Exploring Caregiver Perceptions of Child Sleep Quality Among a Racially and Ethnically Diverse Sample: A Qualitative...

Background: High quality pediatric sleep is shaped by multiple factors, including duration, restoration, and continuity. Multiple socio-ecological factors that are typically enforced by caregivers (e.g., bedtime routines) also determine the likelihood of attaining optimal pediatric sleep health. Consistent with the extant sleep literature on pre-pubertal children, this qualitative study targeted caregivers to identify factors influencing children's sleep quality. Methods: Participants were recruited from Project G-SPACE, a US-based study exploring the influence of greenspace on sleep and mental health among elementary school-aged children. A racial, ethnic, and socio-economically diverse sample of caregivers (n = 21) participated in virtual semi-structured interviews about their perceptions of determinants of child sleep quality and behavior. Template-style thematic analysis was employed to synthesize the interviews. Results: Caregivers report that busy days for their children, especially characterized by high levels of physical activity, facilitate sleep continuity and good sleep quality. Sibling dynamics can be disruptive, resulting in poor sleep quality. To promote sleep health, parents employ rules regarding screentime, food/drink, and bed/wake time schedules, though the latter seems to be more flexible when children are not in school (e.g., weekends). Conclusions: Caregivers demonstrated great variability regarding implementing strategies to enhance their children's sleep quality, suggesting that parents may be unsure of how to optimize the strategies they employ, which are most effective, or how to manage resistance from their children. Clinicians should discuss how to address these practical challenges with caregivers. Future research investigating the developmentally unique differences in determinants of sleep quality among elementary school-aged children is prudent.