It's Time to Put the Nap in Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC): A Systematic Review Demonstrating the Impact of Child Care on Sleep Outcomes in Early Childhood.

Background: Child care-based interventions have largely neglected sleep as an important health behavior for obesity prevention. Child care sleep environments and caregiver practices likely differ from home sleep environments and parent practices. Methods: We summarize findings of past research examining how child care arrangement, dose, and attendance impact young children's sleep using steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology. Keywords related to sleep and child care were entered into PubMed, PsycINFO, and CINAHL, yielding a total of 3535 articles. Results: Twenty-three studies were included in the data extraction process. There was evidence indicating that child care arrangement type, dose, and attendance impact various sleep outcomes among children 0-5 years old. Considerable variation across studies with regard to child care comparison groups and sleep outcomes assessed made making comparisons across studies difficult. However, child care outside the home and increased time spent in child care were commonly positively associated with daytime sleep and negatively associated with nighttime sleep. Child care outside the home was also associated with 24-hour sleep, with decreased sleep observed among infants and toddlers but increased sleep observed among preschool-age children receiving outside care, especially in settings with mandatory naptime. Conclusion: The findings of this review demonstrate that child care impacts children's sleep. More research is needed to understand best practices for promoting sleep across child care settings and inform intervention efforts. Integrating sleep into evidence-based child care obesity prevention interventions, such as Nutrition and Physical Activity Self-Assessment for Child Care, would assist in efforts to reduce obesity risk among young children.