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Healthy sleep in young children: missed opportunity in early childhood programs and policies?
Sleep Health 1 (2015) 86–87
Contents lists available at ScienceDirect
Sleep Health Journal of the National Sleep Foundation journal homepage: http://www.elsevier.com/locate/sleh
Healthy sleep in young children: missed opportunity in early childhood programs and policies? The evidence is clear: healthy sleep in early childhood promotes optimal development. Inadequate sleep, both in terms of quantity and quality, is associated with increased risks of obesity,1,2 emotional and behavioral problems,3,4 and suboptimal cognitive development.5 Long-term sleep problems have detrimental effects on brain development that may last into adulthood. 6 Disparities in sleep health are closely associated with socioeconomic factors and may contribute to long-term health disparities.7 In addition, many parents of young children crave better sleep for their children and themselves and are willing to pay a growing number of private sleep coaches to help. 8 In spite of compelling evidence that healthy sleep helps lay the foundation for early childhood development and long-term health, major systems of care for young children—namely, pediatric primary care and early care and education (ECE)—lack clear guidance for how to promote sleep health. Both primary care and ECE settings present important opportunities for promoting healthy sleep and preventing sleep disorders. The American Academy of Pediatrics (AAP) and its Bright Futures guidelines for child health providers recommend developmentally-staged anticipatory guidance for parents on a wide range of health promotion topics, including sleep. 9 Even with AAP guidance, evidence suggests that many childhood sleep problems are underrecognized and undertreated by pediatricians. 10 The Institute of Medicine recommends that state child care regulations promote age-appropriate sleep duration and healthy sleep practices to prevent early childhood obesity, 11 yet few states have regulations that do. 12 Caring for Our Children, the most comprehensive set of national recommendations for ECE health and safety standards, mentions sleep only with regard to sudden infant death syndrome (SIDS) and cot spacing.13 Similarly, the discussion of sleep in the Head Start Program Performance Standards is limited to SIDS prevention and crib safety. 14 Meanwhile, there are ample discussions in all of these documents about recommended policies to prevent obesity, identify early developmental concerns, and address behavioral problems—all of which may be caused, in part, by inadequate sleep. Early care and education settings are increasingly becoming venues for health promotion and disease prevention. There are major gaps, however, between evidence-based practices and the programs with the potential to implement them on a large scale. Mistry et al 15 presented a useful framework that links early childhood programs and policies to improved child health outcomes in a social-ecological context, building the capacities of families and communities to care for children. Based on this thoughtful conceptual framework, a clear research and policy agenda for sleep health in ECE should (1) identify effective programs and practices; (2) build
evidence for how effective programs are best implemented and disseminated; and (3) leverage key policy opportunities to spread effective programs and incentivize their implementation. A longterm research goal should be to measure how early investment in sleep health promotion and the prevention of sleep problems could yield substantial health and economic benefits. Head Start is a federally-funded, comprehensive ECE program serving nearly 1 million low-income children and their families each year, with services that include nutrition, mental health, and oral health. Health promotion is a core mission of Head Start, which will set the bar for other “whole-child” ECE programs awaiting Congressional approval. These ECE programs could be effective platforms for the dissemination of effective programs, such as the Sweet Dreamzzz Early Childhood Sleep Education Program (ECSEP), which has reached more than 40,000 families in Michigan. In a recent randomized controlled trial, the ECSEP was associated with a 30-minute increase in nightly sleep duration. 16 In a pending study, we plan to test the effects of the ECSEP, supported by a structured Head Start training approach, 17 with additional print, video, and face-to-face guided discussions as reinforcements, along with community involvement. The Head Start National Center on Health, a joint effort between the Department of Health and Human Services Office of Head Start and the AAP, could support such dissemination with training and technical assistance. Doing so would affirm that healthy sleep goes beyond SIDS prevention and could decrease sleep problem morbidity (eg, obesity, injury) and improve developmental potential. To start raising awareness of the need for “sleep health literacy” in ECE, we invite readers to submit articles to a special themed issue of Sleep Health (instructions below). We hope that this issue as well as a pending study to expand the reach of the ECSEP will be first steps toward building the capacity of major early childhood programs and policies to promote healthy sleep for young children. Sleep Health promotion in ECE: opportunities and leverage points Call for submissions to Sleep Health (www.sleephealthjournal.org) Special issue: March 2016 Please submit your articles through the Web site by July 31, 2015 This special issue seeks articles from a broad transdisciplinary perspective on opportunities for the following: • Identifying sleep problems in young children—for example, screening opportunities or experiences • Promoting healthy sleep—for example, relevance, need, or demand for in ECE programs; experiences teaching sleep hygiene
http://dx.doi.org/10.1016/j.sleh.2015.02.002 2352-7218/© 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
87
• Instituting program and policy changes to promote young children's sleep health in ECE—for example, potential leverage points • Scope of practice—we are interested in how healthy sleep is relevant to the divergent fields listed below, including linkages to professional mission and guidelines We are interested in articles from a range of disciplines, including disabilities, early intervention/special education, early childhood education, speech-language pathology, occupational therapy, dentistry, sociology, public health, epidemiology, etc. We are interested in receiving articles from researchers, front-line practitioners, program managers, policy makers, technical assistance providers, and other stakeholders. Please direct questions to Karen Bonuck (Karen. [email protected]), the guest editor for this special issue. Bergen B. Nelson MD, MS Department of Pediatrics, David Geffen School of Medicine at UCLA Los Angeles, CA UCLA Children's Discovery and Innovation Institute, Los Angeles, CA Corresponding author. Department of Pediatrics, University of California, Los Angeles, 10833 LeConte Ave, Room B2-449 MDCC Tel.: +1 310 794 8833 E-mail address: [email protected] Karen Bonuck PhD Department of Family and Social Medicine Albert Einstein College of Medicine, New York, NY
References 1. Suglia SF, Duarte CS, Chambers EC, Boynton-Jarrett R. Social and behavioral risk factors for obesity in early childhood. J Dev Behav Pediatr. 2013;34(8):549–556. 2. Dawson-McClure S, Brotman LM, Theise R, et al. Early childhood obesity prevention in low-income, urban communities. J Prev Interv Community. 2014;42(2):152–166.
3. Lundahl A, Nelson TD. Attention deficit hyperactivity disorder symptomatology and pediatric obesity: psychopathology or sleep deprivation? J Health Psychol. 2014 [pii: 1359105314544991]. 4. Kobayashi K, Yorifuji T, Yamakawa M, et al. Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey. Brain Dev. August 19, 2014:1–11. http://dx.doi.org/10.1177/1359105314544991. 5. Kobayashi K, et al. Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey. Brain Dev. 2014. http://dx.doi.org/10.1016/j. braindev.2014.10.004. 6. Jan JE, Reiter RJ, Bax MC, Ribary U, Freeman RD, Wasdell MB. Long-term sleep disturbances in children: a cause of neuronal loss. Eur J Paediatr Neurol. 2010; 14(5):380–390. 7. Piccolo RS, Yang M, Bliwise DL, Yaggi HK, Araujo AB. Racial and socioeconomic disparities in sleep and chronic disease: results of a longitudinal investigation. Ethn Dis. 2013;23(4):499–507. 8. Ingram DG, Plante DT, Matthews CK. Sleep coaches: characterization of a burgeoning pediatric provider group from internet advertisements for services. J Pediatr. 2015;166(2):487–489. 9. Hagan JF, Shaw JS, Duncan PM, editors. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008. 10. Meltzer LJ, Plaufcan MR, Thomas JH, Mindell JA. Sleep problems and sleep disorders in pediatric primary care: treatment recommendations, persistence, and health care utilization. J Clin Sleep Med. 2014;10(4):421–426. 11. Institute of Medicine. Early childhood obesity prevention policies: goals, recommendations, and potential actions. http://www.iom.edu/Reports/2011/EarlyChildhood-Obesity-Prevention-Policies/Recommendations.aspx; 2011. 12. Benjamin Neelon SE, Duffey K, Slining MM. Regulations to promote healthy sleep practices in child care. Pediatrics. 2014;134(6):1167–1174. 13. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for our children: national health and safety performance standards. Guidelines for early care and education programs3rd ed. . Elk Grove Village, IL: American Academy of Pediatrics; 2011[Washington, DC: American Public Health Association]. 14. Code of Federal Regulations, Title 45, 1304.53(b)(3). Head Start Performance Standards. https://eclkc.ohs.acf.hhs.gov/hslc/standards/hspps/45-cfr-chapter-xiii. 15. Mistry KB, Minkovitz CS, Riley AW, et al. A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health. 2012;102(9):1688–1696. 16. Wilson KE, Miller AL, Bonuck K, Lumeng JC, Chervin RD. Evaluation of a sleep education program for low-income preschool children and their families. Sleep. 2014;37(6):1117–1125. 17. Herman A, Nelson BB, Teutsch C, Chung PJ. A structured management approach to implementation of health promotion interventions in Head Start. Prev Chronic Dis. 2013;10:130015. http://dx.doi.org/10.5888/pcd10.130015.
Contents lists available at ScienceDirect
Sleep Health Journal of the National Sleep Foundation journal homepage: http://www.elsevier.com/locate/sleh
Healthy sleep in young children: missed opportunity in early childhood programs and policies? The evidence is clear: healthy sleep in early childhood promotes optimal development. Inadequate sleep, both in terms of quantity and quality, is associated with increased risks of obesity,1,2 emotional and behavioral problems,3,4 and suboptimal cognitive development.5 Long-term sleep problems have detrimental effects on brain development that may last into adulthood. 6 Disparities in sleep health are closely associated with socioeconomic factors and may contribute to long-term health disparities.7 In addition, many parents of young children crave better sleep for their children and themselves and are willing to pay a growing number of private sleep coaches to help. 8 In spite of compelling evidence that healthy sleep helps lay the foundation for early childhood development and long-term health, major systems of care for young children—namely, pediatric primary care and early care and education (ECE)—lack clear guidance for how to promote sleep health. Both primary care and ECE settings present important opportunities for promoting healthy sleep and preventing sleep disorders. The American Academy of Pediatrics (AAP) and its Bright Futures guidelines for child health providers recommend developmentally-staged anticipatory guidance for parents on a wide range of health promotion topics, including sleep. 9 Even with AAP guidance, evidence suggests that many childhood sleep problems are underrecognized and undertreated by pediatricians. 10 The Institute of Medicine recommends that state child care regulations promote age-appropriate sleep duration and healthy sleep practices to prevent early childhood obesity, 11 yet few states have regulations that do. 12 Caring for Our Children, the most comprehensive set of national recommendations for ECE health and safety standards, mentions sleep only with regard to sudden infant death syndrome (SIDS) and cot spacing.13 Similarly, the discussion of sleep in the Head Start Program Performance Standards is limited to SIDS prevention and crib safety. 14 Meanwhile, there are ample discussions in all of these documents about recommended policies to prevent obesity, identify early developmental concerns, and address behavioral problems—all of which may be caused, in part, by inadequate sleep. Early care and education settings are increasingly becoming venues for health promotion and disease prevention. There are major gaps, however, between evidence-based practices and the programs with the potential to implement them on a large scale. Mistry et al 15 presented a useful framework that links early childhood programs and policies to improved child health outcomes in a social-ecological context, building the capacities of families and communities to care for children. Based on this thoughtful conceptual framework, a clear research and policy agenda for sleep health in ECE should (1) identify effective programs and practices; (2) build
evidence for how effective programs are best implemented and disseminated; and (3) leverage key policy opportunities to spread effective programs and incentivize their implementation. A longterm research goal should be to measure how early investment in sleep health promotion and the prevention of sleep problems could yield substantial health and economic benefits. Head Start is a federally-funded, comprehensive ECE program serving nearly 1 million low-income children and their families each year, with services that include nutrition, mental health, and oral health. Health promotion is a core mission of Head Start, which will set the bar for other “whole-child” ECE programs awaiting Congressional approval. These ECE programs could be effective platforms for the dissemination of effective programs, such as the Sweet Dreamzzz Early Childhood Sleep Education Program (ECSEP), which has reached more than 40,000 families in Michigan. In a recent randomized controlled trial, the ECSEP was associated with a 30-minute increase in nightly sleep duration. 16 In a pending study, we plan to test the effects of the ECSEP, supported by a structured Head Start training approach, 17 with additional print, video, and face-to-face guided discussions as reinforcements, along with community involvement. The Head Start National Center on Health, a joint effort between the Department of Health and Human Services Office of Head Start and the AAP, could support such dissemination with training and technical assistance. Doing so would affirm that healthy sleep goes beyond SIDS prevention and could decrease sleep problem morbidity (eg, obesity, injury) and improve developmental potential. To start raising awareness of the need for “sleep health literacy” in ECE, we invite readers to submit articles to a special themed issue of Sleep Health (instructions below). We hope that this issue as well as a pending study to expand the reach of the ECSEP will be first steps toward building the capacity of major early childhood programs and policies to promote healthy sleep for young children. Sleep Health promotion in ECE: opportunities and leverage points Call for submissions to Sleep Health (www.sleephealthjournal.org) Special issue: March 2016 Please submit your articles through the Web site by July 31, 2015 This special issue seeks articles from a broad transdisciplinary perspective on opportunities for the following: • Identifying sleep problems in young children—for example, screening opportunities or experiences • Promoting healthy sleep—for example, relevance, need, or demand for in ECE programs; experiences teaching sleep hygiene
http://dx.doi.org/10.1016/j.sleh.2015.02.002 2352-7218/© 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
87
• Instituting program and policy changes to promote young children's sleep health in ECE—for example, potential leverage points • Scope of practice—we are interested in how healthy sleep is relevant to the divergent fields listed below, including linkages to professional mission and guidelines We are interested in articles from a range of disciplines, including disabilities, early intervention/special education, early childhood education, speech-language pathology, occupational therapy, dentistry, sociology, public health, epidemiology, etc. We are interested in receiving articles from researchers, front-line practitioners, program managers, policy makers, technical assistance providers, and other stakeholders. Please direct questions to Karen Bonuck (Karen. [email protected]), the guest editor for this special issue. Bergen B. Nelson MD, MS Department of Pediatrics, David Geffen School of Medicine at UCLA Los Angeles, CA UCLA Children's Discovery and Innovation Institute, Los Angeles, CA Corresponding author. Department of Pediatrics, University of California, Los Angeles, 10833 LeConte Ave, Room B2-449 MDCC Tel.: +1 310 794 8833 E-mail address: [email protected] Karen Bonuck PhD Department of Family and Social Medicine Albert Einstein College of Medicine, New York, NY
References 1. Suglia SF, Duarte CS, Chambers EC, Boynton-Jarrett R. Social and behavioral risk factors for obesity in early childhood. J Dev Behav Pediatr. 2013;34(8):549–556. 2. Dawson-McClure S, Brotman LM, Theise R, et al. Early childhood obesity prevention in low-income, urban communities. J Prev Interv Community. 2014;42(2):152–166.
3. Lundahl A, Nelson TD. Attention deficit hyperactivity disorder symptomatology and pediatric obesity: psychopathology or sleep deprivation? J Health Psychol. 2014 [pii: 1359105314544991]. 4. Kobayashi K, Yorifuji T, Yamakawa M, et al. Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey. Brain Dev. August 19, 2014:1–11. http://dx.doi.org/10.1177/1359105314544991. 5. Kobayashi K, et al. Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey. Brain Dev. 2014. http://dx.doi.org/10.1016/j. braindev.2014.10.004. 6. Jan JE, Reiter RJ, Bax MC, Ribary U, Freeman RD, Wasdell MB. Long-term sleep disturbances in children: a cause of neuronal loss. Eur J Paediatr Neurol. 2010; 14(5):380–390. 7. Piccolo RS, Yang M, Bliwise DL, Yaggi HK, Araujo AB. Racial and socioeconomic disparities in sleep and chronic disease: results of a longitudinal investigation. Ethn Dis. 2013;23(4):499–507. 8. Ingram DG, Plante DT, Matthews CK. Sleep coaches: characterization of a burgeoning pediatric provider group from internet advertisements for services. J Pediatr. 2015;166(2):487–489. 9. Hagan JF, Shaw JS, Duncan PM, editors. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008. 10. Meltzer LJ, Plaufcan MR, Thomas JH, Mindell JA. Sleep problems and sleep disorders in pediatric primary care: treatment recommendations, persistence, and health care utilization. J Clin Sleep Med. 2014;10(4):421–426. 11. Institute of Medicine. Early childhood obesity prevention policies: goals, recommendations, and potential actions. http://www.iom.edu/Reports/2011/EarlyChildhood-Obesity-Prevention-Policies/Recommendations.aspx; 2011. 12. Benjamin Neelon SE, Duffey K, Slining MM. Regulations to promote healthy sleep practices in child care. Pediatrics. 2014;134(6):1167–1174. 13. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for our children: national health and safety performance standards. Guidelines for early care and education programs3rd ed. . Elk Grove Village, IL: American Academy of Pediatrics; 2011[Washington, DC: American Public Health Association]. 14. Code of Federal Regulations, Title 45, 1304.53(b)(3). Head Start Performance Standards. https://eclkc.ohs.acf.hhs.gov/hslc/standards/hspps/45-cfr-chapter-xiii. 15. Mistry KB, Minkovitz CS, Riley AW, et al. A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health. 2012;102(9):1688–1696. 16. Wilson KE, Miller AL, Bonuck K, Lumeng JC, Chervin RD. Evaluation of a sleep education program for low-income preschool children and their families. Sleep. 2014;37(6):1117–1125. 17. Herman A, Nelson BB, Teutsch C, Chung PJ. A structured management approach to implementation of health promotion interventions in Head Start. Prev Chronic Dis. 2013;10:130015. http://dx.doi.org/10.5888/pcd10.130015.