Caregivers’ knowledge, attitudes and practices regarding sleep care for 0–3 year-old children: a cross-sectional study

BACKGROUND: Sleep care significantly impacts children's development; however, caregivers' knowledge and practices regarding sleep care remain understudied. This study aims to comprehensively assess caregivers' knowledge, attitudes, and practices (KAP) concerning sleep care for infants and toddlers aged 0-3 years. METHODS: This cross-sectional study was collected from July to October 2024 among caregivers at two maternal and child health hospitals (Wuxi and Xuzhou) in Jiangsu Province, China. A standardized questionnaire assessed caregivers' knowledge, attitudes, and practices (KAP) regarding sleep care for children aged 0-3 years. RESULTS: A total of 2,009 valid responses were obtained, with 1,750 (87.11%) were female caregivers. The median (Q₁, Q₃) scores for knowledge, attitude, and practice were 8.00 (7.00, 9.00), 22.00 (20.00, 24.00), and 37.00 (33.00, 40.00), respectively. Spearman's rank correlation analysis revealed statistically significant positive correlations between caregivers' knowledge and their attitudes (r = 0.119, P < 0.001) and practices (r = 0.167, P < 0.001), as well as attitude and practice (r = 0.258, P < 0.001). Logistic regression analysis revealed that higher knowledge scores [OR = 1.154, 95% confidence interval (CI): 1.034-1.288, P < 0.001], positive attitudes (OR = 1.188, 95% CI: 1.136-1.243, P < 0.001), higher household income (OR = 1.634, 95% CI: 1.066-2.505, P = 0.024), and better child sleep quality (OR < 1, 95% CI: 0.102-0.928, P < 0.05) were independently associated with better sleep care practices. Structural equation modeling showed direct effects of knowledge on both the attitudes (β = 1.346, P < 0.001) and practices (β = 1.152, P < 0.001), as well as of attitude on practice (β = 0.492, P < 0.001). CONCLUSION: Although caregivers demonstrated adequate knowledge, positive attitudes, and generally sufficient sleep care practices, targeted educational interventions remain necessary, particularly for caregivers with lower education and income, to further optimize sleep care behaviors.