INTRODUCTION DURING THE PAST 2 DECADES, SLEEP PRACTICES AND SLEEP PROBLEMS IN CHILDREN HAVE RECEIVED MORE ATTENTION FROM PARENTS AND MEDICAL PROFESSIONALS BECAUSE SLEEP PROBLEMS IN CHILDREN ARE NOW RECOGNIZED TO BE VERY COMMON (estimated prevalence

DURING THE PAST 2 DECADES, SLEEP PRACTICES AND SLEEP PROBLEMS IN CHILDREN HAVE RECEIVED MORE ATTENTION FROM PARENTS AND MEDICAL PROFESSIONALS BECAUSE SLEEP PROBLEMS IN CHILDREN ARE NOW RECOGNIZED TO BE VERY COMMON (estimated prevalence 10% 45%),1-6 often persist over several years,7-9 and can exert adverse effects on cognitive, behavior, emotional, and even physical development.1 Sleep practices and sleep behaviors in children are associated not only with a large number of biologic and psychologic factors, but also with cultural, social, and family factors.1,4,10,11 However, most epidemiologic studies of sleep practices and sleep problems have been of Western children.11-14 Because of the great cultural and socioeconomic differences between China and Western countries, results from Western children may not be generalizable to Chinese children. This study represents the first investigation of bed sharing (cosleeping) and sleep problems in a sample of children from Mainland China. We will use “bed sharing” to mean a child sleeping in the same bed with 1 or 2 parents. Bed sharing between young children (particularly infants) and parents varies across cultures and ethnicities.15,16 In most Western countries, people generally believe that a child should sleep separately from his or her parents as soon as possible to foster the development of autonomy and independence.17 However, in many Asian countries, childrearing practices emphasize the development of interdependence and family closeness, and child-parent bed sharing up to school age is accepted by many families.18 There is evidence that bed sharing is more prevalent in Asian countries than in Western countries. For example, it has been reported that more Japanese than American children share beds with their parents 3 or more times per week.19 A recent report of trends in infant bed sharing in the United States between 1993 and 2000 indicated that infant bed sharing was strongly associated with race or ethnicity, with the highest prevalence being found in Blacks (27.9%), followed by Asians (20.9%), and the lowest prevalence among White families (7.2%). 16 In a study of 427 Korean children aged 12 to 84 months, Yang and Hahn reported a bed-sharing rate as high as 45.0%, and they found that traditional cultural values, child’s age, and maternal attitude toward bed sharing were the main determinants of bed sharing in Korean families.18 Bed-sharing practices also are influenced by family environments, with a higher prevalence of bed sharing among lower socioeconomic and higher stress families.20-22 In an earlier study of bed sharing in urban families with young children in the United States, Lozoff and colleagues found that bed sharing was associated with a lower level of parental education, less professional training, and increased family stress among White families but not among Black families.21 In the United States national trend study of infant bed sharing between 1993 and 2000, results indicated that bed sharing in families with household incomes less than $20,000 was 1.5 times more likely to occur than in those families with an income of more than $20,000.16 A recent study of bed sharing in an inner-city population showed that single marital status of the mother, household crowding, and household moves since the birth of the infant were significantly associated with bed sharing.20 Due to lack of data, it is unclear if these family characteristics are associated with child bed sharing among Chinese families. In China, childrearing practices and beliefs are very similar to those held in other Asian countries such as Korea and Japan. Bed sharing of