Regulations to promote healthy sleep practices in child care.
OBJECTIVE
The purpose of this study was to assess state licensing and administrative regulations promoting healthy sleep practices in child care and to compare these regulations to national recommendations.


METHODS
We reviewed regulations related to healthy sleep practices for all states and territories for both child care centers (centers) and family child care homes (homes). We compared regulations with Institute of Medicine recommendations to promote sleep in child care, including (1) create environments that ensure restful sleep; (2) encourage sleep-promoting behaviors and practices; (3) encourage practices that promote child self-regulation of sleep; and (4) seek consultation yearly from a sleep expert. We used Cochran-Mantel-Haenszel trend tests to assess associations between geographic region and number of regulations consistent with the recommendations.


RESULTS
The mean number of regulations for states was 0.9 for centers and 0.8 for homes out of a possible 4.0. For centers, no state had regulations for all 4 recommendations; 11 states had regulations for 2 of the 4 recommendations. For homes, 9 states had regulations for 2 of the recommendations. States in the Northeast had the greatest mean number of regulations for centers (1.2) and homes (1.1), and states in the South had the fewest (0.7 and 0.7, respectively); these geographic differences were significant for centers (P = .03) but not homes (P = .14).


CONCLUSIONS
More states in the Northeast had regulations consistent with the Institute of Medicine sleep recommendations, but overall few states had regulations consistent with the recommendations.
Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; sara.benjamin@duke.edu.
Sara E
SE
Benjamin Neelon
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia; and.
Kiyah
K
Duffey
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Health Sciences, Furman University, Greenville, South Carolina.
Meghan M
MM
Slining
D002648:Child; D002656:Child Day Care Centers / Q000331:legislation & jurisprudence*; D002675:Child, Preschool; D015438:Health Behavior; D006293:Health Promotion / Q000331:legislation & jurisprudence*; D006801:Humans; D007223:Infant; D008004:Licensure / Q000331:legislation & jurisprudence*; D016487:Parenting; D012017:Referral and Consultation; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000628:therapy; D012927:Social Control, Informal; D012931:Social Environment; D014481:United States
child care; obesity; policy; regulations; sleep