Table 3 Themes, codes, and representative quotes from 27 focus group participants
Theme | Code | Participants’ sociodemographic characteristics | Representative quotes |
|---|---|---|---|
Lifestyle factors | Routine/rule, and individual preference | Mother, housewife, Middle school degree | “I think they get used to their school schedule, because Diego, even though it is a weekend he will be up at 8.” |
Physical activity | Grandmother, housewife, high school degree | “When my grandson was a year and a half old he didn’t sleep at night nor during the day, we put him to bed at 9:00 and he would fall asleep at 10:00 but he wouldn’t fall asleep so that’s when the doctor started him on melatonin, because a child that doesn’t walk and spends most of the day on the floor has very little activity, he doesn’t get tired, we took him out for walks but it was the same, we would get home and he would sleep for an hour, we were going crazy.” | |
Screen time | Physician, medical college degree | “I think that school children are not sleeping enough, well, parents do not have the same control as before, for example, they stay on the Internet, on Facebook at night and I have seen with my own children that their friends are connected at 3 in the morning, I mean there are people who stay on line all night and they are not sleeping.” | |
Diet | Mother, engineer, college degree | “But actually what wakes us all up is our appetite, I mean, one of the kids gets hungry and right ways they are downstairs drinking juice or looking for something to eat.” | |
Stimulant use | Physician, medical college degree | “…it is very common now to see those popular coffee machines all over the place, and one sees school kids and adolescents in their first stages of adolescence freely consuming this, and one knows that this has an effect on sleeping, where the sleep is maintained and should be a way of resting and one sees them drinking coffee.” | |
Family factors | Family routine | Mother, public employee, college degree | “…things that influence the issue of sleep for my son is family organization… in my particular case this structure is a bit broken, because as of 5 months his father is working in another place.” |
Parents’ work schedule | Physician, medical college degree | “Yes, because sometimes the ones who work on shifts for example, one sees that the routine of the child is different on the days when the father is not home than on the 7 days when the father is home, right? On the week where the father is not home the schedules are met by the person in charge, in this case the mother who does not work on shifts…” | |
Adapting to child/coping | Physical therapist, college degree | “What happens in society is that there is a tendency for parents to adapt to the child when they have special needs, a routine is made, and if they have to go to bed they have to go to bed, if they have to wake up early they must wake up early.” | |
Children’s disability/disease-related factors | Diagnosis/comorbidity | Psychologist, college degree | “…in the kids with attention disorders, who are hyperactive, who undergo treatments that make them very active during the day, but at night it’s like they get unplugged and fall dead asleep and do not wake up, I would think that in that particular sleep it is a very rested one and sufficiently long.” |
Medication use | Speech therapist, college degree | “…if the medications influence their dreams, it is possible that their sleep will be interrupted and will need more hours in order to rest.” | |
Sleep problems | Mother, engineer, college degree | “My kids have nightmares, they talk and wake up scared, there aren’t any other sounds they only speak once in a while, they sit up but that’s it, sometimes they wake up crying, the one in the middle is always more scared.” | |
Environmental factors | Light | Special education teacher, college degree | “I think that there are many factors, a set of things, the environment at home may be one, the rules at home. For example, now those of us in Magellan have more light, at 10:00 pm it’s still clear. This may affect a child’s sleep routine.” |
Noise | Mother, unemployed, high school degree | “Well in my case, if there is any sort of noise she wakes up.” | |
Quality of sleeping space | Mother, housewife, high school degree | “The environment is fundamental and the other thing I think the child should have space, comfort, tranquility and for example the main thing is a good bed, the proper mattress, because if the child has a bad bed he won’t sleep properly.” | |
Special education teacher, college degree | “A warm room, a comfortable bed and comfortable sheets, and no worries because when you have worries it doesn’t allow you to sleep well” | ||
Responsibility | Parents’ responsibility | Physical therapist, college degree | “One can give a wide range of possibilities, but the parents must choose.” |
Family’s responsibility | Physician, medical college degree | “Yes, it literally is a frequent question when you are a doctor and the reality of the child will show, and of the 95% that do not have a problem or a cause, arrange to have epilepsy or another disorder. The problem is in inadequate acts, and until the family understands that it is because of their actions, it is difficult to make changes, but to complain and not accept it even though we try to show them different way of what is not functioning well even though they are suffering because there are families that have almost separated because usually it is one person that assumes all responsibilities because the other has to rest for work and as the other has to stay home.” | |
Physicians’ responsibility | Physician, medical college degree | “[Caregivers] want a magic solution, that we give them something so the child will sleep and they can count on this to make the child go to sleep when she needs the child to go to sleep.” | |
Perceptions of good sleep | Feeling next day | Physical therapist, college degree | “I think bad sleep and good sleep have to do with the feeling that you have when you wake up, you feel that you rested, you feel that it was restful for you, you feel you can start the day well or it is hard to start the day, or you feel you needed more hours.” |
Interrupted sleep | Mother | “That I get woken up a few times during the night.” | |
Quality of sleep | Physical therapist, college degree | “A good sleep is a sleep that reaches all stages of restful sleep.” | |
Quantity of sleep | Mother, high school degree | “I think good sleep has to do with time and quantity…” | |
Ideal sleep duration for children | Rehabilitation provider, college degree | (as for adolescents aged 13–18 years) “yes, 8 hours, it’s like adult sleep.” | |
Waking up on one’s own | Rehabilitation provider, technical school degree | “A good sleep is when I wake up without an external factor like an alarm clock or something like that, it doesn’t happen much, but when it does it means that you slept enough, you wake up automatically.” | |
Bedtime | Mother | “If I go to bed late, I will be tired during the day and for example if I put them to bed late I think they too will be tired.” | |
Parental distress | Anxiety | Mother, housewife, high school degree | “Well I have to wake up Anna, because she doesn’t wake up by herself…if she has to go to school, and as you say I make her more nervous, because at 9 when I put her to bed I’m nervous because she has to go to bed so I make her hurry, really I pressure her, in the mornings I pressure her to get up, because she doesn’t get up alone.” |
Frustration | Mother, housewife, high school degree | “My husband and I ‘Dave go to bed, Dave go to sleep, 1, 2, 3’ and I go over there and no, he hides, he goes round one thing or another, but tell him stories no, I only scream.” | |
Coping strategies | Staying with child | Mother, public employee, college degree | “I accompany him for a while, if I have something to do I tell him and I leave him alone, but if I don’t, I stay with him.” |
Sleep medication use | Grandmother, housewife, high school degree | “First as a grandmother, I used to cover him with a blanket, and since he didn’t fall asleep the doctor gave him 2 melatonin.” | |
Bathing | Mother, housewife, high School degree | “Give him a bath.” | |
Story-telling, comforting, and/or affection | Mother, college degree | “Tell them stories, show them affection so they can relax.” | |
Watching television/movies | Mother, housewife, high school degree | “I have been noticing that Anna goes to bed and stays with the television on, even if it’s really low, she falls asleep faster than when I turn off the lights and tell her to go to sleep, it takes her around 45 minutes, but with the television on it takes 15 to 20 minutes.” | |
Sleep management advice from health providers | Establish sleeping routine | Special education teacher, college degree | “Yes in the teacher-parent meeting, I mentioned that children were sleepy and I advised parents to create a sleeping routine, so the learning process was effective.” |
Control use of electronics | Physical therapist, college degree | “For example, too much computer use prior to going to bed, too much television, which are obviously stimulating, before bedtime.” | |
Control stimulant use | Physical therapist, college degree | “Food also, soft drinks, for example, there are children who cannot sleep, and you can tell he had a liter of coke, then obviously he is going to be really active.” |