Risk factors for sleep problems in infants

Main Article Content

Hesti Lestari
Audrey Mety Iriani Wahani
Rocky Wilar
Permatami Herwansyah


Background Sleep disorders in infants can cause developmental problems, suboptimal growth, behavioral disorders, fatigue, irritability, impulsiveness, and poor mother-infant bonding.

Objective To evaluate possible risk factors for sleep disorders in infants.

Methods This cross-sectional study was conducted in healthy infants aged 3-6 months. Subjects were selected using proportional random sampling from four different primary healthcare facilities in Manado, North Sulawesi. Their parents completed the Brief Infant Sleep Questionnaire. Sleep disorder was defined as the presence of one or more conditions including sleep duration less than 9 hours at night (from 19.00 until 07.00), waking up at night (from 22.00 until 06.00) more than 3 times, and more than 1 hour waking at night.

Results Of 112 subjects, 58 (51.8%) were male. Subjects’ mean age was 4.21 (SD 0.829) months and 76 (67.86%) experienced sleep disorders. Sleep disorders had significant associations with low socioeconomic status (OR 17; 95%CI 3.8 to 75.8), middle school or lower maternal education (OR 44.5; 95%CI 9.8 to 202), non-supine sleeping position (OR 8.8; 95%CI 1.9 to 39.7), parental use of electronic devices (OR 156.2; 95%CI 35.1 to 692.9), and non-exclusive breastfeeding (OR 85.2; 95%CI 21.1 to 344.2). Correlative analyses also revealed that electronic media usage had the strongest association with sleep disorders, followed by breastfeeding pattern, maternal education, socioeconomic status, and sleeping position ( 0.839, 0.771, 0.624, 0.433, and 0.309, respectively).  However, there were no significant correlations upon  multivariate analysis.

Conclusion Parental use of electronic media before sleeping is the strongest risk factor for sleep disorders among infants, followed by non-exclusive breastfeeding pattern, low maternal education, low socioeconomic status, and non-supine sleeping position. However, none of these correlations were significant upon multivariate analysis, this show that all these factors influence sleep together

Article Details

How to Cite
Lestari H, Wahani A, Wilar R, Herwansyah P. Risk factors for sleep problems in infants. PI [Internet]. 20Jul.2020 [cited 6Dec.2021];60(4):186-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2374
Developmental Behavioral & Community Pediatrics
Received 2020-01-15
Accepted 2020-07-20
Published 2020-07-20


1. El-Sheikh M, Sadeh A. Sleep and development: introduction to the monograph. Monogr Soc Res Child Dev. 2015;80:1-14. DOI: 10.1111/mono.12141.
2. Bernier A, Matte-Gagne C, Bouvette-Turcot AA. Examining the interface of children’s sleep, executive functioning, and caregiving relationships: a plea against silos in the study of biology, cognition, and relationships. Curr Dir Psychol Sci. 2014;23:284-9. https://doi.org/10.1177%2F0963721414534852.
3. Bruni O, Baumgartner E, Sette S, Ancona M, Caso G, Di Cosimo ME, et al. Longitudinal study of sleep behavior in normal infants during the first year of life. J Clin Sleep Med. 2014;10:1119-27. https://doi.org/10.5664/jcsm.4114
4. Mindell JA, Lee C. Sleep, mood, and development in infants. Infant Behav Dev. 2015;41:102–7. doi: 10.1016/j.infbeh.2015.08.004.
5. Hysing M, Harvey AG, Torgersen L, Ystrom E, Reichborn-Kjennerud T, Sivertsen B. Trajectories and predictors of nocturnal awakenings and sleep duration in infants. J Dev Behav Pediatr. 2014;35:309-16. doi: 10.1097/DBP.0000000000000064.
6. Sadeh A, Tikotzky L, Scher A. Parenting and infant sleep. Sleep Med Rev. 2010;14:89-96. https://doi.org/10.1016/j.smrv.2009.05.003.
7. Tikotzky L. Parenting and sleep in early childhood. Curr Opin Psychol. 2017;15:118-24. https://doi.org/10.1016/j.copsyc.2017.02.016
8. Sekartini R, Adi NP. Gangguan tidur pada anak usia bawah tiga tahun di lima kota di Indonesia. Sari Pediatri. 2006;7:188-93.
9. Bathory E, Tomopoulos S. Sleep regulation, physiology and development, sleep duration and patterns, and sleep hygiene in infants, toddlers, and preschool-age children. Curr Probl Pediatr Adolesc Health Care. 2017;47:29-42. https://doi.org/10.1016/j.cppeds.2016.12.001.
10. Allen SL, Howlett MD, Coulombe JA, Corkum PV. ABCs of sleeping: a review of the evidence behind pediatric sleep practice recommendations. Sleep Med Rev. 2016;29:1-14. https://doi.org/10.1016/j.smrv.2015.08.006.
11. Touchette E. Factors associated with sleep problems in early childhood. In: Tremblay RE, Boivin M, Peters RDeV, eds. Petit D, topic ed. Encyclopedia on Early Childhood Development [online] [cited 2019 02 22]. Available from: http://www.childencyclopedia.com/documents/TouchetteANGxp1.pdf.
12. McDowall PS, Galland BC, Campbell AJ, Elder DE. Parent knowledge of children’s sleep: a systematic review. Sleep Med Rev. 2017;31:39-47. https://doi.org/10.1016/j.smrv.2016.01.002
13. Iwasaki M, Iwata S, Iemura A, Yamashita N, Tomino Y, Anme T, et al. Utility of subjective sleep assessment tools for healthy preschool children: a comparative study between sleep logs, questionnaires, and actigraphy. J Epidemiol. 2010;20:143-149. https://doi.org/10.2188/jea.JE20090054
14. Sadeh A. A brief screening questionnaire for infant sleep problems: validation and findings for an internet sample. Pediatrics. 2004;113:570-7. https://doi.org/10.1542/peds.113.6.e570
15. Field T. Infant sleep problems and interventions: a review. Infant Behav Dev. 2017;47:40–53. https://doi.org/10.1016/j.infbeh.2017.02.002
16. Sadeh A, Mindell JA, Luedtke K, Wiegand B. Sleep and sleep ecology in the first 3 years: a web-based study. J Sleep Res. 2009;18:60-73.
17. Mindell JA, Sadeh A, Wiegand B, How TH, Goh DYT. Cross cultural differences in infant and toddler sleep. Sleep Med. 2010;11:274-80. https://doi.org/10.1016/j.sleep.2009.04.012
18. Simard V, Chevalier V, Bedard MM. Sleep and attachment in early childhood: a series of meta-analyses. Attach Hum Dev. 2017;19:298-321. https://doi.org/10.1080/14616734.2017.1293703
19. Ammari A, Schulze KF, Ohira-Kist K, Kashyap S, Fifer WP, Myers MM, et al. Effects of body position on thermal, cardiorespiratory and metabolic activity in low birth weight infants. Early Hum Dev. 2009;85:497-501. https://dx.doi.org/10.1016%2Fj.earlhumdev.2009.04.005
20. Twenge JM, Hisler GC, Krizan Z. Association between screen time and sleep duration are primarily driven by portable electronic devices: evidence from a population-based study of U.S. children agaes 0-17. Sleep Med. 2019;56:211-8. https://doi.org/10.1016/j.sleep.2018.11.009.
21. Chang AM, Aeschbach D, Du JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci USA. 2015;112:1232–7. https://doi.org/10.1073/pnas.1418490112.
22. Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis. JAMA Pediatr. 2016;170:1202-8. doi:10.1001/jamapediatrics.2016.2341.
23. Engler AC, Hadash A, Shehadeh N, Pillar G. Breastfeeding may improve nocturnal sleep and reduce infantile colic: potential role of breast milk melatonin. Eur J Pediatr. 2012;171:729–32. https://doi.org/10.1007/s00431-011-1659-3.