Who Gets What? Describing the Non-supervisory Training and Supports Received by Home Visiting Staff Members and its Relationship with Turnover.

The early childhood home visiting field lacks a basic understanding of home visiting program staff members' receipt of on-the-job training from experts outside of their programs who are not their immediate colleagues or supervisors. To address this gap, we created a unique dataset by asking program leaders to log the external technical assistance (TA) that staff members received, and we collected a survey from 288 of the same staff members. We performed descriptive analyses to learn how many hours of TA staff members were receiving, what topics the TA most commonly addressed, and what formats (e.g., in-person or virtual/remote, individual, or group) the TA was most commonly provided in. We then associated characteristics of the TA received with staff and program characteristics, as well as with staff members' turnover. Multilevel analyses showed the TA supports that home visiting staff members received differed by role (home visitor or supervisor) and program characteristics, including home visiting model-Nurse Family Partnership (NFP) or Parents as Teachers (PAT)-program size, and maturity. About 23% of the home visiting staff members left their programs over the course of 18 months. PAT staff members were more likely to leave their programs than NFP staff members. We did not find that characteristics of TA received were predictive of staff members' turnover. Implications and the need for further research are discussed.

Toddler naps in child care: associations with demographics and developmental outcomes.

OBJECTIVES: The objectives were to characterize the rate, duration, and factors associated with napping in a large, nationally representative sample of toddlers attending child care. DESIGN: We analyzed a subset of data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort, including parent report, caregiver report, and observational measures. PARTICIPANTS: Data were limited to the 3050 participants reporting that their 2-year-old routinely spent greater than 1 hour per week in nonparental child care. MEASUREMENTS: Interviews were completed to measure child care type (relative, nonrelative, center-based), demographics, bedtime characteristics (eg, presence of a bedtime routine, assistance needed to fall asleep), and naptime. The Bayley Scales of Infant Development-Research Edition was used to measure child outcomes. RESULTS: Napping was reported to occur in 91% of 2-year-olds, with most naps reported to last 2 hours. Significant racial and ethnic differences were found in nap duration, with black children napping longer and Latino children napping shorter than white children, controlling for socioeconomic status and sex. Children cared for by relatives had longer naps than those in nonrelative child care. There were no significant relationships between naps and child outcomes. CONCLUSIONS: Results highlight racial and ethnic differences in daytime napping duration and interesting differences in nap duration in different child care settings. Child care providers may use these results to adopt appropriate expectations, policies, and practices for 2-year-old napping.

Maternal sleep and depressive symptoms: links with infant Negative Affectivity.

This study assessed whether elevated severities of maternal depression and disturbed maternal sleep would be associated with maternal perceptions of higher Negative Affectivity of her infant. Sixty-nine mothers participated in this study. The study was part of a larger randomized controlled study testing the efficacy of acupuncture as a treatment for depression during pregnancy. The present study focused on data collected at 6 months postpartum in a naturalistic follow-up design, using the Hamilton Rating Scale for Depression (HRSD), maternal sleep diaries (completed daily for 1 week), and the Infant Behavior Questionnaire-Revised (IBQ-R). Regression analyses revealed that (a) maternal depression severity was a significant predictor of the IBQ-R Distress and Falling Reactivity scales and (b) poor maternal sleep was a significant predictor of the IBQ-R Sadness scale. Our findings support previous findings of significant links between maternal emotional distress and perceived Negative Affectivity of her infant's temperament and provide a novel insight linking maternal poor sleep with perceived sadness of the infant.

A longitudinal follow-up study of young children's sleep patterns using a developmental classification system.

Sixty-eight families participated in a longitudinal study that included video observations of sleep during the 1st year of life and annual follow-up phone interviews until the children were 4 years of age. Results revealed that approximately 19% of children have a sleep problem at 2 years of age, defined either by research criteria or parental report, and that sleep problems diminished over time. Approximately 25% of children were reported to be cosleeping at each follow-up interview, but only a third of the parents reported this behavior to be problematic. A subgroup of infants (33%), who were considered stable, non-self-soothers in the 1st year, were more likely to have a sleep onset problem and be cosleeping at the 2-year follow-up assessment.

A comparison of the sleep-wake patterns of cosleeping and solitary-sleeping infants.

This study examined whether 3-15, month-old cosleeping infants displayed differences in time spent in active versus quiet sleep, and in the number/duration of nighttime awakenings when compared with solitary-sleeping infants; and also whether they spent the majority of the night sleeping face-to-face, as previously reported. Nine cosleeping and nine solitary-sleeping infants were matched on age, gender, ethnicity, maternal age, and family SES. Video recordings of nighttime sleep yielded percentage of time in active sleep, quiet sleep, and awake, number of wakenings, and the percentage of time cosleeping infants and mothers spent face-to-face. Across age, cosleeping infants had more awakenings per night mean 5.8(1.50) versus 3.2(1.95); t = 3.16, p = .006). The percent of the nighttime spent awake did not differ between groups, suggesting that cosleeping infants had shorter awakenings. Cosleeping infants spent 40% of the night face-to-face with their mothers.

Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy.

OBJECTIVE: To compare the structural growth and developmental outcome of children born to mothers diagnosed with major depressive disorder during pregnancy who were exposed or not exposed to selective serotonin reuptake inhibitors (SSRIs) in utero. STUDY DESIGN: Children whose mothers were diagnosed with major depressive disorder in pregnancy and elected not to take medication (n = 13) were compared with children of depressed mothers treated with SSRIs (n = 31) on birth outcomes and postnatal neurodevelopmental functioning between ages 6 and 40 months. Children underwent blinded standardized pediatric and dysmorphology examinations and evaluations of their mental and psychomotor development with the use of the Bayley Scales of Infant Development (BSID II). RESULTS: The Bayley mental developmental indexes were similar in both groups. Children exposed to SSRIs during pregnancy had lower APGAR scores and scored lower on the Bayley psychomotor development indexes and the motor quality factor of the Bayley Behavioral Rating Scale than unexposed children. CONCLUSIONS: The findings that SSRIs during fetal development might have subtle effects on motor development and motor control are consistent with the pharmacologic properties of the drugs.

Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study.

BACKGROUND: The objectives of this study were to: (1) describe the longitudinal development of sleep-wake patterns of solitary-sleeping infants from 1 to 12 months of age, (2) identify effects on sleep patterns and on self-soothing behaviors of introducing a novel sleep aid, and (3) identify predictive factors of self-soothing at 12 months using a transactional model as a guide. METHODS: Eighty infants' nighttime sleep-wake patterns and associated variables were studied at 5 times across the first year of life using videosomnography and questionnaires. RESULTS: Sleep-wake state developmental changes, as reported in investigations of infant sleep, were replicated, although a great deal of individual variability in the development of all sleep-related variables was noted. No major effects on sleep or on self-soothing behavior were evident from the introduction of the novel sleep aid. Three variables were identified as significant predictors of self-soothing at 12 months: decreasing amounts of time spent out of crib across the first year, high levels of quiet sleep at birth, and longer parental response times to infant awakenings at 3 months. CONCLUSIONS: These data lend preliminary support for the transactional model and suggest that infant and parental factors interact to influence the development of self-soothing.

Use of sleep aids during the first year of life.

OBJECTIVE: In an attempt to foster self-soothing during the night, a novel sleep aid infused with maternal odor was introduced to 4 groups of infants ranging in age from 3 to 12 months. Infants' use of parent-provided sleep aids also was examined. METHODOLOGY: Nighttime sleep and waking behaviors were videotaped for 2 consecutive nights on 3 occasions over a 3-month interval. Using all-night video recording, the study examined the infant's use of a novel sleep aid and parent-provided sleep aids during sleep onset and after nighttime awakenings. RESULTS: Results indicated that infants of different ages differed in the types of sleep aids used when falling asleep either at the beginning of the night or after awakenings in the middle of the night. More 3-month-olds used their thumbs/fingers/hands, whereas more 6-month-olds used soft objects. The 6-month-olds were most likely to use the novel sleep aid. Almost all of the infants at all 4 ages used some type of object during the night. Intra-individual analyses showed that infants tended to change their pattern of sleep aid use over the 3-month study period. CONCLUSIONS: The data provide evidence that infants during the first year of life use sleep aids frequently and interchangeably rather than a specific favorite object.

Sleep patterns of children with pervasive developmental disorders.

Data on sleep behavior were gathered on 100 children with pervasive developmental disorders (PDD), ages 2-11 years, using sleep diaries, the Children's Sleep Habits Questionnaire (CSHQ), and the Parenting Events Questionnaire. Two time periods were sampled to assess short-term stability of sleep-wake patterns. Before data collection, slightly more than half of the parents, when queried, reported a sleep problem in their child. Subsequent diary and CSHQ reports confirmed more fragmented sleep in those children who were described by their parents as having a sleep problem compared to those without a designated problem. Interestingly, regardless of parental perception of problematic sleep, all children with PDD exhibited longer sleep onset times and greater fragmentation of sleep than that reported for age-matched community norms. The results demonstrate that sleep problems identified by the parent, as well as fragmentation of sleep patterns obtained from sleep diary and CSHQ data, exist in a significant proportion of children with PDD.