Sleep in children in foster care: A scoping review

Although the focus on sleep disturbances in children who have experienced adversity has increased, little is known about sleep among children in foster care (CFC). This study aimed to review what research tells us about the relationship between foster care experience and sleep disturbances and to identify knowledge gaps.

This study used Arksey and O'Malley's (2005) 5-part methodology for conducting scoping reviews and the Reporting Checklist for Scoping Reviews (PRISMA-ScR) guidelines. 14 studies met inclusion criteria. Data were synthesized using the 6-phased approach to thematic analysis outlined by Braun and Clarke (2006, 2021).

The majority of included studies were conducted in the United States, used cross-sectional designs, and collected data from foster caregivers. Three themes emerged: sleep quality and disorders; relationships among sleep, trauma, and behavior-related outcomes; and intervention approaches (behavioral, pharmacological, and digital). The most commonly mentioned sleep problems were waking during the night, difficulty falling asleep, night terrors, bed wetting, and sleep efficiency and/or quality. Several studies suggested that trauma exposure played a central role in sleep disturbances in CFC and that unresolved trauma and environmental instability contributed to ongoing fear and insecurity at bedtime and difficulty maintaining sleep. Only 2 studies evaluated intervention effectiveness.

This review suggests that sleep disturbances are a pervasive yet underrecognized issue among CFC. Overall, the literature underscores that sleep health in CFC is both a marker and a mechanism of broader emotional and physiological dysregulation.