title: Napping, development and health from 0 to 5 years: a systematic review.
abstract: BACKGROUND
  Duration and quality of sleep affect child development and health. Encouragement of napping in preschool children has been suggested as a health-promoting strategy.
  
  
  OBJECTIVE
  The aim of this study is to assess evidence regarding the effects of napping on measures of child development and health.
  
  
  METHODS
  This study is a systematic review of published, original research articles of any design.
  
  
  METHODS
  Children aged 0-5 years.
  
  
  METHODS
  Electronic database search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessment of research quality was carried out following a Grading of Recommendations, Assessment, Development and Evaluations (GRADE) protocol.
  
  
  RESULTS
  Twenty-six articles met inclusion criteria. These were of heterogeneous quality; all had observational designs (GRADE-low). Development and health outcomes included salivary cortisol, night sleep, cognition, behaviour, obesity and accidents. The findings regarding cognition, behaviour and health impacts were inconsistent, probably because of variation in age and habitual napping status of the samples. The most consistent finding was an association between napping and later onset, shorter duration and poorer quality of night sleep, with evidence strongest beyond the age of 2 years.
  
  
  CONCLUSIONS
  Studies were not randomised. Most did not obtain data on the children's habitual napping status or the context of napping. Many were reliant on parent report rather than direct observation or physiological measurement of sleep behaviour.
  
  
  CONCLUSIONS
  The evidence indicates that beyond the age of 2 years napping is associated with later night sleep onset and both reduced sleep quality and duration. The evidence regarding behaviour, health and cognition is less certain. There is a need for more systematic studies that use stronger designs. In preschool children presenting with sleep problems clinicians should investigate napping patterns.
authors.affiliation: School of Psychology and Counselling, Institute for Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Thorpe
authors.affiliation: School of Psychology and Counselling, Institute for Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Staton
authors.affiliation: School of Medicine and Dentistry, James Cook University, Queensland, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Sawyer
authors.affiliation: School of Psychology and Counselling, Institute for Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Pattinson
authors.affiliation: Department of Library, Queensland University of Technology, Queensland, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Haden
authors.affiliation: Centre for Accident Research & Road Safety-Queensland, Institute for Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Smith
mesh_terms: D000367:Age Factors; D002652:Child Behavior / Q000502:physiology; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000502:physiology; D007231:Infant, Newborn; D012890:Sleep / Q000502:physiology*; D013997:Time Factors
keywords: Child Psychology; Comm Child Health; Sleep