Sleep: A Key Pillar of Health for Children

One that disproportionately impacts low income families and families of color.

Beth Tinker, PhD in Nursing Science

After graduating from the University of Washington with a Bachelor of Science in nursing, a master’s degree in nursing and a master’s degree in Public Health, Beth Tinker worked for over 15 years in Seattle doing home visits in support of children. During that time, she saw children and families impacted by trauma. Rather than put all the energy on children, she saw the need for interventions that accounted more fully for the context in which the children lived, including parenting and the home environment. She wondered what interventions might look like that created a more supportive context that would better address complicated social issues and lead to healthier outcomes for both children and their families.

So, in 2017, she returned to the UW to earn her PhD. “I really wanted to be a nurse scientist, because a lot of issues I saw during my nursing career are really complex, including poverty and intergenerational issues,” says Tinker. She knew first-hand the university’s strengths and expertise around research. “The nursing faculty is outstanding with people I know and admire. And the continual advances in library resources, technology and access blows my mind.”

Initially Tinker explored a dissertation on trauma and the child welfare population, looking into nurse-family partnership data, but as a Robert Wood Johnson Foundation Future of Nursing Scholar, she had three years to complete her program and was running into time-consuming barriers. That’s when another opportunity presented itself: a home intervention trial focused on behavioral sleep problems and all the things parents can do to promote healthy quantity and quality of sleep in their children.

While it wasn’t what she’d initially had in mind, ultimately it offered a way for Tinker to focus on the issues she cared about. Her interdisciplinary classes took her all over campus for an integrated course of study across nursing, public health, social work, and public policy and focused on social and economic issues, the biology of stress and more.

She also learned a lot about sleep. “I don’t think I thought enough about sleep, until I learned about this literature. Sleep is a pillar of health along with nutrition and exercise,” says Tinker. “Some people brag about only sleeping five hours a night, like it’s a badge of honor. We think successful, rich and powerful people don’t sleep. That’s dangerous. People walk around sleep-deprived and think they are optimally functioning. They aren’t. And for children it’s even more of an issue.”

The study at the center of Tinker’s dissertation targets parents as agents of change, who set the stage with consistency of bedtime routines, home factors, and light and noise restrictions. But changing these patterns is very intensive. “It’s hard to think of scaling something like this,” says Tinker. Given that 25-40 percent of preschool children experience behavioral sleep problems that warrant intervention, Tinker is more interested in how and why a study like this works or does not work for families so the lessons learned can be more broadly applied.

Beth Tinker presents her 1st place poster about her work in sleep research at the Western Institute of Nurses annual conference

Along the same lines, this particular study has a larger percentage of white families with higher incomes, while sleep problems are more common in lower income families and families of color due to family and environmental stress. And a lack of sleep compounds all the existing issues and creates more setbacks for childhood development and families. “When children don’t sleep, parents don’t sleep and they become tired and frustrated,” says Tinker.

Once she earns her PhD, Tinker sees two potential paths in front of her. She could become a faculty member and continue to contribute to the literature through more research and through her students, or she could focus on child and family policy at the city, county or state level. Either way, she plans to make change. “The field has lots to be proud of,” says Tinker. “We’ve seen some amazing developments, but we should also be very dissatisfied with the ongoing and persistent disparities in outcomes for children.”

And as far as she’s concerned, the earlier the better. “I’m all for universal preschool, but that’s not early. Birth is not early. We need to push for prevention because not only does it cost less, but the outcomes are better.” She wants to help the field put more focus on the highest risk families facing the most adversity to close the gap in outcomes that starts even before a person is born. “I want to contribute to research that tells us how to create the best and most supportive context for families and children to thrive,” says Tinker.