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Children’s poor sleep is associated with obesity, academic problems, suicide attempts, and other mental health concerns, but the issue is not consistently addressed in pediatric primary care. A new well-child-visit screening tool for primary care clinicians (PCCs) appears to help boost diagnosis and referrals, according to findings from a study published in JAMA Network Open.

Ariel A. Williamson, PhD, with The Ballmer Institute for Children’s Behavioral Health, University of Oregon, Portland, Oregon, and colleagues tested an electronic, age-based sleep screener that evaluated infant bed sharing, snoring three nights a week, short sleep time, perceived sleep problems, and adolescent daytime sleepiness.

The researchers conducted a retrospective, observational case-control study in the Children’s Hospital of Pennsylvania primary care network of 31 practices in Pennsylvania and New Jersey; 27 in suburban/rural settings and four in metropolitan settings.

During implementation, 204,872 patients completed the screening, with adoption in 89.5% of all well-child visits. The screening indicated that 9.7% of patients had frequent snoring, 12.2% had sleep problems, and 34.4% had insufficient sleep. Bed sharing was reported for 6.5% of infants and 14.7% of adolescents reported daytime sleepiness. The identification of sleep problems was followed by provision of family education resources.

Sleep Disorder Diagnosis 64% More Likely With Screener

Compared with the pre-implementation period, at well-child visits with a completed sleep screener, PCCs were significantly more likely to make a sleep disorder diagnosis (odds ratio [OR], 1.64; 95% CI, 1.56-1.73), order a polysomnogram (OR, 2.67; 95% CI, 2.32-3.20), and refer to sleep clinics (OR, 6.48; 95% CI, 5.03-8.34) or otolaryngology (OR, 4.46; 95% CI, 3.95-5.02).

Rupali Drewek, MD, a pediatric pulmonologist and co-medical director of the Sleep Medicine Program at Phoenix Children’s in Phoenix, who was not involved with the study, told Medscape Medical News the screener is promising and its proactive approach — even in children with no obvious symptoms — allows for earlier intervention and improved quality of life.

“Sleep problems affect up to half of children at some point,” she said, “yet they are rarely addressed unless parents bring them up. Implementing a standardized screening tool during routine pediatric visits ensures systematic identification of issues that might otherwise go unnoticed. Taking action early can lead to better health, better school performance, and less stress for families and the healthcare system.”

Adding a new screening tool should fit easily into a regular checkup without slowing workflow substantially, she said. “It offers a scalable, low‑cost solution to reach millions of children.”

Educating the medical team will be important to successful implementation, she said.

“Everyone on the care team needs to know how to read the results and what to do next if a child’s answers show there might be a sleep problem.”

Lessening Healthcare Inequities

In an accompanying editorial, Sarah M. Honaker, PhD, with the Department of Pediatrics at Indiana University School of Medicine, Indianapolis, and Stephen M. Downs, MD, MS, with the Department of Pediatrics, Wake Forest University in Winston Salem, North Carolina, said the screener, “offers a refreshing departure from this pattern of asking PCCs to know more and do more. [T]his is an opportune time to study the implementation of systems that will support PCCs in providing evidence-based care.”

The editorialists wrote that the broad screening at well-child visits could help lessen healthcare inequities. They noted that children from minoritized backgrounds with a lower socioeconomic status are more likely, for instance, to have obstructive sleep apnea (OSA) and are less likely to receive timely, evidence-based care. “For example, Black children are two to four times more likely to have OSA and less likely to receive a [polysomnogram] referral,” they wrote.

One of the main unanswered questions, Honaker and Downs wrote, is how much the educational components help once the problems have been identified and whether guidance about sleep duration results in actual improvements in sleep duration.

A key strength of the work is replicability in other health systems, with individual adaptations, the editorialists noted.

“[T]he system designed by Williamson and colleagues offers an excellent starting point for other healthcare systems seeking to support PCCs in prevention, identification, and management of pediatric sleep disruption,” they wrote.

Williamson reported receiving honoraria from the National Sleep Foundation, the American Academy of Pediatrics, and Wesleyan University and an honorarium and travel support from The Pennsylvania State University, outside the submitted work.

This study was supported by the Possibilities Project at Children’s Hospital of Philadelphia and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Honaker reported receiving consulting fees from Covington LLC; grants from the National Heart, Lung, and Blood Institute; equity ownership of For Dreamers LLC; and grants from the American Academy of Sleep Medicine Foundation outside the submitted work. Downs reported that he is the co-creator of the Child Health Improvement through Computer Automation (CHICA) software and cofounder of Digital Health Solutions LLC, which licenses CHICA. Drewek reported no relevant financial relationships.

Marcia Frellick is a Chicago-based, independent healthcare journalist and a regular contributor to Medscape Medical News.

A University of Oxford-led review found that women with obesity who underwent structured weight loss before IVF were 47 % more likely to conceive naturally and 21 % more likely to become pregnant overall, suggesting weight management could reduce the need for treatment

Researchers led by the University of Oxford have found that structured weight loss before starting IVF treatment can significantly improve the chances of conceiving naturally. The findings highlight the potential for lifestyle changes to play a key role in reproductive health and reduce reliance on IVF.

The findings are detailed in the Annals of Internal Medicine.

Weight loss and IVF

In England, NHS commissioning bodies restrict access to NHS-funded IVF for women with a Body Mass Index (BMI) over 30.

The research team analysed 12 international trials, which included 1,921 women. It looked at synthesised evidence from a wide range of weight loss interventions, such as diet programmes, exercise, and weight loss medications such as orlistat and older GLP-1 agonists.

Dr Moscho Michalopoulou, lead author from Oxford’s Nuffield Department of Primary Care Health Sciences, said: “Currently, women with obesity can face a double challenge with higher rates of infertility and potential exclusion from NHS-funded IVF. Our findings offer hope. They suggest that offering structured weight loss support could improve the chance of conceiving naturally, which may avoid the need for IVF treatment. Programmes that help women achieve greater weight losses have the potential to help more women achieve a successful outcome, and should be tested in larger high-quality trials.”

47% more likely to conceive naturally after weight loss

The researchers found that women with obesity who participate in weight loss programmes before starting in vitro fertilisation (IVF) are 47% more likely to conceive naturally than those receiving minimal or no weight loss support, according to the most comprehensive systematic review of the evidence to date.

Beyond the increase in natural conception, the study found weight loss interventions increased the odds of any pregnancy (naturally or by IVF) by 21%.

The study suggests that providing structured weight loss support could help women become eligible for NHS IVF treatment and also increase their chances of conceiving without assistance.

Dr Moscho Michalopoulou, lead author from Oxford’s Nuffield Department of Primary Care Health Sciences, said: “Currently, women with obesity can face a double challenge with higher rates of infertility and potential exclusion from NHS-funded IVF. Our findings offer hope. They suggest that offering structured weight loss support could improve the chance of conceiving naturally, which may avoid the need for IVF treatment. Programmes that help women achieve greater weight losses have the potential to help more women achieve a successful outcome, and should be tested in larger high-quality trials.”

Associate Professor Nerys Astbury, who led the research at the University of Oxford, noted: “The evidence on live birth rates was of very low certainty because many studies did not follow the pregnancies through to birth and report this outcome, which is so important to the patients. While there was no evidence of an increase in pregnancy loss, we need larger, high-quality trials to confirm the effect on live births. It was also interesting that when we restricted the analysis to low-energy diet replacement programmes, which led to greater weight loss, there was an increase in live births, but this needs to be confirmed in larger trials.”

The researchers found a trend towards smaller benefits for natural conception for women with Polycystic Ovary Syndrome (PCOS). However, the researchers are calling for larger, more robust trials that compare weight loss programmes and their link to conception to see which method is most effective and for whom, including women with PCOS.

“This isn’t just about improving pregnancy rates – it’s about improving equity of access to fertility treatment,” Professor Astbury added. “We know that people from more deprived areas and those from certain ethnic backgrounds are more likely to live with obesity. Policymakers should consider whether integrating structured weight loss support into fertility services could improve outcomes for patients, while potentially reducing overall costs by increasing the number of women who conceive naturally.”

Dr Michalopoulou concluded: “For women trying to conceive, every month matters. We need efficient, evidence-based pathways that give them the best chance of success. Our work suggests that for many women with obesity, an intensive supported weight loss programme could help them to conceive naturally or make it possible to access IVF services.”