A szakirodalmi adatok szerint az egészségesen fejlődő gyermekek 20–30%-a megtapasztal valamilyen alvásproblémát gyermekkorban. Csecsemőknél és kisebb gyermekeknél az alváshiány és a fiziológiás alvási ritmus felborulása a nappali nyűgösség mellett hosszú távon hatással van a fejlődés minden területére (a mozgás-, a kognitív, a nyelvi készségekre és az emocionális fejlődésre is). Nagyobb gyermekeknél és serdülőknél ez rövid távon nappali fáradtsághoz és figyelemzavarhoz vezet, idővel azonban súlyosabb hatások is lehetnek, a szellemi és a fizikai teljesítmény csökkenésén át a hangulatingadozásig, sőt depressziós és szorongásos tünetek megjelenéséig. Ezért különösen nagy jelentősége van minden olyan környezeti tényező ismeretének, amelyet összefüggésbe hozhatunk a gyermekkorban megjelenő alvásproblémák kialakulásával. A jelen szakirodalmi összefoglaló célja átfogó képet adni azokról a kutatásokról, amelyek a gyermekek alvászavarait családi kontextusban vizsgálják, hiszen gyermekkorban a család funkcionalitása meghatározó tényező a gyermekek alvásának minőségét illetően. Az alvásproblémák megjelenésében a szülők közötti kapcsolat minősége, a szülők konfliktusmegoldó stratégiái, a szülői szerepükben való funkcionalitás, a szülők mentális egészsége, a gyermekkel kialakult kötődés minősége, a szülők nevelési stílusa, az esti, elalvási rituálék mind fontos szerepet játszanak. Figyelembe véve az alvásproblémák hosszú távú negatív következményeit, érdemes számba venni a hatékony intervenciós lehetőségeket. Elmondható, hogy amennyiben a szülő a gyermeke alvásproblémájával keresi fel orvosát, úgy érdemes nagyító alá venni a család funkcionalitását, a szülők párkapcsolati minőségét, a szülő-gyermek kapcsolat minőségét is. Ha ezeken a területeken derül fény problémára, akkor a szakorvosi kezelés mellett érdemes javasolni számukra a szülő-csecsemő/kisgyermek konzultációt, szülőkonzultációt, esetleg párterápiás, családterápiás lehetőségeket, a probléma teljes körű és hosszú távú megoldása érdekében. Orv Hetil. 2024; 165(17): 652–663.
According to the literature, 20–30% of healthy developing children experience some kind of sleep problem in childhood. In infants and young children, sleep deprivation and disruption of the physiological sleep rhythm, in addition to daytime fussiness, have long-term effects on all areas of development (motor, cognitive, language and emotional development). In older children and adolescents, they can lead to daytime fatigue and distraction in the short term, but over time they can have more severe effects, ranging from reduced mental and physical performance to mood swings and even depressive and anxiety symptoms. It is therefore particularly important to be aware of all environmental factors that may be associated with the development of sleep problems in childhood. The aim of this review is to provide a comprehensive overview of research on children’s sleep problems in a family context, as family functioning in childhood is a key determinant of children’s sleep quality. The quality of the relationship between parents, parents’ conflict resolution strategies, functionality in their parenting role, parents’ mental health, the quality of attachment with the child, parents’ parenting style and bedtime rituals all play an important role in the emergence of sleep problems. Considering the long-term negative consequences of sleep problems, it is worth thinking about effective interventional options. It can be said that when a parent consults their doctor about their child’s sleep problems, it is worthwhile to look at the functionality of the family, the quality of the parents’ relationship and the quality of the parent-child relationship. If problems are found in these areas, after a specialist treatment, it is worth suggesting child-parent consultation, parent consultation, and possibly couple therapy and family therapy options in order to find a comprehensive and long-term solution to the problem. Orv Hetil. 2024; 165(17): 652–663.
Barnes CM, Drake CL. Prioritizing sleep health. Public health policy recommendations. Perspect Psychol Sci. 2015; 10: 733–737.
Bolin DJ. Sleep deprivation and its contribution to mood and performance deterioration in college athletes. Curr Sports Med Rep. 2019; 18: 305–310.
Owens J. Classification and epidemiology of childhood sleep disorders. Sleep Med Clin. 2007; 2: 353–361.
Scammell TE. Overview of sleep: the neurologic processes of the sleep-wake cycle. J Clin Psychiatry 2015; 76: e13.
Wolson AR. Sleeping patterns of children and adolescents: developmental trends, disruptions and adaptations. Child Adolesc Psychiatr Clin North Am. 1996; 5: 549–568.
Mindell JA, Leichman ES, Composto J, et al. Development of infant and toddler sleep patterns: real-world data from a mobile application. J Sleep Res. 2016; 25: 508–516.
Scheuring N, Danis I, Papp E, et al. Sleeping habits during infancy and early childhood. [Alvási szokások csecsemő- és kisgyermekkorban.] Védőnő 2015; 25(3): 9–14. [Hungarian]
Scheuring N, Danis I, Papp E, et al. Sleep problems during infancy and early childhood I. Nighttime wakings. [Alvási problémák csecsemő- és kisgyermekkorban I.: Éjszakai ébredések.] Gyermekgyógyászat 2015; 66: 149–153. [Hungarian]
Barry ES. Sleep consolidation, sleep problems, and co-sleeping: rethinking normal infant sleep as species-typical. J Genet Psychol. 2021; 182: 183–204.
Dahl RE. Child and adolescent sleep disorders. Child Adolesc Psychiatr Clin North Am. 1995; 4: 323–341.
Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health 2002; 31(6 Suppl): 175–184.
Laberge L, Petit D, Simard C, et al. Development of sleep patterns in early adolescence. J Sleep Res. 2001; 10: 59–67.
Sadeh A, Mindell J, Rivera L. “My child has a sleep problem”. A cross-cultural comparison of parental definitions. Sleep Med. 2011; 12: 478–482.
Gaál V, Faludi B. Characteristics of narcolepsy in childhood. [A narcolepsia jellegzetességei gyermekkorban.] Orv Hetil. 2024; 165: 211–220. [Hungarian]
Covington LB, Patterson F, Hale LE, et al. The contributory role of the family context in early childhood sleep health: a systematic review. Sleep Health 2021; 7: 254–265.
Condly SJ. Resilience in children: a review of literature with implications for education. Urban Educ. 2006; 41: 211–236.
Harold GT, Sellers R. Annual research review: interparental conflict and youth psychopathology: an evidence review and practice focused update. J Child Psychol Psychiatry 2018; 59: 374–402.
Grych JH, Fincham FD. Marital conflict and children’s adjustment: a cognitive-contextual framework. Psychol Bull. 1990; 108: 267–290.
Davies PT, Cummings EM. Marital conflict and child adjustment: an emotional security hypothesis. Psychol Bull. 1994; 116: 387–411.
Harold GT, Elam KK, Lewis G, et al. Interparental conflict, parent psychopathology, hostile parenting, and child antisocial behavior. Examining the role of maternal versus paternal influences using a novel genetically sensitive research design. Dev Psychopathol. 2012; 24: 1283–1295.
Dahl RE. The impact of inadequate sleep on children’s daytime cognitive function. Semin Pediatr Neurol. 1996; 3: 44–50.
El-Sheikh M, Buckhalt JA, Mize J, et al. Marital conflict and disruption of children’s sleep. Child Dev. 2006; 77: 31–43.
Gregory AM, Caspi A, Moffitt TE, et al. Family conflict in childhood: a predictor of later insomnia. Sleep 2006; 29: 1063–1067.
Kelly RJ, El-Sheikh M. Marital conflict and children’s sleep: reciprocal relations and socioeconomic effects. J Fam Psychol. 2011; 25: 412–422.
Peltz JS, Rogge RD, Sturge-Apple ML, et al. Reciprocal influences among family processes and toddlers’ sleep problems. J Fam Psychol. 2016; 30: 720–731.
Rhoades KA, Leve LD, Harold GT, et al. Marital hostility and child sleep problems: direct and indirect associations via hostile parenting. J Fam Psychol. 2012; 26: 488–498.
Graham AM, Fisher PA, Pfeifer JH. What sleeping babies hear: a functional MRI study of interparental conflict and infants’ emotion processing. Clin Psychol Sci. 2013; 24: 782–789.
Beebe B, Jaffe J, Markese S, et al. The origins of 12-month attachment: a microanalysis of 4-month mother-infant interaction. Attach Hum Dev. 2010; 12: 3–141.
Bernard K, Dozier M. Examining infants’ cortisol responses to laboratory tasks among children varying in attachment disorganization: stress reactivity or return to baseline? Dev Psychol. 2010; 46: 1771–1778.
Oosterman M, De Schipper JC, Fisher P, et al. Autonomic reactivity in relation to attachment and early adversity among foster children. Dev Psychopathol. 2010; 22: 109–118.
El-Sheikh M, Buckhalt JA, Keller PS, et al. Children’s objective and subjective sleep disruptions: Links with afternoon cortisol levels. Health Psychol. 2008; 27: 26–33.
El-Sheikh M, Hinnant JB, Erath SA. VI. Marital conflict, vagal regulation, and children’s sleep: a longitudinal investigation. Monogr Soc Res Child Dev. 2015; 80: 89–106.
Benoit D, Zeanah CH, Boucher C, et al. Sleep disorders in early childhood: association with insecure maternal attachment. J Am Acad Child Adolesc Psychiatry 1992; 31: 86–93.
El-Sheikh M, Buckhalt JA, Keller PS, et al. Child emotional insecurity and academic achievement: the role of sleep disruptions. J Fam Psychol. 2007; 21: 29–38.
Perpétuo C, El-Sheikh M, Diniz E, et al. Attachment to mother and father, sleep, and well-being in late middle childhood. Int J Environ Res Public Health 2023; 20: 3399.
El-Sheikh M, Kelly RJ, Philbrook LE. Sleep and development: familial and socio-cultural considerations. In: McHale S, King V, Buxton O. (eds.) Family contexts of sleep and health across the life course. National Symposium on Family Issues, vol 8. Springer, Cham, 2017; pp. 25–49.
Bernier A, Bélanger MÉ, Bordeleau S, et al. Mothers, fathers, and toddlers: parental psychosocial functioning as a context for young children’s sleep. Dev Psychol. 2013; 49: 1375–1384.
Hiscock H, Wake M. Infant sleep problems and postnatal depression: a community-based study. Pediatrics 2001; 107: 1317–1322.
Maratia F, Bacaro V, Crocetti E. Sleep is a family affair: a systematic review and meta-analysis of longitudinal studies on the interplay between adolescents’ sleep and family factors. Int J Environ Res Public Health 2023; 20: 4572.
Boles RE, Halbower AC, Daniels S, et al. Family chaos and child functioning in relation to sleep problems among children at risk for obesity. Behav Sleep Med. 2017; 15: 114–128.
Philbrook LE, Saini EK, Fuller-Rowell TE, et al. Socioeconomic status and sleep in adolescence: the role of family chaos. J Fam Psychol. 2020; 34: 577–586.
Hall WA, Zubrick SR, Silburn SR, et al. A model for predicting behavioural sleep problems in a random sample of Australian pre-schoolers. Infant Child Dev. 2007; 16: 509–523.
Tyler D, Donovan CL, Scupham S, et al. Young children’s sleep problems: the impact of parental distress and parenting style. J Child Fam Stud. 2019; 28: 2098–2106.
Fiese BH, Winter MA, Sliwinski M, et al. Nighttime waking in hildren with asthma: an exploratory study of daily fluctuations in family climate. J Fam Psychol. 2007; 21: 95–103.
Klein HA, Ballantine J. For parents particularly: raising competent kids. The authoritative parenting style. Child Educ. 2001; 78: 46–47.
Mindell JA, Williamson AA. Benefits of a bedtime routine in young children: sleep, development, and beyond. Sleep Med Rev. 2018; 40: 93–108.
Kovács-Tóth B, Kuritárné Szabó I. The impact of adverse childhood experiences on mental and somatic health in childhood and adolescence. [Az ártalmas gyermekkori élmények hatása a mentális és szomatikus egészségre gyermek- és serdülőkorban.] Orv Hetil. 2023; 164: 1447–1455. [Hungarian]
Lin SX, Cheslack-Postava K, McReynolds L, et al. Adverse childhood experiences and insufficient sleep among US children and adolescents. Acad Pediatr. 2022; 22: 965–971.
Wang SH, Lin KL, Chen CL, et al. Sleep problems during early and late infancy: diverse impacts on child development trajectories across multiple domains. Sleep Med. 2024; 115, 177–186.
El-Sheikh M, Kelly RJ, Buckhalt JA, et al. Children’s sleep and adjustment over time: the role of socioeconomic context. Child Dev. 2010; 81: 870–883.
Sivertsen B, Harvey AG, Reichborn-Kjennerud T, et al. Sleep problems and depressive symptoms in toddlers and 8-year-old children: a longitudinal study. J Sleep Res. 2021; 30: e13150.
Zhu Y, Wang S, Shi X. Poor sleep quality mediates the relationship between intra-family conflict and mental health problems in Chinese adolescents: a three-wave longitudinal study. Curr Psychol. 2023; 42: 25696–25705.
Carpena MX, Munhoz TN, Xavier MO, et al. The role of sleep duration and sleep problems during childhood in the development of ADHD in adolescence: findings from a population-based birth cohort. J Atten Disord. 2020; 24: 590–600.
Felső R, Lohner S, Hollódy K, et al. Relationship between sleep duration and childhood obesity: systematic review including the potential underlying mechanisms. Nutr Metab Cardiovasc Dis. 2017; 27: 751–761.
Morrissey B, Taveras E, Allender S, et al. Sleep and obesity among children: a systematic review of multiple sleep dimensions. Pediatr Obes. 2020; 15: e12619.
Varma P, Conduit R, Junge M, et al. Examining sleep and mood in parents of children with sleep disturbances. Nat Sci Sleep 2020; 12: 865–874.
Harold GT, Leve LD. Parents as partners: how the parental relationship affects children’s psychological development. In: Balfour A, Morgan M, Vincent C. (eds.) How couple relationships shape our world: clinical practice, research, and policy perspectives. Karnac Books, Routledge, London, 2012; pp. 25–56.
Scheuring NG, Gulácsi Á, Ágoston O, et al. Clinical protocol of the early childhood eating and sleep disorders outpatient clinic. [A Koragyermekkori Evés-alvászavar Ambulancia klinikai protokollja.] Lege Artis Med. 2022; 32: 265–277. [Hungarian]
Scheuring N, Papp E, Danis I, et al. Background and diagnostic questions of infants’ and toddlers’ regulation disorders. [A csecsemő- és kisgyermekkori regulációs zavarok háttere és diagnosztikai kérdései.] Gyermekorv Továbbk Szle. 2011; 10: 13–19. [Hungarian]
Danis I. The importance of infant and toddler mental health support in early childhood intervention. [A csecsemő- és kisgyermekkori lelki egészség támogatásának helye a koragyermekkori intervencióban.] Gyógyped Szle. 2015; 2: 100–116. [Hungarian]
Hold me tight projekt. [Ölelj át! program.] Available from: https://www.eft-parterapia.hu/hold-me-tight-program/#hmtprogram [accessed: 6 March 2024]. [Hungarian]
Doss BD, Roddy MK, Wiebe SA, et al. A review of the research during 2010–2019 on evidence-based treatments for couple relationship distress. J Marital Fam Ther. 2022; 48: 283–306.
Emotion-focused therapy. [Érzelem fókuszú terápia. Érzelem Fókuszú Család- és Párterápiás Alapítvány.] Available from: https://www.eft-parterapia.hu/mi-az-eft/ [accessed: 6 March 2024]. [Hungarian]
Greenberg LS, Johnson SM. Emotionally focused therapy for couples. Guilford Press, New York, NY, 1988.
Wiebe SA, Johnson SM. A review of the research in emotionally focused therapy for couples. Fam Process 2016; 55: 390–407.
Szabó Zs. A New approach in couples therapy – The schema couples therapy. [Újféle megközelítés a párterápiában – a séma-párterápia.] Available from: https://www.webbeteg.hu/cikkek/egeszseges/28451/sema-parterapia [accessed: 6 March 2024]. [Hungarian]
Koltai M. Family therapy protocol. [Családterápiás protokoll.] Available from: https://www.csaladterapia.hu/csaladterapia [accessed: 6 March 2024]. Hungarian]