“Struggle at Night – He Doesn’t Let Me Sleep Sometimes”: A Qualitative Analysis of Sleeping Habits and Routines of Hispanic Toddlers at Risk for Obesity

Abstract Background: Hispanic children make up a growing percentage of all children in the U.S. and face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Feeding and sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians can coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover Hispanic parents’ motivations, goals, and ambivalence around nighttime feeding and sleep practices in infants and toddlers already at elevated risk for childhood obesity. By understanding family and social context, future recommendations can be tailored to the family’s needs to best implement healthy nighttime feeding and sleep behaviors.Methods: This qualitative study used a phenomenological approach. 14 Hispanic parents were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Hispanic parents of children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were recruited and consented during regular well child visits. Interviews occurred over several months during 2018-2019; Nvivo was used for analysis of qualitative themes. Multiple reviewers coded and used constant comparative methods to identify common themes. Results: Parents diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Parents shared their intentions and the real-life barriers to implementing recommended habits. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors.Conclusions: Pediatricians need to be sensitive to culture and to the real-world needs of low-income families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.