Behavioral and parental predictors of infant and toddler sleep quality

Abstract

Background Sleep is critical for early development, yet sleep disturbances are prevalent. In low- and middle-income countries (LMICs) like Iran, cultural practices can significantly shape sleep behaviors. This study aimed to identify behavioral and parental factors associated with sleep quality among infants and toddlers aged 0-36 months in Iran. Methods This cross-sectional study surveyed 358 parents using the validated Persian version of the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Multiple linear regression was conducted to examine associations between behavioral and parental factors and the BISQ-R Total Sleep Score. Results The mean Total Sleep Score was 64.2 (SD = 14.3), indicating moderate overall sleep quality. The final regression model explained 28 of the variance in sleep scores (Adjusted R-2 =0.28, p<.001). Pre-sleep screen time, bed-sharing, and increasing child age were significantly negatively associated with sleep quality, whereas higher birth weight and greater parental education were positively associated. Conclusion Modifiable behaviors, particularly screen use before bedtime and bed-sharing, were significantly associated with poorer parent-reported sleep quality in this cultural context. These findings highlight the need for culturally sensitive parental education and anticipatory guidance to support healthy sleep hygiene.