Академический Документы
Профессиональный Документы
Культура Документы
ABSTRACT. Pediatricians provide a major source of changes in many countries. In addition, many na-
knowledge for parents about children’s behavior and tions’ internal ethnic groups have grown to comprise
development, although their advice is largely based on significant percentages of the patient population,
their own cultural values and beliefs in interaction with whose distinct needs and varied views can no longer
their personal and clinical experience. This review pre- be missed (or dismissed) in health care.
sents cross-cultural aspects of children’s sleep behavior
in industrialized and complex modern societies and pro-
Cross-cultural issues in child development have
vides a basis for understanding dimensions and mecha- received considerable attention not only in the pedi-
nisms of cultural differences. We submit that it is the atric but also in the psychologic and anthropologic
interaction between culture and biology that establishes literature.7–10 Because much of this literature ap-
behavioral and developmental norms and expectations proaches development through the lens of encultura-
regarding normal and problematic children’s sleep. Pe- tion and socialization, it may tend to stress the role of
diatricians need to recognize the cultural environment in culture over that of biology as a “prime mover” in
which children live and be knowledgeable about how child development. Here, we also focus on cultural
cultural beliefs and values of both families and physi- aspects of childhood sleep and sleep behavior and
cians interact with the needs and biological characteris-
tics of individual children. Pediatrics 2005;115:204–216;
their interpretation. In doing so, we emphasize that
sleep, culture, children, child development, child rearing. both biological determinants of sleep and the ways in
which culture and biology interact play a major role
in establishing behavioral and developmental norms
P
ediatricians are widely accepted as experts in
child development. In Western countries, they and expectations regarding normal and problematic
are a major source of knowledge for parents children’s sleep. Both influences must be taken into
about children’s behavior and development.1–3 account in the provision of optimal health care and
Many pediatricians, however, lack sound training in parenting advice to the full range of pediatricians’
developmental and behavioral pediatrics, and thus patients and their families. We draw on pediatric,
their advice is largely based on their own cultural psychologic, sociologic, historical, and anthropologic
values and beliefs (many of which may be operating literature in cross-cultural research about sleep along
out of their own direct awareness4) in interaction with some references from literary and journalistic
with their personal and clinical experience. A recent sources that (as representatives of cultural opinion
study of pediatricians’ knowledge about breastfeed- and assumption) also provide valuable information
ing and advice to mothers illustrates this point: pe- and insights on the topic. It is worth mentioning that
diatric residents or practitioners who responded cor- information about cultural issues in children’s sleep
rectly to questions about breastfeeding were in the scientific literature is scant, widely scattered,
overwhelmingly those who had personal experience and fairly narrowly focused (eg, mostly regarding
with breastfeeding of their own children.5,6 cosleeping and bedtime ritual). On the whole, the
In recent years, pediatricians have increasingly topic of children’s sleep culture is not studied very
been confronted with families of widely differing thoroughly in any one discipline.
cultural origins. Worldwide geopolitical boundary Small tribal, traditional, and nonindustrialized so-
shifts, changes in patterns of immigration, and refu- cieties’ sleep behaviors were the topic of a recent
gee relocation in response to political or economic outstanding comparative survey by Worthman and
pressures have created dramatic demographic Melby.11 We expect such societies to differ radically
from our own in almost every regard, but the general
conclusions drawn by these authors apply equally to
From the *Department of Psychiatry and Human Behavior, Division of
Child and Adolescent Psychiatry, E. P. Bradley Hospital Chronobiology and
complex and industrialized societies, which also
Sleep Research Laboratory, and §Division of Pediatric Ambulatory Medi- show considerable variability in their approaches
cine, Department of Pediatrics, Brown Medical School, Providence, Rhode and expectations regarding sleep. Japan and the
Island; and ‡Department of Pediatrics, Growth and Development Center, United States, for example, are both highly industri-
University Children’s Hospital, Zurich, Switzerland.
alized and economically successful “first-world”
Accepted for publication Aug 5, 2004.
doi:10.1542/peds.2004-0815B countries, yet their deep cultural difference between
No conflict of interest declared. emphasis on interdependence and collectivity in the
Address correspondence to Bonnie B. O’Connor, PhD, Division of Pediatric former and on independence and direct competition
Ambulatory Medicine, Department of Pediatrics, Rhode Island Hospital/ in the latter is reflected in dramatically different ap-
Brown Medical School, 593 Eddy St, Potter Suite 200, Providence, RI 02903.
E-mail: boconnor@lifespan.org
proaches to training and patterning of children’s
PEDIATRICS (ISSN 0031 4005). Copyright © 2005 by the American Acad- sleep.12 In another example, Western European
emy of Pediatrics. countries, although geographic neighbors, do not
CONCLUSIONS REFERENCES
Pediatricians need to recognize the cultural envi- 1. Hickson GB, Altemeier WA, O’Connor S. Concerns of mothers seeking
ronment in which children live and how cultural care in private pediatric offices: opportunities for expanding services.
Pediatrics. 1983;72:619 – 624
beliefs and values interact with the needs of the 2. McCune YD, Richardson MM, Powell JA. Psychosocial health issues in
individual child and with the biological characteris- pediatric practices: parents’ knowledge and concerns. Pediatrics. 1984;
tics of his or her sleep patterns. It is not necessary to 74:183–190
know everything about cultural diversity or to be an 3. Young KT, Davis K, Schoen C, Parker S. Listening to parents. A
national survey of parents with young children. Arch Pediatr Adolesc
“expert” on culture, but it is important to understand Med. 1998;152:255–262
basic dimensions and mechanisms of cultural differ- 4. Hall ET. The Silent Language. Garden City, NY: Anchor Press/
ences and their interaction with biology as they func- Doubleday; 1959
tion in individual children and families. Knowing 5. Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P. National
that children “typically” exhibit a particular behavior assessment of physicians’ breast-feeding knowledge, attitudes, train-
ing, and experience. JAMA. 1995;273:472– 476
at a specific developmental stage is unsatisfactory; to 6. Freed GL, Clark SJ, Lohr JA, Sorenson J. Pediatrician involvement in
best meet the needs of patients and families it is breast-feeding promotion: a national study of residents and practitio-
imperative to acknowledge individual behaviors in ners. Pediatrics. 1995;96:490 – 494
the context of the cultural background and social 7. Pachter LM, Harwood RL. Culture and child behavior and psychoso-
cial development. J Dev Behav Pediatr. 1996;17:191–198
circumstances. In addition, clinicians and researchers 8. Rubin KH. Social and emotional development from a cultural perspec-
should attend systematically to their own cultures’ tive. Dev Psychol. 1998;34:611– 615
values and preferences and to the ways in which 9. Harkness S. Cross-cultural research in child development: a sample of
they condition their responses and expectations, both the state of the art. Dev Psychol. 1992;28:622– 625
in the clinic and in all aspects of research design and 10. Harkness S, Super CM. Parents’ Cultural Belief Systems: Their Origins,
Expressions, and Consequences. New York, NY: Guilford Press; 1996
interpretation. 11. Worthman CM, Melby MK. Toward a comparative developmental
Documentation and description of the cultural di- ecology of human sleep. In: Carskadon MA, ed. Adolescent Sleep
versity in which children grow up and the effect of Patterns: Biological, Social, and Psychological Influences. Cambridge,
culture on their development and behavior, of which England: Cambridge University Press; 2002:69 –117
12. Doi T. The Anatomy of Dependence. Tokyo, Japan: Kodansha Inter-
sleep is at the core, may provide an important basis national; 1981
for the reconsideration of our own cultures. Are the 13. Jones RK, Brayfield A. Life’s greatest joy? European attitudes towards
cultural standards provided by our own society op- the centrality of children. Soc Forces. 1997;75:1239 –1270
timal for the development of our children? The large 14. Stearns PN, Rowland P. Children’s sleep: sketching historical change.
J Soc Hist. 1996;30:345–367
diversity of children’s sleep behaviors among societ-
15. Wolf AW, Lozoff B, Latz S, Paludetto R. Parental theories in the
ies and cultures may in fact indicate that an “optimal management of young children’s sleep in Japan, Italy, and the United
cultural standard” does not exist. Instead, individual States. In: Harkness S, Super CM, eds. Parents’ Cultural Belief Systems:
biological determinants and needs of children must Their Origins, Expressions, and Consequences. New York, NY: Guilford
be taken into account when children’s sleep pattern- Press; 1996:364 –384
16. Steger B. Negotiating sleep patterns in Japan. In: Steger B, Brunt L, eds.
ing and sleep problems are addressed. Are all chil- Night-time and Sleep in Asia and the West: Exploring the Dark Side of Life.
dren able to adapt their biological sleep requirements London, England: Routledge Curzon; 2003:65– 86
to culturally defined sleep demands? Notably, the 17. Hufford DJ. Culturally sensitive delivery of health care and human
goodness of fit between individual children’s needs services. In: Staub S, ed. Proceedings of the Governor’s Conference on
Ethnicity. Harrisburg, PA: Pennsylvania Heritage Affairs Commission;
and their cultural environments may provide a con-
1990:35–37
ceptual basis for clinical practice. 18. Super CM, Harkness S. The developmental niche: a conceptualization
Internationally collaborative and broadly interdis- at the interface of child and culture. Int J Behav Dev. 1986;9:545–569
ciplinary studies are needed to disentangle the re- 19. O’Connor BB. Healing Traditions: Alternative Medicine and the Health
spective roles of culture and biology in children’s Professions. Philadelphia, PA: University of Pennsylvania Press; 1995
20. Kryger M, Roth T, Dement W. Principles and Practice of Sleep Medicine.
sleep behavior. These studies must be carried out 3rd ed. Philadelphia, PA: W. B. Saunders Co; 2000
with methodologic rigor, according to disciplinary 21. Benington JH, Heller HC. Restoration of brain energy as the function
standards, with both subjective and objective mea- of sleep. Prog Neurobiol. 1995;45:347–360
sures standardized for different cultures and using 22. Maquet P. The role of sleep in learning and memory. Science. 2001;294:
1048 –1052
both qualitative and quantitative approaches. This
23. Borbély A, Achermann P. Sleep homeostasis and models of sleep
breadth, depth, and conceptual clarity of investiga- regulation. In: Kryger M, Roth T, Dement W, eds. Principles and Practice
tion are needed to help clinicians better understand of Sleep Medicine. 3rd ed. Philadelphia, PA: W. B. Saunders Co; 2000:
the culture-biology interaction in the establishment 377–390
of behavioral and developmental norms and expec- 24. Borbély AA. A two process model of sleep regulation. Hum Neurobiol.
1982;1:195–204
tations and eventually to comprehend what consti- 25. Daan S, Beersma DG, Borbély AA. Timing of human sleep: recovery
tutes a sleep problem, when and for whom, and how process gated by a circadian pacemaker. Am J Physiol. 1984;246(2 pt
best to approach it. The time is ripe. 2):R161–R183
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/115/Supplement_1/204
References This article cites 64 articles, 10 of which you can access for free at:
http://pediatrics.aappublications.org/content/115/Supplement_1/204#
BIBL
Subspecialty Collections This article, along with others on similar topics, appears in the
following collection(s):
Developmental/Behavioral Pediatrics
http://www.aappublications.org/cgi/collection/development:behavior
al_issues_sub
Permissions & Licensing Information about reproducing this article in parts (figures, tables) or
in its entirety can be found online at:
http://www.aappublications.org/site/misc/Permissions.xhtml
Reprints Information about ordering reprints can be found online:
http://www.aappublications.org/site/misc/reprints.xhtml
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/115/Supplement_1/204
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2005 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
1073-0397.