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Perceived Toddler Sleep Problems, Co-sleeping, and Maternal Sleep and Mental Health

Covington, Lauren B. MS, RN*; Armstrong, Bridget PhD; Black, Maureen M. PhD†,‡

Journal of Developmental & Behavioral Pediatrics: April 2018 - Volume 39 - Issue 3 - p 238–245
doi: 10.1097/DBP.0000000000000535
Original Articles
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Objective: Childhood sleep problems are associated with insufficient parental sleep and adverse maternal mental health symptoms, which may be exacerbated when mothers/toddlers co-sleep (i.e., bed/room sharing). This study examines maternal sleep duration as a mechanism linking perceived toddler sleep problems with maternal mental health and examines whether these associations vary by co-sleeping, in addition to exploring alternative models.

Methods: Low-income mothers of toddlers (n = 280) (age 12–32 months) recruited from Women, Infants, and Children and pediatric clinics provided demographic information and completed questionnaires on their toddler's sleep and their own sleep duration and mental health symptoms (depressive symptoms, anxiety, and stress). Indirect and conditional indirect models were conducted to examine the relation between perceived toddler sleep problems and maternal mental health.

Results: Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping (mean = 6.1 h). Maternal sleep duration mediated the relation between perceived toddler sleep problems and maternal symptoms of depression, anxiety, and stress for co-sleeping mothers. Maternal sleep duration did not mediate relations between maternal mental health symptoms and perceived toddler sleep problems.

Conclusion: This study provides a conceptual model by which parent and child sleep is related to parental mental health. Practitioners might consider alternatives to co-sleeping when discussing sleep arrangements with parents. Future studies should replicate results longitudinally and examine whether reducing co-sleeping improves maternal sleep duration and reduces perceptions of toddler sleep problems.

*University of Maryland School of Nursing, Baltimore, MD;

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD;

RTI International, Durham, NC.

Address for reprints: Maureen M. Black, PhD, Department of Pediatrics, University of Maryland School of Medicine, 737 West Lombard St, Room 161, Baltimore, MD 21201; e-mail:

Supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), R01HD056099 [to M.M. Black].

Disclosure: The authors declare no conflict of interest.

L. B. Covington and B. Armstrong wrote the first draft of the manuscript. M. M. Black reviewed and revised the manuscript. All authors contributed to the conceptualization of the manuscript and interpretation of the findings and approved the final submission. The study sponsor did not have involvement in the design, data collection, analysis, interpretation of data, writing of the report, or the decision to submit the paper for publication. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Clinical Trials Registration: NCT02615158.

See the Video Abstract at

Received June 05, 2017

Accepted October 25, 2017

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