Regulations to Promote Healthy Sleep Practices in Child Care

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Previous studies have examined state regulations for child care facilities and found substantial variation among states. None of these studies examined regulations related to healthy sleep practices, which is an important and often overlooked intervention target for obesity prevention. WHAT THIS STUDY ADDS:We reviewed state regulations related to healthy sleep in child care and compared them to recent national recommendations put forth by the Institute of Medicine. We found that many states lacked regulations, highlighting an important and timely opportunity for improvement.abstract OBJECTIVES: The purpose of this study was to assess state licensing and administrative regulations promoting healthy sleep practices in child care and to compare these regulations to national recommendations. METHODS:We reviewed regulations related to healthy sleep practices for all states and territories for both child care centers (centers) and family child care homes (homes). We compared regulations with Institute of Medicine recommendations to promote sleep in child care, including (1) create environments that ensure restful sleep; (2) encourage sleeppromoting behaviors and practices; (3) encourage practices that promote child self-regulation of sleep; and (4) seek consultation yearly from a sleep expert. We used Cochran-Mantel-Haenszel trend tests to assess associations between geographic region and number of regulations consistent with the recommendations. RESULTS:The mean number of regulations for states was 0.9 for centers and 0.8 for homes out of a possible 4.0. For centers, no state had regulations for all 4 recommendations; 11 states had regulations for 2 of the 4 recommendations. For homes, 9 states had regulations for 2 of the recommendations. States in the Northeast had the greatest mean number of regulations for centers (1.2) and homes (1.1), and states in the South had the fewest (0.7 and 0.7, respectively); these geographic differences were significant for centers (P = .03) but not homes (P = .14).CONCLUSIONS: More states in the Northeast had regulations consistent with the Institute of Medicine sleep recommendations, but overall few states had regulations consistent with the recommendations.

Observed compliance with safe sleeping guidelines in licensed childcare services

“…The rate of non-compliance with supine placement of infants observed in the current study (44%), is strikingly consistent with those reported within the USA (40%) 11. In contrast to studies from the USA11 20 29 our findings could not be explained by inconsistent regulation,20 nor of availability of evidence-based guidelines or confidence in knowledge 29. Availability of guidelines was universally high.…”

“…In licensed childcare services, the obligation to follow health guidelines is often formalised in regulations. In the USA, regulations vary by state and are not always consistent with evidence-based safe sleeping guidelines 20. Evidence of practices indicate that childcare providers do not necessarily follow safe sleeping recommendations, particularly in relation to supine positioning 11.…”

Economic Conditions May Contribute to Increased Violence toward Children: A Nationwide Population-Based Analysis of Pediatric Injuries in Taiwanese Emergency Departments

“…According to the regulations of the act, guardians should not leave children alone in an environment that can easily cause danger or damage. Moreover, public enlightenment of safe sleep environment also contributed to the establishment of safe home environment and decrease of accidental falls [ 24 ].…”

State Regulations Promoting Infant Physical Activity in Early Care and Education

“…We reviewed regulations for the main types of child care facilities, child care centers (centers) and family child care homes (homes), consistent with prior ECE regulatory reviews. 15,[17][18][19][20][21][22][23] Typically, states have separate regulations for centers and homes, although in some instances the same set of regulations governs both types of facilities. Generally, centers have a greater number of staff members, care for more children, and are located in a separate, dedicated building.…”

“…Family child care homes typically include one provider, who is often the owner, with fewer children. As we did for our prior studies, 15,17,24,25 we grouped subcategories of facilities into either centers or homes for the purpose of this review. This categorization is especially important, as centers and homes represent two distinct types of ECE settings and the enactment of new regulations often varies substantially between centers and homes.…”