Foster Caregivers' Perceptions of Children's Sleep Patterns, Problems, and Environments

Objective: The disparity of problems, impairments, and disorders among children in foster care is well-documented and spans virtually every domain of functioning. Sleep, however, has received minimal attention among this vulnerable group, which is concerning given the multitude of ways sleep affects children's development, health, and behavior.

Methods: A total of 485 foster caregivers from across the United States completed a survey including quantitative items and qualitative, open-ended questions about sleep and related health and behavior for one child (M = 6.4 years, SD = 2.2; range 4-11 years) currently in their care.

Results: Overall, caregivers reported developmentally appropriate child sleep and wake times; however, difficulty falling asleep (avg. 46 min per night) and staying asleep (avg. 34 min awake overnight) were common. Additionally, a high prevalence of sleep-related problems was reported including moving to someone else's bed during the night (85.8%), nightmares (51.2%), sleep terrors (26.4%), snoring (32.8%), bedwetting (31.6%), and teeth grinding (21.8%). Qualitative responses indicated emotional and behavioral challenges at bedtime, particularly elevated fear, and anxiety.

Conclusions: Findings are consistent with previous work finding significant health disparities among children placed in foster care. Results highlight a need for trauma-informed, behavioral sleep interventions for this pediatric population which might serve to reduce other health disparities.