Sleep - White out

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Sleep is vital for all of us, but for very young children the quality and quantity of sleep has a huge impact on their growth and development, as well as their general contentment and how well they settle in a setting.

‘Sleep deprivation can have a number of profound effects on a child’s mental, physical and emotional health. It can also significantly impact on youngsters’ behaviour during the day. A child who is sleep deprived is unlikely to be able to meet their full potential’ (Dawson 2016).

At Trust Taplins Childcare in Southampton (part of the Taplins Childcare Department at University Hospital Southampton NHS Trust), we found that the new intake for the baby room were finding it difficult to settle.

The baby room practitioners and I worked with parents and spent time thinking about why this might be. One key factor seemed to be the difference in amounts of sleep that each child would routinely have at home and at nursery.

SETTLING IN

Children and their parents are invited to three settling visits before they officially start at Taplins, helping them to start getting to know the setting and build a relationship with their key person. It also gives our team an opportunity to start getting to know the child and their individual needs, allowing practitioners to mirror each child’s home routine.

Despite this, some of the new cohort of children joining the baby room found settling more difficult, and so the baby room team, led by Vicki Ansell and James Sheen, senior nursery nurses, and I, investigated why this might be.

We work closely with parents, and when we discussed this with them, several commented on how little their child slept at nursery. Parents also reported that their child fell asleep on the journey home from nursery. We are a workplace nursery and most children attend for full day sessions, so we started to think about the impact that a lack of sleep during the nursery day might be having.

Although practitioners work hard to mirror each child’s home routine (such as following sleep times and use of comforters) as in most nurseries, the environment in the sleep room can never be made completely silent. As a result, the sleep that the babies were getting could not exactly replicate what happened at home, where a quiet place would be the norm.

Some children were taking longer to fall asleep at nursery than they would at home or were waking after very short periods of time and so were not getting into a deep sleep – and this could be their only sleep of the day.

Our analysis of the impact of this identified:

• a negative impact on the children’s mood
• children finding it harder to settle at nursery due to tiredness
• children feeling less ready to take part in routines/activities
• children being overtired at the end of their nursery session, impacting on the time that the parents had with their children at the end of the nursery day
• children falling asleep on their way home at the end of the day, affecting their evening routine.

James noted, ‘The effects of little or no sleep for young children are huge – children will often be tearful and more sensitive with different (especially new) situations. This can also affect others around them – for example, if one baby is upset then this can easily cause other babies to become upset.’

Once lack of sleep had been identified as a possible cause of difficulties settling, the team decided to set up a project to investigate this. Initially, they asked parents to record their child’s normal sleep pattern at home, including the length of daytime naps. Practitioners then spent two weeks recording the amount of sleep that each child had at nursery, as well as how long they took to settle to sleep.

This showed that, on average, children at home slept for 90 minutes per day, whereas when they were at nursery this dropped to an hour per day. Cumulatively, over the week this meant that some full-time children were losing the equivalent of two daytime naps. Some of the children had an even greater difference between home and nursery sleep times (see case study).

MAKING A CHANGE

We decided to try to increase the length of sleep that the children had at nursery with the aim of having a positive impact on their willingness to interact.

We introduced white noise into the sleep room via a baby monitor. White noise has been shown to have a positive impact because the brain focuses on that sound rather than any other sounds within the environment.

We felt that this would stop children focusing on other noises in the sleep room, such as another baby crying, and so they would be more likely to have an undisturbed sleep – or if they were woken up, they would be more likely to be able to settle themselves back to sleep.

White noise was played throughout the day in the nursery sleep room for two weeks to allow the children to become used to it and then the amount of sleep each child had was recorded again. When the data was analysed, it showed that, on average, each child’s sleep amount at nursery had increased by almost two hours per week (see graph).

While how quickly a child settled to sleep did not seem to change, how easily each child settled back to sleep if they were disturbed did improve.

The impact of both the quality and quantity of their sleep improving meant that the children were happier, and this showed in their readiness to take part in activities and routines, both at home and at nursery. These positive effects were also seen in their levels of emotional well-being at nursery.

REFLECTION

The data that we collected was shared with parents in the regular newsletter, and this provoked lots of interest, with several discussions taking place between parents and practitioners. It transpired that some children were also finding sleep routines at home difficult, and so some parents decided to introduce white noise at home as well.

The team also discussed the data, the impact of carrying out research, introducing a change, and seeing the measurable positive impact of this in improving outcomes for children. This had a really positive impact on our team.

One of our staff values is ‘Always Improving’, so this research project has been important to us not only to improve each child’s nursery experience and their general happiness levels, but also to make sure that as a team we always have the enthusiasm and drive to evaluate our practice and make changes.

Practitioners in the baby room were highly engaged in this project and the results provoked lots of discussion within the team about what we do within nursery and why. We are now looking at other areas of our practice across the nurseries that we can research and make improvements to.

WHAT NEXT?

Practitioners realised that as the cohort of children who took part in this project would shortly be transitioning to the toddler room, it was important to share their findings with the whole nursery team. White noise has now been introduced into all sleep rooms throughout Taplins Childcare Department. Replicating the positive impact of this project improves consistency and the experience of each child at Taplins.

This project could be successfully adapted to other settings. Introducing white noise is such a simple change but had a significant positive impact on child well-being both at nursery and at home.

CASE STUDY: Matilda

Matilda started nursery at 13 months old. At home she would routinely sleep for around two hours during the day, whereas at nursery she generally slept for around 35 mins per day. Matilda attended nursery four days a week, so as the week progressed, she became more and more tired. This affected her interactions as she felt less ready to take part in activities and routines both in nursery and at home.

Matilda’s parents note, ‘When Matilda started at nursery, some days she wouldn’t sleep at all. At most, she would sleep for ten-20 minutes per nap. This made the journey home and to bed a daily battle. If she fell asleep on the way home, she then wouldn’t resettle at night until much later, meaning that by the end of the week she was exhausted and wouldn’t want to get up in the morning.

‘Following the introduction of white noise, Matilda started to sleep longer during the nursery day. She is quite a light sleeper, so although she still slept less at nursery than at home, this increase had a positive effect on Matilda and how settled and content she was at nursery.’

Vicki agrees: ‘Following the introduction of white noise, Matilda began to sleep longer and more deeply – this really showed in how ready she was to play and engage with both peers and practitioners.’

REFERENCES

Dawson V (2016) ‘Why sleep is so very important’, www.pacey.org.uk/news-and-views/pacey-blog/2016/september-2016/why-sleep-is-so-very-important

‘All about…sleep’ is at www.nurseryworld.co.uk