Promoting Healthy Sleep Among Low-income Children Presenting to Urban Primary Care

Statement of Problem

Insomnia (difficulty falling/staying asleep) and insufficient sleep during early childhood have been shown to negatively impact child development. For example, sleep problems can lead to inattention and poor social-emotional skills, which can make it harder for children to be ready for school. With insomnia and poor sleep impacting 20-30 percent of young children, the National Academy of Medicine has referred to poor sleep as a critical public health concern for the last decade.

Although there is a robust evidence base for the benefits of sleep intervention in early childhood, few studies have examined the efficacy of such treatments among low-income groups. Research shows that children exposed to socio-demographic risk factors are more likely to show sleep difficulties and often face substantial barriers to accessing and engaging in care. Pediatric primary care is an ideal setting to deliver interventions given how accessible it is to families and the expansion of behavioral health services into primary care. Intervention in primary care may be especially feasible during early childhood, when there are many well-child visits. Unfortunately, there is little research on sleep intervention programs in this context. 


This project seeks to address the salient gaps in knowledge related to the lack of tested, evidence-based behavioral sleep treatments delivered to low-income families in pediatric primary care. This research will adapt and re-package evidence-based behavioral sleep education and intervention strategies, with a focus on developing scalable interventions that we can disseminate to primary care and other community contexts.

First, we will conduct interviews with patients (caregivers of preschoolers with sleep problems) and primary care providers to identify attitudes, beliefs and behaviors that are critical for adapting and implementing a sleep intervention for low-socioeconomic preschoolers in primary care. Based on what we learn, we will adapt and implement behavioral sleep intervention strategies and obtain feedback from an advisory board consisting of Children’s Hospital of Philadelphia family partners, primary care providers and sleep intervention experts. Our final step will be to measure the efficacy of the adapted intervention in a pilot randomized trial with families referred to either the adapted sleep intervention in primary care or a waitlist control group.   

Next Steps

Investing in sleep health is crucial for child development and a critical movement toward equitable health. As nearly one-third of low-socioeconomic children do not get adequate sleep, there is an urgent need for accessible solutions to help families. This project will also support research on the adaption, implementation and evaluation of brief behavioral interventions in primary care so we can better understand how to use the primary care setting to support improved sleep health.

This project page was last updated in November 2019.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Promoting Healthy Sleep Among Low-income Children Presenting to Urban Primary Care [Online]. Available at: [Accessed: plug in date accessed here]. 

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