Early childhood is a critical period for the formation of lifelong eating and sleeping behaviors and patterns (1). By the time children are 3 or 4 years old, eating and sleeping is not only deprivation-driven, but also influenced by their responsiveness to environmental cues, particularly caregiver interaction experience (2). Unfortunately, eating and sleeping problems are quite common in young children (3, 4). The eating problems among young children include 7 aspects: ill-balanced eating, food responsiveness, bad eating habits, satiety responsiveness, external factor eating, emotional eating, and initiative eating (4). Similarly, the sleeping problems are usually characterized by difficulties in sleep onset, sleep maintenance and sleep quality despite adequate sleep conditions, such as sleeping onset delay, night waking and bedtime resistance (5). Studies have found that the prevalence of eating problems in young children is estimated to be between 25 and 45% (6), while the prevalence of sleeping problems ranges from 20 to 65% (5). Eating problems in young children are associated with an increased likelihood of sleeping problems (7, 8). It has been established that eating or sleeping problems not only have a negative correlation with the physical growth of young children (9), but also their social-emotional development. A cross-sectional study of 7,179 three-year-old children found that those who had a partial eclipse, such as eating vegetables less frequently, scored higher in social-emotional problems (10). Additionally, a case-control study showed that 3- to 6- year-olds who got inadequate sleep (less than 9 h) and went to bed late (after 23:01) had higher scores for social-emotional problems (11).

Early childhood is a key period for social-emotional development (12) and parenting beliefs and practices play a significant role in this development (13). Parents encounter struggles and hardships while caring for their young children’s eating and sleeping, leading to unfavorable parent-child interactions (14). Parents’ concerns about their young children’s eating and sleeping problems reflect their parenting efficacy and satisfaction related to caring for their children’s eating and sleeping, which are important factors that affect young children’s social-emotional development (15). Existing research has shown that parenting sense of competence (parenting efficacy and satisfaction) is negatively correlated with children’s eating and sleeping problems (1), while positively correlated with children’s social-emotional development (16). However, most studies often measured young children’s eating and sleeping problems through scales or observations, and separately examined the relationship between an only eating or sleeping problems and young children’s social-emotional development separately. Therefore, it is important to explore the relationship between eating and sleeping problems simultaneously and social-emotional development in young children from the perspective of parental concerns, and further understand the relationship between only eating, only sleeping, the co-occurrence of eating and sleeping problems and social-emotional development in young children. The relationship between these factors may reflect the larger family environment in which young children live, which could help inform public health policies aimed at improving child health and well-being.

This study included 997 Chinese children with 53.2% boys and 46.8% girls, and the mean age was 57.7 months (SD = 8.0 months). Of the participants, 2.8% were 36-month-old (M = 37.9 months, SD = 2.4 months), 27.4% were 48-month-old (M = 49.3 months, SD = 2.9 months), and 69.8% were 60-month-old (M = 61.9 months, SD = 5.1 months). The majority of the children (69.8%) were the first-born child in their families. Parents were the primary caregiver for 39.1%, while parents and others were caregivers for 60.9%.

According to the reports of parents, 27.4% of the children were concerned about their eating or sleeping problems; 19.6% had only eating problems, 4.1% had only sleeping problems, and 3.7% had the co-occurrence of eating and sleeping problems. Table 1 displays frequencies and percentages of children’s eating and sleeping problems. Parents reported a total of 280 and 77 frequencies, respectively, for children’s only eating or only sleeping problems. The most common eating and sleeping problems were ill-balanced eating (36.8%), bad eating habits (26.7%), and difficulty in falling asleep (48.1%). Based on parental report on the ASQ:SE-2, 21.9% (218/997) of children were identified with suspected social-emotional development delay.

Table 2 displayed that gender, caregiving mode, and parents’ concerns about eating or sleeping problem were found to have a significant difference on the rate of suspected social-emotional development delay in children. However, there was no significant difference due to month and birth order.

Binary logistic regression showed that children with only eating problems (OR = 1.71), and those with the co-occurrence eating and sleeping problems (OR = 2.52) had a higher risk of suspected social-emotional development delay than those without any problems. Furthermore, boys had a higher risk of suspected social-emotional development delay than girls (OR = 1.49) (Table 3).

In this study, we found a significant association between 3- to 6-year-olds’ eating and sleeping problems that parents were concerned and social-emotional development. It gives us an idea of the relationship between young children’s eating and sleeping problems and social-emotional development from the perspective of parenting beliefs. Here, we discuss our findings and give proposals for practice and research.

Results showed that 27.4% parents who were concerned about their children’s eating or sleeping problems. Out of this group, 19.1% reported their children’s only eating problems, 4.1% reported only sleeping problems, and 3.7% reported the co-occurrence of both. However, this is lower than the rates of eating problems (25 to 45%) (6) and sleeping problems (20 to 65%) (5) reported in young children in previous studies. This discrepancy might be due to the fact that this study examines children’s eating and sleeping problems from the perspective of parents’ concerns. Parents’ concerns stem from lower parenting efficacy or lower satisfaction in caring for children with eating and sleeping problems, even though some young children may have eating or sleeping problems, but their parents have no concerned about these. In this study, the parents’ concerns about eating or sleeping problems with higher proportion were ill-balanced eating, bad eating habits and difficulty falling asleep, which is consistent with the findings of previous studies (3, 6).

This study indicated that children whose parents were concerned about only eating or co-occurrence of eating and sleeping problems were at higher risk for suspected social-emotional development delay compared to those whose parents had no such concerns. Specifically, the risk of suspected social-emotional development delay in children whose parents are reported only eating problems is 1.71 times and children who have the co-occurrence of eating and sleeping problems is 2.52 times higher than those who had no such concerns separately. Previous studies have consistently demonstrated that young children with eating or sleeping problems, such as ill-balanced eating and difficulty falling asleep, are more likely to have suspected social-emotional development delay (25). Good eating or sleeping habits, including balanced food intake and regular meal or sleep time, are beneficial to children’s physical and mental health (26). This study did not find a relationship between a only sleep problem and social-emotional development in young children, which is contrary to previous research (11). This may be because the parents in this sample reported lower rates of only sleeping problems and some parents were not concerned about sleeping problems in their children. Parents may experience challenges and frustrations when caring for children with eating or sleeping problems. Existing research has demonstrated that these problems are connected to the caregiver concerns (27). Parents’ concerns reflect their low parenting efficacy and satisfaction in eating and sleeping care, which is a result of their lack of parenting sense of competence. Studies have shown that there is a negative correlation between parenting sense of competence and their children’s social-emotional development (16). Examining the relationship between young children’s eating and sleeping problems and their social-emotional development from the perspective of parental concern is essential for the promotion of physical and mental well-being in young children.

In order to prevent and intervene young children’s social-emotional development, our study suggests that interventions should not only focus on the child’s social-emotional development, but also on parenting sense of competence in caring for their children’s eating and sleeping. Future research should develop successful family-oriented approaches to tackle eating and sleeping problems, which could reduce parental anxiety and enhance the parent-child bond. It is essential for child care professionals and policy makers to recognize the importance of parenting sense of competence in providing for their children’s eating and sleeping needs, and to provide support and guidance.

This study has some limitations. Firstly, in this study, we did not observe any correlation between only sleep problems and social-emotional development. To further validate these findings, more specific questionnaires should be used to evaluate parents’ concerns about eating or sleeping problem. Secondly, parents were the primary reporters in this study, however, for a more comprehensive understanding of children’s lunches and lunch breaks, teachers should be included in the future. Lastly, this study used a convenience sampling method to examine the relationship between parents’ concerns about children’s eating and sleeping problems and children’s social-emotional development. As the current study revealed a gender difference in children’s social-emotional development, which is consistent with previous studies, future research could use the gender of children whose parents have concerns about eating or sleeping problems as a matching variable to examine the relationship between parents’ concerns about eating or sleeping problems and social-emotional development.

Our research explored the connection between parents’ concerns about eating or sleeping problem and sleeping problems and social-emotional development from the perspective of parenting beliefs. Our findings showed that children whose parents were concerned about only eating or the co-occurrence of eating and sleeping problems was linked to have a higher risk of suspected social-emotional development delay. Therefore, it is essential not only to focus on children’s physical eating and sleeping problems, but also to consider the parenting sense of competence in caring for their child’s eating and sleeping in order to prevent and intervene in children’s social-emotional development.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving humans were approved by the Psychology Ethics Committee of Zhejiang Sci-Tech University. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants' legal guardians/next of kin.

TH: Conceptualization, Data curation, Investigation, Methodology, Software, Writing – original draft, Writing – review & editing. SL: Funding acquisition, Supervision, Writing – review & editing, Conceptualization, Methodology. JZ: Supervision, Writing – review & editing. LX: Investigation, Writing – review & editing. YZ: Investigation, Writing – review & editing.