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Sleep Measurement in Toddlers From Low-income Families

Covington, Lauren B., PhD, MS, RN*; Rogers, Valerie E., PhD, RN; Black, Maureen M., PhD‡,§

Journal of Developmental & Behavioral Pediatrics: April 2019 - Volume 40 - Issue 3 - p 219–223
doi: 10.1097/DBP.0000000000000651
Brief Report
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Objectives: (1) To examine toddler sleep in a low-income sample by comparing sleep diaries and actigraphy and (2) to assess whether toddlers are meeting the National Sleep Foundation recommendations (11–14 hours of sleep/24 hours and bedtime before 9 PM).

Methods: A convenience sample of mother-toddler dyads was recruited from 2 health care sites serving low-income communities. An actigraph was placed on the toddler's ankle and was worn for 3 days and nights. Mothers concurrently completed a sleep diary. Bedtime, nighttime sleep duration, nap duration, and 24-hour sleep duration were collected by both measures. Actigraphy data were analyzed using a combination of manufacturer’s scoring algorithm and manual editing. Descriptive statistics and paired samples t-tests were conducted to examine the differences between sleep estimates by a sleep diary and actigraphy.

Results: Twenty toddlers (aged 13–42 months) were included in the analyses. Based on actigraphy, 1 toddler went to bed by 9 PM on all 3 nights. Six toddlers achieved 11 to 14 hours of sleep measured in a 24-hour period for 1 of the 3 days, but when sleep was averaged across the study, none achieved this goal. Compared with actigraphy, sleep diaries underestimated bedtime by 1 hour, overestimated nighttime sleep duration by 2.5 hours, and overestimated 24-hour sleep duration by 2.3 hours, on average for all 3 nights.

Conclusion: Mothers reported significantly earlier bedtimes and longer sleep durations for their toddlers compared with actigraphy, suggesting that objective measures differ from sleep diaries in assessing sleep in toddlers from low-income families. Findings should not be generalized to populations of low-income families without replication.

*College of Health Sciences, School of Nursing, University of Delaware, Newark, DE;

School of Nursing, Department of Family and Community Health, University of Maryland Baltimore, Baltimore, MD;

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

§RTI International, Research Triangle Park, NC.

Address for reprints: Lauren B. Covington, PhD, MS, RN, University of Delaware, School of Nursing, 100 Discovery Boulevard, 5th floor, Newark, DE 19713; e-mail:

Supported in part by funding through the Children's HealthWatch donors, which are listed in L.B. Covington was supported through a grant from Sigma, Global Nursing Excellence, Pi Chapter.

Disclosure: The authors declare no conflicts of interest.

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Received September 23, 2018

Accepted December 26, 2018

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