0899 Early Childhood Sleep Resources Vary by Caregiver Shift Work: Perceptions of Enhanced Usual Care Families in an RCT

Abstract Introduction Little is known about sleep problem resolution and resources sought among families receiving usual care in outpatient pediatrics. This mixed methods study examined caregiver-perceived child sleep problems and experiences seeking sleep care in families randomized to “enhanced usual care” (EUC; provision of a sleep education handout) in a randomized controlled trial (RCT) of a behavioral sleep intervention. We also examined whether perceptions varied by caregiver shift work, which can impact child sleep. Methods Of the 97 caregiver-child dyads in the RCT, 47 were randomized to EUC (caregivers: 98% mothers, 75% Black, 36% shift-working, 36% living <=125% of poverty line; mean child age=2.6 years, 53% girls). Of the 47 randomized to EUC, 36 completed the follow-up (~15 weeks post-baseline), which included caregiver-reported child sleep problems (5-point Brief Child Sleep Questionnaire item dichotomized as no/a very small problem vs a small to severe problem) and a semi-structured interview regarding perceptions about the EUC sleep education handout and any other sleep resources sought. Integrated thematic analysis was used for qualitative coding (kappa=0.84), with a joint display analysis used to stratify and compare themes for shift-working and non-shift working caregivers. Results Shift workers were more likely to report a child sleep problem at follow-up (89%) than non-shift workers (44%), X2=4.90, p=.027. Qualitatively, some non-shift-working caregivers noted that the EUC sleep education handout was beneficial for addressing child sleep. In contrast, shift workers described the handout as being unhelpful, stating that they had already tried the strategies listed. Shift workers also reported making extra pediatrician or specialist appointments or seeking other interventions to address sleep, noting limited guidance overall. Non-shift-working caregivers did not reference these resources and described doing their own online research for support. Conclusion Shift workers were less likely than non-shift workers to report early childhood sleep problem resolution at 15 weeks after assignment to enhanced usual care in an RCT. Shift workers also described the sleep education handout provided as unhelpful, and, unlike non-shift-working caregivers, described being unable to find helpful external sleep resources. Future research on tailoring early childhood sleep resources for shift-working families is needed. Support (if any) NICHD K23HD094905 (PI: Williamson)