. Mothersof reactive bedsharers were similar to mothers of solitary sleepers with regard to the importancethey ascribed to their children sleeping through the night by 12 months, which lends furthersupport to the type of “reactive” sleep arrangement (where children return to bedsharing after asustained period of solitary sleeping) as a distinct category (Keller & Goldberg, 2004; Ramoset al., 2007). However, mothers and children in the reactive bedsharing sleep-arrangement groupdid not differ significantly from those in the other sleep-arrangement groups with regard totheir difficulty in learning to sleep through the night. In addition, mothers of early roomsharersplaced greater importance on their children sleeping through the night than did mothers of earlybedsharers, with this latter group placing the least amount of importance on their child sleepingthrough the night in the first year than did mothers of children in all other sleep arrangements.This finding illustrates the importance of differentiating, when sample sizes permit, betweenfamilies who roomshare versus those who bedshare.

Overall, examination of major maternal and child variables in a logistic regression modelindicated a good fit with the dependent measure of whether children slept through the nightearly (during infancy) or later (during toddlerhood). The greatest contributions were made bythe importance mothers placed on having their children sleep through the night at an early ageand by the type of sleep arrangement. Children who started sleeping through the night afterthe first year of infancy had mothers who placed less importance on this “milestone” and whopracticed bedsharing arrangements during the first year. The variables in the model explained



a moderate amount of variance in whether children slept through the night in infancy or intoddlerhood.

Together, these findings illustrate the importance of maternal values and attitudes in relationto the age at which young children learn to sleep through the night. This is in accord with theposition that familial and cultural values play a role in children’s sleep arrangements and sleeppractices (Lozoff, Askew, & Wolf, 1996). The present findings suggest that parents’ practicesregarding getting their children to sleep through the night also reflect personal beliefs about whatis important for children.

The sleep-through-the-night findings for families favoring bedsharing are consistent withthe child-related findings surrounding breastfeeding. The child-related findings in this studysuggest, first, that children who weaned at a later age were more likely to sleep through the nightat a later age. For families who value an earlier age of sleeping through the night, a later ageof weaning may not be desirable. However, in accord with recent recommendations from theAmerican Academy of Pediatrics (2005) and the World Health Organization (1990) concerningthe physiological health benefits accrued from breastfeeding beyond the child’s first year, a laterage of weaning and a later age of sleeping through the night may be desirable for families forwhom night wakings do not pose a problem. Pediatric practitioners should be aware that a laterage at weaning may be expected and could be viewed as normative for these families. On theother hand, families who suffer from a chronic lack of sleep and other problems related to sleepdisruption, weaning and the use of a sleep-intervention method may outweigh the purportedphysiological benefits of longer term breastfeeding.

There were differences in mothers’ reports of their children’s difficulty in learning to sleepthrough the night in relation to the number of children in the home, such that mothers who hadmore children in the home reported that their preschool child experienced less difficulty learningto sleep through the night by themselves compared to mothers with fewer children in the home.Parents who have previously experienced sleep-through-the-night issues with prior children maybe better prepared to deal with these issues with later born children.

An important contribution of this study was its approach to examining child temperament,not in relation to night waking as in previous studies (e.g., Sadeh & Anders, 1993) but with respectto reported level of difficulty of the experience of learning to sleep through the night. In thisstudy, children who were recalled to have had a more difficult temperament also were reportedto have experienced greater difficulty in learning to sleep through the night. Consideration ofthe child’s temperament and perceived difficulty in learning to sleep through the night may bearon what type of parental response or sleep method is most effective.

A number of noteworthy findings have emerged from our investigation of the maternalcontext in relation to the child’s sleep-through-the-night experience. Using a nonclinical sample,mothers in this sample who reported higher depressive symptoms at the present time also recalledgreater personal difficulty with their child’s earlier experience of learning to sleep through thenight; these mothers also tended to recall their infants as more difficult in temperament. Thesedata were based on retrospective accounts provided by mothers and, as such, preclude us fromdrawing inferences about causality. However, the findings suggest that for some mothers, theexperience of getting their child to sleep may bear negatively on their psychological well-being.Of course, it may be the case that mothers who were more depressed also recalled more difficultyin getting their child to sleep through the night.

In the parenting domain, the significant, negative association between closeness of themother–child relationship and mothers’ recall of their difficulty with their child’s experience



of sleeping through the night suggests that these issues are interrelated. However, given thecorrelational nature of the data, it is unclear whether the mother–child relationship enduredgreater conflict prior to the sleep-through-the-night experience or occurred as a result of adifficult “crying-it-out” sleep-intervention experience that impacted the mother’s feelings abouther child. It is important that future research examine prospectively the relation between thequality of the mother–child relationship and a potentially stressful sleep-intervention experience.

The results from this study also indicate that mothers varied in their views about theimportance of children’s sleeping through the night, and other parenting characteristics wereconcordant with these values. The findings that emerged here in relation to parenting suggest adifferent picture from that indicated by some sleep experts. Instead of appearing unable to setboundaries about their child’s sleep (e.g., Ferber, 1985), mothers of children who slept throughthe night at a later age and placed less emphasis on sleeping through the night during infancyappeared to hold parenting values congruent with a greater commitment to the parenting roleand a greater support for their child’s autonomy. For parents who do not necessarily value anearly age in sleeping through the night, it is consistent that their children would sleep throughthe night at a later age.

Future research should include information on maternal and familial values about theappropriate expected age of sleeping through the night in relation to whether mothers considernight wakings to be problematic. Although many health professionals would view these older agenight wakings to be a sleep problem prima facie, it is gradually becoming evident that whetherparents perceive sleep behaviors such as night waking to be disruptive tends to vary according tocultural and personal parenting beliefs (Keller & Goldberg, 2004; Lee, 1992; Lozoff et al., 1996;Ramos et al., 2007). This is in accord with the theoretical framework of the developmental niche,in which parental attitudes, cultural values, and developmental goals for their children guideparents’ childrearing practices (Harkness, 1992; Harkness et al., 2006; Super & Harkness, 1986).For example, some mothers may regard sleep interventions as essential to avoid further familystress due to sleep disruption, or may view learning to sleep through the night as a necessarymilestone that is culturally prescribed or an important experience that leads to the Americanideal of the developmental goal of independence (Harkness, Super, & van Tijen, 2000). Othermothers, especially those who report developmental goals of closeness and security (Harknesset al., 2006), may wish to keep their children in close proximity at night and, as such, mayminimize the importance of night-waking issues. Indeed, the findings of this study suggest thatmothers varied widely in their views of their children’s nighttime sleep behaviors, which in turnclosely aligned with their vision for their children’s development.

Limitations and Future Research

Generalizability of the findings is limited by the nature of the sample, which was a conveniencesample of largely middle-class, Caucasian families. Inferences about causality cannot be madegiven that the sleep data during infancy and toddlerhood were retrospective, and the studyused a descriptive, nonexperimental design. Another major limitation of the current study is thereliance on a single source of data—maternal report—for information about sleep experiencesover the child’s first few years of life. This raises the possibility that mothers’ current stateof well-being and the child’s recent sleep behaviors may color mothers’ recollections of theextent to which the early sleep experiences were stressful. The reliance on maternal recall ofinfant temperament may not adequately assess the relation between early temperament and



infants’ sleeping through the night experience. Whereas use of maternal retrospective reportsof infant temperament continues in research today (e.g., Goodnight, Bates, Staples, Petit, &Dodge, 2007), research questions concerning the impact of sleep-through-the-night experienceson child and family well-being would benefit from examination in a prospective, longitudinaldesign.

Although various factors related to the sleep experience were examined, this study did notinclude detailed questions concerning the nature of the sleep intervention itself (e.g., the amountof crying, whether multiple interventions were used over time). The effects of different sleepinterventions on family relationships and well-being are a prime area for further study. Futureresearch should carefully examine the extent to which sleep interventions that include a great dealof crying without parental responsiveness may impact infants’ and young children’s emotionalhealth and well-being. Prospective studies are needed to evaluate interventions that endorse“crying it out” and their association with children’s attachment security as well as child/parentalstress and relationship quality (especially if the first attempted intervention does not succeed).

Clinical Implications

Pediatricians and other healthcare practitioners should take into account the cultural and socialcontexts of children’s sleep arrangements, and should understand that families vary in theirnighttime parenting values and practices. Prior to advising parents about sleep interventions,clinicians should seek to understand whether parenting values fit parents’ nighttime sleep prac-tices. Practitioners can play an important role in helping parents anticipate continued nightwakings by relaying that night wakings constitute a normative nighttime experience especiallyfor breastfeeding children. Further, for parents who seek sleep interventions, practitioners canhelp tailor a plan that helps meets the parents’ needs and desires. In addition, it is important forclinicians and researchers to identify which child and parent factors contribute to the successor failure of a particular sleep intervention. Some methods aimed at getting children to sleepthrough the night may ameliorate family life, but they also may be associated with personal andfamily difficulties if the sleep intervention proves to be a difficult experience for children andtheir parents. Taking these multiple factors into consideration can have a significant impact onthe quality of care.

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