Sleepingproblems in young children; prevention and intervention in Youth Healthcare.

Sleepingproblems are common in young children; international studies have shown a prevalence of 20-30% in infants, toddlers and pre-schoolchildren. Correlations have been shown between sleepshortage in children and behavioural, cognitive and social problems, parental stress, family problems and childabuse. Furthermore, in children of all ages, a consistent relationship has been found between sleepshortage and overweight and obesity. It can be expected that when sleep improves in children, these problems can be reduced, and health and well-being of both child and parent can be improved. A recent meta-analysis study showed that giving parents information about sleep prior to the existence of sleepingproblems can have a preventive effect on the development of sleepingproblems in children. When sleepingproblems are already present, behavioural therapy based on extintion and stimuluscontrol is most effective.



This study will examine the effectiveness of two interventions: A preventive and a therapeutical intervention, both carried out by Youth Healthcare nurses. The preventive intervention consists of giving information about sleep to parents of children younger than 2 months old. We expect that this will reduce the prevalence of sleepingproblems in these children between the age of 2 to 18 months old, as compared to care-as-usual. 2400 children will be included in this study. The therapeutical intervention consists of a modified behavioural intervention based on extinction ('sleeping problems in children' by Schregardus, 2001) given to children aged 6 months to 4 years old with moderate to severe sleepingproblems. 350 children will be included in this study. We expect to see a reduction of sleeping problems (bedtime problems, night wakings and sleepshortage) and of behavioural problems related to sleep. Secundary outcomes are improvement of parenting style, reduction of parenting problems and improvement of well-being and psychosocial problems of the parents (reduction of stress, tiredness, depression). In both studies, the control group receives care-as-usual as offered by the Youth Healthcare organisation.



This study will, in addition to existing knowledge about the treatment of excessive crying in Youth Healthcare, lead to accesible evidence-based interventions for the prevention and treatment of sleepingproblems in young children.

1. Giving specific information about sleep to parents with children younger than 2 months old will reduce the prevalence of sleepingproblems in children in the age of 2 months to 4 years;

2. The modified behavioural intervention of Schregardus is more effective in reducing the degree and intensity of sleepingproblems in children in the age of 6 months to 4 years old than to care-as-usual, and is expected to improve parenting competence.

1. T0: at inclusion (sleeping problems, behavioural problems of the child, parenting, psychosocial problems of parents);

2. T1: 1 week after intervention (sleeping problems, behavioural problems of the child);

3. T2: 3 weeks after intervention (sleeping problems, behavioural problems of the child);

4. T3: 6 weeks after intervention (sleeping problems, behavioural problems of the child);

5. T4: 6 months after intervention (sleeping problems, behavioural problems of the child, parenting, psychosocial problems of parents).

Behavioural therapeutical intervention: Modified intervention of schregardus with patient-preference (parents can choose between direct extinctin and gradual extinction).

Control group receives care-as-usual as offered in Youthhealthcare.