Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study

Background: Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4–12 years old in the US, leveraging data from the Environmental Influences on Child Health Outcomes (ECHO) Program. Methods: Data collection occurred in July 2019–March 2020 (pre-pandemic) and two pandemic periods: December 2020–April 2021 and May–August 2021. Qualitative interviews were performed in 38 participants. Results: We found no changes in sleep duration, but a shift to later sleep midpoint during the pandemic periods. There was an increase in latency at the first pandemic collection period but no increase in the frequency of bedtime resistance, and a reduced frequency of naps during the pandemic. Qualitative interviews revealed that parents prioritized routines to maintain sleep duration but were more flexible regarding timing. Children from racial/ethnic minoritized communities slept less at night, had later sleep midpoint, and napped more frequently across all collection periods, warranting in-depth investigation to examine and address root causes. Conclusions: The COVID-19 pandemic significantly impacted children sleep, but parental knowledge of the importance of sleep might have played a significant protective role. Impact: During the COVID-19 pandemic, US children changed their sleep habits, going to bed and waking up later, but their sleep duration did not change. Sleep latency was longer. Parental knowledge of sleep importance might have played a protective role. Regardless of data collection periods, children from racial/ethnic minoritized communities slept less and went to bed later.This is one of the first study on this topic in the US, including prospective pre-pandemic qualitative and quantitative data on sleep habits.Our findings highlight the pandemic long-term impact on childhood sleep. Results warrants further investigations on implications for overall childhood health.