618 Qualitative analysis of bedtime challenges and parental interventions in foster care children

Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development. Limited research has focused on vulnerable populations such as children in foster care. Foster care children endure placement instability, which may contribute to disrupted sleep patterns and unpredictability around bedtime (Leathers, et al., 2019). The Fostering Sleep study examined foster caregivers’ perceptions of children’s sleep challenges and strategies for improving sleep difficulties. Methods Foster caregivers of children ages 4–11 throughout the US were invited to complete the Qualtrics Sleep Health among Children in Foster Care Survey via foster care Facebook groups. The survey included quantitative and qualitative questions focused on sleep patterns and behaviors. Qualitative questions on barriers and opportunities to improve sleep were examined: what helps foster care children sleep well; what kinds of difficulties do foster care children experience at bedtime? Results 483 foster care parents responded. Responses to bedtime difficulties were coded using 27 categories (e.g., parasomnias, bedtime resistance, trouble self-soothing); responses to what helps your child sleep well were coded based on 22 categories (e.g., comfort items, melatonin, TV as in intervention, communication to reassure safety). The most prevalent sleep/bedtime difficulties were fear/anxiety (23.2%), nightmares (19.6%), environment (18.4%). For example, one parent responded: “He fears never waking up. He fears that the sun is not going to come back up. He fears that the bad guys will come get him.” Difficulties varied by age-- 4–5: fear/anxiety, destabilization from call/visit biological parent, nightmares; 6–9: nightmares, fear/anxiety, environment; 10–11: fear/anxiety, nightmares, emotional/behavioral difficulties. Most frequent parenting approaches were bedtime routine (63.0%), reading before bedtime (36.5%), physical reassurance (26.6%). Interventions also varied according to age-- 4–5: routine, reading, physical reassurance; 6–9: routine, reading, noise control; 10–11: routine, technology regulation, reading. Conclusion Foster caregivers reported fear/anxiety as most common bedtime difficulty and physical reassurance as most frequent parenting strategy for healthy sleep. Findings suggest that anxiety and fear often interfere with sleep and, in turn, physical reassurance as a helpful bedtime strategy. Undoubtedly, there is a need for sleep research and preven