Are parenting behaviors associated with child sleep problems during treatment for acute lymphoblastic leukemia?

Abstract

Sleep disturbance is a recognized common side effect in children treated for acute lymphoblastic leukemia (ALL). Although associated with treatment factors such as hospitalization and corticosteroids, sleep problems may also be influenced by modifiable environmental factors such as parenting behaviors. The purpose of this study was to examine sleep problems in children undergoing treatment for ALL compared to healthy children and whether parenting practices are associated with sleep difficulties. Parents of 73 children aged 2–6 years who were (1) in the maintenance phase of ALL treatment (ALL group, n = 43) or (2) had no major medical illness (healthy control group, n = 30) participated in the study. Parents completed questionnaires measuring their child's sleep behavior and their own parenting practices. Parents of children undergoing ALL treatment reported significantly more child sleep problems; 48% of children with ALL compared to 23% of healthy children had clinical levels of sleep disturbance. Parents of the ALL group also reported significantly more lax parenting practices and strategies associated with their child's sleep including co‐sleeping, comforting activities, and offering food and drink in the bedroom. Results of multivariate regression analysis indicated that, after controlling for illness status, parent–child co‐sleeping was significantly associated with child sleep difficulties. Strategies employed by parents during ALL treatment may be a potential modifiable intervention target that could result in improved child sleep behaviors. Future research aimed at developing and testing parenting interventions aimed to improve child sleep in the context of oncology treatment is warranted.

Adverse mental health outcomes in a population‐based cohort of survivors of childhood cancer

“…37 Our findings are consistent with those from the Danish population-based cohort study, which demonstrated a 38% elevation in the risk for contact with hospital psychiatric departments. 38,39 Other studies have demonstrated that parenting stress and perceived childhood vulnerability negatively impact adjustment in their children. Similarly, we demonstrated that patients diagnosed at ages 0 to 4 years were one-third more likely than older children to experience a severe psychiatric event later in life.…”

High prevalence of parent‐reported sleep problems in pediatric patients with acute lymphoblastic leukemia after induction therapy

“…Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer and it requires an intensive treatment regimen of frequent chemotherapy administrations over the course of 2‐3 years . During maintenance treatment, a relatively stable phase in which most children resume their daily activities, sleep problems are common and often include a behavioral component . Sleep duration is often adequate, but nighttime awakenings are frequent and sleep onset latency (defined as the minutes between bedtime and the first minute of sleep) is longer .…”

“…Some risk factors for sleep problems in childhood cancer patients have previously been identified, such as glucocorticoid treatment, younger age, sex, and co‐sleeping . In young and severely ill children, patient‐reported outcomes (PROs) often depend on parental reports.…”

“…In young and severely ill children, patient‐reported outcomes (PROs) often depend on parental reports. The potential influence of parental functioning and parenting behaviors on these outcomes is often not taken into account . However, sleep problems are common in parents of pediatric cancer patients, with prevalence rates up to 71% in the hospital setting .…”

Measuring cancer‐specific child adjustment difficulties: Development and validation of the Children's Oncology Child Adjustment Scale (ChOCs)

“…Additionally, despite the development of cancer‐specific measures examining family impacts, parent emotional responses and child quality of life, specific measures to evaluate child behavioral impacts are lacking . We have previously identified specific issues related to child adjustment in pediatric oncology, namely, eating, sleep, and externalizing behavior, that have deleterious effects on child outcomes and are a significant source of stress for parents . This study aimed to develop and validate a parent‐report questionnaire measuring child adjustment difficulties that can identify adjustment issues for children during treatment and early survivorship; and focuses on difficulties with sleep, eating, oppositional behaviors, and emotional difficulties associated with cancer.…”