Early childhood sleep patterns and association with caregiver-child relationships in rural China: caregiver depression as a mediator.

Background: Caregiver-child relationships are closely related to early childhood development outcomes. This study explores the association between child sleep patterns and the caregiver-child relationship in rural China and the mediating role of caregiver depression.

Method: Drawing on a survey of 776 children aged 5-25 months and their primary caregivers, we used ordinary least squares regression to analyze whether children's sleep patterns are associated with the caregiver-child relationship. We conducted mediation analyses to explore how caregiver depression mediated the association between children's sleep patterns and the caregiver-child relationship, and whether the association differed between mother- and grandmother-caregiving households. In analyzing the caregiver-child relationship, we used two of the most widely examined descriptive axes: care and control, where care is measured by the degree of warmth between the caregiver and the child, and control is measured by invasiveness (as opposed to autonomy), which reflects the degree to which the caregiver perceives the child as intrusive or overly demanding.

Results: Results show that caregivers of children with more sleep difficulties perceived less warmth and more invasion in their relationship with the child. Maternal depressive symptoms mediated the relationship between children's sleep and caregiver-child interactions by predicting caregivers' perceived invasion.

Conclusion: The findings provide new evidence on the relationship between children's sleep patterns and caregiver-child relationships in rural areas. Efforts to improve child development in low-resource settings should attend to both caregiver depression and child sleep quality.