Sleep Patterns, Problems and Ecology among Toddlers in Families with a Child Protective Services Maltreatment Referral.

Purpose: To describe sleep patterns, problems, and ecology among toddlers (13 to 36 months) from families referred to Child Protective Services (CPS) for maltreatment and to compare sleep duration among a subgroup (24- to 36-month-olds) to previously published population-based data.

Design And Methods: A secondary analysis of a larger longitudinal study was conducted. Participants included 113 parent-toddler dyads recruited out of CPS offices based on having a recent maltreatment referral. Parents reported about their toddler's sleep at two time points (approximately six months apart).

Results: At the earlier and later time points, respectively, mean sleep duration was 11.03 and 10.90 h (nighttime), 1.36 and 1.36 h (daytime), and 12.47 and 12.28 h (total 24-h). Of the toddlers, 24% and 17% had two or more nighttime awakenings, 34% and 33% had at least a somewhat hard time falling asleep, and 25% and 26% had difficulty sleeping alone. Mean bedtimes were 8:50 pm and 8:58 pm. Nighttime sleeping arrangement/location, nap arrangement/location, and method of falling asleep at night varied. Compared to the population-based data, nighttime sleep duration was 43 min longer and nap duration was 46 min shorter in the CPS sample.

Conclusions: Symptoms of behavioral sleep problems were common in this sample of toddlers from families referred to CPS for maltreatment. Distribution of sleep, but not total 24-hour sleep, differed significantly between the CPS sample and the population-based data.

Practice Implications: Nurses caring for toddlers from families involved with CPS can play an integral role promoting sleep health and addressing behavioral sleep problems.