NEW ORLEANS, La. – Only 48% of school age children in the United States get 9 hours of sleep most weeknights, according to new research being presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition in New Orleans. Those who do, the study suggests, are significantly more likely to show a positive outlook toward school and other signs of “childhood flourishing,” a measure of behavioral and social well-being.
An abstract of the study, “Sounding the Alarm on the Importance of Sleep: The Positive Impact of Sufficient Sleep on Childhood Flourishing,” will be presented on Saturday, Oct. 26, at the Ernest N. Morial Convention Center in New Orleans.
“Chronic sleep loss is a serious public health problem among children,” said abstract author Hoi See Tsao, MD, FAAP. “Insufficient sleep among adolescent, for example, is associated with physical and mental health consequences including increased risk of depression and obesity and negative effects on mood, attention and academic performance.”
“As healthcare providers, we want every child to reach his or her full potential, Dr. Tsao said. “Our research shows that children who get enough sleep are more likely to demonstrate measures of childhood flourishing in comparison to children with insufficient sleep.”
Researchers analyzed responses from parents and caregivers of 49,050 children ranging in age from 6-17 years old in the combined 2016-2017 National Survey of Children’s Health. They answered questions on how many hours of sleep a randomly selected child in their household slept on an average weeknight. For the study, sufficient sleep was defined as sleeping greater than or equal to 9 hours on an average weeknight.
For individual flourishing markers, the caregiver was asked if the child showed interest and curiosity in learning new things; cared about doing well in school; did required homework; worked to finish tasks started and stayed calm and in control when faced with a challenge. Prior research suggests that the more flourishing markers children have, the more likely they are to have healthy behaviors and fewer risky behaviors. A combined flourishing measure was created to identify children for whom caregivers felt met all five individual flourishing markers.
The researchers found that sufficient sleep, reported in 47.6% of the 6 to 17-year-old children, was positively associated with several individual flourishing markers, as well as the combined childhood flourishing measure. Compared with children who did not get 9 hours of sleep most weeknights, those who did had 44% increased odds of showing interest and curiosity in learning new things, 33% increased odds of doing all required homework; 28% increased odds of caring about doing well in school; 14% increased odds of working to finish tasks started, and 12% increased odds of demonstrating the combined flourishing measure.
The analysis adjusted for age, federal poverty level, time spent in front of a television, time spent with computers, cell phones, video games and other electronic devices, adverse childhood experiences (including abuse, neglect and other potentially traumatic experiences) and mental health conditions.
The researchers also identified risk factors associated with insufficient sleep, which included lower levels of parental or caregiver education, children living in families at lower federal poverty levels, increased duration of digital media usage, increased number of adverse childhood experiences and the presence of mental health conditions.
Dr. Tsao said the study reinforces the importance of increasing efforts to help children get the recommended amount of sleep for their age. She said efforts should especially focus on digital media usage, bedtime routines, the length of the school day and school start times.
“Interventions like these may help children demonstrate more measures of childhood flourishing, enhance their development and give them brighter futures,” she said.
Dr. Tsao will present an abstract of the study, available below, on Saturday, Oct. 26, at 1:40 p.m. in rooms 231-232 of the Ernest N. Morial Convention Center. To request an interview with her, journalists may contact Brown University communications officer Jill Kimball at
or (401) 863-5450. During the meeting, you may reach AAP media relations staff in the National Conference Press Room at 504-670-5406
In addition, Dr. Tsao will be among highlighted abstract authors will give brief presentations and be available for interviews during a press conference starting at noon on Sunday, Oct. 27, in rooms 208-209 (Press Office) of the Ernest N. Morial Convention Center.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit
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Editor’s note: The abstract presentation will reflect additional analysis and figures that do not appear in the abstract, below.
Abstract Title: Sounding the Alarm on the Importance of Sleep: The Positive Impact of Sufficient Sleep on Childhood Flourishing
Hoi See Tsao, MD, FAAP, presenting author
BACKGROUND: Chronic sleep loss amongst youth is a major public health crisis globally and is associated with a multitude of physical and mental health issues. Flourishing describes a child’s resilience, approach towards learning and overall positive, behavioral and social well-being. There are a limited number of studies that describe how sleep sufficiency affects childhood flourishing across all school-age children. OBJECTIVE: The objective of this study was to assess the association between sleep sufficiency and childhood flourishing markers. METHODS: This cross-sectional study used parental responses for children aged 6-17 years (n=49,050) from the combined 2016-2017 National Survey of Children’s Health. Sleep sufficiency was defined as having greater than or equal to 9 hours of sleep on an average weeknight per the American Academy of Pediatrics’ 2014 policy statement. The five childhood flourishing markers examined individually and as a combined measure were parental reports of their child showing interest and curiosity in learning new things, doing all required homework, caring about doing well in school, working to finish tasks he or she starts and staying calm and in control when faced with a challenge. Logistic regression was used with complex survey design and applied weights in Stata. The model was adjusted for age, federal poverty level, time spent in front of a television, time spent with computers, cell phones, video games and other electronic devices, adverse childhood experiences and mental health conditions. RESULTS: Overall, only 47.6% of US children were estimated to have sufficient sleep (Table 1). Sufficient sleep was found to have a positive impact on individual flourishing markers and as a combined measure. In the adjusted model, children with sufficient sleep had a 12% increase in the odds of demonstrating the combined flourishing measure (OR=1.12; 95% CI 1.01, 1.26). Children with sufficient sleep also had a statistically significant increase in the odds of showing interest and curiosity in learning new things (OR= 1.44; 95% CI 1.26, 1.65), doing all required homework (OR=1.33; 95% CI 1.19, 1.48), caring about doing well in school (OR=1.28; 95% CI 1.13, 1.44) and working to finish tasks he or she starts (OR=1.14; 95% CI 1.02, 1.27), with the first 3 markers showing a greater than 25% increase in odds (Figure 1). CONCLUSION: This study demonstrates that sufficient sleep positively impacts childhood flourishing, which could have a critical role on physical and mental health, school performance and the future positive well-being of children. Efforts are needed to maximize sleep sufficiency for children including addressing caffeine consumption, digital media usage, bedtime routines and school duration and start times.
TABLE 1. Prevalence of Childhood Flourishing Markers of 6 to 17-Year-Old Children in the United States by Hours of Sleep on an Average Weeknight, National Survey of Children’s Health 2016-2017 (n=49,050)
*Values are weighted percentages. Percentages may not equal 100% due to rounding.
FIGURE 1. Adjusted Odds Ratios of Childhood Flourishing Markers Amongst 6 to 17-Year-Old Children in the United States with Sufficient Sleep (?9 hours/night) in Comparison to Insufficient Sleep (?8 hours/night), National Survey of Children’s Health 2016-2017 (n=49,050)
Odds ratios adjusted for age, federal poverty level, time spent in front of a television, time spent with computers, cell phones, video games and other electronic devices, adverse childhood experiences and mental health conditions
AAP contacts: Lisa Black, 630-626-6084,
or Laura Alessio, 630-626-6276,
This part of information is sourced from https://www.eurekalert.org/pub_releases/2019-10/aaop-oho101819.php