Exploring Children's Perceptions of Sleep and Sleep Habits

Abstract

This qualitative study explores children's perceptions of sleep and sleep habits. Using purposive sampling, in-depth semi-structured interviews were conducted with twelve generally healthy preschool children aged five and six (seven girls, five boys) undergoing typical development. ATLAS.ti was used to manage the data. Thematic analysis of the interview transcripts identified eight key themes: (1) Sleep behaviour, (2) Dreams, (3) Feelings upon waking, (4) Daytime functioning, (5) Facial appearance, (6) Sleep environment, (7) Bedtime routines, and (8) Sleep resistance and midnight awakenings. The findings suggest that young children have a foundational understanding of sleep and its associated habits. Therefore, sleep education programs should consider children's perspectives to ensure that information is relevant and meaningful for them.

Keywords

sleep sleep habits preschool children qualitative thematic analysis

Sleep is vital to children's health and development (Briguglio et al., 2020; Miller et al., 2021). A lack of sleep has been associated with obesity and mental health risk, and harms cognitive and language development (Cheng et al., 2020; Matricciani et al., 2019; Miller et al., 2021; Morrissey et al., 2020). Throughout the developmental lifespan, children are recommended to have a certain amount of sleep for their developmental needs. According to the American Academy of Sleep Medicine, children aged five require 10 to 13 h of sleep, while children aged six require 9 to 12 h (Paruthi et al., 2016). However, recent studies have shown that the prevalence of sleep problems was 37.6% with high heterogeneity, shorter sleep duration (i.e., below the recommended hours of sleep), and longer sleep onset latency (Bacaro et al., 2021; Chen et al., 2021).

Poor sleep has been associated with sleep habits such as going to bed late and using electronic devices at bedtime (Galland et al., 2024; Staples et al., 2021). Children with good sleep habits (e.g., consistent bedtime routine) were perceived to enjoy better sleep (Mindell et al., 2015). Parents play an essential role in inculcating healthy behaviour in their children, including good sleep habits (Meltzer et al., 2021; Munasinghe et al., 2016). Furthermore, parental sleep hygiene could affect their sleep and children's sleep habits (Chehri et al., 2022).

Studies have been conducted to improve children's sleep at multiple levels (Furlong, 2019; Sadler et al., 2020; Williamson et al., 2019). However, most studies on young children's sleep have not focused on understanding children's perceptions. Many such studies are concerned about anonymity and children's ability to have their own perceptions (Powell et al., 2011). Although children have the right to express their opinions and perspectives about their lives (United Nations, 1989), interviewing young children to obtain rich data remains a significant challenge in research. Regardless of the challenges, children's voices are beneficial in understanding their world (Morison et al., 2000). Interestingly, children as young as 3 to 6 can express their perspective on the world (Dayan & Ziv, 2012; Ponizovsky-Bergelson et al., 2019).

Furthermore, for a sleep intervention or prevention program to be effective, it needs to be tailored to both the individual and local context (Mindell & Williamson, 2018; Redeker et al., 2018). For example, in Malaysia, the prevalence of children co-sleeping with their parents is higher than those who sleep in their own rooms (Daban & Goh, 2019). Understanding how children perceive their sleep and sleep habits could help us in designing interventions and program delivery to the children (Ludwig et al., 2019; Rodgers et al., 2019). Thus, in this study, we aimed to explore preschool children's perceptions of their sleep and sleep habits.

Method

Design

In-depth semi-structured interviews were conducted with preschool children using a phenomenological approach. The protocol of the present qualitative study was approved by the institutional review board, as part of a primary study that explored mothers’ and children's perceptions of the child's sleep and sleep habits.

Participants

Using purposive sampling, preschool children aged five and six years were recruited from a kindergarten in Perak. The present study focused on five and six-year-old children, as they have developed an understanding of the world by using primitive reasoning (Santrock, 2021). Moreover, this is a suitable developmental phase to instil good habits (Issanchou, 2017; Pérez-Ferra et al., 2020; WHO, 2019). The inclusion criteria of the study included: (i) children aged five and six years old who were (ii) generally healthy; and (iii) typically developing. The exclusion criteria were: (i) child with a health problem (e.g., asthma, heart disease) who were (ii) currently taking medication; or (iii) atypically developing (e.g., autism spectrum disorder, Attention Deficit Hyperactive Disorder, Global Developmental Delay). The inclusion and exclusion criteria were screened based on the mother's report. This sampling approach was used to ensure the homogeneity of the participants, and to minimise any confounding factors that may affect the understanding of sleep.

Twelve preschool children (seven girls, five boys) participated in the study, with an equal number of children aged five and six years old. All participants were Malay Muslims. Nine of them were co-sleeping with their parents, and another three were co-sleeping with their siblings. The total score of the Short-Form Children Sleep Habits Questionnaire (SF-CSHQ; Bonuck et al., 2017) for all participants was above 30 (M = 36.91, SD = 4.09), indicating the potential for sleep behavioural problems. The sleeping arrangement and the SF-CSHQ were used to identify the children's sleep habits. Participant characteristics are presented in Table 1.

Table 1.
Participants’ Demographic Information.

Child Age Gender Co-sleeping SF-CSHQ* (Mother's report)

C1 6 Girl Parent 46

C2 5 Boy Parent 34

C3 5 Girl Parent 38

C4 5 Boy Parent 43

C5 6 Girl Parent 34

C6 6 Girl Siblings 36

C7 5 Girl Parent 38

C8 6 Boy Parent 35

C9 6 Girl Siblings 36

C10 5 Girl Siblings 33

C11 5 Boy Parent 36

C12 6 Boy Parent 32

*
SF-CSHQ: Short-Form Children Sleep Habits Questionnaire.

Interview Procedure and Instruments

Participant recruitments were carried out in a kindergarten in Perak. Parents were contacted via phone, inviting them to the study. Written informed consent was obtained from the parents consenting to the interview with the children. Parents also had the opportunity to ask questions if they needed further information about the study. Parents were asked to provide demographic information (i.e., age, gender, religion, sleeping arrangements) and complete the SF-CSHQ.

The SF-CSHQ is a 23-item, retrospective parent-report questionnaire that was used to examine sleep behaviour in children. The SF-CSHQ was adapted to Malay using Back Translation (Brislin, 1970; Ozolins et al., 2020). The SF-CSHQ has five subscales (i.e., bedtime, sleep behaviour, walking during the night, morning waking and daytime sleepiness) with a reliability (α = .83), sensitivity of 89.2% and specificity of 44.6% (Bonuck et al., 2017; Shetty et al., 2022). A score of 30 or more indicates a higher risk of sleep behaviour problems. The SF-CSHQ was used to provide quantitative information about the children's characteristics, but no further analysis was performed.

Semi-structured interviews were conducted at the kindergarten once consent was obtained from the parents. Verbal consent was also obtained from the children, per the United Nations Convention on the Rights of the Child (Sudarsan et al., 2022; United Nations, 1989). The parents were not present during the interview. Additional practical considerations were applied such as the interview being conducted at the child's familiar place (kindergarten), rapport being built before the start of the interview (e.g., talking about the child's favourite toys, using play), and a short break was given during the interview if needed. The interviews were conducted in the Malay language (the child's first language) and were audio recorded, then transcribed verbatim by the first author (AMB). The semi-structured interviews were guided by the interview protocol (See Table 2 interview outline) and supplementary questions to encourage the child to talk. The interviews varied between 25 to 40 min, with an average time of 30 min.

Table 2.
Interview Outline.

List of interview Questions

Sleep
1. Can you tell me about sleep?

2. How do you feel when you have had a good sleep?

3. How do you feel when you have had a poor sleep?

4. Can you tell me why sleep is important?

5. Are there any events that may cause sleep concerns for you?

Sleep habits
6. What do you usually do before you go to sleep?

7. How do you sleep?

8. Have you ever awoken at midnight?

9. How do you wake up in the morning?

Data Analysis

The present data set consisted of twelve transcribed interviews which were analysed using thematic analysis, following guidelines from Braun and Clarke (2006). The thematic analysis was applied as the study's primary aim was to identify patterns of the themes within the data set exploring the participant's understanding of sleep and sleep habits. The transcriptions were analysed following the six key steps (Braun & Clarke, 2006): (i) familiarizing with the data (ii) generating initial codes; (iii) searching for themes; (iv) reviewing themes; (v) defining and naming themes; and (vi) producing the report.

During the whole thematic analysis steps, the codes and emerging themes were initially extracted by AMB (first author) and were reviewed and discussed with FR and NMMR. All parties discussed and agreed upon any differences in opinions. ATLAS.ti was used to manage the data during the extraction of the codes and emerging themes. Data saturation can be achieved from the repetition of the responses from the participants, typically from six to twelve interviews (Guest et al., 2006). The present study refers to COREQ criteria in reporting the study to minimise bias and comprehensiveness (Tong et al., 2007). The table illustrates the specific criteria followed from COREQ in this study and is available upon request from the authors.

Results

Thematic analysis of the transcript elicited five emerging themes on sleep perceptions and three themes on sleep habits. (see Figure 1).

Figure 1.
Themes emerged from children's perceptions of sleep and sleep habits.

Children's Perceptions of Sleep

Theme 1: Sleep Behaviour

Behaviours during sleep such as closing eyes and lying down were associated with sleep by the children. A few also mentioned that they often moved and changed their position while sleeping. They also described their body and pillow position during sleep onset to find the most comfortable position. A boy (C12) explained how he found the most comfortable position for him to sleep: “When I was lying down, I slept on my stomach, then turned to the right or left and tossing and turning again if it was uncomfortable”. In addition, the children also mentioned that they became unaware of their surroundings during sleep. For example, a boy (C8) said, “When I slept, there were noises, but I was unaware”.

Theme 2: Dream

Some children knew they were asleep, as they remembered their dreams. Dreams vary and could range from dreaming about their favourite toys (e.g., dinosaurs, skateboards) and family members to the scariest things like ghosts. However, some children believed that reciting prayers at bedtime could protect them from getting nightmares. A boy (C8) shared, “When I slept, I did not feel anything because I was unaware of what was happening around me, but I once dreamt about a ghost, I would recite the prayer”. This is also mentioned by a girl (C1): “I knew when I slept, I would dream about meeting my family, grandmother, and aunt. I also dreamt about scary things, being chased by a ghost. The nightmare did not often occur because I recited the sleep prayer”.

Theme 3: Feelings Upon Waking

Some children noted that feelings upon waking were an indicator of their sleep. Good sleep made them feel “fresh” and made it easier for them to wake up and get ready for school. In contrast on some days, it was hard for them to get up as early as six o’clock in the morning, and consequently, they were late for school. A girl (C6) shared, “I did not want to wake up, it was hard to wake up. When my mom asked me to wake up for a shower, I went back to sleep. I did not want to wake up early.” Another girl (C5) also shared, “I woke up by myself at six in the morning. I felt sleepy because it was too early. I felt lazy to wake up, sleepy and I did not want to go to school”.

Theme 4: Daytime Functioning

Another commonly reported indicator of sleep was daytime functioning. The children retrospectively perceived how they were doing during the day, which reflected their lack of sleep or good night's sleep. Lack of sleep would cause them to feel sleepy or fall asleep in class, limiting their play time at school. A girl (C1) said, “When my friends asked me to play, I wanted to sleep”. A boy (C12) also shared how lack of sleep would affect his performance in class: “If I did not sleep at night, I would fall asleep the next day in the class. I would not be able to learn when I sleep in the class”.

Theme 5: Facial Appearance

Facial appearance notably emerged as an indicator of sleep. The children mentioned that their eyes would appear “reddish” with dark circles under their eyes and “panda eyes” in the morning following poor sleep. Some noted that a lack of sleep may cause itchy eyes or sore eyes. A girl (C10) mentioned, “Red eyes, there would be purple under the eyes. Usually, my friend got red here (pointing to the eyes), a lot and big, then I knew that he had not slept, he must have been playing games”.

Children's Perceptions of Sleep Habits

Theme 6: Sleep Environment

Half of the children shared that they slept in totally dark environments, while the rest mentioned they needed a dim light to sleep for several reasons, such as feeling scared, night awakenings and toilet trips. The sources of light were either a bed lamp, the bathroom or another room. Some of the children switched off the lights before sleep, and a few of them needed their parents to switch off the lights once they fell asleep. A boy (C8) said, “When I am playing smartphone, [the light was] on, because mom said, if I am playing smartphone [in the dark], then [my] eyes cannot see. I slept, mom [would] switch off the light”.

The children noted that they like to sleep in a room with an air conditioner. Although some would want to sleep with an air conditioner on, their parents would not allow them to do so due to health reasons. For example, a boy (C4) shared, “Hot, I did not switch on the air conditioner. My mom did not allow it as I would get a cough at home. My mom only switched on the fan”.

Theme 7: Bedtime Routine

The children reported their bedtime routines, which can be categorized into hygiene-related activities, bedtime chats, and screen use. For hygiene-related activities, most of the children talked about brushing their teeth, using the toilet, changing diapers and keeping their toys. A boy (C12) shared why he needed to go to the toilet: “Before I went to bed, I needed to go to the toilet to pee. If I did not go to the toilet and then slept, when I woke up, my bed was already wet”.

Bedtime chats emerged as one of the activities the child did with their parents. Some children chatted with their mothers while mothers cuddled them to sleep, and most of them recited prayers. Some also had bedtime stories read to them. A girl (C1) shared, “I would chat with mommy. We chatted about mommy's childhood, how and what mommy played when she was a kid. Then I would say “goodnight”, recite the sleep prayer and then sleep”.

Screen use was also mentioned by the children, such as watching television, and using a smartphone to watch videos. The children shared that they could have longer screen time during the weekend, as they would not have to get up early the next day for school. In addition, the children reported that their routines were not fixed every night, as they could forget to brush their teeth sometimes. A girl (C5) shared her bedtime routines: “Before I slept, I finished my milk, switched off the light, fan, and the TV. After that, I went to pee, brushed my teeth but only sometimes, I recited sleep prayer”. Furthermore, parents accompanying them during bedtime also influenced them, as a few of child reported that their father said it was okay to brush their teeth the next morning, unlike their mom who asked them to do it before sleeping.

Theme 8: Sleep Resistance and Midnight Awakening

Other commonly reported sleep habits were resistance to sleep and midnight awakening. At times, the children were reluctant to go to bed if they were not sleepy. They also had a later bedtime during the weekend. A few children also shared that they would wake up in the middle of the night. The midnight waking could be due to noise, toilet trips and room temperature. A few of them shared that they were scared, but that hugging the pillow or teddy bear made them feel better. Some would cover their whole body using a blanket or call for their parents. Usually, the midnight waking was only for a brief period, and most of them could get back to sleep. A girl (C1) shared what she did during midnight waking: “I hugged my pillow, teddy bear or mommy. I woke my mommy up and told her I could not sleep”.

Discussion

This study explored children's perceptions of sleep and their sleep habits. The children judged their sleep based on sleep behaviour, dreams, feelings upon waking, daytime functioning, and facial appearance. Meanwhile, children's sleep habits included sleep environment, bedtime routine, and sleep resistance and midnight awakening.

The children knew they were asleep through closed eyes, lying down and becoming unaware of their surroundings. In addition, during sleep, some children are restless and their sleep position changes due to adjusting their body for the most comfortable sleeping position. Children were reported to prefer lateral and supine positions, followed by prone positions during sleep, and had more movement during sleep than adults (De Koninck et al., 1992). Sleep position has also been found to affect to sleep quality and night awakening, as an individual who preferred the right lateral position was found to have better sleep quality, a lower tendency to wake up during the night, and lower frequency of nightmares compared to the left lateral and supine positions (Agargun et al., 2004; Zhang et al., 2022).

The children also associated dreams with sleeping. They dreamt about their favourites such as games and family members, and sometimes they also had nightmares (Honig & Nealis, 2012). Although the frequency of dreams was not related to sleep quality, having nightmares could influence sleep quality, daytime mood and behaviour (Paul et al., 2015; Ribeiro et al., 2020). However, the children believed that reciting prayers could protect them from scary dreams. As all the children in this study were Muslim, reciting prayers during bedtime has become part of their bedtime routine. This finding suggests that religion could influence children's bedtime practices.

The children understand how their sleep quality can affect their feelings upon waking the next day. Good sleep makes it easier for them to wake up and go to school early, while poor sleep has caused them to become moody and too “lazy” to go to school. The influence of sleep was more apparent on school days compared to the weekends when they could wake up naturally and at a later time. On a night of good sleep quality, the children were eager to go to school and anticipating daytime activities, as they had no trouble waking up. This is consistent with Ramlee et al.'s (2017) findings, which showed that judgement of sleep quality can be influenced by feeling refreshed upon waking and mood the day after.

The findings show that the children were generally aware of the importance of sleep. Sleep is the time for the body to rest and restore energy. A lack of sleep causes them to feel sleepy and affects their daily activities, such as playing, learning and praying. Sleep was found to be bi-directionally associated with physical activity. Children who sleep more at night are likely to have higher physical activity during the day and lower sedentary time (Antczak et al., 2021).

The children also understood that poor sleep can be manifested via facial appearance. Previous findings demonstrated that sleep loss could result in changes in facial appearance, such as red eyes, swollen eyes, decreasing eye-openness and increasing facial paleness and periorbital darkness (Holding et al., 2019; Sundelin et al., 2013). Notably, the current study's findings have opened up a novel understanding that the child can judge their sleep based on facial cues of sleep loss. Future studies should further investigate to what extent children can perceive sleep-loss-related changes in facial appearance.

The findings show that children were sleeping in the dark or with dim light in a cool and quiet environment. Half of the children reported sleeping with a light on due to fear, midnight awakening, and toilet trips. Past studies have shown that the prevalence of sleep problems was associated with high exposure to light at night (Xu et al., 2023). Children exposed to light at bedtime demonstrated shorter sleep duration and poorer sleep quality than those who slept with light off (Lo, 2016). Thus, parents must minimise their children's exposure to light during sleep and at bedtime.

All children (and families) have a bedtime routine. However, bedtime activities before sleep may vary on a nightly basis. Establishing bedtime routines has been associated with the emotional well-being of children and parents and positive outcomes, including better sleep quality, readiness for school, and greater executive function performance (Kitsaras et al., 2018). Findings from a previous longitudinal study suggest that children had behavioural difficulties when non-regular bedtime routines were not established at home (Kelly et al., 2013). Further investigation is also suggested to explore the effect of inconsistency between mothers and fathers in establishing bedtime routines in children.

The present study also found that screen use was part of bedtime activities for most of the children. This was also one of the reasons for their bedtime procrastination and delayed sleep time on weekends. This was concerning as screen use before bedtime was associated with shorter and later sleep time (Staples et al., 2021). Notably, there is a need for parents to undergo psychoeducation on bedtime routines to promote better sleep in children.

The children reported having trouble initiating sleep due to screen use and no signs of sleepiness. Some also experience difficulty in staying asleep as they are awake in the middle of the night from the noise from their surroundings. Frequent midnight awakening is associated with poor sleep quality and daytime sleepiness in children (Li et al., 2014). This is a crucial time for parents to introduce and practice sleep hygiene for children as it could reduce interrupted sleep in the middle of the night. For some children, getting back to sleep is challenging as they need the presence of their parents to fall asleep (Gültekin & Temel, 2020). Besides, most of the children in our study were co-sleeping with their parents, which may be influenced by socio-ecological factors such as household income and parents’ perceptions (Meltzer et al., 2021). It is one of the environmental factors that reflects culturally based values and beliefs (Jeon et al., 2021).

Limitations

There were several limitations in this study. As this is a qualitative study, the interpretation of the study might be influenced by the researcher's perceptions and experience. Second, this study has not specifically explored the children's sources of information on their sleep knowledge. Thus, it is recommended for future studies to explore this area to improve the delivery of information to children. In addition, it is recommended that future studies use objective sleep measures (e.g., actigraphy) to accompany the children's subjective perceptions as it allows comparison of the objective and subjective measures of sleep in preschool children. Finally, the present study's findings cannot be generalised to other children in Malaysia, as it has limited diversity in terms of sociodemographic backgrounds. Future studies should explore perceptions of sleep among preschool children from different ethnic and cultural backgrounds.

Conclusion

Overall, the present study has demonstrated perceptions of sleep and sleep habits from children's perspectives. The findings could be used as a guide in developing the contents for sleep education programmes that are suitable for preschool children. Hence, the programme could improve the children's understanding and awareness about good sleep quality and habits. Despite its limitations, the findings of this qualitative study contribute to the literature, demonstrating the need for a more comprehensive and rigorous method of examining sleep in young children.

Child	Age	Gender	Co-sleeping	SF-CSHQ* (Mother's report)
C1	6	Girl	Parent	46
C2	5	Boy	Parent	34
C3	5	Girl	Parent	38
C4	5	Boy	Parent	43
C5	6	Girl	Parent	34
C6	6	Girl	Siblings	36
C7	5	Girl	Parent	38
C8	6	Boy	Parent	35
C9	6	Girl	Siblings	36
C10	5	Girl	Siblings	33
C11	5	Boy	Parent	36
C12	6	Boy	Parent	32

	List of interview Questions
Sleep	1. Can you tell me about sleep? 2. How do you feel when you have had a good sleep? 3. How do you feel when you have had a poor sleep? 4. Can you tell me why sleep is important? 5. Are there any events that may cause sleep concerns for you?
Sleep habits	6. What do you usually do before you go to sleep? 7. How do you sleep? 8. Have you ever awoken at midnight? 9. How do you wake up in the morning?

Footnotes

Acknowledgements

We would like to express our gratitude to all participants of this study.

ORCID iD

Fatanah Ramlee

Ethical Consideration

The study was approved by the Human Research Ethics Committee, Universiti Pendidikan Sultan Idris (Reference number: 2022-0618-01).

Consent to Participate

Written informed consent was obtained from the participants’ parents, while verbal consent was also secured from the participants before the interviews.

Consent for Publication

Not applicable.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interest

The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article.

Data Availability Statement

The data of this study are available upon reasonable request. For further inquiries, please contact fatanah@fpm.upsi.edu.my.

Author Biographies

Fatanah Ramlee, PhD, is a senior lecturer and clinical psychologist at the Department of Psychology, Faculty of Human Development, Sultan Idris Education University, Malaysia. Currently she is the Deputy Dean (Research and Innovation) of the Faculty of Human Development. She received training in Behavioural Sleep Medicine at Warwick University, UK. Her research interests are in Health and Clinical Psychology particularly in sleep, physical activity, pain and mental health.

Amirah Munawwarah Badruzzaman, BPsych (Hons), is a master's student at the Department of Psychology, Faculty of Human Development, Sultan Idris Education University, Malaysia. She is interested in studying sleep in young children.

Nor Mashitah Mohd Radzi, PhD, is a senior lecturer at the Department of Early Childhood Education, Faculty of Human Development, Sultan Idris Education University, Malaysia. She is the Coordinator of the Business Unit, FPM XCELL at Sultan Idris Education University. Her research interests are early childhood education and children's assessment and evaluation.

References

Agargun

M. Y.

Boysan

Hanoglu

(2004). Sleeping position, dream emotions, and subjective sleep quality. Sleep and Hypnosis, 6(1), 8–13.

Antczak

Sanders

Del Pozo Cruz

Parker

Lonsdale

(2021). Day-to-day and longer-term longitudinal associations between physical activity, sedentary behavior, and sleep in children. Sleep, 44(4), 1–10. https://doi.org/10.1093/sleep/zsaa219

Bacaro

Gavriloff

Lombardo

Baglioni

(2021). Sleep characteristics in the Italian pediatric population: A systematic review. Clinical Neuropsychiatry, 18(3), 119–136. https://doi.org/10.36131/cnfioritieditore20210302

Bonuck

K. A.

Goodlin-Jones

B. L.

Schechter

Owens

(2017). Modified children’s sleep habits questionnaire for behavioral sleep problems: A validation study. Sleep Health, 3(3), 136–141. https://doi.org/10.1016/j.sleh.2017.03.009

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Briguglio

Vitale

J. A.

Galentino

Banfi

Dina

C. Z.

Bona

Panzica

Porta

Dell'osso

Glick

I. D.

(2020). Healthy eating, physical activity, and sleep hygiene (HEPAS) as the winning triad for sustaining physical and mental health in patients at risk for or with neuropsychiatric disorders: Considerations for clinical practice. Neuropsychiatric Disease and Treatment, 16, 55–70. https://doi.org/10.2147/NDT.S229206

Brislin

R. W.

(1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216. https://doi.org/10.1177/135910457000100301

Chehri

Taheri

Khazaie

Jalali

Ahmadi

Mohammadi

(2022). The relationship between parents’ sleep quality and sleep hygiene and preschool children’ sleep habits. Sleep Science, 15(3), 272–278. https://doi.org/10.5935/1984-0063.20220051

Chen

Lin

(2021). The prevalence of sleep problems among children in mainland China: A meta-analysis and systemic-analysis. Sleep Medicine, 83, 248–255. https://doi.org/10.1016/j.sleep.2021.04.014

10.

Cheng

Rolls

Gong

Zhang

X. Y.

Feng

(2020). Sleep duration, brain structure, and psychiatric and cognitive problems in children. Molecular Psychiatry, 26(8), 3992–4003. https://doi.org/10.1038/s41380-020-0663-2

11.

Daban

K. D. Y.

Goh

D. Y. T.

(2019). Comparison of sleep characteristics, patterns, and problems in young children within the southeast Asian region. Behavioral Sleep Medicine, 17(3), 281–290. https://doi.org/10.1080/15402002.2017.1342168

12.

Dayan

Ziv

(2012). Children’s perspective research in pre-service early childhood student education. International Journal of Early Years Education, 20(3), 280–289. https://doi.org/10.1080/09669760.2012.718114

13.

De Koninck

Lorrain

Gagnon

(1992). Sleep positions and position shifts in five age groups: An ontogenetic picture. Sleep, 15(2), 143–149. https://doi.org/10.1093/sleep/15.2.143

14.

Furlong

(2019). Child sleep: A systemic exploration of the knowledge and experience of educational psychologists, parents and primary school staff .

15.

Galland

B. C.

Haszard

J. J.

Jackson

Morrison

Meredith-Jones

Elder

D. E.

Beebe

Taylor

R. W.

(2024). Predictors for achieving optimal sleep in healthy children: Exploring sleep patterns in a sleep extension trial. Sleep Health, 10(2), 213–220. https://doi.org/10.1016/j.sleh.2023.09.012

16.

Guest

Bunce

Johnson

(2006). How many interviews are enough?: An experiment with data saturation and variability. Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822X05279903

17.

Gültekin

Temel

A. B.

(2020). Sleep problems and effective factors in preschool children. Florence Nightingale Journal of Nursing, 28(2), 164–173. https://doi.org/10.5152/FNJN.2020.18063

18.

Holding

B. C.

Sundelin

Cairns

Perrett

D. I.

Axelsson

(2019). The effect of sleep deprivation on objective and subjective measures of facial appearance. Journal of Sleep Research, 28(6), e12860. https://doi.org/https://doi.org/10.1111/jsr.12860

19.

Honig

A. S.

Nealis

A. L.

(2012). What do young children dream about? Early Child Development and Care, 182(6), 771–795. https://doi.org/10.1080/03004430.2011.579797

20.

Issanchou

(2017). Determining factors and critical periods in the formation of eating habits: Results from the Habeat project. Annals of Nutrition and Metabolism, 70(3), 251–256. https://doi.org/10.1159/000471514

21.

Jeon

Dimitriou

Halstead

E. J.

(2021). A systematic review on cross-cultural comparative studies of sleep in young populations: The roles of cultural factors. International Journal of Environmental Research and Public Health, 18(4), 1–45. https://doi.org/10.3390/ijerph18042005

22.

Kelly

Sacker

(2013). Time for bed: Associations with cognitive performance in 7-year-old children: A longitudinal population-based study. Journal of Epidemiology and Community Health, 67(11), 926–931. https://doi.org/10.1136/jech-2012-202024

23.

Kitsaras

Goodwin

Allan

Kelly

M. P.

Pretty

I. A.

(2018). Bedtime routines child wellbeing & development. BMC Public Health, 18(1), 1–12. https://doi.org/10.1186/s12889-018-5290-3

24.

Ren

Shi

Jin

Yan

Jiang

Shen

(2014). Frequent nocturnal awakening in children: Prevalence, risk factors, and associations with subjective sleep perception and daytime sleepiness. BMC Psychiatry, 14(1), 1–11. https://doi.org/10.1186/1471-244X-14-204

25.

M. J.

(2016). Relationship between sleep habits and nighttime sleep among healthy preschool children in Taiwan. Annals of the Academy of Medicine Singapore, 45(12), 549–556. https://doi.org/10.47102/annals-acadmedsg.v45n12p549

26.

Ludwig

Smith

S. S.

Heussler

(2019). How well do children understand the vocabulary of sleep? HLRP: Health Literacy Research and Practice, 3(1), e53–e69. https://doi.org/10.3928/24748307-20190122-01

27.

Matricciani

Paquet

Galland

Short

Olds

(2019). Children’s sleep and health: A meta-review. Sleep Medicine Reviews, 46, 136–150. https://doi.org/10.1016/j.smrv.2019.04.011

28.

Meltzer

L. J.

Williamson

A. A.

Mindell

J. A.

(2021). Pediatric sleep health: It matters, and so does how we define it. Sleep Medicine Reviews, 57, 101425. https://doi.org/10.1016/j.smrv.2021.101425

29.

Miller

M. A.

Bates

Cappuccio

F. P.

(2021). Systematic review and meta-analyses of the relationship between short sleep and incidence of obesity and effectiveness of sleep interventions on weight gain in preschool children. Obesity Reviews, 22(2), 1–22. https://doi.org/10.1111/obr.13113

30.

Mindell

J. A.

A. M.

Sadeh

Kwon

Goh

D. Y. T.

(2015). Bedtime routines for young children: A dose-dependent association with sleep outcomes. Sleep, 38(5), 717–722. https://doi.org/10.5665/sleep.4662

31.

Mindell

J. A.

Williamson

A. A.

(2018). Benefits of a bedtime routine in young children: Sleep, development, and beyond. Sleep Med Rev, 40, 93–108. https://doi.org/10.1016/j.smrv.2017.10.007

32.

Morison

Moir

Kwansa

(2000). Interviewing children for the purposes of research in primary care. Primary Health Care Research and Development, 1(2), 113–130. https://doi.org/10.1191/146342300675316801

33.

Morrissey

Taveras

Allender

Strugnell

(2020). Sleep and obesity among children: A systematic review of multiple sleep dimensions. Pediatric Obesity, 15(4), e12619. https://doi.org/10.1111/ijpo.12619

34.

Munasinghe

L. L.

Yuan

Faught

E. L.

Willows

N. D.

Veugelers

P. J.

(2016). Parental encouragement of healthy lifestyles for their children and personally caring about healthy lifestyles is positively associated with children using vitamin D supplements. Nutrients, 8(10), 596. https://doi.org/10.3390/nu8100596

35.

Ozolins

Hale

Cheng

Hyatt

Schofield

(2020). Translation and back-translation methodology in health research–a critique. Expert Review of Pharmacoeconomics and Outcomes Research, 20(1), 69–77. https://doi.org/10.1080/14737167.2020.1734453

36.

Paruthi

Brooks

L. J.

D'Ambrosio

Hall

W. A.

Kotagal

Lloyd

R. M.

Malow

B. A.

Maski

Nichols

Quan

S. F.

Rosen

C. L.

Troester

M. M.

Wise

M. S.

(2016). Consensus statement of the American academy of sleep medicine on the recommended amount of sleep for healthy children: Methodology and discussion. Journal of Clinical Sleep Medicine, 12(11), 1549–1561. https://doi.org/10.5664/jcsm.6288

37.

Paul

Schredl

Alpers

G. W.

(2015). Nightmares affect the experience of sleep quality but not sleep architecture: An ambulatory polysomnographic study. Borderline Personality Disorder and Emotion Dysregulation, 2(1), 1–9. https://doi.org/10.1186/s40479-014-0023-4

38.

Pérez-Ferra

Quijano-López

García-Martínez

(2020). Impact of educational habits on the learning of 3-6 year old children from the perspective of early childhood education teachers. Sustainability (Switzerland), 12(11), 4388. https://doi.org/10.3390/su12114388

39.

Ponizovsky-Bergelson

Dayan

Wahle

Roer-Strier

(2019). A qualitative interview with young children: What encourages or inhibits young children’s participation? International Journal of Qualitative Methods, 18, 1–9. https://doi.org/10.1177/1609406919840516

40.

Powell

Graham

Taylor

Newell

Fitzgerald

(2011). Building capacity for ethical research with children and young people: An international research project to examine the ethical issues and challenges in undertaking research with and for children in different majority and minority world contexts. University of Otago Centre for Research on Children and Families / Lismore: Centre for Children and Young People. http://epubs.scu.edu.au/ccyp_pubs/32/

41.

Ramlee

Sanborn

A. N.

Tang

N. K. Y.

(2017). What sways people’s judgment of sleep quality? A quantitative choice-making study with good and poor sleepers. Sleep, 40(7), zsx091. https://doi.org/10.1093/sleep/zsx091

42.

Redeker

N. S.

Ordway

M. R.

Banasiak

Caldwell

Canapari

Crowley

Fenick

Jeon

O'Connell

Sude

Sadler

L. S.

(2018). Community partnership for healthy sleep: Research protocol. Research in Nursing & Health, 41(1), 19–29. https://doi.org/10.1002/nur.21840

43.

Ribeiro

Gounden

Quaglino

(2020). Is there a link between frequency of dreams, lucid dreams, and subjective sleep quality? Frontiers in Psychology, 11, 1–7. https://doi.org/10.3389/fpsyg.2020.01290

44.

Rodgers

R. F.

Wertheim

E. H.

Damiano

S. R.

Gregg

K. J.

Paxton

S. J.

(2019). A qualitative, prospective study of children’s understanding of weight gain. British Journal of Developmental Psychology, 37(3), 369–381. https://doi.org/10.1111/bjdp.12279

45.

Sadler

L. S.

Banasiak

Canapari

Crowley

A. A.

Fenick

O'Connell

Ordway

M. R.

Sude

Trevino

Redeker

N. S.

(2020). Perspectives on sleep from multiethnic community parents, pediatric providers, and childcare providers. Journal of Developmental and Behavioral Pediatrics : JDBP, 41(7), 540–549. https://doi.org/10.1097/DBP.0000000000000799 .

46.

Santrock

J. W.

(2021). Life-Span Development. McGraw-Hill Education.

47.

Shetty

Newton

A. T.

Reid

G. J.

(2022). Parenting practices, bedtime routines, and consistency: Associations with pediatric sleep problems. Journal of Pediatric Psychology, 47(1), 49–58. https://doi.org/10.1093/jpepsy/jsab072

48.

Staples

A. D.

Hoyniak

McQuillan

M. E.

Molfese

Bates

J. E.

(2021). Screen use before bedtime: Consequences for nighttime sleep in young children. Infant Behavior & Development, 62, 101522. https://doi.org/10.1016/J.INFBEH.2020.101522

49.

Sudarsan

Hoare

Sheridan

Roberts

(2022). Giving voice to children in research: The power of child-centered constructivist grounded theory methodology. Research in Nursing and Health, 45(4), 488–497. https://doi.org/10.1002/nur.22231

50.

Sundelin

Lekander

Kecklund

Van Someren

E. J. W.

Olsson

Axelsson

(2013). Cues of fatigue: Effects of sleep deprivation on facial appearance. Sleep, 36(9), 1355–1360. https://doi.org/10.5665/sleep.2964

51.

Tong

Sainsbury

Craig

(2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

52.

United Nations. (1989). Convention on the rights of the child. https://www.unicef.org/media/ 52626/file.

53.

WHO. (2019). To grow up healthy, children need to sit less and play more. WHO. https://www.who.int/news/item/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more.

54.

Williamson

A. A.

Mindell

J. A.

Hiscock

Quach

(2019). Sleep problem trajectories and cumulative socio-ecological risks: Birth to school-age. Journal of Pediatrics, 215, 229–237.e4. https://doi.org/10.1016/j.jpeds.2019.07.055

55.

Zhang

Tao

Sun

(2023). Association between exposure to light at night (LAN) and sleep problems: A systematic review and meta-analysis of observational studies. Science of The Total Environment, 857, 159303. https://doi.org/10.1016/j.scitotenv.2022.159303

56.

Zhang

Xiao

Zheng

Xiao

Huang

(2022). The relationship between sleeping position and sleep quality: A flexible sensor-based study. Sensors, 22(16), 1–14. https://doi.org/10.3390/s22166220