Introduction

This knowledge path directs readers to a selection of current, high-quality resources about sleep in infants, children, adolescents, and pregnant women. This knowledge path can be used by health professionals, researchers, educators, community advocates, and families to learn more about sleep, to improve diagnosis and treatment of sleep disorders, for program development, and to locate training resources and information to answer specific questions. Separate briefs present resources for families and schools. This knowledge path has been developed by the six national Pediatric Pulmonary Training Programs and the MCH Library at Georgetown University, all of whom are funded by the Maternal and Child Health Bureau (MCHB). It will be updated periodically.

Overview

Sleep is an important component of daily life for people of all ages, with children spending an average of 30 percent to 50 percent of their day sleeping. Sleep is especially important for infants, children, adolescents, pregnant women, and new mothers. Good sleep is essential to a well-functioning family. Poor sleep and/or sleep disorders in children can have an impact on the child and the entire family. Infants, children, and adolescents are particularly vulnerable to sleep disorders and are at higher risk than adults for getting insufficient sleep. Sleep problems are increasingly being recognized as a public health issue with ties to obesity, attention deficit hyperactivity disorder (ADHD), autism, and poor school performance. Underserved populations are at higher risk for sleep problems. Health professionals, families, and communities need to be knowledgeable about how to improve sleep and be able to recognize sleep disorders.

General Resources for Professionals

Websites

• American Academy of Sleep Medicine (AASM). Sleep medicine practice tools and guidelines and information about membership, accreditation, coding, and legislation. Some information is accessible to members only, including journal articles and a state policy directory. Patient education brochures, learning modules, webinars, and some other materials are available for a fee. Also see AASM's blog.
  
  
• Healthy People 2020. National health-promotion and disease-prevention initiative of the Department of Health and Human Services (DHHS). View the overview, objectives, and recommended interventions and resources for sleep health.
  
  
• National Center on Sleep Disorders Research (NCSDR). Initiative to coordinate government-supported sleep research, training, and education. NCSDR is located within the National Heart, Lung, and Blood Institute (NHLBI). See the SLEEPRFA-L listserv and a publications list.
  
  
• National Sleep Awareness Roundtable (NSART). National coalition of government, professional, voluntary, and other organizations that aims to address public and professional awareness and education about sleep and sleep disorders. NSART is a program of the National Sleep Foundation (NSF).
  
  
• National Sleep Foundation (NSF). Information about sleep and sleep disorders in infants, children, adolescents, and pregnant women. Includes findings from the Sleep in America polls, which address topics such as technology use and sleep, adolescents and sleep, and children and sleep. NSF is an independent nonprofit organization dedicated to achieving a better understanding of sleep and sleep disorders and supporting education, sleep-related research, and advocacy.
  

Additional Electronic Publications

• Birch LL, Parker L, Burns A, eds. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: National Academies Press. [Report, Brief]. This report contains a chapter about sleep.
  
  
• Graham MG, ed. 2000. Sleep Needs, Patterns and Difficulties of Adolescents: Summary of a Workshop. Washington, DC: National Academies Press. [Report].
  

Databases

See the following set of MCH Library resource briefs to identify additional data and statistics, literature and research, and programs about sleep and sleep disorders.

• Maternal and Child Health Data and Statistics
• Maternal and Child Health Literature and Research Databases
• Maternal and Child Health Programs Databases
  

News and Commentary

• American Academy of Sleep Medicine (AASM): Sleep Education. This blog covers news and information about sleep and sleep disorders.
  
  
• National Center on Sleep Disorders Research: SLEEPRFA-L List. This monthly e-mail alert service presents information about NIH initiatives and activities of potential interest to sleep and circadian researchers.
  

Resources for Families

• See the MCH Library family resource brief Sleep in Babies, Kids, Teens, and Pregnant Women for links to sleep specialists, sleep centers, and websites.
  

Resources for Schools

• See the MCH Library school resource brief Sleep.
  

Resources on Specific Aspects of Sleep

• Anxiety, Depression, Trauma, and Stress
• Attention Deficit Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorders
• Bruxism, Parasomnias, and Rhythmic Movement Disorder
• Caffeine
• Insomnia
• Narcolepsy
• Polysomnography
• Pregnancy
• Restless Legs Syndrome (RLS)
• Sleep Apnea
• Sleep Deprivation
• Sleep Practices

Anxiety, Depression, Trauma, and Stress

• Children's Anxiety Institute: Sleep Habits Can Affect Levels of Stress and Anxiety in Children and Teens. Information about the relationship between sleep and stress and anxiety levels.
  
  
• Depression and Bipolar Support Alliance: Sleep. Information for families about sleep in children and adolescents and early onset of bipolar disorder. Links to information about the importance of sleep, getting a good night's sleep, depression and sleep, and sleep tools.
  
  
• National Child Traumatic Stress Network (NCTSN). Resources for families, educators, health and social services professionals, policymakers, and the media about child and adolescent traumatic stress, effective interventions, data, and terrorism and disaster preparedness to lessen traumatic effects. Several items broadly address sleep difficulties as a behavior associated with exposure to trauma.
  

Attention Deficit Hyperactivity Disorder (ADHD)

• American Academy of Sleep Medicine (AASM): Sleep Problems Are Common in Children with ADHD. Information about common sleep problems in children and adolescents with ADHD.
  
  
• National Sleep Foundation: ADHD and Sleep. Information about the link between ADHD and a variety of sleep problems.
  

Autism Spectrum Disorders

• Autism Speaks: Sleep Disturbance. Information about the Autism Treatment Network Sleep Committee and its work to develop a sleep hygiene toolkit and an algorithm for carrying out the initial diagnostic and treatment steps for sleep disturbances in children with autism.
  
  
• Malow BA. 2007. A Good Night's Sleep in Children with ASD: What We Know, and What We Still Need To Understand Through Research. Nashville, TN: Vanderbilt Sleep Disorders Center. [Report]. Also view Dr. Malow's PowerPoint presentation, Promoting Sleep in Children with Autism Spectrum Disorders (2007).
  
  
• WebMD Medical Reference. 2010. Helping Your Child with Autism Get a Good Night's Sleep. New York, NY: WebMD LLC. [Article].
  
  
• Wheeler M. 2003. Good Night, Sleep Tight, and Don't Let the Bed Bugs Bite: Establishing Positive Sleep Patterns for Young Children with Autism Spectrum Disorders. Bloomington, IN: Indiana Resource Center for Autism. [Article].
  

Bruxism, Parasomnias, and Rhythmic Movement Disorder

• American Academy of Sleep Medicine (AASM).
  
  Childhood Parasomnias. Information about parasomnias in children (nightmares, sleep terrors, sleep walking, confusional arousals, or bedwetting). Includes a chart comparing childhood parasomnias and tips for parents.
  
  Rhythmic Movement. Information about rhythmic movement disorder (body rocking, head banging, or head rolling).
  
  
• KidsHealth: Bruxism. Information about bruxism (teeth grinding or clenching) in children.
  

Caffeine

• American Academy of Sleep Medicine (AASM): Sleep and Caffeine. Information about the effects of caffeine on sleep and the caffeine content of drinks. Includes information about caffeine and adolescents.
  

Insomnia

• American Academy of Sleep Medicine (AASM): Behavioral Insomnia of Childhood. Information about symptoms and when to seek treatment.
  
  
• Society of Behavioral Sleep Medicine: Childhood Insomnia. Information about symptoms, diagnoses, and treatment.
  

Narcolepsy

• Children's Hospital of Philadelphia Sleep Center: Narcolepsy. Information about the symptoms, possible causes, and treatment for narcolepsy.
  
  
• Narcolepsy Network. Information about narcolepsy in children and adolescents. Resources include brochures, a sleep log, and contact information for support groups, sleep centers, and sleep professionals.
  

Polysomnography

• Beck SE, Marcus CL. 2009. Pediatric Polysomnography. Sleep Medicine Clinics 4(3): 393–406. [Journal article].
  
  
• Carroll JL. [Accessed 2011]. Sleep Apnea in Children. Little Rock, AR: University of Arkansas for Medical Sciences. [Case study].
  
  
• Children's Hospital of Philadelphia Sleep Center. [Accessed 2011]. Your Child's Study: General Instructions. Philadelphia, PA: Children's Hospital of Philadelphia. [Fact sheet].
  
  
• Kidshealth. 2010. Polysomnography (Sleep Study). Wellington, NZ; Auckland, NZ: Paediatric Society of New Zealand; Starship Foundation. [Fact sheet].
  
  
• Porquez EJ. 2009. Polysomnography and the Pediatric Patient. RT: For Decision Makers in Respiratory Care. January 2009. [Article].
  
  
• Also see the American Academy of Sleep Medicine (AASM) guidelines, Practice Parameters for the Respiratory Indications for Polysomnography in Children (2011).
  

Pregnancy

• American Academy of Sleep Medicine (AASM): Sleep and Pregnancy. Information about how sleep may be affected during each stage of pregnancy and during the postpartum period. Includes tips to help improve sleep and links to related articles.
  
  
• National Sleep Foundation: Pregnancy and Sleep. Information about sleep problems that may occur during pregnancy, treatment options, and coping tips.
  

Restless Legs Syndrome (RLS)

• Cleveland Clinic. 2009. Periodic Limb Movement Disorder. Cleveland, OH: Cleveland Clinic Foundation. [Fact sheet].
  
  
• National Institute of Neurological Disorders and Stroke (NINDS). 2011. Restless Legs Syndrome Fact Sheet. Bethesda, MD: National Institute of Neurological Disorders and Stroke (NINDS). Also available in Spanish.
  
  
• Restless Legs Syndrome (RLS) Foundation. Information about RLS, treatment, and research. Includes online discussion groups, an electronic newsletter, and contact information for health professionals and support groups. Resources include
  
  Restless Legs Syndrome and Periodic Limb Movement Disorder in Children and Adolescents: A Guide for Healthcare Providers. (2007).
  
  
• Also see the Pregnancy section for resources about RLS during pregnancy.
  

Sleep Apnea

• American Sleep Apnea Association (ASAA): Children's Sleep Apnea. Information about sleep apnea in children. Includes a directory of pediatric sleep specialists and an online support forum for pediatric sleep apnea.
  
  
• Cataletto ME, Lipton AJ, Murphy TD. 2011. Childhood Sleep Apnea. New York, NY: WebMD LLC. [Article].
  
  
• KIDSAPNEA.COM. Information about obstructive sleep apnea in children and its causes, consequences, and treatment. Topics include failure to thrive and orthodontics. KIDSAPNEA.COM was developed and is maintained by Allen J. Moses, D.D.S.
  
  
• Childhood obesity is associated with sleep apnea. See the MCH Library knowledge path, Overweight and Obesity in Children and Adolescents for resources about the prevention, identification, management, and treatment of overweight and obesity in children and adolescents.
  

Sleep Deprivation

• Boyse K. 2010. Sleep Problems. Ann Arbor, MI: University of Michigan Health System. This brief presents information about sleep in infants, children, and adolescents and includes a section about sleep deprivation.
  
  
• Colten HR, Altevogt BM, eds. 2006. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: National Academies Press. [Report, Brief].
  

Sleep Practices

• Breus MJ. 2011. Co-Sleeping Neither Helps nor Hurts Child Development. New York, NY: WebMD LLC. [Article]. Please note: This article addresses bed sharing when a child is 1, 2, and 3 years old. It also refers to the American Academy of Pediatrics recommendation against bed sharing with infants under age 1 because of the risk of Sudden Infant Death Syndrome (SIDS).
  
  
• Cleveland Clinic: Sleep and Children. Information about sleep and encouraging healthy sleep practices by age group: infants, toddlers and preschoolers, school-age children, and adolescents.
  
  
• First Candle: Bedtime Basics. Information and materials for this educational outreach campaign to help prevent infant deaths caused by unsafe sleep practices including bed sharing. Resources include
  
  Room Sharing Is Safer Than Bed Sharing/¡Compartir la Habitación Is Mejor Que Compartir la Cama! (2010). [Brochure].
  
  
• National Sleep Foundation: Sleep Hygiene. Information and examples of healthy sleep practices. Includes information about adolescents.
  
  
• National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center: Safe Sleep. Information for parents, caregivers, and health professionals about safe sleep for infants, including bed sharing. Materials include
  
  Helping Baby "Back to Sleep" (rev. ed.). (2009). [Brochure]. Also available in Spanish.
  
  Hot Topics in Infant Safe Sleep: An Interactive Workshop with Rachel Moon, M.D. (2011). [Webinar from the ASIP-Pregnancy Loss and Infant Death Alliance 2010 International Conference on Perinatal and Infant Death].
  
  Safe Sleep for Your Baby Around the Clock: Birth to 12 Months (rev. ed.). (2009). [Brochure]. Includes information about bed sharing.
  
  
• Also see the sleep environment section of the Infant Mortality and Pregnancy Loss knowledge path.
  

Related MCH Library Resources

• Autism Spectrum Disorders knowledge path, family resource brief, school resource brief
• Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents knowledge path, family resource brief, school resource brief
• Health Insurance and Access to Care for Children and Adolescents knowledge path, family resource brief
• Infant Mortality and Pregnancy Loss knowledge path (Includes a section about sleep environment), family resource brief
• Medications resource brief
• Overweight and Obesity in Children and Adolescents knowledge path, family resource brief, school resource brief
• Preconception and Pregnancy knowledge path, family resource brief
• Reaching Out to Children and Youth Following Disasters resource brief
• Screening resource brief
• Social and Emotional Development in Children and Adolescents knowledge path, family resource brief, school resource brief
  

Sleep in Infants, Children, Adolescents, and Pregnant Women: Knowledge Path. (October 2011). (Updated: January 2013).
Authors: Susan Chauncey Horky, L.C.S.W., M.S.W., University of Florida; Susan Brune Lorenzo, M.L.S., MCH Library; Mary H. Wagner, M.D., University of Florida.
Contributors: Kristen Hedger Archbold, R.N., Ph.D., University of Arizona; Candace Dreier, R.R.T., University of Wisconsin; Carla Salldin, Parent Consultant, University of Washington; Sarah Walker, M.S., M.P.H., R.D., University of New Mexico.
Reviewers: Jeanne Anastasi, M.A., National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center; Olivia Pickett, M.A., M.L.S., MCH Library.
Editor: Ruth Barzel, M.A., MCH Library.