CPCE Core faculty member Ariel Williamson, PhD is an advocate for healthy sleep across the lifespan, but especially in childhood and adolescence, when insufficient and poor quality sleep can negatively impact child development. Dr. Williamson, CPCE Director Alexander Fiks, MD, MSCE, and Lisa J. Meltzer, PhD, a pediatric psychologist at National Jewish Health in Denver, CO, recently published a Viewpoint in JAMA Pediatrics titled “A Stimulus Package to address the Pediatric Sleep Debt Crisis in the United States.” In it, they highlight the potential role of pediatricians and other primary care professionals in supporting sleep health. They offer three suggestions for better integration of sleep into primary care. 

First, sleep should be thought of as a vital sign, monitored and tracked across preventive visits. The National Sleep Foundation Sleep in America Poll contains questions on nighttime sleep duration, regularity, and electronics usage which could be used to guide sleep assessments, and the validated Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures may be used to assess any reported sleep disturbances. 

Second, the growing presence of wearable devices and mobile applications may be leveraged to support prevention, problem identification, and initial behavioral treatment. While the authors acknowledged some limitations of these tools, including acceptability across diverse racial/ethnic and socioeconomic groups, these tools nonetheless could provide value to clinicians, and integration with electronic health record (EHR) systems could help to facilitate uptake.

Third, pediatricians and sleep specialists can mobilize a public health campaign to raise awareness of known sleep-related morbidities and promote sleep health. The Safe to Sleep campaign (formerly known as Back to Sleep) to reduce the risk of sudden infant death syndrome (SIDS) provides a highly successful model.

In addition to raising awareness about the need to address pediatric sleep in primary care, Dr. Williamson has led research projects with Jodi Mindell, PhD, of the CHOP Sleep Center, focused on identifying individual child, family, and environmental factors associated with poor sleep in early childhood and the persistence of sleep problems over time. Identifying these factors can contribute to tailoring sleep interventions that prevent poor child health and wellbeing. In an editorial accompanying a study conducted outside of CHOP and published in JAMA Pediatrics, Dr. Williamson, Dr. Fiks, and Jonathan A. Mitchell, PhD, of the CHOP Division of Gastroenterology, Hepatology and Nutrition noted that "the tailoring of messages to specific subgroups of adolescents ... may help pediatric clinicians become more effective and efficient in providing advice that addresses the epidemics of poor sleep and obesity in adolescence.” 

What's next? Dr. Williamson is currently conducting a NICHD-funded K23 Career Development project focused on addressing early childhood sleep problems in primary care. In this work, she is partnering with families and primary care clinicians to adapt evidence-based behavioral sleep strategies for implementation in urban primary care with families who are predominantly of lower socioeconomic status backgrounds.