Researchers find social determinants add up leading to poorer sleep

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Poor sleep habits and sleep disorders are very common in early childhood, especially in children exposed to multiple family and environmental risks like parental depression and poverty, according to new research from the Children's Hospital of Philadelphia (CHOP) published in the journal Sleep.

For the study, researchers recruited 205 pairs of otherwise healthy children between two and five years old and their caregivers from the waiting rooms of two urban and three suburban primary care clinics in the CHOP Care Network. Caregivers completed a child sleep questionnaire that included questions about a child's typical sleep patterns over the previous two weeks.

While the study included patients with a range of socioeconomic backgrounds, the study intentionally included an over-representation of families with lower incomes so that there was a robust sample of social determinants of health. Family and environmental risk factors included having a caregiver with symptoms of depression, living in a single caregiver household, and living in a lower-income neighborhood, among other risks.

Among the surveyed patients, poor sleep health habits were widespread, researchers said. More than 80 percent engaged in at least one unhealthy sleep habit. The most reported poor sleep health habit was the presence of an electronic device in the child's bedroom, with nearly two thirds of surveyed children having one. These included televisions (46.3 percent), tablets (34.6 percent) and smartphones (18 percent), among other devices.

Nearly half of these patients went to bed after 9 p.m. and more than a third didn't get enough sleep each night. More than 20 percent of children consumed one or more caffeinated beverages per day. In addition, more than two-thirds of children experienced symptoms of pediatric insomnia, such as taking more than 30 minutes to fall asleep or resisting going to bed, according to the study.

Importantly, the likelihood of having greater sleep concerns increased by 9 to 18 percent for each additional family and environmental risk factor, demonstrating the cumulative effect of these risks. Researchers found that having a caregiver with depressive symptoms or lower educational attainment and living in a crowded or single-caregiver home had the strongest correlation with poor sleep.

Researchers said that although many of these social determinants of health are difficult to change, several of the poor sleep behaviors and insomnia symptoms can be targeted through child sleep interventions.