A Good Night for All Children: on Children’s Sleep Health and Wellness

A Good Night for All Children:
The Impact of the Pajama Program
on
Research Highlights
Recommendations for sleep requirements
are as follows;
Children’s Sleep Health and Wellness
Terry Cralle, RN, Certified Clinical Sleep Educator, Certified Professional in Healthcare
Quality
W. David Brown, PhD, Diplomate, American Academy of Sleep Medicine / Certified
Behavioral Sleep Medicine / Assistant Professor in Psychiatry, UT Southwestern
Medical School /Sleep Psychologist, Children’s Medical Center Dallas
Newborns
Preschool
School-aged
Teens
Adults
16 – 18 hours a day
11 – 13 hours a day
10 – 11 hours a day
9 – 10 hours a day
7 - 8 hours a day
Approximately 15 million American children
are affected by inadequate sleep.
SLEEP IS THE FORGOTTEN COUNTRY AND IS NOT GETTING THE
ATTENTION IT MERITS. IT PLAYS OUT IN THE HOME, IN THE
PEDIATRICIAN’S OFFICE, AND IN SCHOOL. SLEEP IS AN IMPORTANT
FACTOR IN THE LIVES OF CHILDREN.
Insufficient sleep disrupts every physiologic
function in the human body.
—MARY A. CARSKADON, PHD
Sleep, along with diet and exercise, is at the very foundation of health
and well-being. It is a fundamental and critical biological need—not an
optional endeavor to be taken lightly. Quite simply, sleeping is one of
the most important functions in life, and it must be prioritized as such.
In recent years, the importance of sleep in a child’s growth and
development has been confirmed by researchers. In addition to the
fact that children generally need more sleep than adults, we are
learning that ensuring sleep in childhood can have lifetime benefits.
Although the critical importance and the need for sleep in children may
seem obvious, many of our children fail to get the sleep they need for
optimal physical and psychological development and functioning,
especially those affected by poverty and living in transition or crisis.
Between 10 and 45 percent of otherwise healthy children are
estimated to have sleep problems; in economically disadvantage
populations, this percentage may be as high as 94 percent. Among
children with developmental disorders, including autism, the
prevalence of sleep problems ranges from 40 to 80 percent.
pg. 1
Sleep and emotional functioning are closely
linked.
Sleep related problems affect approximately
25-40% of children and adolescents.
Children without regular bedtime schedule
have more behavioral difficulties.
Sleep is a key factor in how young children
respond to their world.
During the early years of life, the rate of learning is more rapid than at
any time in the life cycle. Researchers theorize that sleep may be
critical for keeping nerve cells functioning optimally to accommodate
this crucial time of rapid development. In fact, attention, motivation,
emotions, stress responses, outlook, school performance, behavior,
memory, relationships, mood, and even propensity for substance
abuse are but a few aspects of our lives affected by sleep.
From a physical perspective, sleep is involved in cellular repair, the
release of growth hormone, immunity, strengthening of the nervous
system, metabolism, and weight management—all while playing a vital
role in crucial brain development.
Many children, however, are not getting the sleep their bodies and
minds require. Suboptimal sleeping conditions, stress, early school
start times, poor sleep habits, lack of a sleep schedule, electronics and
an overall lack of education about the importance of sleep contribute
to this critical and widespread problem. Research has demonstrated a
distinct vulnerability to the effects of poor sleep quality on all children,
especially those in distress and facing challenges such as poverty,
homelessness, and foster care, among others.
The Pajama Program can be seen as an evidenced-based, targeted
intervention for helping children in distress to achieve the quality sleep
they need with the comfort and security they deserve. The simple and
inexpensive gesture of providing pajamas and books to a child in need
is the first step in a profound journey toward making a real,
measurable, and extreme impact on the quality of a child’s life.
Chronic insomnia affects nearly 16% of
adults and up to 25% of children.
Frequent, insufficient sleep is associated
with depressive and anxiety disorders.
As little as 15–30 minutes of sleep loss in
preschoolers can lead to greater fussiness
and irritability the next day.
As sleep duration in children has declined,
obesity rates have increased.
Pre-sleep time that is dominated by screen
time is associated with a later sleep onset.
Sleep Quality
Children’s sleep health has become a new priority in prevention and
intervention, as sleep deprivation is associated with numerous adverse
behavioral, cognitive, and health outcomes. For optimum functioning,
children require sufficient, quality sleep.
It is a given that insufficient sleep disrupts not only a child’s night but a
child’s day as well. A child is less mentally alert, more inattentive,
impulsive, argumentative, hyperactive, and prone to accidents and
injury following a poor night’s sleep. Memory consolidation, mood
regulation, attention, school performance, and the capacity to learn
are all diminished when sleep is compromised. Additionally, poor
quality sleep negatively impacts the immune system, which makes a
child more susceptible to illness, chronic and acute health problems.
pg. 2
An adequate bedtime schedule could serve
as a preventive measure against depression
in children.
Sufficient sleep in childhood is essential for a
healthy adulthood.
Inadequate sleep is a risk factor for disease.
Sleep Problems in Childhood May Negatively Impact Adulthood
Why is it crucial to support and protect a child’s access to adequate
and comfortable sleep? A key reason is that if children lack appropriate
sleep, every aspect of their growth and development may be
negatively impacted. Recent research has demonstrated that poor
sleep patterns early in life can cause a host of problems later in life.
Perhaps most alarming is the suggestion that sleeplessness and lack of
quality sleep in early childhood could impair cognitive performance
well into adulthood. Without enough sleep, particularly in childhood,
the way our brain functions may be fundamentally changed for the
remainder of life.
Insufficient sleep is not just a concern for younger children;
adolescents are developmentally vulnerable to insufficient or poor
quality sleep as well. Sleep insufficiency in adolescents is associated
with poor school performance, risk-taking behaviors, diabetes, mood
swings, motor vehicle accidents, obesity, substance abuse, depression,
and even suicide. Chronically sleep-deprived youth are drawn to
stimulants like coffee, energy drinks and drugs of abuse such as
amphetamines, and when they subsequently have difficulty falling
asleep at night, they may be drawn to drugs to help them sleep.
Sleep in Distressed Children
Children’s sleep health must be prioritized to give all children the
advantages provided by optimal sleep. The fact is that not all sleep is
equal, and as a result, the benefits of quality sleep are not equally
enjoyed by all children. Children in distress can be at an especially
great disadvantage when it comes to realizing the physical and
psychological benefits of adequate sleep.
Unfortunately, this poor sleep quality leads to learning, emotional, and
behavioral problems—influencing health, achievement, performance,
and overall quality of life in both the short and long term. A
bidirectional relationship between sleep and poverty is evident: poor
sleep can lead to lower socioeconomic status by means of learning
difficulties and compromised performance as well as psychological and
physical problems, while a lower socioeconomic status can lead to poor
sleep.
Scientific support exists for improving children’s sleep health, as doing
so will have a lasting, positive impact on individuals and society as a
whole. Targeted interventions, such as those provided by the Pajama
pg. 3
Children sleeping less than ten hours a night
before age three are at risk for ADHD as well
as language and reading problems.
Homeless children are sick four times more
often than other children.
Sleep reduces the stress hormone cortisol.
Children with irregular bedtimes up to the
age of three are negatively affected when it
came to math and reading skills and spatial
awareness.
Effective interventions for bedtime problems
and nighttime awakenings include positive
routines and parental sleep-health
education.
Environmental conditions that can lead to
poor sleep quality include:
-inferior beds and bedding
-inadequate space
-noise in the home and/ or neighborhood
-tobacco smoke
-poor ventilation
-inadequate heating and cooling
There is a positive correlation between
sadness and daytime drowsiness.
Poor sleep quality during childhood may
permanently affect brain functioning.
Program, can help to narrow the gap for children in crisis and
effectively mediate the significant personal and societal consequences
of poor sleep quality.
It is evident from the research that a failure to prioritize the sleep
needs of children—especially children in distress—to ensure adequate,
healthful sleep places vulnerable children at further risk and
disadvantage for problems. Children in poverty and distress suffer from
many disadvantages, and considerable evidence suggests that poor
sleep is one major, preventable cause.
A Bedtime Routine for All Children
Quality sleep must be fostered by a calming, comforting, positive, and
predictable transition from wake to sleep. When this is achieved,
usually in a series of steps, it is referred to as a pre-sleep or bedtime
routine. It is well known that children of all ages thrive on predictable
and structured routines that help them feel safe and secure. A regular
schedule provides children with a sense of order and organization,
while following a consistent bedtime routine aids in the development
of healthy sleep habits that result in quality sleep.
Far more crucial than its name implies, a bedtime routine serves a
critical function in the achievement of healthy sleep. Having consistent
bedtime preparation activities that occur in the same order and at
roughly the same time every night encourage the activities associated
with winding down, going to bed, and falling asleep. The routine itself,
defined by its repetitiveness, predictability, and pleasantry, induces
relaxation and promotes sleep onset. Once learned, this habit or
routine will provide structure and security in the often chaotic and
unstructured environment of a child in distress.
This pre-sleep routine is comprised of several consistent steps, always
performed in the same order, so it can be easily duplicated in any
environment. Familiar patterns and rituals provide children with the
security of knowing what to expect, as well as helping them to foster a
personal sense of responsibility. The bedtime routine or sleep ritual
can be fairly short, lasting 20–40 minutes, and serves as a signal to the
child that it is bedtime. A good sleep ritual also serves to help the child
fall asleep on his or her own.
The routine may consist of any number or combination of steps, but all
should lead the child closer to the bed and sleep. The steps might
consist of a snack, bath, teeth brushing, putting on pajamas, reading a
pg. 4
A slightlyfrom
Children
sleepy
a lower
sixth-grader
socioeconomic
will perform
status
on
have
a
fourth-grade
experienced
level
higher
in thelevels
classroom.
of
aggression, anxiety, low self-esteem,
delinquency, and depression due to
insufficient sleep.
We have the ability to affect quality of lives
through ensuring better sleep quality in
The
improvement
of sleep could potentially
children
and adolescents.
alleviate many health problems among the
homeless.
Sleep
serve as a countermeasure
to the
There may
are differences
in sleep health based
stress
thatfactors
accompanies
on social
such as homelessness,
ethnoracial group,
poverty,
and natural
educationdisplacement,
level, and household
income.
disasters.
Sleep patterns and duration predicted
adolescents' cigarette, alcohol, and
marijuana use.
School-age children who do not have a sleep
routine do not meet their sleep
requirements.
Children from disadvantaged households are
less likely to have consistent bedtime
routines than more advantaged children.
The American Academy of Pediatrics
recommends
bedtimes
bedtime
Chronic sleep regular
restriction
amongand
adolescents
activities
in
order
to
cue
children
for
falling
may increase suicidal risk.
asleep; helping them associate the prebedtime period with the upcoming sleep
period.
Insufficient sleep is associated with
substantial personal and public health
issues, such as depression and accidental
injury and mortality.
In one study of 3120 high school students,
the majority of the adolescents did not get
Childrensleep
in poverty
live in
conditions
enough
and their
sleep
loss interfered
unsuitable
forfunctioning.
attaining optimal sleep.
with
daytime
It is crucial to make sleep a high priority and
take action to promote sleep health among
children.
story, turning on the night light—all in as quiet and calm a setting as
possible.
Consistency and predictability of the routine are vitally important for
ensuring quality sleep. Regular bedtimes and quiet pre-sleep routines
are associated with improved success in going to bed, falling asleep,
sleeping through the night, and waking in the morning.
Pajamas Represent Comfort
THE CLOTHING A CHILD SPENDS 8–10 HOURS SLEEPING IN IS
IMPORTANT TO A CHILD'S WELL-BEING. NEW PAJAMAS ARE A
NECESSARY PART OF PROMOTING GOOD HEALTH AND PREVENTING
INFECTIONS AND DISEASE, AS WELL AS PROVIDING PSYCHOLOGICAL
BENEFITS.
—SHELDON H. CHERRY, MD, CLINICAL PROFESSOR OF OBSTETRICS &
GYNECOLOGY, MT. SINAI SCHOOL OF MEDICINE, NYC
Pajamas are a key component of even the most basic bedtime routine.
Children’s pajamas are often in child-pleasing colors, textures, and
patterns, and are typically designed for sleep comfort and safety. For
many Americans, changing into pajamas before going to sleep is
probably the most symbolic part of the bedtime routine, representing
security and comfort, which, ultimately, positively impacts bedtime and
the ability to sleep.
Unfortunately, pajamas are not an available part of the bedtime
routine for all children, especially for those in crisis or transition.
Through the provision of pajamas, the Pajama Program helps to ensure
improved sleep and the numerous benefits that accompany it.
Inarguably, well rested children are healthier, happier, and potentially
smarter as a result of getting adequate sleep.
Bedtime Is Book Time
The enjoyment and pleasure of a bedtime story before sleep is
indisputable. Bedtime reading is associated with emotional warmth, a
sense of well-being, and sleep readiness—but for children in crisis,
living in shelters or group homes, books—like pajamas—are frequently
an inaccessible luxury. Books stimulate a child’s development and wellbeing in many ways. In addition to improving reading ability, a book at
bedtime promotes a host of benefits that include language
development, increased motor skills, decreased stress levels, improved
memory skills as well as enhanced emotional and social development.
pg. 5
Low socioeconomic position is associated
with poorer sleep quality, shorter sleep
Reduced
sleep time
in children
duration total
and difficulty
initiating
and
predicted
more
delinquent
behavior and
maintaining sleep.
more concentration problems.
Total sleep time decreases with age among
children from 11 to 15 years old.
Sleep problems at ages 3–8 predicted onset
of alcohol, cigarette, and marijuana use
Sleeplessness
is aonset
socioeconomic
as a
among boys and
of alcoholas
usewell
among
public
health
issue.
girls.
Sleep is an essential component of both
physical and psychological functioning that
The
improvement
sleep
could
potentially
supports
health asof
well
as the
ability
to
alleviate
many
health
problems
among
the
handle stress.
homeless.
Chronic sleep restriction among adolescents
may increase suicidal risk.
Even minor sleep restriction impacts
children's neurocognitive functioning.
Sleep quality and schedule are linked with
each other.
Children
households
Reducingfrom
sleepdisadvantaged
opportunity has
a direct are
less
likely
to
have
consistent
bedtime
effect on academic performance.
routines than more advantaged children.
The public health ramifications of sleep are
under-recognized and far-reaching.
There is a bidirectional relationship between
sleep and mental health.
.
Children in poverty often live in conditions
unsuitable for attaining optimal sleep.
The pleasant content of a book at bedtime helps set the stage for the reverie of a child’s mind as he or
she drifts off to sleep. If only at bedtime, this positive aspect of the presleep routine allows children to escape the concerns of their day.
A Good Night for All Children
THE PAJAMA PROGRAM CREATES A FOUNDATION ON WHICH TO
EFFECTIVELY COMMUNICATE, EDUCATE, AND FACILITATE SLEEP HEALTH
AND WELLNESS FOR ALL CHILDREN.
Many children have not experienced the security and comfort of having a
parent tuck them into bed at night. Many children have never enjoyed
the simple comfort of warm, clean pajamas and a bedtime story. Some of
the children served by the Pajama Program have been abused or
neglected; some are living with their families below the poverty level and
are in desperate need of food, clothing, and shelter.
National educational initiatives in sleep health and wellness aimed at
children, parents, educators, and community leaders are essential if we
are to make real progress in ensuring a better life for all children. As
individuals and as a society, it is imperative that we make children’s sleep
health a priority and are vigilant about providing the best sleep possible
for our children to ensure their health, safety, education, well-being and
quality of life—for their future depends on it. No child’s health—or
potential—is expendable; and we must make the attainment of quality
sleep equally accessible to every child. The bottom line is simple: all
children deserve the health and restorative benefits of a good night’s
sleep, starting with pajamas and a good book. We all deserve a dream.
A significant proportion of school aged
children get less sleep than recommended.
Minority children living in low income, urban
communities are at risk for decreased sleep
duration, increased behavioral sleep
problems and sleep disturbances.
Poor sleep quality is strongly associated with
poverty – creating a sleep disparity
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