Sleep Health Education in Pediatric Community Settings: Rationale and Practical Suggestions for Incorporating Healthy Sleep Education into Pediatric Practice

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease affecting young people. It has a profound impact on their physical, mental and social lives, leading to long-term disability. With the growing awareness of the importance of sleep in all areas of functioning in young people, an emerging literature has drawn attention to the role of sleep in the pathogenesis of JIA. Sleep disturbances in children and adolescents with JIA arise from a wide range of symptoms and pathways, leading to a vicious cycle that exacerbates subclinical inflammation, symptoms and disease progression. Putative factors contributing to sleep disturbances include chronic inflammation, JIA-associated sleep disorders, JIA symptoms (e.g. pain), psychological comorbidities and potential circadian disruption, which may be exacerbated by the transition to adolescence. Here, we review these pathways and advocate key strategies and alternatives for sleep management in young people with JIA in clinical settings. We identify gaps in knowledge and suggest future directions to improve our understanding of JIA sleep disorders, including clinical trials investigating potential strategies to improve sleep health in this young population.

Sleep patterns of 419 toddlers with congenital heart disease were comparable with the normative population except for increased likelihood across the cohort of sleeping in parents' room and increased disrupted sleep in children aged 18-23 months. Disrupted sleep patterns were associated with lower maternal education and increased medical complexity.

There is a gap in patient education and coaching of lifestyle factors related to pediatric migraine, which nurses are in a unique position to fill in order to provide comprehensive care to these patients. In order to help fill this gap, we conducted a targeted review of studies examining migraine and lifestyle factors in children and adolescents. Studies older than 2010, studies examining adults above the age of 18, studies not available in the English language, and secondary sources were excluded from the review. A final sample of 42 studies was included in this review. Lifestyle factors including stress, sleep, obesity, and diet were identified as playing a significant role in increasing the frequency, severity, and duration of migraine attacks in pediatric patients. Based on these findings, a framework is discussed for practical applications of this knowledge by nursing staff working in primary and specialty care clinics.

This chapter provides an update on pediatric sleep research with a specific focus on best practices in behavioral methods to prevent and address bedtime problems in youth. The chapter covers how to best manage the most common sleep problems in children and adolescents including recommendations for addressing night wakings, insomnia, bedtime refusal and delays, and parasomnias in children and adolescents. Case examples highlighting some of the recommended interventions are included. This chapter also discusses the importance of screening for sleep-disordered breathing/obstructive sleep apnea and the impacts of these disorders on children’s health and mental health. Recommendations on media and sleep are also provided. Efficacious methods to provide parent education and guidance on these issues are detailed.

This paper describes evidence-based strategies for the dissemination of empirically supported interventions for infant behavioral sleep problems.

To identify parents' needs, a survey sampled 1022 parents in the Niagara region about use of health resources, tracking occurred of public health nurses' consultations with parents about infant sleep, and nurses obtained sleep workshop evaluation data from 18 parents. A focus group with 10 participants, a survey of Niagara Region Public Health and Emergency Services (NRPH&ES) employees, and consultations with external stakeholders identified gaps in parents' and infants' care and public health nurses' training needs. We developed solutions by creating evidence-based tools and a program for parents and public health nurses. We implemented and disseminated information via sharing tools on the NRPH&ES website, and workshops for community agencies and public health nurses.

Seventy childhood educators, support workers, and social and public health professionals attended our community workshop. Twenty-three public health nurses attended our training workshop. In guided discussion, nurses evaluated the workshop as addressing gaps in knowledge and enhancing NRPH&ES interventions to manage infants' behavioral sleep problems. Fifteen parents attended a sleep workshop pilot, with seven parents indicating a preference for follow-up telephone support. Fifty individuals attended our oral presentation at the Ontario Public Health Convention.

For next directions, community and other public health agencies want access to our tools and program components. We received a research grant to design, implement, and evaluate sharing tools and program components with community agencies (daycares and childcare centres).

To determine whether simultaneous school start time changes (delay for some schools; advance for others) impact adolescents' sleep.

Quasi-experimental study using cross-sectional surveys before and after changes to school start times in September 2015.

Eight middle (grades 7-8), 3 secondary (grades 7-12), and 8 high (grades 9-12) schools in Fairfax County (Virginia) public schools.

A total of 2017 (6% of ~34,900) students were surveyed before start time changes, and 1180 (3% of ~35,300) were surveyed after.

A 50-minute delay (7:20 to 8:10 am) in start time for high schools and secondary schools and a 30-minute advance (8:00 to 7:30 am) for middle schools.

Differences before and after start time changes in self-reported sleep duration and daytime sleepiness.

Among respondents, 57.5% were non-Hispanic white, and 10.3% received free or reduced-priced school meals. Before start time changes, high/secondary and middle school students slept a mean (SD) of 7.4 (1.2) and 8.4 (1.0) hours on school nights, respectively, and had a prevalence of daytime sleepiness of 78.4% and 57.2%, respectively. Adjusted for potential confounders, students with a 50-minute delay slept 30.1 minutes longer (95% confidence interval [CI], 24.3-36.0) on school nights and had less daytime sleepiness (−4.8%; 95% CI, −8.5% to −1.1%), whereas students with a 30-minute advance slept 14.8 minutes less (95% CI, −21.6 to −8.0) and had more daytime sleepiness (8.0%; 95% CI, 2.5%-13.5%).

Both advances and delays in school start times are associated with changes in adolescents' school-night sleep duration and daytime sleepiness. Larger changes might occur with later start times.