A number of variables have been demonstrated to affect children's sleep patterns:

• temperament

• pregnancy and birth events(5)

• medical and developmental events(1,)

• environmental factors and parenting practice.(6)

Chronic illness may have an impact on a young infant's sleeping pattern. Asthma, middle ear infections, milk allergy, or gastrointestinal disturbance will all disrupt a child's sleep. Premature babies are also like to have more sleep problems that full-term babies, although the reasons for this are unclear. The babies may have more immature gut and nervous systems, which may make them more irritable and less able to settle into patterns, or the parents may be more anxious and have difficulty separating once the infant returns home. (D

Assessment of the impact of the parents' response to the infant's waking is critical when determining aetiology. A psychodynamic perspective proposes that sleep problems develop when mothers have difficulty in attachment and separation from their infants. The parents own unconscious fears and desires restrict their ability to separate.(8) A behavioural perspective recognizes that parents' behavioural responses to their infant's waking or inability to settle to sleep can maintain the poor settling and night waking.(6) Adair et al. found that 9-month-old infants are more likely to wake at night (40 per cent) if their parents are present when they fell asleep at bedtime than infants whose parents are absent (22 per cent).(9)

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