UC researcher studies the impact of socio-ecological factors on children's sleep

“Limited research defines disparities and inequities in early childhood sleep health,” explains Randi Bates, PhD, assistant professor in the UC College of Nursing. “Also missing from this work is the examination of the effects of racism, housing instability, peak levels of screen media use and stress on the sleep health of toddlers and preschoolers. Our long-term goal is to design and test strategies and health policy to help families prevent and remedy inequities in early sleep health.”

Bates and her team will recruit 550 racially and economically diverse families from the metropolitan regions of Cincinnati and Columbus to conduct a micro-longitudinal study over a six-month period to examine sleep health in children aged 20 months to 48 months.

“We are looking at this from a multisystem perspective,” says Bates. “Some multilevel factors such as structural and personal experiences with racism are an understudied area for young children’s sleep health. We’re also examining how stress may influence children’s sleep. Screen time for little ones might disrupt sleep. So, we’re also going to look at how some conditions of screen time might influence children’s sleep more than others. For this study, our target age group is toddlers and preschoolers. There’s been a lot of focus on infants."

Trained as a nurse and family nurse practitioner, Bates is a former postdoctoral researcher at the Ohio State University Crane Center for Early Childhood Research and Policy. Her clinical practice spanned public health, acute care and managing chronic disease. Her research focuses on understanding the role of early life stress on health. She uses a bioecological lens to examine how different levels of ecologies or environments, from the molecular to the macro, shape stress and health-related behaviors in young children — key factors that may influence chronic disease. 

According to the Sleep Foundation, most healthy adults need at least seven hours of sleep nightly, but young children need more: Infants should get 12 to 16 hours with naps, and toddlers need 11 to 12 hours with naps. Preschoolers require 10 to13 hours of sleep, while school-aged children need between nine and 12 hours.

Bates says children who have sleeping problems don’t necessarily grow out of it. She adds that up to 40% of young children might have sleeping difficulties at some point and research suggests that 11% of kids with sleeping difficulties will experience them throughout their life.

The Society of Behavioral Medicine reports that good sleep in children supports better attention, school performance, emotional regulation and impulse control. It also promotes better immune system functioning and helps children fight off germs and infections. Long-term sleep problems increase risk for mental and physical health concerns, including depression, anxiety, risky behaviors and viral illnesses.

Looking at stress in very young children is an area of emerging research. Researchers in the field measure stress hormones, including the release of cortisol, in toddlers and infants, who can’t tell the adults around them that they are feeling significant stress.

“Not all stress is bad,” says Bates. “You need stress to learn new skills. But for children, toxic stress can be related to damaging outcomes later in life across many domains, such as cancer, cardiovascular disease and adverse mental health issues, including chronic depression. 

“Some children are more sensitive to stress than others. Our research suggests toddlers with increased physiological chronic stress were having a more difficult time maintaining and initiating sleep. With this new study, we want to identify these stress and sleep patterns.”

Bates is working with a pediatric expert from Yale University, along with interdisciplinary experts in sociology and developmental psychology, to really understand the inequities and disparities in early childhood sleep health.

“What I really hope for this research is to provide children and their families with the opportunity to sleep,” says Bates. “It’s not just what the parents do. Sleep advice might not matter if the parents don’t have the resources to help their child sleep. Sleep is so important for everything. It’s not just a behavior but also a biological process and if your child doesn’t sleep the parents probably don’t either.”

Issues with sleep can lead to behavior issues for children and problems with school performance, explains Bates.

The research study is supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under Award Number R01HL170100. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Featured photo at top of child sleeping. Credit/iStockPhoto/shironosov.