Night-time sleep in preschool-aged children; the factors influencing sleep duration and the lived experience of Māori whānau

Abstract

Aims: The aims of this study were to identify what behaviours affect the sleep duration of preschoolaged children, to explore barriers to sleep in Māori tamariki and identify interventions to improve sleep that would be acceptable to Māori. Introduction: Sleep is one of the three pillars of health, with inadequate sleep associated with obesity(1-3) and negative effects on emotional wellbeing and learning(4-6). Data from the New Zealand Health Survey 2019 shows that there are inequities between Māori and Pākehā in the amount of sleep preschool-aged children are having(7). Sleep is influenced by behaviours in the home but also societal factors, including housing, early childhood education and parental employment(8). Methods: A mixed-methods approach was used. An online survey of 819 caregivers was conducted on sleep duration, screen use, parenting styles, bedtime routine components and household chaos. Regression analysis was performed to identify what parenting behaviours were associated with sleep duration. In-depth semi-structured interviews were conducted with Māori māmā and key informants who work in Māori or sleep health and analysed using thematic analysis. Results: The key findings from this study were that 22.3% of participants reported that their child slept for less than 10 hours a night, with 16.9% of Pākehā and 24.3% of Māori children reportedly sleeping less than 10 hours a night. Screen use at bedtime was significantly associated with shorter nocturnal sleep, whereas cuddles, reading and brushing teeth were significantly associated with longer nocturnal sleep. However, as this study is cross-sectional no conclusions about causation can be made. Themes identified from the semi-structured interviews were knowledge and beliefs, day affects night, the sleep environment and parenting and support. Key findings were the lack of sleep knowledge healthcare workers had, and the lack of support they provided whānau around sleep difficulties, how inadequate housing affects sleep and how current sleep promotion tools are often not relevant to the lived experience of Māori. Conclusion: The findings of this study suggest a significant proportion of children in New Zealand are not meeting sleep recommendations and that whilst some improvements to sleep length can be made by altering the behaviours within the house, external influences such as inadequate housing and work factors also exert a significant influence. Improving knowledge of parents and healthcare workers, as well as developing culturally appropriate tools may help improve inequities in sleep.