Evidence-Based Behavioral Strategies for Children’s Sleep in Smartphone Apps: Content Analysis

Stats:

• 20% to 30% of children have difficulty sleeping
• 2% of app descriptions reviewed included sleep improvement strategies
• 21.6% of apps had at least one evidence-based behavioral sleep strategy

Background

Many young children have trouble sleeping, which may lead to consequences including behavioral and physical problems and stress for parents. While sleep problems are common, many families face barriers to accessing specialized sleep care from providers trained in empirically supported behavioral sleep strategies.

Smartphone apps are a more accessible source of help with childhood sleep problems. But although apps are convenient, studies of sleep apps targeted towards adults found that less than half were based on evidence-based practices. No previous studies have been conducted on sleep apps specifically catered to children.

Researchers from the Breathing Institute at Children’s Hospital Colorado had two goals for this study:

• Examine the number of available sleep apps for children and their characteristics
• Analyze the purported features and claims in the developer description of these apps

Research methods

Researchers searched for children’s sleep apps in Apple iTunes and Google Play using the terms “kids sleep,” “child sleep,” and “baby sleep.” Out of the 649 apps identified, 566 were excluded because they were not for children, not for sleep, and had less than 100,000 downloads.

A content analysis was conducted on the developers’ description in the remaining 83 apps, documenting:

• Type of app
• Price
• User rating
• Number of users

Evidence-based behavioral strategies were evaluated based on the ABC’s of SLEEPING pediatric sleep recommendations. 

The following recommendations received a rating of strong or moderate support and were included in a checklist for analysis of the app descriptions:

• Sufficient sleep opportunity for age
• Bedtime no later than 9 p.m.
• Consistent sleep schedule
• Bedtime routines
• Limited access to electronics during and after bedtime
• Independent sleep skill development
• Emotional needs met during the day

Results

Types of sleep apps

Sleep improvement strategy apps

There were only two apps that gave advice and helped parents track children’s sleep patterns, included recommendations by sleep experts and provided guided steps for sleep.

Huckleberry: Baby & Child Tracker, Sleep Experts

• Described as offering recommendations and personalized guidance from nurse practitioners, certified sleep consultants and board-certified behavioral therapists
• Fee-based analysis and recommendations of child’s sleep schedule

Johnson’s Bedtime Baby Sleep

• Recommends three-step bedtime routine for children (bath, massage, quiet time)
• Published trial found parents reported increased sleep duration and improved sleep quality after use of the app

White noise or music apps

Baby Night Light - Sleep Aid

• Features sound detection to automatically turn on a nightlight to soothe the child if they awoke

Bedtime games or stories

Moshi Twilight Sleep Stories: Kids Bedtime App

• Only app to use audio-only stories, meditations, music, and sounds to help children sleep

A content analysis identified five common themes among the app descriptions:

• Helps child fall asleep (46%)
• Improve well-being and development (22%)
• Stop crying at bedtime (9%)
• Develop good sleeping habits (8%)
• Huckleberry: Baby & Child Tracker, Sleep Experts and Johnson’s Bedtime Baby Sleep: only apps to report empirical support and use behavioral strategies
• Johnson’s: only app clinically proven to help baby fall asleep faster and sleep through the night better
• Trusted by parents (6%)

Behavioral strategies

Eighteen apps had at least one evidence-based behavioral sleep strategy. Three apps contained more than one:

• Johnson’s: bedtime routines, consistent sleep scheduling
• Moshi Twilight Sleep Stories: Kids Bedtime App: relaxation, bedtime routines
• Huckleberry: relaxation, bedtime routines, consistent sleep scheduling, and sufficient sleep opportunity for age

Discussion and conclusion: Despite many options, few sleep apps include evidence-based behavioral strategies

Study authors noted that apps targeting sleep in pediatric populations were less likely to incorporate evidence-based behavioral strategies than sleep apps targeted to adult populations. This is consistent with previous findings from investigations of other apps meant to address childhood sleep difficulties. Some apps promoted one evidence-based strategy while contradicting another; white noise apps used for regulating sleep through sound required visual use of an electronic device. 

Collaboration between app developers and sleep researchers could help create apps supported by evidence to help with children’s sleep. Clinicians can support families in selecting apps that align with evidence.