Inconsistent sleep regulations in childcare could harm children’s health

Thousands of licensed childcare centres across Canada may not be ensuring that children get adequate, healthy sleep due to inconsistent sleep regulations.

A new UBC study led by pediatric sleep expert and nursing professor emeritus Dr. Wendy Hall found that sleep regulations for licensed childcare facilities vary widely across Canadian provinces and territories, often leaving centres without clear guidelines to support children’s sleep needs.

"We found significant disparities in sleep-related regulations across provinces and territories. For instance, B.C. regulations lack specific guidelines about general or daily sleep programming, focusing instead on maintaining a safe sleep environment through factors like positioning, equipment safety and prohibited practices," said Dr. Hall.

Alberta’s regulatory requirements do not specify sleep programming or space but do specify required staffing. In the Atlantic provinces, regulations vary about programming incorporating time for rest or sleep into the day. Ontario regulations specify daily sleep amounts, dedicated age-specific sleep space and equipment, and sleep staffing, positioning and monitoring, and prohibited practices. Quebec regulations do not specify general or daily sleep programming, staffing during sleep/rest, sleep positioning or sleep monitoring. There are operating manuals available to help licensees interpret regulations but many manuals are years out of date.

Dr. Hall noted that nearly three-quarters of children in Canada are in childcare settings – 56 per cent are in some form of childcare and an additional 26 per cent are on waitlists. "The lack of consistent regulations creates confusion regarding the appropriate number and length of naps/rest periods for children, particularly across various age groups. Although naps are crucial for development, many centres prioritize only one rest period per day, which may not meet infants’ needs or may exceed needs of three- to four-year-olds."

The definition of an “infant” also varies among provinces – the age range can vary from 12 to 24 months – which affects sleep space and equipment guidelines and children’s development.

The study also notes that there are equity concerns as well. Children from lower socio-economic backgrounds who may not sleep as long at night can particularly benefit from access to naps in the day – but there are no consistent provisions for this across childcare in Canada.

To ensure children get quality, sufficient sleep and rest, Dr. Hall recommends looking at the Canadian 24-hour movement guidelines as a good starting point for the early years. These guidelines integrate children’s physical activity, sedentary time and sleep, recommending naps for infants and children under two years, and nap options for ages three to four.

Childcare centres also need to emphasize safe sleep practices, monitoring children during sleep to ensure their safety. Only regulations in B.C. and Ontario emphasize sleep positioning.

"It’s important to understand that each province or territory sets its own childcare regulations, which makes it challenging to create a consistent national approach," added Dr. Hall. Many governments already struggle to provide adequate childcare and staff, making it challenging to improve sleep regulations. However, organizations like the Canadian Sleep Society and the Canadian Child Care Federation could advocate for better sleep regulations. Sleep should also be a key part of training for early childhood educators.

Parents can monitor their child’s sleep patterns, talk to childcare providers about their children’s needs and familiarize themselves with sleep guidelines. For example, American Academy of Sleep Medicine guidelines are useful in the context of recommendations for a 24-hour period, but do not separate naps from nighttime sleep. The Canadian 24-hour movement guidelines provide specific recommendations for naps within the broader sleep framework.