The Effects of the COVID19-Related Lockdown Are Modulated by Age: An Italian Study in Toddlers and Pre-Schoolers

Abstract

Although the issue has been repeatedly explored, data on the impact of the COVID-19 pandemic on children’s sleep quality are inconsistent. To clarify these discrepancies, here we investigate possible age-related differences. During the lockdown, 112 parents of toddlers (0–3 years, N = 61) and pre-schoolers (4–5 years, n = 51) completed an online survey including the Children’s Sleep Habits Questionnaire (CSHQ). Sleep-related items required an additional retrospective judgment, referring to the pre-pandemic period. During the lockdown, sleep schedules were delayed in both age groups whereas sleep quality (CSHQ total scores) improved in pre-schoolers but not in toddlers. Between-groups comparisons revealed that, prior to the lockdown, pre-schoolers showed worse sleep quality than toddlers, whereas this difference disappeared during home confinement. Also, pre-schoolers’ sleep timing was advanced before the lockdown and delayed during the lockdown relative to toddlers’. Our data highlight a significant modulation of age on the impact of the pandemic crisis on sleep, with pre-schoolers experiencing greater effects than toddlers. This profile suggests that factors affecting sleep features have different weights at different ages: sleep patterns would be mainly determined by developmental factors (i.e., biological drive) in younger children, whereas environmental factors (e.g., major lifestyle changes) would have a stronger effect on older ones.

The Interaction between Lockdown-Specific Conditions and Family-Specific Variables Explains the Presence of Child Insomnia during COVID-19: A Key Response to the Current Debate

“…The preliminary studies that took place in Italy identified a weak impact [ 1 ], and then in following participants during four weeks, suggested they are transient [ 2 ]. Subsequent studies that took place in a mix of countries generally corroborate the observation of a delayed sleep phase, but are conflictual with regard to a negative sleep impact [ 1 , 3 , 4 , 5 , 6 ]. For example, Liu et al [ 5 ] in China found a reduction in sleep disorders in 4–6 year-olds, and Cerasuolo et al [ 6 ] in Italy found an improvement in overall sleep quality also in this age group, but not for children 0–3 years old (in whom sleep was stable).…”

“…Subsequent studies that took place in a mix of countries generally corroborate the observation of a delayed sleep phase, but are conflictual with regard to a negative sleep impact [ 1 , 3 , 4 , 5 , 6 ]. For example, Liu et al [ 5 ] in China found a reduction in sleep disorders in 4–6 year-olds, and Cerasuolo et al [ 6 ] in Italy found an improvement in overall sleep quality also in this age group, but not for children 0–3 years old (in whom sleep was stable). In contrast, Lecuelle et al [ 7 ] in France found a 22% increase in sleep disorders in the young child age group, and Bruni et al [ 8 ] in Italy also found disturbances in young children for sleep variables (e.g., in duration, falling asleep, night awakenings, and parasomnias).…”

“…Note: 1 Comparative Fit Index; 2 Bollen's Incremental Fit Index; 3 Non Normed Fit Index (also known as Tucker-Lewis Fit Index); 4 Root Mean Square Error of Approximation; 5 Goodness of Fit Index; 6 Adjuted Goodness of Fit Index; 7 Minimum function test statistic: null hypothesis corresponds to an ideal model, thus smaller χ 2 values, and hence p-values > 0.05 are preferred for the observed model [73]. See Table S1 in the Supplementary Materials, as well as Schermelleh-Engel and colleagues [81], for more detailed information on the fit indices and their recommended thresholds.…”

“…As screen exposure is strongly linked to sleep disturbance, it is arguably a crucial explanatory variable to account for, since moreover, a large number of COVID-19 studies observed increases in screen exposure for all age groups during lockdown [ 5 , 7 , 8 , 40 ]. As screen exposure was not controlled for in a number of COVID-19 studies [ 2 , 6 , 20 , 45 ], this variable ties into our response that may explain, at least partially, the conflicting results in the literature.…”

“…The Sleep Disturbance Scale for Children (SDSC) [ 60 ] comprehensively evaluates insomnia, and so far, all COVID-19 studies that utilized it found a negative lockdown impact in young children [ 1 , 7 , 8 ]. In contrast, the Children’s Sleep Habits Questionnaire (CSHQ) [ 61 ] also includes behavioral and contextual questions related to sleep, such as “afraid to fall asleep in the dark, afraid to fall asleep alone, falls asleep with rhythmic movements, needs special object”, which may be quite unrelated to insomnia, and indeed, results are mixed for studies that employed this scale [ 5 , 6 , 20 , 61 ], in which absence or even a positive lockdown effect was found in some cases [ 5 , 6 ]. Finally, some studies focused more on changes in children’s circadian rhythms or sleep phases [ 6 , 35 ], rather than a full report on insomnia severity such as with the SDSC.…”