Sleep Health 1 (2015) 86–87
Contents lists available at ScienceDirect
Sleep Health
Journal of the National Sleep Foundation
journal homepage: http://www.elsevier.com/locate/sleh
Healthy sleep in young children: missed opportunity in early childhood
programs and policies?
The evidence is clear: healthy sleep in early childhood promotes
optimal development. Inadequate sleep, both in terms of quantity
and quality, is associated with increased risks of obesity,1,2 emotional
and behavioral problems,3,4 and suboptimal cognitive development.5
Long-term sleep problems have detrimental effects on brain develop-
ment that may last into adulthood. 6 Disparities in sleep health are
closely associated with socioeconomic factors and may contribute
to long-term health disparities.7 In addition, many parents of young
children crave better sleep for their children and themselves and
are willing to pay a growing number of private sleep coaches to
help. 8 In spite of compelling evidence that healthy sleep helps lay
the foundation for early childhood development and long-term
health, major systems of care for young children—namely, pediatric
primary care and early care and education (ECE)—lack clear guidance
for how to promote sleep health.
Both primary care and ECE settings present important opportuni-
ties for promoting healthy sleep and preventing sleep disorders. The
American Academy of Pediatrics (AAP) and its Bright Futures guide-
lines for child health providers recommend developmentally-staged
anticipatory guidance for parents on a wide range of health promo-
tion topics, including sleep. 9 Even with AAP guidance, evidence sug-
gests that many childhood sleep problems are underrecognized and
undertreated by pediatricians. 10 The Institute of Medicine recom-
mends that state child care regulations promote age-appropriate
sleep duration and healthy sleep practices to prevent early childhood
obesity, 11 yet few states have regulations that do. 12 Caring for Our
Children, the most comprehensive set of national recommendations
for ECE health and safety standards, mentions sleep only with regard
to sudden infant death syndrome (SIDS) and cot spacing.13 Similarly,
the discussion of sleep in the Head Start Program Performance Stan-
dards is limited to SIDS prevention and crib safety. 14 Meanwhile,
there are ample discussions in all of these documents about recom-
mended policies to prevent obesity, identify early developmental
concerns, and address behavioral problems—all of which may be
caused, in part, by inadequate sleep.
Early care and education settings are increasingly becoming
venues for health promotion and disease prevention. There are
major gaps, however, between evidence-based practices and the
programs with the potential to implement them on a large scale.
Mistry et al 15 presented a useful framework that links early
childhood programs and policies to improved child health outcomes
in a social-ecological context, building the capacities of families and
communities to care for children. Based on this thoughtful conceptual
framework, a clear research and policy agenda for sleep health in
ECE should (1) identify effective programs and practices; (2) build
http://dx.doi.org/10.1016/j.sleh.2015.02.002
2352-7218/© 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
evidence for how effective programs are best implemented and
disseminated; and (3) leverage key policy opportunities to spread
effective programs and incentivize their implementation. A long-
term research goal should be to measure how early investment in
sleep health promotion and the prevention of sleep problems could
yield substantial health and economic benefits.
Head Start is a federally-funded, comprehensive ECE program
serving nearly 1 million low-income children and their families
each year, with services that include nutrition, mental health, and
oral health. Health promotion is a core mission of Head Start, which
will set the bar for other “whole-child” ECE programs awaiting
Congressional approval. These ECE programs could be effective
platforms for the dissemination of effective programs, such as the
Sweet Dreamzzz Early Childhood Sleep Education Program (ECSEP),
which has reached more than 40,000 families in Michigan. In a
recent randomized controlled trial, the ECSEP was associated with a
30-minute increase in nightly sleep duration. 16 In a pending study,
we plan to test the effects of the ECSEP, supported by a structured
Head Start training approach, 17 with additional print, video, and
face-to-face guided discussions as reinforcements, along with
community involvement.
The Head Start National Center on Health, a joint effort between
the Department of Health and Human Services Office of Head Start
and the AAP, could support such dissemination with training and
technical assistance. Doing so would affirm that healthy sleep goes
beyond SIDS prevention and could decrease sleep problem morbidity
(eg, obesity, injury) and improve developmental potential.
To start raising awareness of the need for “sleep health
literacy” in ECE, we invite readers to submit articles to a special
themed issue of Sleep Health (instructions below). We hope that
this issue as well as a pending study to expand the reach of the
ECSEP will be first steps toward building the capacity of major
early childhood programs and policies to promote healthy sleep for
young children.
Sleep Health promotion in ECE: opportunities and leverage points
Call for submissions to Sleep Health (www.sleephealthjournal.org)
Special issue: March 2016
Please submit your articles through the Web site by July 31, 2015
This special issue seeks articles from a broad transdisciplinary
perspective on opportunities for the following:
• Identifying sleep problems in young children—for example, screening
opportunities or experiences
• Promoting healthy sleep—for example, relevance, need, or demand
for in ECE programs; experiences teaching sleep hygiene

• Instituting program and policy changes to promote young children's
sleep health in ECE—for example, potential leverage points
• Scope of practice—we are interested in how healthy sleep is
relevant to the divergent fields listed below, including linkages to
professional mission and guidelines
We are interested in articles from a range of disciplines,
including disabilities, early intervention/special education, early
childhood education, speech-language pathology, occupational
therapy, dentistry, sociology, public health, epidemiology, etc. We are
interested in receiving articles from researchers, front-line practitioners,
program managers, policy makers, technical assistance providers, and
other stakeholders. Please direct questions to Karen Bonuck (Karen.
Bonuck@einstein.yu.edu), the guest editor for this special issue.
Bergen B. Nelson MD, MS
Department of Pediatrics, David Geffen School of Medicine at UCLA
Los Angeles, CA
UCLA Children's Discovery and Innovation Institute, Los Angeles, CA
Corresponding author. Department of Pediatrics, University of
California, Los Angeles, 10833 LeConte Ave, Room B2-449 MDCC
Tel.: +1 310 794 8833
E-mail address: BNelson@mednet.ucla.edu
Karen Bonuck PhD
Department of Family and Social Medicine
Albert Einstein College of Medicine, New York, NY
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