Sunday, 25 November 2012

Sleep and Preschool part 2ii

So now I return to yesterday's post about outdoor environments being an important part to health and sleep quality in preschool children. In Sweden 97% of all 3-5 year olds attend a preschool setting (referred to as a DCC in the research article - Day Care Centre) this means that in Sweden the time spent at preschool covers a large proportion of a preschooler's life.
example of a great outdoor environment - half way up a mountain in Austria

The article points out that microbes and the spread of infections may be slower due to the expanded outdoor spaces compared to the indoor environments, but there is research that can show both sides of the coin - that infections spread equally fast and that outdoor preschools and "indoor" preschools tend to have the same number of absences as each other - obviously more research needs to be made into this area...

Today, overweight, craving appetite, a lack of sleep, restlessness
and medicalization to calm the parents’ worries are
important health issues for the child population even in a
welfare country such as Sweden (1)

The article goes on to describe how a good outdoor environment can have a positive impact on the above mentioned quote. The quality of the outdoor environment at each preschool was assessed by the Outdoor Play Environment Categories (OPEC) scoring tool. 

Vegetation gives protection from excessive ultraviolet radiation
known to affect the occurrence of skin cancer.
Green outdoor environments are also known to buffer the
impact of life stress in young individuals, especially if they
grow up in deprived areas compared to the impact on
children from affluent areas. Preschool children
areas including woodlands had better attention capacity,
were calmer and appeared less stressed than did children
who attended urban DCCs in a more dense and barren
environment. (1)

OK, so far not a whole load about sleep - so I will not go into the details about weight, stress and health so much and will focus on what the article has to say about sleep. As I mentioned yesterday the children playing in preschool yards that rated high on the OPEC rating system tended to sleep longer, and since sleep has a positive impact on health one can deduce that the affects of a good outdoor environment has a double positive impact on the preschoolers health.

Important for children′s health is the length of sleep per
24 h. This study indicates that the quality of the outdoor
environment in combination with long outdoor stay
resulted in longer night sleep. Physical activity was less
important as an explanatory variable, with the effect of
OPEC and outdoor stay removed. (1)

This means that being physically active indoors does not have the same effect as being outdoors for long periods of time. It is the time spent outdoors in a good quality environment that is important. This can be tricky when weather is extreme - either extremely hot or extremely cold and therefore limiting time that can be spent outdoors, but does indicate that it is important that we think about HOW we can lengthen time spent outdoors - appropriate clothing, shade, shelter etc. There was no more mention about routines in USA restricting outdoor play - this is something I will have to look elsewhere to find out more...

The article points out that children's night time sleep has decreased in many countries around the world in the last 10 years. Iglowstein et al (2) write that bedtime resistance has decreased significantly between 1974 and 2001 - could it be that our parenting techniques are in fact hindering children from getting enough sleep? Are we making a decision NOT to enter the whole bedtime resistance fight scenario and allowing our children to stay up longer (rather than deal with the tantrum) - since children still have to get up to go to preschool/school in the morning, parental wishes to avoid bedtime arguments could in fact be having a detrimental effect on our children's health through lack of sleep over 24hrs.? Lack of sleep, so I read, increases children's appetite and weight and occurrence of infections (1).

However, many parents experience
difficulties to put the child to bed for the night if the nap is
too long at DCC. At the preschools studied in United
States, the mid-day nap was mandatory for the
children. These children were much alerter at pick-up
time compared to their peers in Malmo¨ , as experienced by
the research team. We could be criticized for not including
the nap on the way home in the night sleep variable.
Children from high-quality outdoor environment had
however, even though they napped on their way home,
longer night sleep. (1)

Interesting to read that napping is mandatory in the preschools in USA, I would be VERY interested to find out more about how the napping effects the night sleep - but there was no more information about this in the article... But I interpret these words to mean that napping does not seem to impact night sleep as much as lack of outdoor play in a good quality environment.

Studies from United States show that children
from very poor areas benefit more from high-quality
environment compared to better off peers. Thus,
the relation between environment and health found in this
study would be even more pronounced with participants
from low socio-economic groups. (1)

The more ECE research I read the more it seems apparent that children from very poor areas always seem to be the ones that benefit the most from good quality settings which means that there needs to be investments made in all preschool settings, and not just the ones that can afford them.

Söderström et al have written several articles based on this research, I have included another one on the reference list here (3) where there is more information about how a good outdoor environment helps support children's attention levels. In this article it does go on to describe the "outdoor preschool" (UR och Skur/Forest School) as positive for most children as they are outside for long periods of time BUT that the long days for some children means that these children remain stressed - as "children cannot re-store their cognitive capacity beyond restoration" (3) - as a nature-like environment or environments with nature elements added to it, helps with restoration.

So I end this post with
  • we need to play outdoors in a good quality, nature like, environments to aid longer sleep
  • we need to make sure we adults take up the bedtime fight and ensure our children are getting enough sleep
  • it would be good to find out how long we should be playing outside for the children to benefit from the positive effects mentioned 
  • I want to find out more about how napping and night sleep impact each other
  • there needs to be a post soon about good outdoor environments...


(1) The quality of the outdoor environment influences childrens health – a
cross-sectional study of preschools
M Söderström (,2, C Boldemann3, U Sahlin4, F Mårtensson5, A Raustorp6,7, M Blennow8  October 2012 Acta Pædiatrica ISSN 0803-5253

 (2) Pediatrics 2005;115;233
H. Largo
Oskar G. Jenni, Heidi Zinggeler Fuhrer, Ivo Iglowstein, Luciano Molinari and Remo
in the First 10 Years of Life
A Longitudinal Study of Bed Sharing and Sleep Problems Among Swiss Children

(3) Outdoor environmental assessment of attention promoting settings for preschool children

F.Ma ̊rtenssona,C.Boldemannb,􏰀,M.So ̈derstro ̈mc,d,M.Blennowe,J.-E.Englundf,P.Grahna

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