Influence of ACEs on Sleep Health in Early Childhood as Mediated by Family Routines

Background/Objectives: Sleep health is a multi-faceted biopsychosocial concept that affects well-being across the lifespan. Insufficient sleep occurs in large numbers of children and there is emerging evidence for the influence of socioecological factors and adverse childhood experiences (ACEs). The purpose of this study was to determine the influence of adverse childhood experiences on sleep health in preschool age children as mediated by family interaction habits and outdoor play. Methods: Our secondary analysis of the 2023 National Survey of Children’s Health used the weighted dataset filtered for children ages 3–5 years. Results: Sixty-six percent of parents reported adequate child sleep; nearly 89% of parents reported consistent bedtimes. Seventy-one percent reported no ACEs. Most children had one or more hours of outdoor play each day. Daily family interaction (reading, singing, stories, meals) occurred in approximately half of families. Structural equation modeling results indicated that the negative effects of ACEs on consistent bedtime were mediated by reading aloud and family meals, while adequate sleep duration was mediated by reading aloud and singing/storytelling. Conclusions: These findings represent a promising picture of young children and families, and insight into a window of time during child development when family interaction can positively affect sleep health in spite of adverse childhood experiences.