Parental Behaviors, Emotions at Bedtime, and Sleep Disturbances in Children with Cancer

Abstract

Background Poor sleep is common for children during cancer treatment, but there is limited understanding of the nature of children’s sleep throughout the treatment trajectory. The current exploratory study used an explanatory sequential mixed method approach to examine quantitative associations among sleep problems in children with cancer, parental behavior, and children’s sleep hygiene, with follow-up qualitative characterizations of children’s sleep across cancer treatment stages. Procedure Eighty parents of children with cancer (aged 2–10 years; in active treatment, maintenance treatment, or off treatment) completed an online survey querying the child’s sleep quality (Sleep Disturbance Scale for Children—Disorders of Initiating and Maintaining Sleep subscale) and behaviors (Child Sleep Hygiene Scale) and sleep-related parenting behaviors (Parental Sleep Strategies). A subsample (n = 17 parents) participated in qualitative interviews to better characterize the processes of children’s sleep and parents’ sleep-related behaviors. Results Children’s sleep quality, sleep hygiene, or parental sleep strategies were not significantly different by cancer treatment groups. Greater sleep disturbance in children was associated with their parents’ tendency to accommodate the child’s bedtime requests. Qualitatively, cancer treatment-related anxiety in both children and parents influence the onset of these disruptive sleep behaviors. Conclusion Parents’ sleep-related behaviors affect children’s sleep during cancer treatment. Parents’ accommodation may start during active treatment to alleviate cancer-related challenges, and these behaviors may continue into maintenance therapy and off treatment to reinforce sleep disturbance. Behavioral interventions targeting unhelpful parental behaviors may improve sleep in children with cancer during and after cancer treatment.

Clinical validity of the PROMIS pediatric sleep short forms in children receiving treatment for cancer

“…Prior research has described increased clinical sleep referrals in patients with brain tumors, 32 but other studies have not found differences in sleep by diagnostic groups. 28,33 Although radiation significantly impacts sleep in adult oncology, 34 we did not find a difference in sleep in the current sample.…”

Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment

“…Caregivers further endorsed changes in family rules around behavioral expectations and screen time, reporting a generally more accommodating style of discipline. This finding adds to existing literature that has documented changes in parenting practices during childhood cancer treatment, 24,28 leading to higher levels of lax parenting behaviors among caregivers of youth with cancer in comparison to those without cancer 10 . Changes in behavioral expectations may seem appropriate during treatment (e.g., accommodating impact of corticosteroid symptoms), 29 but could have negative implications for child emotional and behavioral functioning 10,30 .…”

“…Most caregivers reported changes in mealtime, eating, and bedtime/sleep rules and routines during treatment. Children with cancer commonly experience disruptions to eating and sleep during active treatment due to side effects of medication (e.g., nausea, drowsiness) and hospitalization (e.g., environmental factors such as lights, noises, and change in food environment) 23,24 . Treatment‐related eating and sleep disturbances can cause caregivers to relax rules and routines (i.e., accommodating) in attempts to meet the child’s needs in the moment 24–26 .…”

“…Children with cancer commonly experience disruptions to eating and sleep during active treatment due to side effects of medication (e.g., nausea, drowsiness) and hospitalization (e.g., environmental factors such as lights, noises, and change in food environment) 23,24 . Treatment‐related eating and sleep disturbances can cause caregivers to relax rules and routines (i.e., accommodating) in attempts to meet the child’s needs in the moment 24–26 . However, accommodating caregiving behaviors are largely ineffective to improve sleep and feeding/eating concerns among children on cancer treatment; and moreover, these caregiving behaviors may persist into later phases of treatment and survivorship and reinforce long‐term sleep and eating disturbances 24,27 .…”

“…Treatment‐related eating and sleep disturbances can cause caregivers to relax rules and routines (i.e., accommodating) in attempts to meet the child’s needs in the moment 24–26 . However, accommodating caregiving behaviors are largely ineffective to improve sleep and feeding/eating concerns among children on cancer treatment; and moreover, these caregiving behaviors may persist into later phases of treatment and survivorship and reinforce long‐term sleep and eating disturbances 24,27 . Rules and routines around eating and sleep may be modifiable behavioral mechanisms to reduce short‐ and long‐term physical health complications of childhood cancer treatment, yet more work is needed to understand how to prevent caregivers from developing accommodating behaviors on treatment, or how to effectively intervene to prevent the persistence of these behaviors.…”