Cross Cultural Differences in Toddler and Infant Sleep

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. (2010). Cross-cultural differences in infant and toddler sleep. Sleep Medicine, 11(3), 274-280.

Child sleep problems are based more on culturally-influenced parental perceptions than actual biological reasons, and nighttime sleep issues tended to be perceived more problematic than daytime naps.

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Sample

  • N: 29,287
  • Subject Ages: Birth to 36 months
  • Location:
    • Predominantly Asian (P-A) countries and regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam
    • Predominantly Caucasian (P-C) countries: Australia, Canada, New Zealand, United Kingdom, United States
  • SES: Variable
  • Eligibility: Parents who completed the questionnaire
  • Additional:
    • Urban samples
    • 48.1% boys
    • 89.7% mothers
    • 75.7% parents were between 25 and 35 years old
    • 83.7% parents had some college education
    • 52.1% parents were employed full-time
    • There were significant differences between P-A and P-C for birth order, sex, age of respondent, education of respondent and employment status.

Objectives

  1. To characterize sleep patterns, sleep behaviors and sleep problems in a large sample of children ages birth to 36 months in multiple P-A and P-C countries/regions.
  2. To assess sleeping arrangements and parental perceptions of sleep problems in these young children.

Variables Measured, Instruments Used

  • Daytime and nighttime sleep patterns, sleep-related behaviors, sleeping arrangements (bed-sharing and room-sharing) and bedtime, child’s behavior during the last two weeks - Brief Infant Sleep Survey questionnaire expanded, Internet-based

Design—Cohort, cross-cultural

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Findings

  1. Statistically significant cross-cultural differences were found in sleep patterns and problems.
  2. Children in the predominantly Asian (P-A) countries were reported by their parents to sleep less, have later bedtimes, room-share, and be perceived as having more sleep problems than children in predominantly Caucasian (P-C) countries
  3. Parentally defined sleep problems are clearly a universal issue. Parents in all 17 countries/regions reported significant sleep issues. Surprisingly, though, some of the largest country/region-based differences were how sleep was perceived as a problem by parents, ranging from a low of 10.1% in Vietnam to 75.9% in China.
  4. Minimal differences were found for daytime sleep (naps), with all children in this study following the same maturational pattern in napping behaviors. These results indicate a strong biological contribution to daytime sleep, rather than what appears to be a stronger culturally based influence to nighttime sleep.

Limitations

  • Cohort has an above-average level of education and is primarily urban.
  • This Internet survey did not prevent a person from participating more than once and could not ensure whether the participant had a child.
  • Parents with concerns about a child’s sleep may have been more likely to participate.
  • Participants in Vietnam and Thailand completed the survey by paper and so may have responded differently or have had different characteristics than those who completed the survey on the Internet.
  • Parental reports of infant behavior are necessarily limited as they may be inaccurate. Terms such as “sleep problem” may differ across cultures.
  • This study is broad in its geographic scope and does not provide information about the vast differences that might exist among subcultures and different ethnicities in a given country or region.