The purpose of this study was to assess state licensing and administrative regulations promoting healthy sleep practices in child care and to compare these regulations to national recommendations.
We reviewed regulations related to healthy sleep practices for all states and territories for both child care centers (centers) and family child care homes (homes). We compared regulations with Institute of Medicine recommendations to promote sleep in child care, including (1) create environments that ensure restful sleep; (2) encourage sleep-promoting behaviors and practices; (3) encourage practices that promote child self-regulation of sleep; and (4) seek consultation yearly from a sleep expert. We used Cochran-Mantel-Haenszel trend tests to assess associations between geographic region and number of regulations consistent with the recommendations.
The mean number of regulations for states was 0.9 for centers and 0.8 for homes out of a possible 4.0. For centers, no state had regulations for all 4 recommendations; 11 states had regulations for 2 of the 4 recommendations. For homes, 9 states had regulations for 2 of the recommendations. States in the Northeast had the greatest mean number of regulations for centers (1.2) and homes (1.1), and states in the South had the fewest (0.7 and 0.7, respectively); these geographic differences were significant for centers (P = .03) but not homes (P = .14).
More states in the Northeast had regulations consistent with the Institute of Medicine sleep recommendations, but overall few states had regulations consistent with the recommendations.
Comments
Promoting Healthy Sleep in Child Care Setting
The analysis by Nelson et al., "Regulations to Promote Healthy Sleep Practices in Child Care" highlights the gap between policy and practice when it comes to child health. Their analysis focused on the Institute of Medicine (IOM) recommendations for reducing childhood obesity, which include encouraging healthy sleep practices in child care settings and seeking expert consultation on healthy sleep. The authors found that few states had regulations consistent with the IOM recommendations. Overall, when sleep recommendations were present, they pertained to just to SIDS. Early childhood is the foundation for lifelong health; thus linking early childhood programs and policies to health outcomes is critical.1 The Nelson et. al. paper offers a strong example of this disconnect between child health outcomes and policies.
The second part of this IOM recommendation, though not a focus of the paper, points to a critical missed opportunity. In it, the IOM recommends that early childhood professionals be trained "to counsel parents about their children's age-appropriate sleep durations." 2 Child care settings are an optimal venue for delivering health messages to both parents as well as children, and thus extending messages into the home setting. In fact, the National Action Plan to Improve Healthy Literacy cites the need to: "embed accurate, accessible and actionable health information in all early childhood programs, such as Head Start." 3Head Start mandates parent education as well as teaching children about healthy behaviors. Furthermore, Congress is now considering expanding preschool programs that, like Head Start, integrate health promotion activities.
Promoting 'sleep health literacy' in early childhood settings would reach upwards of 4 million US children. Sweet Dreamzzz, Inc. the nation's only non-profit devoted to sleep health education, has actually developed and implemented such a program. Over 2,000 Michigan families in Head Start have received their Early Childhood Sleep Education ProgramTM (ECSEP). In a randomized controlled trial, the ECSEP was shown to increase preschool (ages 3-5 years) children's nightly sleep by 30 minutes.4 The ECSEP, which integrates seamlessly with Head Start routines, trains preschool teachers, children, and parents in the essentials of sleep hygiene. Early childhood is a critical window for brain development and forming healthy habits. Aligning child care policies with evidence-based interventions that promote healthy sleep practices could have far-reaching impact upon human health and development.
1. 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. American journal of public health. Sep 2012;102(9):1688-1696. 2. Press TNA. Institute of Medicine (IOM) Early Childhood Obesity Prevention Policies. . Washington, DC2011. 3. U.S. Department of Health and Human Services OoDPaHP. National Action Plan to Improve Health Literacy. Washington, DC: Author; 2010. 4. 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.
Conflict of Interest:
None declared