Bedtime Routines Research Articles

Night Sleep, Parental Bedtime Practices and Language Development in Low-Risk Preterm and Full-Term Late Talkers: A Longitudinal Study in the Third Year of Life.

Background: Studies on night sleep and parental bedtime practices and their associations with language development in populations at risk of language delay and neonatal conditions, such as late talkers and preterm children, are scarce. Objectives: Our objective was to longitudinally examine the development of night sleep (total night sleep difficulties, settling, night waking, and co-sleeping), parental bedtime practices (total parental bedtime practices, active physical comforting, encouraging autonomy, and leaving to cry), and expressive language (word and sentence production), and their associations in low-risk preterm and full-term late talkers from 31 to 37 months of age. Methods: Parents of 38 late talkers, 19 low-risk preterm and 19 full-term children, completed the Italian versions of the Infant Sleep Questionnaire, the Parental Interactive Bedtime Behavior Scale, and the MacArthur-Bates Communicative Development Inventory Words and Sentences Long Form. Results: Late talkers' night sleep difficulties, such as settling to sleep and night waking, decreased over time, with low-risk preterm late talkers experiencing more night waking and co-sleeping than full-term peers. Parents reported that instances of active physical comforting and leaving to cry also decreased, with parents of low-risk preterm late talkers reporting higher active physical comforting scores than parents of full-term peers. Improvements in parental practices of encouraging autonomy were significantly associated with increased sentence production from 31 to 37 months. Conclusions: Findings highlight the importance of monitoring night sleep in preterm and full-term late talkers. They also suggest that populations vulnerable to sleep and language delays may particularly benefit from targeted interventions promoting autonomy in their bedtime routines, which, in turn, could support their language development trajectories.

Media Use in Daily Routines and Young Children’s Social Skills

ABSTRACT Research Findings: The current study examined (1) whether children’s media use during afterschool or bedtime routines, beyond their total media use, contributes uniquely to their peer social skills, and (2) whether joint media engagement serves as a protective factor for any negative associations between media use in daily routines and peer social skills. The study followed 459 children in a Midwestern U.S. state from kindergarten to Grade 1. Teachers reported on children’s peer social skills at both time points. Parents reported frequency of media use in afterschool and bedtime routines, daily media use duration, and joint media engagement. Hierarchical linear modeling was utilized to account for class-level clustering effects. Frequency of media use in afterschool routines negatively predicted children’s peer social skills in first grade, controlling for total media use, peer social skills in kindergarten, and demographics. However, media use in bedtime routines did not significantly predict social skills. Neither of these associations was significantly moderated by parental joint media engagement. Practice or Policy: The current results call for future research focused on effective means to regulate children’s media use in their daily routines to foster positive social development.

A Comprehensive Assessment of Bedtime Routines and Strategies to Aid Sleep Onset in College Students: A Web-Based Survey.

College students often experience sleep-wake alterations. Different factors can contribute to insomnia symptoms in this population. The present study aims at investigating pre-sleep behaviours and strategies used to aid sleep onset in young college students and their association with insomnia symptoms. A total of 548 Italian college students (mean age = 23.48 years, range = 19-30 years, 80.5% female) completed a web-based survey on pre-sleep behaviours and sleep-onset facilitators, insomnia symptoms and sleep hygiene, anxiety and depression, and coping strategies. The use of electronic devices at bedtime and as a sleep-onset facilitator was predominant. Students using specific behaviours as sleep-onset facilitators were characterised by more psychological difficulties and poorer sleep. In multivariable linear regression analysis, the frequency of using medications and melatonin, regardless of motivations, was associated with higher insomnia symptoms. The use of specific sleep-onset facilitators positively correlated with the severity of insomnia symptoms. Many students engage in behaviours that are considered sleep-interfering and that are often employed in an attempt to facilitate sleep onset without benefits. Overall, the motivational factors behind pre-sleep behaviours need to be addressed in preventive programs targeting young college students.

Sleep habits of preschool children after the COVID-19 lockdown in a municipality in Paraíba, Brazil

Introduction: the COVID-19 pandemic has brought changes in routines, use of time, behaviors, social relationships and concerns that can compromise children’s sleep, and studies on the subject are essential. Objective: to evaluate the sleep habits of preschool children after the COVID-19 lockdown in Brazil.Methods: this is a cross-sectional study nested in a cohort of live births to assess growth and development up to 1,000 days of age. For this study, data were collected from children at 4 years of age related to biological profile, health status, maternal care, screen time and physical activity, and behavior during the COVID-19 pandemic. The mean scores of the children’s sleep habits (bedtime routine, rhythmicity and affective separation) were analyzed according to the children’s characteristics using the Student’s t-test. Results: sleep routine was the most impaired sleep habit, with lower averages in cases of hospitalization (p = 0.047), mother’s difficulty in caring for the child (p = 0.003) and great concern about COVID-19 during the pandemic (p = 0.003); followed by rhythmicity, which was also worse in the previous situations. In addition, children with more than 60 minutes of recreational screen time (p = 0.002) and without a mask-wearing routine during the pandemic (p = 0.003) had lower average bedtime routines. Health problems at birth (p = 0.001), hospitalization (p = 0.000), special health needs (p = 0.025) and mother’s difficulty in providing care (p = 0.037) negatively interfered with affective separation. Conclusion:children with health problems, excessive screen time and concern about COVID-19 during the pandemic, as well as the difficulty of maternal care, influenced children’s sleep habits.

The relationships between bedtime routines and preschooler’s sleep health and well-being: a cross-sectional survey in Japan

The relationships between bedtime routines and preschooler’s sleep health and well-being: a cross-sectional survey in Japan

0834 Bedtime and Naptime Routines: Associations with Newborn and Parental Sleep Outcomes

0834 Bedtime and Naptime Routines: Associations with Newborn and Parental Sleep Outcomes

Performance of wearable sleep trackers during nocturnal sleep and periods of simulated real-world smartphone use

Goal and aimsTo test sleep/wake transition detection of consumer sleep trackers and research-grade actigraphy during nocturnal sleep and simulated peri-sleep behavior involving minimal movement. Focus technologyOura Ring Gen 3, Fitbit Sense, AXTRO Fit 3, Xiaomi Mi Band 7, and ActiGraph GT9X. Reference technologyPolysomnography. SampleSixty-three participants (36 female) aged 20-68. DesignParticipants engaged in common peri-sleep behavior (reading news articles, watching videos, and exchanging texts) on a smartphone before and after the sleep period. They were woken up during the night to complete a short questionnaire to simulate responding to an incoming message. Core analyticsDetection and timing accuracy for the sleep onset times and wake times. Additional analytics and exploratory analysesDiscrepancy analysis both including and excluding the peri-sleep activity periods. Epoch-by-epoch analysis of rate and extent of wake misclassification during peri-sleep activity periods. Core outcomesOura and Fitbit were more accurate at detecting sleep/wake transitions than the actigraph and the lower-priced consumer sleep tracker devices. Detection accuracy was less reliable in participants with lower sleep efficiency. Important additional outcomesWith inclusion of peri-sleep periods, specificity and Kappa improved significantly for Oura and Fitbit, but not ActiGraph. All devices misclassified motionless wake as sleep to some extent, but this was less prevalent for Oura and Fitbit. Core conclusionsPerformance of Oura and Fitbit is robust on nights with suboptimal bedtime routines or minor sleep disturbances. Reduced performance on nights with low sleep efficiency bolsters concerns that these devices are less accurate for fragmented or disturbed sleep.

An Exploration of the Environmental Setting Mothers and Early Adolescent Youth Prefer to Have Conversations About Daily Stressors

Parent-child conversations are impacted by environmental setting. Yet, few studies have considered where mothers and early adolescent youth prefer to have conversations about daily stressors. This study examines where mothers and youth prefer to have conversations about daily stressors, differences in preference based on demographic variables, and why certain environmental settings are preferred. One hundred youth ( M = 11.04, 53% boys) and their mothers participated in semi-structured interviews. Findings showed that youth preferred to communicate in their bedroom, the kitchen, and the living room, whereas mothers preferred the kitchen, their child’s bedroom, and the car. Using thematic analysis, we found that participants preferred communicating in physically and psychologically comfortable environments, private locations that were away from others, and that they relied on bedtime and mealtime routines to engage in regular conversations. Findings suggest that the place mothers and youth converse matters and may meaningfully impact parent-child conversations about daily stressors.

Direct and Indirect Contributions of Child Temperament, Parenting Stress, and Bedtime Routines to Children’s Sleep Behaviors During the Covid-19 Pandemic

ABSTRACT The current study examined the direct and indirect contributions of children’s temperament (reactivity, persistence, and rhythmicity), parenting stress, and bedtime routines to Turkish children’s sleep behaviours during the COVID-19 pandemic. The sample was 313 mothers of children between 16 and 84 months (M = 52.42, SD = 12.36). Mothers reported their children’s sleep behaviours, children’s bedtime routines, parenting stress, and children’s temperament. Multivariate path analyses were run to test the direct and indirect effects. Results indicated that parenting stress was negatively related to children’s sleep behaviours. Further, it was found that consistency of bedtime routine environments was positively associated with children’s sleep behaviours. For the indirect associations, children’s temperament (rhythmicity and reactivity) was indirectly associated with children’s sleep behaviours via the consistency of bedtime routines. Findings underline the importance of child temperament, parenting stress, and bedtime routines for children’s sleep behaviours. The implications of the findings are discussed in light of previous research and the Bioecological model of human development in considering their functioning during the COVID-19 pandemic.

Bedtime routines in Greek families: characteristics, barriers, and facilitators for establishing and maintaining optimal routines

BackgroundBedtime routines are amongst the most common, recurrent family activities with close associations for child health, development and wellbeing especially sleep. Despite the importance of bedtime routines, no previous study has examined them within the context of a Greek family.MethodA mixed methods, stepped approach was used in this study. A cross-sectional study examined the prevalence and characteristics of bedtime routines (PRE) in families with young children and explored associations with parental mood (POMS) and child's sleep (CSHQ). A qualitative study using the Theoretical Domains Framework (TDF) examined barriers and facilitators for achieving optimal routines.ResultsTotal of 54 parents with a mean age of 35.9 (SD = 5.95) completed the cross-sectional study while 20 parents participated in the interviews. There were strong positive correlations between total scores on the POMS and total scores on the CSHQ r = 0.482, p < 0.001 and strong negative correlation between total scores on the POMS and total scores on the PRE, r = −0.308, p = 0.023. In terms of barriers and facilitators, social desirability, social comparison, environmental factors and resistance from children were amongst the most common barriers to establishing a good bedtime routine.ConclusionBedtime routines are highly prevalent in Greek families with the quality of those routines varying between households. Addressing common barriers in achieving better bedtime routines could help families benefit in the short and long-term.

Common Childhood Sleep Problems and Disorders.

Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

Eat, Sleep, Lust, Repeat: Bedtime Routine, Health and Herbals in Early Modern England

ABSTRACT Getting a good night’s sleep was of great importance to early modern people because it was central to healthy routine and the practice of piety. Re-examining printed regimens and herbals reveals that lust was thought to interrupt slumber and that managing sexual impulse and activity is a hitherto unexplored aspect of sleep care. Aspects of routine had to be repeated moderately and in succession in order to prevent disease and imbalance. Feeling sleepy and feeling lustful were, this article finds, connected in complicated and often conflicting ways in bedtime routine. Printed herbals and domestic recipe books shows that soporific materials were also useful in lessening lust. Such findings point to a shared culture of herbal knowledge that centred around bedtime and beds. Early modern people grappled with social, practical, moral and medical concerns when deciding how and when to use their beds, revealing the ways in which sleep care, sexuality and the pursuit of a healthy body and soul intersected.

A comparison of perceived barriers to optimal child sleep among families with low and high income

ObjectiveFamilies with low-income experience suboptimal sleep compared to families with higher-income. Unique drivers likely contribute to these disparities, along with factors that universally impede sleep patterns, despite income level. To inform intervention tailoring, this mixed-methods study gathered parent’s perceptions about child sleep challenges to identify similarities/differences in families with lower-income and higher-income. MethodsParents who experienced difficulties with their child (ages 2-4years) sleep were categorized as lower income (n = 15; $30,000 ± 17,845/year) or higher income (n = 15; $142,400 ± 61,373/year). Parents completed a survey and semistructured interview to explore barriers and facilitators for child sleep. Two coders independently evaluated transcripts for lower-income and higher-income groups using inductive analyses. Constant-comparison methods generated themes and characterized similarities/differences by income group. ResultsGroups were similar in themes related to diverse bedtime routines, nighttime struggles with child sleep, parent strategies to reduce night wakings, parent effort to provide a sleep-promoting environment, and presence of electronic rules. Groups differed in themes related to factors influencing routine setting (eg, lower income: external factors influencing routines; higher income: personal attributes for structure), parent appraisal of child sleep (eg, higher income: ambivalence; lower income: mostly negative appraisal), nap timing and duration (eg, lower income: longer naps), and strategy utilization and pursuit of resources (eg, higher income: more parents tried various strategies and accessed online/print resources). ConclusionsParents experienced many similar barriers to child sleep, with a few distinct differences by income group. These findings can inform future intervention components for all families, as well as customized components to address the unique needs of families across income levels.

Structured case conference for sleep disturbances in nursing home residents with cognitive impairment

Structured case conference for sleep disturbances in nursing home residents with cognitive impairment Abstract: Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: "offering appropriate activations during daytime", "creating bedtime routines", "checking the sleep environment", "observation of potential physical and psychological causes", "reflection on night care routines", and "use of drug therapies only in exceptional cases". Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.

P099 Use of Digital Technology During Child Bedtime Routines: A qualitative investigation

Abstract Introduction The Child Bedtime Routines Study (CBRT) sets out to examine patterns and attitudes towards sleep in daily life in a novel and detailed way, by constructing personal timelines of 5–8-year-old children’s sleep routines in their homes, their digital technology use, and parental attitudes and behaviours surrounding sleep and digital technology use. Methods This project involved individual semi-structured interviews with 30 parents of 5–8-year-old children via zoom. During the interview parents completed a novel visualisation of their home environment and the visual diagramming tasks for afternoon and evening, sleep and wake routines at home via the online interactive platform Mural. Results Thirty parents (Female = 86.7%) of 30 children (66.7% boys) aged between 5 and 8 years participated in the study. The most common description of their child using technology was watching shows or videos via tv or tablet. Over 76% of parents identified having rules or regulations regarding digital technology use. There was little technology use reported around bed-time routines, however, the use of apps to listen to bedtime stories was reported by some. Discussion The interviews allowed for greater description and nuance regarding the parenting decisions around technology use in the home. Household rules around the use of digital technology by children were not specifically oriented around bedtime or the potential impact of technology on sleep quality, duration, or timing. The use of technology-based sleep aids may increase, and a better understanding of the potential benefits and costs of those technologies needs to be understood.

Helping Clinicians Conceptualise Behavioural Insomnia in Children: Development of the Manifestations and Vulnerabilities of Behavioural Insomnia in Childhood Scale (MAVBICS).

This paper outlines the development and psychometric evaluation of the Manifestations and Vulnerabilities of Behavioural Insomnia in Childhood Scale (MAVBICS), an instrument intended to assess the manifestations of, and factors underpinning, child behavioural insomnia. The MAVBICS comprises two sections: a more general sleep and bedtime information section (Section1), and a psychometric measure of six theoretically derived factors that underlie, contribute to, and are manifestations of, child sleep problems (Section2), that is the focus of this research. Study 1 comprised an exploratory factor analysis of Section2 items (EFA; n = 328 parents of children aged 3-12years), with a final 25 items found to load highly onto 6 factors; Sleep Maintenance Problems (4 items, α = 0.88), Co-Sleeping Behaviours (4 items, α = 0.93), Bedtime Routines (5 items, α = 0.82), Bedtime Resistance (5 items, α = 0.88), Bedtime Worries (3 items, α = 0.85) and Bedtime Fears (4 items, α = 0.86). Study 2 comprised a confirmatory factor analysis (CFA) of Section2 items and tests of convergent validity (n = 313), with results confirming the factor structure and providing evidence for convergent validity through correlations in expected directions between MAVBICS scores and other sleep, anxiety and behaviour measures. Study 3 tested the test-retest reliability of Section2 items (n = 53), and found support for the temporal stability of the MAVBICS over a 2-week period. Overall, the results provide strong preliminary evidence for the validity of the MAVBICS total score and its subscales, although the Bedtime Routines subscale may be less useful.

Bedtime routines, development, and caregiver educational attainment in toddlerhood

BackgroundImplementing a consistent bedtime routine is an empirically supported intervention to improve sleep in toddlers, but little is known about its association with social-emotional outcomes, and among children living in lower socioeconomic status (SES) contexts.ObjectiveThis study examined the longitudinal associations between bedtime routines, social-emotional development, and caregiver educational attainment in toddlers presenting to primary care.MethodCaregivers of 40 toddlers (Mage = 12.85 months, 57.5% female, 62.5% Black/African American) completed questionnaires on sociodemographic factors and child bedtime routine consistency at their 12-month well visit. At the 15- and 24-month well visits, data were collected on child bedtime routine consistency and social-emotional development, including the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) for social-emotional problems and competency and the Ages and Stages Questionnaire (3rd edition; ASQ-3) to assess communication and personal-social skills.ResultsOverall, the majority of families engaged in a consistent bedtime routine (≥5 nights/week) at all time points (63% at 12 months, 75% at 15 months, and 86% at 24 months). Controlling for concurrent bedtime routine consistency, toddlers with a more consistent bedtime routine at 12 months exhibited less dysregulation at age 15 months. Toddlers without a consistent bedtime routine at 15 months exhibited more externalizing and internalizing problems and dysregulation at 24 months. Furthermore, there was a significant interaction between bedtime routine consistency at 15 months and caregiver education for internalizing problems at 24 months, such that toddlers of caregivers with a high school education or less who lacked a consistent bedtime routine showed the most internalizing problems.ConclusionClinicians should consider recommending that families with toddlers incorporate a nightly bedtime routine not only to improve overall sleep health, but also to potentially optimize toddlers' positive social-emotional and behavioral trajectories, especially in families with lower educational attainment.

Affiliative Parent−Adolescent Bedtime and Waketime Interactions are Associated with Adolescent Sleep

ABSTRACT Objectives The current study examined whether evening and morning affiliation (i.e., warmth) and autonomy (i.e., more or less in charge) around sleep routines predicted adolescent sleep on weekdays. Method Participants were 28 parent (Mage = 43.19; 85.17% mothers) and adolescent (Mage = 12.34 years) dyads who completed the same electronic diaries morning and evening for 10 days, with a total number of 221 nights observed across dyads. Sleep duration and sleep quality were assessed via the Pittsburgh Sleep Diary; degree of affiliation and autonomy around bedtime and waketime routines were assessed with single items on a visual analog scale. Multilevel modeling was utilized to evaluate the effects of more or less affiliation or autonomy on sleep outcomes (i.e., duration and quality) between and within dyads. Results Across all participants, adolescents who reported more affiliative interactions with their parent around bedtime and waketime slept longer and had better sleep quality at night. Further, when adolescents experienced greater than average affiliative interactions with their parent than was typical for them, they had better sleep quality that night. Adolescent sleep quality and duration were not impacted by whether or not adolescents were in charge of their bedtime and waketime routines. Conclusions Findings support parents’ role in social and emotional security and highlight the importance of affiliative parent interactions around the sleep period for optimal sleep for young adolescents.

Association between resilience promotion factors during childhood and risk of drug use disorder during adulthood.

Few studies have been conducted on the relationship between "outside-residing" resilience characteristics and the risk of developing drug use disorder later in life. These characteristics include responsive and caring parenting, household routines involving regular family meals and bedtime routines, social support from peers, participation in organized activities, and religious service attendance. We quantified the association between these resilience promotion factors during childhood and the risk of developing criteria for drug use disorder during adulthood using data from a retrospective cohort study of 618 adults born in Massachusetts during 1969-1983, including those with adverse childhood experiences (ACEs). Self-administered questionnaires gathered information on criteria for drug use disorder, ACEs, and family and community resilience promotion factors. Compared to individuals with "low" numbers of resilience promotion factors, 30% (95% CI: 0.5-0.9) and 50% reductions (95% CI: 0.4-0.8) in the risk of developing one or more criteria for drug use disorder were observed among those with "moderate" and "high" numbers of resilience factors, respectively (p value for trend=0.003). Overall, family factors were associated with greater risk reductions than comparable numbers of community factors. Among individuals with ACEs, a "high" number of family factors but not community factors were associated with a reduction in risk (RR:0.6, 95% CI:0.4-1.0 for family factors, RR:1.0, 95% CI:0.5-1.8 for community factors). These results suggest that the risk of developing criteria for drug use disorder decreases in a dose-response fashion according to the number of "outside-residing" resilience promotion factors during childhood, and that family factors are associated with greater risk reductions than community factors, particularly among individuals with ACEs. Coordinated prevention efforts at the family and community level are recommended to reduce the risk of this important societal problem.

0124 The influence of the family environment on children’s sleep during the school year and summer

Abstract Introduction More than a third of US children do not receive adequate sleep. Earlier bedtimes, consistent bedtime routines, and good sleep hygiene help to support more adequate sleep. Our previous work has shown that during summer, 5-8-year-old children go to bed later and obtain less sleep compared to the school year. We hypothesized that school year-summer differences in the family environment would explain differences in children’s sleep timing during these periods. Methods During the school year and summer, 119 parents of 5–8-year-olds completed measures of child temperament, sleep hygiene, parenting practices, and parent stress and social support. Child sleep was measured for 8 days using wrist actigraphs. Sleep onset and offset were determined using the Sadeh algorithm and sleep diaries to determine sleep midpoint. Paired samples t-tests examined school year-summer differences in family environment variables and stepwise linear regression analyses were used to examine the effect of the family environment on sleep midpoint, controlling for age, gender, chronotype, and sleep duration. Results Compared to the school year, during summer parents reported less parent-child conflict before bed (t(117)=3.913, p<.001), less consistent bedtime routines (t(117)=4.808, p<.001), and average daily screen use (t(117)=-2.756, p=.007) and greater child surgency or impulsivity (t(108)=-2.960, p=.004. Overall, our model explained 48% of the variance in children’s sleep timing during the school year (p=<.001) and 45% during the summer (p=<.001). In the final model, greater caffeine intake (β=2.1, p=.033), later chronotype (β=0.4, p=<.001) and greater effortful control or self-regulatory skills (β=0.2, p=.047) predicted having a later sleep midpoint during the school year. During the summer, less consistent bedtime routines and later chronotype (β=0.3, p=.002) predicted having a later sleep midpoint (β=-0.2, p=.022). Conclusion The relaxed nature of the summer family environment likely contributes to decreased conflict over bedtime, increased child media use, and decreased bedtime routine consistency. However, only decreases in bedtime routine consistency contributed to later bedtimes during summer. Worryingly, 5-8-year-olds appear to be using caffeine during the school year contributing to later sleep timing. Addressing summer bedtime routines and children’s school-year caffeine intake are important targets for intervention to improve children’s sleep. Support (if any) Texas Children's Pediatric Pilot Award