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Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral
Mikayla Carson1, Olivia Cicalese2, Esha Bhandari2
1Saint Joseph's University (M Carson and JA Mindell), Philadelphia, Pa.
Insights
Caregivers report many more child sleep problems than clinicians document. This discrepancy highlights a need for better screening tools and communication to address early childhood sleep issues effectively.
Area of Science:
- Pediatric Health
- Sleep Medicine
- Clinical Documentation
Background:
- The American Academy of Pediatrics recommends routine screening for child sleep problems during well-child visits.
- Existing research indicates a significant difference between caregiver and clinician reports of sleep issues in children.
- This study investigates the congruence between caregiver-reported and clinician-documented sleep problems and their management.
Purpose of the Study:
- To assess the agreement between caregiver-reported child sleep problems and clinician-documented sleep issues and management.
- To identify the prevalence of various sleep problems as reported by caregivers versus documented by clinicians.
- To inform improvements in pediatric sleep problem screening and clinical documentation.
Main Methods:
- A study involving 170 caregiver-child dyads with children aged 2-5 years.
- Caregivers completed questionnaires on habitual snoring, insomnia symptoms, and sleep health behaviors (electronics, caffeine, sleep duration).
- Caregiver reports were compared against sleep problem documentation in the electronic health record by clinicians.
Main Results:
- Over 92% of children had at least one caregiver-reported sleep problem (e.g., insomnia symptoms, electronics use, insufficient sleep).
- In contrast, only 20% of children had a clinician-documented sleep problem, with significantly lower rates for referrals and recommendations.
- A substantial gap exists between caregiver concerns and clinical records regarding child sleep issues.
Conclusions:
- A significant discrepancy exists between caregiver-reported and clinician-documented child sleep problems and management.
- Future initiatives should enhance screening tools and clinician education to improve documentation and family discussions.
- Addressing this gap is crucial for improving overall child health and well-being through better management of early childhood sleep problems.
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.
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