Behavioral sleep problems such as sleep onset difficulties, night wakings, and inadequate duration affect 25-40% of 2.5 to 5 year-old children. Here, we propose a randomized controlled trial and longitudinal follow- up of a health behavior change intervention that aims to give parents knowledge and skills, and motivate them to set goals, problem-solve, and improve their child's sleep. Previous interventions have largely focused on a single aspect of sleep (such as bedtime resistance) and utilized a single tactic (such as graduated extinction). Despite the availability of these strategies, parents often struggle to address their child's sleep problems, which may stem from multiple factors including an inconsistent bedtime, a bedtime routine that is a poor match for the child's temperament, variable parental responses to child behavior, and social and environmental barriers. As a result parents may need to be coached in how to make multiple changes in bedtime behaviors, and without active support, may give up on worthwhile changes before reaching the tipping point where positive outcomes are seen. To better address the multifactorial nature of early childhood sleep problems, the successfully pilot-tested SHIP (Sleep Health in Preschoolers) intervention offers parents education and tools utilizing evidence-based strategies. Short-term consequences of sleep problems in young children include behavior problems and parental stress and sleep loss. In the long-term, observational studies have associated early childhood sleep problems with obesity, mental illness, and poor academic achievement. Causal evidence regarding these long-term effects can provide the motivation and evidence needed to make early childhood sleep a public health priority. Using an innovative and multi-faceted approach to child sleep, we will leverage the experimental nature of a RCT design to test the causality of the relationship between early childhood sleep problems and subsequent obesity, emotional and behavior problems, and poor academic achievement. While understanding the long-term outcomes of poor sleep in early childhood is vital to improving health, even acute behavior problems and parental sleep loss highlight the need for effective and accessible interventions. As such, our specific aims are as follows: 1. To test if the SHIP program can significantly improve sleep in intervention preschool children as compared to active controls, both following intervention and at follow-up. 2. To test whether intervention for early childhood sleep problems leads to decreased long-term sequelae (excess weight gain, emotional and behavioral problems, and poor school achievement) in the intervention group as compared to active controls. 3. To explore how intervention in early childhood affects the trajectory of sleep problems and family response to re-emergent sleep problems over 3 years. Achieving these aims has the dual potential to improve child sleep and expand our scientific understanding of how early childhood sleep problems affect development.

Public Health Relevance

We propose a randomized controlled trial of an intervention for preschool children with sleep problems, in which we aim to give parents the knowledge, motivation, and skills necessary to set goals, problem-solve, and improve their child's sleep. In collecting three years of follow-up data, we will be able to determine the impact of early childhood sleep intervention on childhood sleep problems, obesity, poor academic achievement, and emotional and behavioral problems, as well as parental stress and daytime tiredness. This study has the dual potential to expand treatment resources for young children with behavioral sleep problems and to increase our scientific understanding of the long-term consequences of early childhood sleep problems.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Haverkos, Lynne
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Seattle Children's Hospital
United States
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Hale, Lauren; Kirschen, Gregory W; LeBourgeois, Monique K et al. (2018) Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents. Child Adolesc Psychiatr Clin N Am 27:229-245