Improving Sleep Among Children in Foster Care 

By Carol Ripple, PhD, Senior Advisor, Pajama Program | September 25, 2023

Pajama Program supports equitable access to healthy sleep. We focus our work on caregivers and children facing adversity due to poverty, housing insecurity, or familial instability. Children in foster care have a special place in our hearts: being removed from their family, experiencing multiple placements, and past and ongoing trauma mean their sleep suffers. Poor sleep imperils all children’s well-being, but our own research tells us sleep problems in the foster care community are more prevalent and more severe than among other children. Our research also tells us that foster care agency staff may not have the tools they need to help caregivers with children’s sleep. 

Pajama Program’s Senior Advisor Carol Ripple, PhD, and Chief Program Officer Jahna Orzano have been working with Good Night Advisory Council members Candice Alfano, PhD, Ellie McGlinchey, PhD, and Amy Wolfson, PhD, on developing Fostering Sleep, an evidence-based sleep health education program for foster care staff. Based on our collective expertise and on research we have conducted together since 2019, this program provides information and strategies to staff so they can, in turn, help foster caregivers support healthy sleep. In this program, we explain what we mean by healthy sleep and describe common challenges. We share actionable strategies (such as healthy sleep routines) to share with caregivers, suggest ways staff can incorporate attention to sleep in their practice, and encourage interactive problem solving. Because every child and family is unique, we urge staff to help caregivers observe what soothes the child, talk to the child about their experiences and preferences, and create a routine that works for everyone involved. We emphasize the critical role of healthy sleep for foster children and their caregivers—fostering children can be extremely demanding, and healthy sleep is critical to enabling caregivers to cope with daily challenges.  

A key element of our approach is providing feelings of safety and security to children in foster care. Dr. Alfano observed, “Early in life, caregivers nurture sleep through stable routines, calming cues, and attachment security, all of which help children feel safe enough to sleep. Unfortunately, children in foster care have often missed out on these pivotal early experiences and their sleep health suffers.” Connecting with caregivers is one of the best ways to help any child relax, particularly when they have experienced trauma. At Pajama Program, we suggest reading to children at bedtime is an excellent way to connect, but singing, drawing, coloring, and other calming activities that bring a sense of calm and comfort work, too.  

In this program, we caution against giving melatonin to children. In our research, we found that 50 percent of 4- to 11-year-old children in foster care were given melatonin, as compared to 1.3 to 1.4 percent of 2- to 11-year-olds in the general population. Melatonin use in children is problematic for several reasons [hyperlink to our melatonin blog?] and should be used only in specific situations and for a limited time. Behavioral approaches, such as comforting bedtime routines, are the gold standard for dealing with sleep problems, and they are essential to helping children in foster care get the healthy sleep they need to thrive.  

We will continue to develop Fostering Sleep as we pursue our goal of national expansion. On September 29th, we will hold an in-person workshop for our foster care agency partners in New York City, hosted by The New York Foundling. More sessions are planned for 2024. The more we hear about sleep problems in the foster care community, the more resolved we are to bring good nights for good days to children in the system.   

To learn more about Pajama Program and the Good Night Advisory Council, visit us at

Help us support good nights for good days for all children, everywhere.