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BMC Pediatrics

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Open Access 01-12-2022 | Obesity | Research

“Struggle at night – He doesn’t let me sleep sometimes”: a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity

Authors: Megan J. Gray, Christian E. Vazquez, Ojasvie Agnihotri

Published in: BMC Pediatrics | Issue 1/2022

Abstract

Background

Hispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers.

Methods

This qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018–2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes.

Results

Mothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn’t bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors.

Conclusions

Pediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.

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Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8.

Marcus MD, Baranowski T, DeBar LL, et al. Severe obesity and selected risk factors in a sixth grade multiracial cohort: the HEALTHY study. J Adolesc Health. 2010;47(6):604–7. https://doi.org/10.1016/j.jadohealth.2010.04.017.CrossRefPubMedPubMedCentral

Deboer MD, Wiener RC, Barnes BH, Gurka MJ. Ethnic differences in the link between insulin resistance and elevated ALT. Pediatrics. 2013;132(3):e718–26. https://doi.org/10.1542/peds.2012-3584.CrossRefPubMedPubMedCentral

Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50(6):761–79. https://doi.org/10.1016/j.amepre.2015.11.012.CrossRefPubMed

Fisher A, McDonald L, van Jaarsveld CH, et al. Sleep and energy intake in early childhood. Int J Obes (Lond). 2014;38(7):926–9. https://doi.org/10.1038/ijo.2014.50.CrossRef

Halal CS, Matijasevich A, Howe LD, Santos IS, Barros FC, Nunes ML. Short sleep duration in the first years of life and obesity/overweight at age 4 years: a birth cohort study. J Pediatr. 2016;168:99-103.e3. https://doi.org/10.1016/j.jpeds.2015.09.074.CrossRefPubMedPubMedCentral

Miller MA, Kruisbrink M, Wallace J, Ji C, Cappuccio FP. Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep. 2018;41(4). https://doi.org/10.1093/sleep/zsy018.

Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American academy of sleep medicine. J Clin Sleep Med. 2016;12(06):785–6. https://doi.org/10.5664/jcsm.5866.CrossRefPubMedPubMedCentral

Morrissey B, Taveras E, Allender S, Strugnell C. Sleep and obesity among children: a systematic review of multiple sleep dimensions. Pediatr Obes. 2020;15(4):e12619. https://doi.org/10.1111/ijpo.12619.CrossRefPubMedPubMedCentral

10.

Bell JF, Zimmerman FJ. Shortened nighttime sleep duration in early life and subsequent childhood obesity. Arch Pediatr Adolesc Med. 2010;164(9):840–5. https://doi.org/10.1001/archpediatrics.2010.143.CrossRefPubMed

11.

Sluggett L, Wagner SL, Harris RL. Sleep duration and obesity in children and adolescents. Can J Diabetes. 2019;43(2):146–52. https://doi.org/10.1016/j.jcjd.2018.06.006.CrossRefPubMed

12.

Touchette E, Petit D, Tremblay RE, et al. Associations between sleep duration patterns and overweight/obesity at age 6. Sleep. 2008;31(11):1507–14. https://doi.org/10.1093/sleep/31.11.1507.CrossRefPubMedPubMedCentral

13.

Taveras EM, Rifas-Shiman SL, Oken E, Gunderson EP, Gillman MW. Short sleep duration in infancy and risk of childhood overweight. Pediatr Adolesc Med. 2008;162(4):305. https://doi.org/10.1001/archpedi.162.4.305.CrossRef

14.

Anderson SE, Andridge R, Whitaker RC. Bedtime in preschool-aged children and risk for adolescent obesity. J Pediatr. 2016;09(176):17–22. https://doi.org/10.1016/j.jpeds.2016.06.005.CrossRef

15.

Roy M, Haszard JJ, Savage JS, et al. Bedtime, body mass index and obesity risk in preschool‐aged children. Pediatr Obes. 2020;15(9):e12650. https://doi.org/10.1111/ijpo.12650.

16.

Combs D, Goodwin JL, Quan SF, Morgan WJ, Parthasarathy S. Longitudinal differences in sleep duration in Hispanic and Caucasian children. Sleep Med. 2016;18:61–6. https://doi.org/10.1016/j.sleep.2015.06.008.CrossRefPubMed

17.

Ash T, Taveras EM, Redline S, Haneuse S, Quante M, Davison K. Contextual and parenting factors contribute to shorter sleep among Hispanic/Latinx compared to non-Hispanic white infants. Ann Behav Med. 2021;55(5):424–35. https://doi.org/10.1093/abm/kaaa062.CrossRefPubMed

18.

Harries V, Brown A. The association between baby care books that promote strict care routines and infant feeding, night-time care, and maternal-infant interactions. Matern Child Nutr. 2019;15(4):e12858. https://doi.org/10.1111/mcn.12858.CrossRefPubMedPubMedCentral

19.

Bruni O, Baumgartner E, Sette S, et al. Longitudinal study of sleep behavior in normal infants during the first year of life. J Clin Sleep Med. 2014;10(10):1119–27. https://doi.org/10.5664/jcsm.4114.CrossRefPubMedPubMedCentral

20.

Messayke S, Davisse-Paturet C, Nicklaus S, et al. Infant feeding practices and sleep at 1 year of age in the nationwide ELFE cohort. Matern Child Nutr. 2021;17(1):e13072. https://doi.org/10.1111/mcn.13072.CrossRefPubMed

21.

Paul IM, Hohman EE, Loken E, et al. Mother-infant room-sharing and sleep outcomes in the INSIGHT Study. Pediatrics. 2017;140(1):e20170122. https://doi.org/10.1542/peds.2017-0122.CrossRefPubMed

22.

Seng CT. Predominantly nighttime feeding and weight outcomes in infants. Am J Clin Nutr. 2016;104(2):380–8. https://doi.org/10.3945/ajcn.116.130765.CrossRef

23.

Scher A, Hall WA, Zaidman-Zait A, Weinberg J. Sleep quality, cortisol levels, and behavioral regulation in toddlers. Dev Psychobiol. 2010;52(1):44–53. https://doi.org/10.1002/dev.20410.CrossRefPubMedPubMedCentral

24.

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(5):309–16. https://doi.org/10.1097/DBP.0000000000000064.CrossRefPubMed

25.

Azad MB, Vehling L, Chan D, et al. Infant feeding and weight gain: separating breast Milk from breastfeeding and formula from food. Pediatrics. 2018;142(4). e20181092. https://doi.org/10.1542/peds.2018-1092.

26.

Ball HL, Howel D, Bryant A, Best E, Russell C, Ward-Platt M. Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta Paediatr. 2016;105(6):628–34. https://doi.org/10.1111/apa.13354.CrossRefPubMed

27.

Schachter FF, Fuchs ML, Bijur PE, Stone RK. Cosleeping and sleep problems in Hispanic-American urban young children. Pediatrics. 1989;84(3):522–30.CrossRef

28.

Olsen NJ, Rohde JF, Händel MN, Stougaard M, Mortensen EL, Heitmann BL. Joining parents’ bed at night and overweight among 2- to 6-year-old children - results from the “healthy start” randomized intervention. Obes Facts. 2018;11(5):372–80. https://doi.org/10.1159/000492003.CrossRefPubMedPubMedCentral

29.

Moon RY, SYNDROME TFOSID. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5). https://doi.org/10.1542/peds.2016-2940.

30.

Mindell JA, Meltzer LJ, Carskadon MA, Chervin RD. Developmental aspects of sleep hygiene: findings from the 2004 national sleep foundation sleep in America poll. Sleep Med. 2009;10(7):771–9. https://doi.org/10.1016/j.sleep.2008.07.016.CrossRefPubMed

31.

Meltzer LJ, Montgomery-Downs HE. Sleep in the family. Pediatr Clin North Am. 2011;58(3):765–74. https://doi.org/10.1016/j.pcl.2011.03.010.CrossRefPubMedPubMedCentral

32.

Berger KS. The developing person through the life span. 9th ed. New York: Worth Publishers; 2014.

33.

Cartagena DC, Ameringer SW, McGrath J, Jallo N, Masho SW, Myers BJ. Factors contributing to infant overfeeding with Hispanic mothers. J Obstet Gynecol Neonatal Nurs. 2014;43(2):139–59. https://doi.org/10.1111/1552-6909.12279.CrossRefPubMed

34.

Lucas CT, Messito MJ, Gross RS, et al. Characteristics associated with adding cereal into the bottle among immigrant mother-infant dyads of low socioeconomic status and Hispanic ethnicity. J Nutr Educ Behav. 2017;49(1):27-34.e1. https://doi.org/10.1016/j.jneb.2016.08.017.CrossRefPubMed

35.

Gross RS, Mendelsohn AL, Arana MM, Messito MJ. Food insecurity during pregnancy and breastfeeding by low-income Hispanic mothers. Pediatrics. 2019;143(6). https://doi.org/10.1542/peds.2018-4113.

36.

National Academies of Sciences, Engineering, and Medicine. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press; 2020. https://doi.org/10.17226/25747.

37.

Pérez-Escamilla R, Segura-Pérez S, Lott M, on behalf of the RWJF HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Durham: Healthy Eating Research; 2017. Available at http://healthyeatingresearch.org.

38.

Schmitt BD. Pediatric telephone protocols: office version. 17th ed. Elk Grove Village: Amercian Academy of Pediatrics; 2021.

39.

Salihu HM, Wilson RE, King LM, Marty PJ, Whiteman VE. Socio-ecological model as a framework for overcoming barriers and challenges in randomized control trials in minority and underserved communities. Int J MCH AIDS. 2015;3(1):85–95.PubMedPubMedCentral

40.

Milan S, Snow S, Belay S. The context of preschool children’s sleep: racial/ethnic differences in sleep locations, routines, and concerns. J Fam Psychol. 2007;21(1):20–8. https://doi.org/10.1037/0893-3200.21.1.20.CrossRefPubMed

41.

Ramos KD, Youngclarke DM. Parenting advice books about child sleep: cosleeping and crying it out. Sleep. 2006;29(12):1616–23. https://doi.org/10.1093/sleep/29.12.1616.CrossRefPubMed

42.

Moon R. Sleep: What every parent needs to know. 2nd ed. AAP Press. Elk Grove Village: Amercian Academy of Pediatrics; 2013.

43.

Mathews AA, Joyner BL, Oden RP, Alamo I, Moon RY. Comparison of infant sleep practices in African-American and US Hispanic families: implications for sleep-related infant death. J Immigr Minor Health. 2015;17(3):834–42. https://doi.org/10.1007/s10903-014-0016-9.CrossRefPubMedPubMedCentral

44.

Peña MM, Rifas-Shiman SL, Gillman MW, Redline S, Taveras EM. Racial/ethnic and socio-contextual correlates of chronic sleep curtailment in childhood. Sleep. 2016;39(9):1653–61. https://doi.org/10.5665/sleep.6086.CrossRefPubMedPubMedCentral

45.

States NRCUPoHitU. Hispanics and the future of America. 2006.

46.

Li J, Kaiser T, Pollmann-Schult M, Strazdins L. Long work hours of mothers and fathers are linked to increased risk for overweight and obesity among preschool children: longitudinal evidence from Germany. J Epidemiol. 2019;73(8):723–9. https://doi.org/10.1136/jech-2018-211132.CrossRef

47.

Champion SL, Rumbold AR, Steele EJ, Giles LC, Davies MJ, Moore VM. Parental work schedules and child overweight and obesity. Int J Obes. 2012;36(4):573–80. https://doi.org/10.1038/ijo.2011.252.CrossRef

48.

Martinez SM, Thompson-Lastad A. Latino parents’ insight on optimal sleep for their preschool-age child: does context matter? Acad Pediatr. 2015;15(6):636–43. https://doi.org/10.1016/j.acap.2015.07.003.CrossRefPubMed

49.

Schneider‐Worthington CR, Berger PK, Goran MI, Salvy SJ. Learning to overeat in infancy: concurrent and prospective relationships between maternal BMI, feeding practices and child eating response among Hispanic mothers and children. Pediatric Obes. 2021;16(6). https://doi.org/10.1111/ijpo.12756.

50.

Ochoa A, Berge JM. Home environmental influences on childhood obesity in the Latino population: a decade review of literature. J Immigr Minor Health. 2017;19(2):430–47. https://doi.org/10.1007/s10903-016-0539-3.CrossRefPubMedPubMedCentral

51.

McFarren H, Vazquez C, Jacobs EA, DelaTejera G, Gray M. Understanding feeding practices of Latinx mothers of infants and toddlers at risk for childhood obesity: a qualitative study. Matern Child Nutr. 2020;16(3):e12983. https://doi.org/10.1111/mcn.12983.CrossRefPubMedPubMedCentral

52.

Creswell JW, Creswell JWQiard. Qualitative inquiry & research design : choosing among five approaches. 2nd ed. Thousand Oaks: SAGE; 2007.

53.

Fusch PI, Ness LR. Are we there yet? data saturation in qualitative research. Qualitative Rep. 2015;20(9):1408–16. https://doi.org/10.46743/2160-3715/2015.2281.CrossRef

54.

Pérez-Escamilla R, Segura-Pérez S, Hall Moran V. Matern Child Nutr. 2019;15(3):e12855. https://doi.org/10.1111/mcn.12855.CrossRefPubMedPubMedCentral

55.

West K, Kenen J. The sleep lady®'s good night, sleep tight : gentle proven solutions to help your child sleep without leaving them to cry it out. Revised and updated edition. ed. New York City: Hatchett Books; 2020, vi. p. 471.

56.

Weissbluth M. Healthy sleep habits, happy child : a step-by-step program for a good night's sleep. ballantine books trade paperback edition, fifth edition. ed. New York City: Ballantine group; 2021. 1 online resource.

57.

So B. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–41. https://doi.org/10.1542/peds.2011-3552.CrossRef

58.

Ziegler EE. Consumption of cow’s milk as a cause of iron deficiency in infants and toddlers. Nutrition ReviewS. 2011;69:S37–42. https://doi.org/10.1111/j.1753-4887.2011.00431.x.CrossRefPubMed

59.

USDept of Agriculture. Dietary guidelines for Americans,2020–2025. 9th ed. 2020.

60.

Coles L, Thorpe K, Smith S, et al. Children’s sleep and fathers’ health and well being: a systematic review. Sleep Med Rev. 2022;61:101570. https://doi.org/10.1016/j.smrv.2021.101570.CrossRefPubMed

61.

Lollies F, Schnatschmidt M, Schlarb AA, Genuneit J. Child sleep problems affect mothers and fathers differently: how infant and young child sleep affects paternal and maternal sleep quality, emotion regulation, and sleep-related cognitions. Nat Sci Sleep. 2022;14:137–52. https://doi.org/10.2147/nss.s329503.CrossRefPubMedPubMedCentral

62.

Ragni B, De Stasio S, Barni D, Gentile S, Giampaolo R. Parental mental health, fathers’ involvement and bedtime resistance in infants. Ital J Pediatr. 2019–12–01 2019;45(1). https://doi.org/10.1186/s13052-019-0731-x.

Title: “Struggle at night – He doesn’t let me sleep sometimes”: a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity
Authors: Megan J. Gray
Christian E. Vazquez
Ojasvie Agnihotri
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Obesity
Obesity
Published in: BMC Pediatrics / Issue 1/2022
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-022-03434-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

“Struggle at night – He doesn’t let me sleep sometimes”: a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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