Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral

Acad Pediatr. 2023 Aug;23(6):1234-1241. doi: 10.1016/j.acap.2023.02.001. Epub 2023 Feb 9.

Abstract

Objective: The American Academy of Pediatrics recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (ie, habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent.

Methods: The sample included 170 caregiver-child dyads (child Mage = 3.3 years, range = 2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record.

Results: About 92.3% of children had at least 1 caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine).

Conclusions: There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems.

Keywords: clinical screening; insomnia; primary care; sleep; sleep health; snoring.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Caffeine
  • Caregivers*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Referral and Consultation
  • Sleep Deprivation
  • Sleep Initiation and Maintenance Disorders*
  • Snoring
  • United States

Substances

  • Caffeine