Association between structural characteristics, caregivers' knowledge and beliefs about sleep and daily schedule, and the management of sleep routines for infants in ECEC settings (Hebrew)

Sleep has an impact on children's well-being, health, and functioning. Hence the importance of providing infants with their developmental sleep needs in early childhood education and care settings (ECEC). However, in the first year of life, sleep is characterized by frequent changes and a wide range of individual differences in infants' sleep patterns. These characteristics make sleep a particularly challenging element in the daily routine of infants in group care settings.

Recently, researchers have highlighted the importance of translating current evidence from sleep science to practice in ECEC settings and the need to increase caregivers' knowledge on how to promote healthy sleep in children. Until now, there has been little research on how sleep is managed in ECEC settings and research on groups of infants is especially lacking. The few studies that have been done on infants' daytime sleep have mainly focused on their effect on infants' functioning. The relationship between the structural characteristics of the ECEC setting, the knowledge and beliefs of the caregivers and the sleeping routines of infants in the ECEC setting has hardly been investigated.

The professional guidance of childcare programs, both in Israel and globally, is to meet the individual sleep needs of each infant. In the Israeli reality as of 2023, where the number of infants in a class (up to 22 infants) and the standard adult-infant ratio (1:6) are high, there is a reasonable concern that in practice, ECEC settings implement a fixed sleep schedule for all children. Also, in Israel, the age range defined for the infant class is wide (4-15 months) and the question arises as to how the age composition of the group affects its sleep routines. Do caregivers manage to provide developmentally appropriate sleep for both a 5-month-old infant and an 11-month-old infant staying in the same group?

In a quantitative study based on questionnaires, infants' sleep routines were examined in ECEC settings in Israel. The study involved 98 caregivers working with infants (3-11 months) in subsidized and private group settings (daycare centers and family daycare homes). In particular, we investigated whether caregivers have the required developmental knowledge of infants' sleep, whether they provide a personalized and developmental-appropriate sleep schedule and, what are the structural factors that support or inhibit it. We also ask about the degree of influence the caregiver's care beliefs have on the way she manages the infants' sleep routines.

The questionnaire was distributed through supervisors from the organizations that operate daycare centers, groups of caregivers on Facebook and by contacting the managers of private education and care settings directly, based on information from the internet. The study collected demographic data of caregivers (age, years of experience, education and training), as well as the settings (private/subsidized, socioeconomic status, group size, adult-child ratio and age composition). The caregivers' knowledge of sleep (α=.63) and their care approach (structure α=.77 / attunement α=.77) were also evaluated. In addition, the management of infants' sleep routines was examined (the degree of regularity of bedtimes in the daily schedule, if there are group bedtimes and how infants wake up). If there were group bedtimes, the caregivers were asked to report the sleep time windows for each age group with different sleep times in the classroom. As a result, a sleep practice quality score was compiled for each ECEC setting, in the age groups of 3-5, 6-8 and 9-11 months.

The study's significant findings are that contrary to recommendations, most settings maintain a fixed daily schedule with group sleep times for infants. Also, the quality of sleep practice decreases as infants age, in a larger group, in groups that are relatively mature with a lower percentage of infants, a structured approach and a less experienced caregiver. It was found that in-service training is associated with a more attuned approach. Furthermore, it was discovered that 25% of settings reported a decrease in the morning nap for infants aged 9-11 months, a sleep pattern that is associated with older children.

The recommendations that emerge from the study are reducing the group size of infants, maintaining supervision and increasing the hours of in-service training for caregivers. It is necessary for caregivers to acquire knowledge about the developmental sleep needs of infants, and that knowledge should be taken into consideration when planning a daily schedule.

Further research is needed to determine the necessary structural conditions to provide adequate sleep care for infants in terms of group size, age composition and training. What practical knowledge do experienced caregivers hold that helps them provide developmentally appropriate sleep practices? And what is the effect of a developmentally incompatible sleep standard on the cognitive and emotional functioning of infants and toddlers? The findings of this study may be valuable to other countries, which are dealing with large groups and high adult-infant ratio standard in infant education and care settings.