World Journal of Pediatrics最新文献

Background: Bedtime problems and night wakings are common in children under six, particularly in China. The current study summarizes the core tenets of the "Chinese guideline for the treatment of bedtime problems and night wakings in children under 6 years of age (2023)", and discusses the associated challenges and suggestions for practices relevant to both domestic and international contexts.

Data sources: This review draws on literature from PubMed and Web of Science, published up to 2025, combined with evidence from the guide itself, as well as relevant consensus statements and expert recommendations.

Results: The guideline provides three strong recommendations, including behavioral intervention, early sleep hygiene education, and bedtime massage; four conditional recommendations under professional supervision, including separate sleeping arrangements, white noise, melatonin and iron supplementation; and three non-recommended interventions, including pacifier use, early complementary feeding, and daytime physical activity. Challenges in assessment and treatment involve the absence of standardized diagnostic criteria, reliance on subjective reports, multifactorial etiology with frequent comorbidities, and culturally embedded family sleep practices. Comprehensive evaluation requires integrating both subjective and objective measures while accounting for medical, behavioral, and environmental factors within cultural frameworks. Intervention should be individualized through shared decision-making with parents, combining modalities based on etiological profiling, with non-pharmacological strategies constituting first-line management.

Conclusions: Effective management for bedtime problems and night wakings in young children requires standardized tools, and culturally adaptable, and family-centered interventions according to evidence-based guidelines. Strengthening professional training and parental education is crucial for guideline implementation and improved pediatric sleep health.

Background: Sleep-related movement disorders (SRMDs), such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD), are common in pediatric sleep practice. There is increasing literature on RLS, PLMD, and a newly described sleep disorder called "restless sleep disorder (RSD)". We aimed to review and provide recent updates on SRMDs.

Data sources: A comprehensive search for relevant English-language peer-reviewed publications focused on three common SRMDs, namely, RLS, PLMD and RSD, in a variety of indices in PubMed and SCOPUS. Both relevant databases and systematic reviews are included.

Results: SRMDs, especially RLS and PLMD, are common in children and adolescents. However, they are underrecognized. Genetics, abnormal dopaminergic functions, and iron deficiency are the main pathophysiologies of RLS and PLMD. RLS and RSD may share common pathophysiologic mechanisms, as evidenced by low iron stores in both conditions. The diagnoses of RLS, PLMD, and RSD require specific clinical criteria and polysomnographic features. Several comorbid conditions have been associated with RLS, PLMD, and RSD. Iron therapy has been shown to be effective for treating RLS, PLMD, and RSD. There is increasing evidence on the effectiveness of specific medications in children with RLS and PLMD, but the data are still limited.

Conclusions: This review summarizes the pathophysiology, clinical manifestations, diagnostic criteria, and management of RLS, PLMD, and RSD in children based on relevant and recent literature. It is important for pediatricians to recognize the clinical presentation of RLS, PLMD, and RSD to facilitate early diagnosis. Further studies are needed to examine the pathogenesis, long-term consequences, and pharmacologic therapy of RSD in children.

Background: The impact of melatonin on pediatric populations has not yet been widely researched. This narrative review is intended to summarize the current literature regarding the efficacy and safety of melatonin for children and potential pitfalls in its clinical use, in order to assist pediatric practitioners in making evidence-based recommendations that serve the best interests of their patients and families.

Data sources: A literature review of melatonin in the pediatric population was conducted using PubMed search terms: melatonin, pediatrics, child/adolescent.

Results: Melatonin use in the pediatric population world-wide has increased significantly over the past several decades. While a number of studies, largely in children with neurodevelopmental disorders with insomnia, have suggested that melatonin is generally safe and well-tolerated, a similar body of evidence is overall lacking for typically developing children and prospective studies regarding long-term adverse events are lacking. In addition, recent studies have raised concerns regarding the variable content of melatonin in over-the-counter products, as well as safety issues relating to accidental ingestions.

Conclusions: Due to a number of concerns regarding inappropriate use, lack of efficacy and safety data across pediatric populations and variability in actual content, melatonin should be used with caution in children and only under medical supervision.

Background: The relationship between daily affective states and subjective sleep measures is known to be reciprocal in both adults and children. However, its consistency across infancy to early adolescence and varying sociocultural contexts remain unclear. We investigated the bidirectional relationship between happiness and sleep quality in children from the U.S. and China and examined the predictive role of maternal prenatal psychosocial support.

Methods: A total of 1300 children aged 11-12 years in the U.S. Healthy Brain and Behavior Study (HBBS) and China Jintan Child Cohort (CJCC) studies were included in the analyses. Happiness and sleep quality from infancy to early adolescence were retrospectively reported by mothers. Prenatal psychosocial factors were recalled by mothers through a structured interview. Random-intercept cross-lagged panel modeling was conducted to analyze the data.

Results: Happiness and sleep quality trajectories differed significantly between U.S. adolescents in the HBBS and Chinese adolescents in the CJCC (P < 0.001). In both cohorts, cross-lagged effects showed consistent associations between happiness and subsequent sleep quality across the five time points (coefficients: 0.086-0.154, P < 0.01). The relationship between sleep quality and subsequent happiness was significant from 1-3 to 11 years. The bidirectional relationship was stronger in the Chinese cohort. Maternal prenatal psychosocial support positively predicted children's happiness (β = 0.072, P < 0.001) and sleep quality (β = 0.056, P < 0.001) trajectories.

Conclusions: A bidirectional relationship exists between children's happiness and sleep quality, with potential cultural variations. Maternal prenatal psychosocial support plays a key role in fostering children's long-term emotional well-being and sleep quality.

Background: The Chinese version of the Children's Sleep Habits Questionnaire (CSHQ-CH) has been widely used in clinical practice and research since it was developed in 2007. This study aimed to examine the psychometric properties of the revised version (CSHQ-CH-R) and establish cut-off values for screening for sleep disturbances in Chinese preschool-aged and school-aged children.

Methods: A community sample of 3850 preschool and school-aged children aged 3-12 years were obtained from 6 kindergartens and 2 primary schools in Shanghai, Beijing and Chengdu, China, from December 2019 to February 2020. A clinical sample of 119 children aged 3-12 years who were diagnosed with sleep disorders were recruited from a tertiary pediatric hospital in Shanghai from September 2019 to November 2021. Caregivers completed the original 33 items of the CSHQ-CH plus an additional 15 items through an online platform. Item analysis was conducted to develop the CSHQ-CH-R, which included discriminative validity, redundancy and ambiguity. Internal consistency, interobserver reliability, test-retest reliability, concurrent validity (correlations with actigraphy) and discriminative validity were then analyzed. The cut-off values for both the full scale and subscale scores were generated by receiver operating characteristics.

Results: The final version of the CSHQ-CH-R included 30 items and 8 subscales. Three subscales (bedtime resistance, sleep duration and daytime sleepiness) were revised, and the other five subscales were unchanged from those of the CSHQ-CH. The internal consistency for the full scale was 0.83 for the community sample, and 0.73 for the clinical sample. The internal consistency ranged from 0.47 (sleep duration) to 0.72 (bedtime resistance) for the community sample, and 0.38 (sleep duration) to 0.83 (sleep-disordered breathing) for the clinical sample. The interobserver reliability for the full scale was 0.55, and ranged from 0.38 (parasomnias) to 0.74 (bedtime resistance) for the subscales. The test-retest reliability was 0.70 for the full scale, and ranged from 0.54 (sleep duration) to 0.78 (bedtime resistance) for the subscales. Concurrent validities against actigraphy were 0.62 and 0.33 for "time in bed" and "night sleep duration", respectively. The clinical sample scored higher than the community sample did for the full scale and subscales (P < 0.01). A cut-off total score of 44 was determined, with an area under the curve of 0.76, a sensitivity of 0.64, and a specificity of 0.76. To facilitate cross-cultural comparisons, psychometric properties and cut-off values for the CSHQ-CH with the original 33 items were also provided.

Conclusion: The CSHQ-CH-R exhibits satisfactory to good psychometric properties, indicating its suitability for identifying sleep problems among Chinese preschool- and school-aged children.

Background: Preschoolers and young children are vulnerable to psychosocial and behavioral disorders linked to lifestyle factors such as screen time and sleep disturbances. Our study examines the relationship between screen time and adherence to recommendations with children's behavioral and emotional difficulties, with a focus on the role of sleep duration.

Methods: Cross-sectional analyses were conducted within the multicenter prospective Childhood Obesity Risk Assessment Longitudinal Study (CORALS), which included 1420 children aged 3-6 years. Screen time (hours/day) and adherence to recommendations (≤ 2 hours/day) were assessed. Behavioral and emotional difficulties were measured via the strengths and difficulties questionnaire. Multivariable linear and logistic regression models were used to estimate associations between screen time (continuous and dichotomous) and strengths and difficulties questionnaire scores, adjusting for potential confounders. We also tested the moderating effect of sleep and conducted isotemporal substitution analyses replacing screen time with sleep duration.

Results: Higher screen time was associated with higher total strengths and difficulties questionnaire scores [β 95% confidence interval (CI), 0.35 (0.10, 0.61)], emotional symptoms [0.10 (0.01, 0.19)], conduct problems [0.10 (0.01, 0.18)], and greater odds of exceeding the 16-point strengths and difficulties questionnaire cutoff for behavioral and emotional difficulties [odds ratio (OR) (95% CI), 1.21 (1.04, 1.41)]. Children who adhered to screen time recommendations had lower strengths and difficulties questionnaire total scores [β (95% CI), - 0.64 (- 1.19, - 0.10)] and odds of experiencing behavioral and emotional difficulties [OR (95% CI), 0.67 (0.47, 0.95)]. Sleep duration moderated the screen time-strengths and difficulties questionnaire association (P = 0.020). The isotemporal substitution of screen time for sleep duration was associated with lower strengths and difficulties questionnaire scores across all subscales, except for prosocial behavior.

Conclusions: Higher screen time was associated with greater emotional and behavioral difficulties, whereas adherence to screen time recommendations and adequate sleep duration were inversely associated. Managing screen time and promoting sleep are crucial for children's well-being.

Background: This study compared multilevel factors associated with sleep duration and bedtime regularity in children with and without neurological and developmental disorders (NDD) using a nationally representative sample.

Methods: We combined data from the 2016-2017, 2018-2019, and 2020-2021 United States National Survey of Children's Health (NSCH), including 86,014 children aged 9-17 years. Parent-reported outcomes included adequate sleep duration (yes/no) and bedtime regularity (yes/no). We assessed the relationship between twenty independent individual, social, and environmental variables on the sleep outcomes. We used random survival forest decision trees to identify the five most predictive variables [in terms of variable importance (VIMP)]. Regression analyses were then used to assess directionality and independent associations.

Results: A greater proportion of children with NDDs versus those who are typically developing (TD) had parent reports of not achieving adequate sleep duration (34.0% versus 30.9%, respectively) and bedtime regularity (18.8% versus 13.7%, respectively). For adequate sleep, achieving bedtime regularity, having more family meals together and older age emerged as the most important independent variables for both TD children and those with NDDs. For bedtime regularity, achieving adequate sleep, and having more family meals together were the most proximal independent variables for NDD and TD children.

Conclusion: Increasing the frequency of family meals and addressing both sleep duration and bedtime regularity may serve as key modifiable intervention targets to improve sleep health in children, including those with NDDs.

Background: Good sleep quality, appropriate sleep timing, and mindfulness support emotional and mental health well-being. However, few studies have examined their role in the association between neuroticism and subjective well-being (SWB) among adolescents. This study investigated their potential moderating and mediating effects on the neuroticism-SWB relationship in early adolescents.

Methods: We enrolled 1110 adolescents in the China Jintan Child Cohort-Wave II study, with 543 providing complete data on sleep, neuroticism, and SWB (2011-2013, 12.98 ± 0.88 years old, 49% females) and 188 providing trait mindfulness data (2013-2014). The sleep variables included sleep quality (Pittsburgh sleep quality index) and chronotype (mid-sleep time on weekends corrected for sleep debt). SWB was measured via the Oxford happiness questionnaire, neuroticism was measured via the Big Five Inventory, and mindfulness was measured via the five facet mindfulness questionnaire. Linear regression was used to estimate the moderating effect, and generalized structural equation modeling was used to examine the mediating effects.

Results: Neuroticism (b = -5.07, P < 0.001) significantly predicted lower SWB, which was mediated by poor sleep quality (β = -3.76, P = 0.002) and trait mindfulness (β = -2.13, P = 0.002). No moderating effects were found for sleep quality or mindfulness (P > 0.05). Chronotype was not a moderator or a mediator between neuroticism and SWB, although a moderate (vs. late) chronotype was independently associated with better SWB (b = 5.91, P = 0.04).

Conclusions: Poor sleep and mindfulness mediate, but do not moderate, the relationship between neuroticism and SWB. While the late chronotype predicts poorer SWB, it does not contribute to the neuroticism-SWB relationship. The findings underscore the importance of healthy sleep and mindfulness-based strategies to support well-being in early adolescents high in neuroticism.