The Donegal public health nursing service is providing the first community based, PHN led sleep clinic, for children with behavioural sleep difficulties.
Sleep research was carried out in 2014 in two sites in Ireland, to establish the prevalence rate of disorders of initiating and maintaining sleep (DIMS). DIMS is relatively common in young children. International literature identifies a prevalence rate of 20-40 per cent amongst children from one to five-years-old. Prior to this study, there were no published studies that indicated the prevalence rate of DIMS in the Irish population. Sleep disturbance can impact significantly on family life and can lead to neurocognitive and psychosocial impairment, but if identified early, interventions to address sleep difficulties have been shown to have positive outcomes.
The aim of the research studies carried out in Donegal and Kildare, was to establish the prevalence of sleep disorders in a sample of six to 48 months old Irish children, and the suitability of the Tayside Children’s Sleep Questionnaire (TCSQ), for use in the primary care setting, to identify children with behavioural sleep disorders.
The study was a cross-sectional study in two populations. The clinical sample comprised of 50 children, referred to a sleep clinic in Donegal operated by the Registered Advanced Nurse Practitioner (RANP) in child health and parenting. The control groups consisted of 100 children attending their PHN for routine developmental assessment, in two sites in Kildare and Donegal. Parents were asked to fill out demographic details and the TCSQ.
The prevalence rate of DIMS in the clinical sample was 96 per cent. In the Donegal control sample, the prevalence rate of DIMS was 40 per cent, compared to a rate of 66 per cent in the Kildare control sample. There was a significant difference in scores on the TCSQ between the clinical versus control groups. There was a significant relationship between scoring above the TSCQ cut-off point and parent’s subject perception of whether or not their children had sleep difficulties. The TSCQ was also identified by PHNs as a useful screening tool for DIMS. The prevalence rate of DIMS in this study was slightly higher than previous studies. The results of this study indicate that the TCSQ is a suitable screening tool for use in a primary care setting to identify DIMS in children from six to 48 months old.
Due to the high incidence of DIMS identified in the study, it was decided that locally accessible, PHN led behavioural sleep clinics would be a way of providing support to parents of children with sleep difficulties in Donegal. A one day course was designed and delivered to all PHNs in Donegal by the Registered Advanced Nurse Practitioner (RANP) in child health and parenting, prior to commencement of sleep clinics. The RANP then attended the community sleep clinics to provide training and mentoring to PHNs in the sleep clinics.
A sleep steering committee was established to oversee the roll out of sleep clinics in five primary care networks. Terms of reference were agreed and Letterkenny primary care network was the first site where a sleep clinic was set up, opening its doors in December 2014.
Sleep clinics were established in four primary care centres with roll out planned to the other networks in Donegal on a cascading basis.
An audit is currently being carried out as part of the process and service users are providing feedback on the service. This will further inform development of the service offered to parents. The audit was carried out by repeating the Tayside Children’s Sleep Questionnaire2 (TCSQ) six months after discharge from the sleep clinic.
Initial results are good with children who scored in the clinical range at the initial assessment in the sleep clinic. These children had a score of normal six months after discharge from the clinic. This shows that the initial improvement in behavioural sleep difficulties, reported by parents on discharge from the clinic, had been maintained six months following discharge. The sample size for the first audit was small but all discharged children will be followed up from all the clinics in Donegal, six months after discharge to repeat the TCSQ. This will provide a bigger audit group from different clinics across the county.
All PHNs in Donegal attended the one day training on behavioural sleep difficulties, and even though they may not be carrying out full assessments in the sleep clinics, all PHNs are able to provide anticipatory advice and support to parents relating to establishing good sleep practices. Through time, it is hoped that, this will also help reduce the incidence of behavioural sleep difficulties experienced by families in Donegal.
PHN led sleep clinics are a way of providing early intervention for a problem before it becomes chronic and leads to increased stress on parents and children. It helps support good social and emotional development of the child by empowering parents
through providing evidence based information to deal with the sleep difficulty and supporting parents to implement the advice given to deal with the behavioural sleep difficulty. Tired parents appreciate this level of support and the guidance given in a structured way with a clear goal, which is to help their child sleep well.
Mindell, J. A., Owens, J. A. (2009). A clinical guide to paediatric sleep: diagnosis and management of sleep problems. Lippincott Williams and Wilkins, Philadelphia.
McGreavey, J. A., Donnan, P. T., Pagliari, H. C., and Sullivan, F. M. (2005). The Tayside children’s sleep questionnaire: a simple tool to evaluate sleep problems in young children. Child: care, health and development, 31(5), pp. 539-544.