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BACKGROUND AND OBJECTIVES: Sleep during hospitalization is important, but data on children’s sleep quality during hospitalization are lacking. We sought to document sleep duration and awakenings in hospitalized children and explore associations between sleep and chronic care complexity, home sleep quality, and late-night food consumption. METHODS: Children aged 2 to 17 years admitted to a hospitalist service for at least 24 hours were approached for participation. Children were video recorded from 20:00 to 08:00. Paired investigators reviewed recordings and extracted data. Investigators blinded to sleep data separately extracted clinical and demographic information. Analyses included Spearman correlations and linear and generalized linear regression models with t and Wald χ2 tests. RESULTS: The mean time subjects (n = 57) initiated sleep was 22:35 (range: 20:00–02:47), with a mean sleep duration of 475 minutes (89–719 minutes). Subjects awakened 2.2 times (0–7 times, SD: 1.9) per night, on average, with the average total time awake during those awakenings of 55.7 minutes (2–352 minutes, SD: 75 minutes). In multivariate analysis, children with private insurance had longer sleep duration. Additionally, subjects who ate a snack after 21:00 went to sleep much later (odds ratio: 9.5; confidence interval: 2.6 to 34.9) and had 64 minutes less total sleep time and spent less time in bed than patients who did not eat late (P = .007). CONCLUSIONS: Hospitalized children sleep less than recommended and experience frequent awakenings. Some demographic variables are related to sleep. Many hospitalized children also consume food at night, which is associated with later bedtime and less sleep. Future efforts to improve sleep in hospitalized children are needed.

Background Viral bronchiolitis is a common cause of hospitalization in young children, but despite a variety of therapeutic options, the mainstay of treatment remains supportive care. Objective To examine the most recent evidence for supportive care measures and pharmacologic options in the treatment of bronchiolitis in the hospital setting. Method MEDLINE search with expert medical librarian for publications on management and therapies for bronchiolitis. Results Evidence does not support the use of bronchodilators, racemic epinephrine, deep suctioning, systemic corticosteroids, or antibiotics in the absence of a concomitant bacterial infection, as these treatments do not change the course of illness or shorten length of stay (LOS). Nebulized hypertonic saline is not routinely recommended, though it may provide some benefit for patients with anticipated prolonged LOS. Continuous pulse oximetry should not be routinely used in stable patients as it may be associated with longer LOS. Supplemental oxygen should be used to maintain oxyhemoglobin concentrations ≥90%, a level lower than what many clinicians may have used previously. Current evidence suggests high-flow nasal cannula may reduce intubation rate, but its effect on LOS is unclear. Intravenous or nasogastric tube hydration should be used when oral hydration is not sufficient. Conclusion Overall, bronchiolitis remains a self-limited disease whose mainstay of therapy is supportive care.