Table 2.
Items used to assess caregiver-identified and clinician-documentation/referral patterns by sleep construct
| Sleep construct | Caregiver identification | Clinician documentation | Relevant clinical referral | Clinician sleep-related guidance |
|---|---|---|---|---|
| SDB symptom: snoring | SRBD subscale item: “While sleeping, does your child snore more than half the time?” (yes= 1, no= 0, and I don’t know=missing) | Progress note indication of any child snoring = 1 No progress note indication = 0 |
Otolaryngology = 1 Sleep Clinic = 1 Polysomnography = 1 No referral= 0 |
-- |
| Insomnia symptoms (Summed score of 0 = 0; summed score > 1 = 1) | BCSQ item (sleep problem): “How much of a problem is your child’s sleep?” (small to severe problem = 1; no problem or a very small problem=0) | Progress note indication of any sleep problem, bedtime resistance, difficulty falling asleep, prolonged sleep onset latency, or night awakenings (=1) No progress note indication= 0 |
Sleep Clinic = 1 No referral = 0 |
Progress note and/or AVS recommendations related to having a bedtime routine, consistent sleep schedule, independent sleep training = 1 No clinical guidance documented = 0 |
| BCSQ item (bedtime resistance): “Typically, how difficult is bedtime for your child, for example, crying, fussing, protesting?” (somewhat difficult, moderately difficult, or very difficult = 1) | ||||
| BCSQ item (difficulty falling asleep): “How often, if ever does your child have a difficult time falling asleep at night?” (>3 nights per week = 1; not difficult = 0) | ||||
| BCSQ item (sleep onset latency): “How long does it typically take your child to fall asleep?” (>30 minutes = 1) | ||||
| BCSQ item (night awakenings): “How often does your child wake during the night, if ever?” (>3 nights per week = 1) | ||||
| Sleep health behaviors | National Sleep Foundation Item (Caffeine): “Thinking about caffeinated beverages such as Coke, Pepsi, Mountain Dew, iced teas, and coffee, how many cups or cans of caffeinated beverages does your child typically drink each day?” (consumption of > 1 caffeinated beverages = 1) | Progress note indication of caffeine consumption = 1 No progress note indication= 0 |
-- | Progress note and/or AVS recommendations related to avoiding caffeine = 1 No clinical guidance documented = 0 |
| BCSQ Items (Electronics): “Which of the following usually occurred on most nights for your child in the hour before bedtime? (Please check all that apply) (choice=watch television)” and/or “How does your child fall asleep most of the time? (Please check all that apply) (choice= while watching television)” (watch TV < 1 hour before bed and/or fall asleep to TV = 1) | Progress note indication of electronic use = 1 No progress note indication = 0 |
-- | Progress note and/or AVS recommendations related to electronics usage and/or screen time = 1 No clinical guidance documented =0 |
|
| BCSQ item (sleep duration combined items): “How much total time does your child spend sleeping during the NIGHT (between 7:00 in the evening and 8:00 in the morning)?” and “How much total time does your child spend sleeping during the DAY (between 8:00 in the morning and 7:00 in the evening)?” (<11 hours total [24-hour] sleep duration for 2-year-olds and <10 hours total sleep duration for 3- to 5-year-olds = 1) |
Progress note indication of insufficient sleep duration = 1 No progress note indication = 0 |
-- | Progress note and/or AVS recommendations related to sleep duration = 1 No clinical guidance documented =0 |
Note. AVS = after visit summary; SRBD = sleep-related breathing disorder subscale of the Pediatric Sleep Questionnaire; BCSQ = Brief Child Sleep Questionnaire