Research Review

Poor Sleep a Problem for Foster Children

Health effects of insomnia can persist into adulthood

Children living in foster care may have a higher risk of developing insomnia, and this can lead to long-term mental and physical health problems, according to a study led by researchers at the University of Georgia.

The researchers conducted in-depth interviews with 24 adults who lived in foster care to learn more about their sleep patterns before entering care, while living in care, and after they entered adulthood. They published their findings in Children and Youth Services Review.

Poor sleep can make it difficult for children to pay attention in school or form healthy social relationships, but it can also contribute to chronic health problems like depression, obesity, diabetes, and heart disease, according to the Centers for Disease Control and Prevention.

“A lot of children in foster care have experienced physical or mental abuse prior to entering care, and we know that this can lead to insomnia caused by posttraumatic stress disorder,” says Rachel A. Fusco, an associate professor in University of Georgia’s School of Social Work and lead author of the study. “But foster care may also involve moving into new homes multiple times, and that can make children feel unsafe … they begin to associate bed time with fear and uncertainty.”

They found that a substantial number of study participants suffered from poor sleep during their time in foster care, experiencing nightmares or a pervasive fear of darkness.

“People who didn’t grow up in foster care may remember sleeping at a friend’s house or in a relative’s home, and we often don’t sleep well in those places because they’re filled with unfamiliar sights and sounds,” Fusco says. “Even when a foster child is placed in home with kind and loving foster parents, the strange new surroundings can be difficult to overcome, especially if they change homes frequently.”

Many foster children also do not experience bedtime rituals like having a bath or reading a book, so they don’t have the benefit of calm and comforting patterns before they go to bed, she says.

“I would do anything I could to stay awake,” one study participant said. “I just didn’t like being asleep. I was always afraid I would die in my sleep and never would see my mom again. I would make myself sit up against the wall so I wasn’t comfortable. I would pinch my arm. I would do all kinds of stuff to keep from falling asleep.”

And these problems can persist into adulthood. Many of the study participants reported using marijuana or alcohol to induce sleep.

“I’m not going to lie to you, I will drink a 40 [ounce bottle of beer],” another study participant said. “I think it helps a lot. I don’t do it every night because my mom has booze problems, and I don’t want all that nonsense, but most nights I do. I just don’t want to lay there, you know?”

While the importance of quality sleep is well-established in medical literature, it has not been extensively studied in the context of foster care, Fusco says. But she does see opportunities to help.

For example, social workers and caregivers may implement programs to regularly assess sleep in youth, which could be incorporated into regular health screenings and assessments of children in foster care.

Fusco also says that many study participants were reluctant to seek help because of the stigma attached to mental health problems. But both children and adults may be more receptive to health interventions focused specifically on sleep quality, as this is a low-stigma issue.

“I think the positive here is that if we help people improve their sleep, we can help them improve so many other aspects of their lives.”

The study was coauthored by Shanti J. Kulkarni, PhD, an associate professor at the University of North Carolina, Charlotte School of Social Work.

Source: University of Georgia