Elsevier

Sleep Medicine

Volume 32, April 2017, Pages 83-86
Sleep Medicine

Original Article
Sensory profile in infants and toddlers with behavioral insomnia and/or feeding disorders

https://doi.org/10.1016/j.sleep.2016.12.009Get rights and content

Highlights

  • Sleep and feeding difficulties tend to coexist in early childhood.

  • Parental report on sensory profile of children with BI and/or FD was different compared to healthy controls.

  • The differences in sensory profile may underlie the development and partially explain the coexistence of the two disorders.

Abstract

Background

Sleep and feeding difficulties are two common disorders in early childhood. It has been shown that feeding difficulties are more common among children with sleep disorders and vice versa. Since a child's characteristics play a substantial role in these two conditions, we aimed to investigate the sensory profile of infants and toddlers with behavioral insomnia (BI) or feeding disorders (FDs) in comparison with healthy age-matched controls.

Methods

Children aged 7–36 months with BI or FD were recruited from the sleep and feeding disorders clinics. Healthy controls were recruited from well-baby clinics. Parents completed a questionnaire which included demographics and socioeconomic status, as well as a sensory profile evaluation using the Infant/Toddler Sensory Profile (ITSP).

Results

Twenty-five children with BI, 28 with FDs and 32 controls were recruited. Oral processing scores were significantly lower in both BI and FD groups vs the controls (p = 0.015 and 0.001, respectively). Auditory processing scores were lower in the FD group vs the controls (p = 0.028). The scores of three out of the four ITSP sensory quadrants (Low Registration, Sensory Sensitivity, and Sensation Avoiding) were significantly lower in the FD group vs the controls (p = 0.027, 0.025, and 0.001, respectively), and in one quadrant (Sensation Avoiding) in the BI group vs the controls (p = 0.037).

Conclusions

There were considerable differences in sensory processing, as reported by parents between children with BI and those with FDs compared to healthy controls, most often in the direction of the ‘hypersensitive’ profile. These differences may underlie the development and partially explain the coexistence of the two disorders. Sensory profile may be a target of intervention as part of the management of sleep and feeding disorders in early childhood.

Introduction

Behavioral insomnia (BI) of childhood is a prevalent condition, affecting 10–30% of children aged 6–36 months [1]. The clinical manifestations consist of difficulty in falling or staying asleep or both. These difficulties usually reflect certain established patterns of interaction between parent and child at times of sleep transition [1], [2]. Interaction between caregiver characteristics, child characteristics, and parent–child interaction factors substantially contribute to this disorder [1], [2]. If left untreated, bedtime problems, and night awakenings can negatively impact the daytime functioning and behavior of both the child and the entire family. BI can lead to increased irritability, temper tantrums, impaired emotion regulation and behavior problems on the part of the child. It can also shorten parental sleep, leading to increased sleepiness, negative mood and decreased daytime functioning on the part of the parents [3].

Feeding difficulties are common in pediatric practice and encompass a spectrum ranging from children with physiological difficulties in ingesting food, through picky eaters to full-fledged infantile feeding disorders. They may include inappropriate/disruptive mealtime behaviors, food refusal, self-feeding inadequacy, excessive mealtime duration, and food selectivity [4], [5], [6], [7]. The prevalence of problematic eating and feeding behaviors is 25% in infants and young children [4], [5], [6], [7]. Problematic eating and feeding behaviors are sources of concern for parents and, if prolonged, can lead to weight loss or failure to gain weight and cause cognitive and developmental delay [8], [9], [10]. Feeding disorders (FDs) in healthy children are linked to a variety of causes, ranging from environmental disruption, parental incompetence, the child's temperament, and psychological factors. It has been shown that certain characteristics of the infant combined with certain vulnerabilities in the parent lead to negative responses and conflicts in their interactions [11].

We recently discovered that feeding and eating difficulties are more prevalent among children with BI of childhood, and that sleep problems are more frequent in children with FDs [12]. We also observed that maternal characteristics, such as knowledge/attitude/perceptions about sleep and feeding, are different in these two disorders in comparison with controls [13]. A child's characteristics might play a substantial role in these two common conditions, leading to the development of sleep difficulties, feeding difficulties or both in early childhood. The child's characteristics may affect parent–child daily interactions including bedtime and mealtime interactions. Sensory profile is one of the child's characteristics, often reported by parents and caregivers.

Sensory processing is the ability to integrate information received from the body's basic sensory systems and to form appropriate and efficient behavioral responses. Impaired sensory processing may result in various functional problems and affect daily routines. The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0–3) [14] defines three types of regulation disorders of sensory processing in infants: hypersensitive (corresponding to ‘sensory over-responsivity’), hyposensitive (corresponding to ‘sensory under-responsivity’) and Sensory Seeking. Sensory difficulties may underlie/mediate the development of both sleep and feeding disorders. It is possible that the child's early sensory characteristics may affect daily parent–child interactions, including those at bedtime and mealtimes. Indeed, sensory processing impairments have been found in school-aged children with sleep difficulties [15] as well as in children with feeding disorders [16], [17].

The aim of the present study was to investigate the sensory profile of children with BI and children with FDs in comparison with healthy controls. Our hypothesis was that sensory processing difficulties are more common in children with sleep disorders and in those with FDs compared to children without such difficulties.

Section snippets

Methods

Children 7–36 months of age who were diagnosed as having BI based on the International Classification of Sleep Disorders criteria [1] were recruited from the Pediatric Sleep Center at Dana Children's Hospital. Infants and toddlers who were diagnosed as having FDs based on Chatoor criteria [6] were recruited from the Clinic of Feeding Disorders at Dana Children's Hospital. In addition, children in the same age group who attended the well-baby clinics in metropolitan Tel Aviv for routine periodic

Results

Between January 2012 and December 2015, 85 infants and toddlers were recruited: 25 with BI, 28 with FDs and 32 controls. The characteristics of the children in the three groups are presented in Table 1. A family history of sensory integration disorder was reported in three cases (one from the FD group and two from the control group).

Three out of the 25 children with BI (12%) and one out of the 32 controls (3%) reported feeding problems based on the BPFAS questionnaire. Eight out of the 28

Discussion

The present study shows for the first time that young children with either FDs or BI were reported by their caregivers to show considerably more sensory difficulties compared to controls. These differences in sensory profiles may underlie the development of these two disorders and partially explain their coexistence as previously reported by our group [12]. Sensory difficulties are often reported by parents in the pediatric clinical setting. While these difficulties are well recognized in the

Acknowledgements

This research was supported by the Israel Science Foundation (grant no. 707/12).

References (22)

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      For example, a retrospective chart review of 177 children aged 0–36 months from an occupational therapy clinic specializing in sleep, found that 36% of the children had a pattern of increased sensitivity, and that over-sensitivity was correlated with longer sleep latency [47]. Another study assessed infants and toddlers with behavioral insomnia and found differences in sensory profiles in comparison to healthy controls [46]. Furthermore, children with ASD have a higher prevalence of atypical sensory behaviors and sleep disturbances compared to typical children [42].

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