Bedtime Routines Research Articles

Time for bed! Earlier sleep onset is associated with longer nighttime sleep duration during infancy

Objective/backgroundClinical recommendations include putting infants to bed using a consistent bedtime routine at an appropriate hour to promote longer nighttime sleep. Actigraphy was used in this exploratory study to examine how bedtime routines and nighttime sleep onset were associated with nighttime total sleep time (TST) and efficiency from 6 to 24 weeks of age. Patients/methodsInfants (n = 24) wore sleep actigraphs for three, one-week periods at 6, 15, and 24 weeks of age. Nighttime TST, sleep efficiency, sleep onset and offset were quantified. Mothers reported on infant bedtime routines using the Brief Infant Sleep Questionnaire at each age. Multilevel models examined between- and within-person associations. ResultsAs infants aged, sleep onset was earlier, and bedtime routines became shorter (p's < 0.05). Infants fell asleep between 7 and 8:00PM on 24% of the nights. Most mothers (70%) reported that they often fed infants to sleep for the night. For every 1 h earlier in infants' usual sleep onset, nighttime TST was 34.4 min longer that night (p < 0.01). Infants with earlier than usual sleep onset had slightly earlier sleep offset the next morning (8.4 min for every 1 h earlier in onset; p = 0.02). Between-person analyses showed similar patterns. Infants with a more consistent bedtime routine and who were not typically fed to sleep at bedtime had longer nighttime TST at 6 weeks, with a trend or no association at later ages. ConclusionInfants who fell asleep earlier also slept longer at night. Keeping infants up later in hopes of them sleeping in longer may be counterproductive.

0964 Out Like a Light: Preliminary Results of Parent-Child Dyad Use of an Audio-Based Mobile Application Aiding Bedtime Routine and Sleep Health

Abstract Introduction Adequate sleep is essential for a child’s growth and development. However, a growing number of children are experiencing trouble falling asleep. Smartphone audio-based mobile applications with soothing melodies and calming nighttime stories may improve sleep onset. Our study examined the efficacy of Moshi Twilight, an app designed to improve sleep onset, among children ages 3-8 years old using a parent-child dyadic approach. Methods Our within-subjects pre-post study design focused on healthy children studied over 10 days, spanning 3 weeknights and 2 weekend nights. During the baseline (Days 1-5) and exposure (Days 6-10) conditions the Child Sleep Health Questionnaire was used to measure children’s sleep behavior. The PROMIS and Pittsburgh Sleep Quality Index were used to assess parents’ sleep quality. Parents exposed their child to 1 story per night (15-20 minutes) during the exposured condition. Statistical analysis was based on paired t-tests, independent t-tests, and correlations. Results On average, participating parents were 37 (SD +9.6) year-old mothers. The sample was: 60% Black; 20% White, 20% other race/ethnicity. On average, children were 4 (SD + 0.78) years old and 50% male. Paired t-tests showed significant differences in children’s sleep onset within 20 minutes (t=2.582, 95% CI 0.116, 2.634, p= 0.036). Significant correlations were noted for children’s bedtime consistency (r = -0.755, p = 0.030), falling asleep in own bed (r = 0.735, p=0.015) and sleep duration (r = -0.715, p=0.046,) Significant correlations and paired t-test in parents’ sleep onset were also found (r = 0.744, p = 0.014); (mean= -1.2, t= -3.674, 95% CI -1.939, -0.461, p=0.005) Conclusion Our results showed that the audio-based sleep app, Moshi Twilight, might be useful in improving sleep health among both children and parents. This could be included in enhance bedtime routine among preschool-aged children. Support Bezos Grant and Community Service Plan grant.

Self-Reported Rapid Eye Movement Sleep Behavior Disturbance and Its Associated Factors among Medicine and Health Science Students at the University of Gondar.

Introduction Rapid eye movement sleep behavior disorder (RBD) is characterized by dream-enacting behavior (shouting, punching, and falling out of bed) related to unpleasant dreams and loss of normal rapid eye movement (REM) sleep muscle atonia. Rapid eye movement sleep enhances learning and memory by regulating neuronal synapses, and if it is undesirable, it can lead to cognitive impairment and poor academic performance and may end up with death. To the best of our searching databases, there is no such study conducted in Ethiopia. Therefore, this study is aimed at determining self-reported symptoms of RBD and its associated factors among the University of Gondar medicine and health science students (2019). Methods We conducted a cross-sectional study from June 1 to July 2019, among medicine and health science students at the University of Gondar using a simple random sampling technique. A self-reported RBD screening questionnaire was used to collect the data. We used Epi Info™ 7.0.8.3 and Stata 14 for data entry and statistical analyses, respectively. Descriptive statistics (frequency with percent and mean with standard deviation) and adjusted odds ratio (AOR) with 95% uncertainty interval (UI) were computed. In a multivariable binary logistic regression, variables with a p < 0.05 were declared as significant. Results Three hundred and eighty-seven students took part in the study. The mean age of participants was 20.81 (±1.83) years. The prevalence of self-reported RBD was 46.25% [95% UI (41.26%-51.24)]. Physical exercise immediately before sleep (AOR = 2.50, 95% UI (1.24-5.02)), using Facebook immediately before sleep (AOR = 1.93, 95% UI (1.18-3.15)), having daytime sleepiness (AOR = 1.92, 95% UI (1.16-3.19)), and self-reported depressive symptoms (AOR = 2.40, 95% UI (1.45-3.99)) were significantly associated with self-reported RBD. Conclusion The current study revealed a high prevalence of self-reported RBD. This remarkable problem suggested a need to design strategies to prevent RBD symptoms among university students through targeting screening of depression, daytime sleepiness, and adjusting bedtime routines such as physical exercise and internet use immediately before going to bed.

P092: Caregiver perspectives on children's functional outcomes following fracture: a qualitative study

Introduction: Fractures are a common childhood presentation to the emergency department (ED). While ED providers are aware of treating pain, we are less aware of the functional impact of these fractures. Eighty percent of children with a fracture experience compromise in their daily function. Understanding the functional outcomes of fractures will help optimize discharge instructions for at-home care. The primary objective of our study was to describe caregivers' perspectives on the impact of their child's fracture on: (1) child functioning, (2) caregiver functioning and (3) family life. Methods: We performed a qualitative study interviewing caregivers of children (5 to 11 years) who received care for acute (&lt; 24 hours old), non-operative long bone fractures at a Canadian tertiary care pediatric ED. Audio-recorded, semi-structured telephone interviews were completed 1-2 weeks post-ED visit, until thematic saturation was achieved. Transcripts were read and coded by two researchers concurrent with data collection. We applied content analysis to the interview material, explicating themes to summarize the data utilizing NVivo software. Results: Twenty-five interviews were completed. Most children (23/25) suffered upper extremity fractures and most participants were mothers (21/25). All caregivers reported a change in their child's function. The most commonly affected areas included: sleep, play and activities of daily living (ADL's; ie. dressing, bathing, eating). Children were impacted by pain and related negative emotional responses. All children required additional help from their caregivers to carry out ADL's. Strategies included changing household routines and missing work. Importantly, caregivers described a disrupted family dynamic. Adapting to their injured child's functional deficits and caring for pain and distress took time and attention away from the household's previously well-functioning routine. This burden was felt by all family members. Key concerns from caregivers included pain management, fracture healing/complications, and regression of their child's independence. Conclusion: Function is universally impaired in younger children with fractures. We suggest 5 main points to include in discharge instructions: (1) monitoring pain and providing analgesia, (2) helping children with ADL's, even if previously independent, (3) allotting extra time for morning and bedtime routines, (4) offering safe choices for play and (5) coaching children in positive thinking and problem-solving.

Perspectives on Sleep from Multiethnic Community Parents, Pediatric Providers, and Childcare Providers.

To describe the perceptions of (1) parents, childcare, and health care providers regarding sleep health among multiethnic infants and toddlers living with socioeconomic adversity, (2) factors that contribute to sleep health and its consequences, and (3) best ways to promote sleep health in these children. Nested within a larger community-engaged mixed methods study, we used a descriptive qualitative design to describe the experience of multiethnic young parents who were raising 6- to 36-month-old children, pediatric health care providers, and childcare providers living and working in an urban under-resourced community. Semistructured interviews with 25 parents and 16 providers were conducted, transcribed, coded, and analyzed using thematic analysis by a 6-member research team. Interviews continued until themes were saturated. Parent responses and provider responses resulted in overlapping and divergent findings. Common themes among all respondents were the importance of sleep, interest and desire for more sleep health information, and common environmental/social impediments to healthy family sleep. Divergent themes included the importance of bedtime routines and timing, views on the family bed, importance of naps, and healthy sleep aids. Childcare centers were suggested as good sites for sleep health promotion programs. Sleep is a topic of interest and importance for young families. There are unique family challenges to be considered in any sleep health promotion program tailored to the needs of the community. The voices of parents and community providers are valuable assets informing the development of novel family-friendly approaches for decreasing sleep disparities and improving the health of young children and families.

Parent survey of sleep problems among children with CHARGE syndrome

Sleep problems are common among children, especially those with developmental disabilities, visual impairments, and behavioral problems. Past research has indicated a particularly high prevalence of clinically-relevant sleep problems for children with CHARGE syndrome, who often possess all three of these qualities. To gather additional information regarding the nature of these sleep problems and how they are most commonly treated amongst parents, an explorative survey was conducted with 30 parents of children with CHARGE syndrome with comorbid sleep problems using the Sleep Disturbance Scale for Children, as well as demographic and sleep questionnaires developed for use in this study.Our findings indicated that problems of sleep initiation and maintenance were most commonly reported, consistent with previous research. Parents most often reported the following factors suspected of contributing to sleep problems: self-regulation difficulties, teeth grinding, hormonal imbalance, problem behaviors, and anxiety. The most commonly administered treatments were reported to be the use of positive bedtime routines, melatonin treatment, the use of a weighted blanket, and prescription medications, respectively. While parents reported overall that they felt all three of these intervention strategies were slightly effective at improving their child’s sleep problem, the use of positive bedtime routines and melatonin treatment were perceived as more effective by parents. These results aid professionals in the selection of future research and intervention strategies to recommend for parents of children with CHARGE syndrome.

Predictive Factors of Toddlers' Sleep and Parental Stress.

Background: Although most infants consolidate their sleep habits during the first year of life, for many children, sleep is described as disrupted during toddlerhood. Along with individual child variables such as temperamental characteristics, parenting behaviors play a key role in determining children’s sleep–wake patterns. The aims of the current study were to evaluate the relationship among toddlers’ sleep quality, emotion regulation, bedtime routines, parental bedtime involvement, parental perceived social support and stress, and to integrate a novel combination of the aforementioned dimensions into predictive models of toddlers’ sleep quality and parental stress. Methods: One hundred and sixty parents with 2–3-year-old children filled out the following self-report questionnaires: the Parent–Child Sleep Interaction Scale; the Emotion Regulation Checklist; the Social Provisions Scale; and an ad-hoc questionnaire to assess parental involvement in everyday and bedtime care for children. Three multiple regression analyses were conducted by regressing maternal and paternal parenting stress and infant’s quality sleep onto the independent variables described above. Results: Toddlers’ emotion regulation and parental psychosocial functioning were related to parental stress. Toddlers’ night awakenings and the time required by toddlers to fall asleep were related to parental distress. Conclusions: The findings evidenced the bidirectional associations among the studied variables, highlighting the protective role of social support in reducing parenting stress and of paternal bedtime involvement in improving toddlers’ sleep quality.

Behavioral insomnia in a pediatric sleep clinic: retrospective study

Background/Objective: Behavioral insomnia is a common sleep disorder among children, with potentially negative impact on health, behavior, and cognition. This study aimed to characterize a pediatric population referred to a Sleep Disorder Clinic of a tertiary hospital due to behavioral insomnia. Methods: Retrospective and descriptive study based on the review of medical records of patients with insomnia over an eight-year period (2008−2016). Results are presented as median (minimum-maximum), mean (standard deviation), and percentage. Results: A total of 964 children attended the Sleep Disorder Clinic in the considered time period, 162 (16.8%) of which due to insomnia and 137 (14.2%) to behavioral insomnia. Most children (58.4%) were male and the median age at referral was 45 months (5 months–18 years). The median bedtime was 10 pm (8 pm−4 am) and nocturnal awakenings were frequent, particularly in pre-school aged children. Regarding bedtime routines, 62% of children were not able to fall asleep alone, 48.9% had television in the bedroom, 43.1% (11.9% of which, teenagers) required an object to fall asleep, and 42.3% required lights on. Most patients (62%) had a routine to fall asleep, which was dependent on the caregiver in younger children and on television and reading in teenagers. The most frequent daytime symptoms were sleepiness in older children and irritability in younger children. Regarding treatment, 29.9% were taking drugs before referral. Conclusions: Most children in this study were preschoolers, an important age window. Later sleep time, TV in the bedroom, and parental dependence to fall asleep were frequent, revealing a broad area for intervention. The authors propose greater investment in training health professionals and caregivers working in the area, in order to promote the adoption of adequate sleep hygiene as a form of prevention.

A cross-sectional study of obesogenic behaviours and family rules according to family structure in European children

BackgroundThere has been an increase in children growing up in non-traditional families, such as single-parent and blended families. Children from such families have a higher prevalence of obesity and poorer health outcomes, but research on the relationship with obesogenic behaviours is limited.ObjectivesTherefore, the aim of this study was to investigate whether there are associations between family structures and obesogenic behaviours and related family rules in European children and adolescents.MethodsThe sample included 7664 children (mean age ± SD: 10.9 ± 2.9) from 4923 families who were participants of the multi-centre I.Family study (2013/2014) conducted in 8 European countries. Family structure was assessed by a detailed interview on kinship and household. Obesogenic behaviours (screen time, sleep duration, consumption of sugar-sweetened beverages (SSBs)) and family rules (rules for computer and television, bedtime routine, availability of SSBs during meals) were determined by standardized questionnaires. Multilevel mixed-effects linear and logistic regression models were used to model the associations of family structure with obesogenic behaviours and family rules. Sex, age, parental education level, number of children and adults in the household and BMI z-score were covariates in the models. Two-parent biological families were set as the reference category.ResultsChildren from single-parent families were less likely to have family rules regarding screen time (OR: 0.62, 95% CI: 0.40–0.94, p = 0.026) with higher reported hours of screen time per week (β = 2.70 h/week, 95% CI: 1.39–4.00, p < 0.001). The frequency of weekly SSB consumption differed by family structure in a sex-specific manner: girls from single-parent (β = 3.19 frequency/week, 95% CI: 0.91–5.47, p = 0.006) and boys from blended/adoptive families (β = 3.01 frequency/week, 95% CI: 0.99–5.03, p = 0.004) consumed more SSBs. Sleep duration, bedtime routines and availability of SSBs during meals did not differ between children from these family structures. Parental education did not modify any of these associations.ConclusionsParents in non-traditional family structures appear to experience more difficulties in restricting screen time and the intake of SSBs in their children than parents in traditional two-parent family structures. Our findings therefore suggest that additional support and effective strategies for parents in non-traditional families may help to reduce obesogenic behaviours in children from such family types.

Bedtime Routines Intervention for Children (BRIC) using an automated text messaging system for behaviour change: study protocol for an early phase study

BackgroundThis work concerns the activities in the last hour before bed for young children born to first-time parents, so called bedtime routines (BTR). These activities include amongst others tooth brushing, reading a book, having a bath and avoiding food and drinks before bed. Having a set bedtime at a suitable hour is also very important. Establishing good bedtime routines has been shown to be really important for a number of health, wellbeing, development and social outcomes. Currently, there is no evidence-based bedtime routine intervention for first-time parents using a novel design (i.e. text messages). Existing research has highlighted the importance of bedtime routines and the lack of appropriate mechanisms in place for parents who sought support.MethodsThe proposed study includes 2 work packages. Work package 1 focuses on the development of the intervention through a combination of qualitative work (1:1 interviews with parents on barriers and facilitators on bedtime routines using the Theoretical Domains Framework) and an expert group of key stakeholders. Work package 2 involves a small-scale (n = 50) feasibility and effectiveness study to examine proof of concept with first-time parents using text messages to communicate the intervention. Quantitative information relating to uptake, engagement, retention and effectiveness of the intervention as well as qualitative information (focus groups with parents who took part in the study) will be collected. Overall, the effectiveness of the intervention will be assessed through the APEASE criteria (acceptability, practicability, effectiveness, affordability, safety, equity).DiscussionThis study can provide initial yet important support for further exploration in the field of bedtime routines in more complicated family structures (parents with more than 1 child, separated families etc.). Also, the implementation of a novel study design (i.e. text messages) could lead to considerable cost savings while maintaining high retention, uptake and engagement from the participants. Should the intervention meet the APEASE criteria, a more comprehensive intervention on bedtime routines for first-time parents will be explored in a more robust (RCT and longitudinal) approach.Trials registrationDue to the nature of the study, no trial registration is currently in place.

Development and Validation of the Pediatric Sleep Practices Questionnaire: A Self-Report Measure for Youth Ages 8–17 Years

ABSTRACT Objective: To develop and evaluate the validity of a self-report measure of sleep practices for youth 8–17 years. Methods: Following recommended guidelines for the development of patient reported outcomes (PROs), sleep practice concepts were identified through expert (n = 8) and child (n = 28) concept elicitation interviews and a systematic literature review. Items were developed based on these concepts and tested in cognitive interviews with children (n = 32). Psychometric analyses were applied to item response data collected from a diverse sample of youth 8–17 years (n = 307). Construct validity was evaluated through tests of associations between sleep practices and sleep disturbance and sleep-related impairment. Finally, clinical validity of the tool was assessed by comparing scores of youth with and without a parent-identified sleep problem. Results: The final Pediatric Sleep Practices Questionnaire (PSPQ) included 15 items that were used to identify 5 sleep practices: sleep timing, sleep routines and consistency, technology use before bedtime, sleep environment, and the need for parental presence to fall asleep. A confirmatory factor analysis supported the hypothesized structure (all factor loadings ≥ 0.72) and PSPQ indices were significantly associated with self-reported sleep disturbances and sleep-related impairment. Finally, children with parent-reported sleep problems had shorter sleep opportunity, later bedtimes, greater need for parental presence, poorer bedtime routines, and more technology use than children without parent-reported sleep problems. Conclusions: The PSPQ was developed using best-practice PRO development methodology. The PSPQ can be used in clinical settings and for research assessment to capture modifiable sleep practices that may promote or interfere with healthy sleep.

Parents' perspectives on participation of young children with attention deficit hyperactivity disorder, developmental coordination disorder, and/ or autism spectrum disorder: A systematic scoping review.

During the early years of a child's life, participation is essential for learning and development. Children with disabilities are at risk for decreased participation. The interplay between environment and participation is identified as one of the most important factors influencing successful participation. The objective of this scoping review was to synthesize peer-reviewed literature about barriers and facilitators of participation according to the perspective of parents of children younger than 6 years with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/ or Developmental Coordination Disorder (DCD). The scoping review followed Arksey and O'Malley's framework. Relevant studies were identified by a comprehensive search of scientific databases (PubMed and Web of Science). Studies describing perspectives of parents regarding their child's participation, written in English, and published between 2001 and September 2017 were included. A total of 854 articles were retrieved, with 13 meeting the criteria. Elements contributing to perceived barriers and facilitators were identified and organized according to the International Classification of Functioning, Child-Youth framework. Concepts contained in these studies were linked to "activities and participation" (general tasks and demands, such as bedtime and dinner routines, and social, civic life, such as play and leisure). Environment-focused factors identified were situated on "support and relationships, " "attitudes, " and "services, systems, and policies." The review revealed guidelines focusing on family-centred care, communication with, and providing information to parents with young children with developmental disabilities (ADHD, DCD, and/ or ASD).

Current approaches to the diagnosis and treatment of behavioral insomnia in children

Behavioral insomnia is the most common sleep disorder in young children. It significantly reduces the quality of parent's life and is one of the common complaints to a pediatrician or neurologist. The basis treatment of childhood insomnia is behavioral therapy, which includes sleep hygiene, age-appropriate daily routine and sleep associations, stable bedtime routines, positive reinforcement, bedtime fading, scheduled awakenings. Although a systematic ignoring («crying it out») is effective and widely used in behavioral therapy, it has low compliance and its safety is insufficiently studied. Therefore, a systematic ignoring is not a priority method of behavioral therapy and should not be used in children under 6 months of age. Behavioral therapy of childhood insomnia is complemented by psychological and informational support from parents, and in some cases, drug therapy. Prevention includes education of expectant parents on baby sleep hygiene.

Screen-use, active-play and sleep behaviours in a nationally representative sample of infants, toddlers and pre-school children from the U.S.

AbstractIntroductionInadequate sleep, excessive screen-use and low-levels of physical activity may lead to an increased risk of childhood obesity. Caregivers during early childhood should limit screen-time, encourage active play and establish bedtime routines to ensure adequate sleep. The benefits of such may also extend to improved attention, learning, memory, psycho-social development and other factors. There is limited data on such lifestyle behaviours in infants and children in the U.S. Therefore, this analysis describes findings from the Feeding Infants and Toddlers Study (FITS) 2016.MethodsFITS 2016 is a national, cross-sectional survey of caregivers of children aged 0–3.9 y in the U.S. Demographic data and information on feeding practices, sleep, physical activity and screen-use were collected using a questionnaire (n = 4380). Differences in behaviours across age groups were assessed using a one-way ANOVA or chi-squared tests.ResultsChildren older than 12 months slept for an average of 9.6 (sd = 2.0) hours per night, which was significantly higher than infants (0–11.9mo) who slept for 8.9 (sd = 2.1) hours per night (P &lt; 0.001). All children slept for approximately one hour during the day. There were no significant difference in the weekly hours spent in active play (mean = 20.8,sd = 16.5) between younger and older children, while participation in sports was higher among older versus younger children. However, time spent playing video games, watching TV videos/DVDs and using a screen was significantly higher in older versus younger children (P &lt; 0.001). For example, infants spent 7.8 hours per week watching TV, compared to 9.4 hours in 3 year old children (P &lt; 0.001). Approximately 65% of caregivers reported that they did not allow electronics in the bedroom, however this decreased with increasing age (P = 0.036). Consequently, 5% of infants (0–11.9mo) viewed a tablet or smartphone in their bedroom, compared to 26% of 3 year old children (P &lt; 0.001).DiscussionRecent guidelines from the American Academy for Pediatrics (AAP) recommend that children younger than 18 months avoid use of screen media, and that children aged 2–5 should limit screen-time to one hour per day. This data from the US FITS suggests that children are exceeding these recommendations. However, the current population are meeting the AAP physical activity recommendation of minimum 60 minutes/day. Furthermore, infants and children in this population are also failing to meet the AAP sleep recommendations. Therefore, further emphasis needs to be placed on the importance of limiting screen-time and promoting physical activity and positive sleep behaviours in this young population.

Sleep Quality, Emotion Regulation and Parenting Stress in Children with Congenital Heart Disease

The aim of this study is to evaluate parental perceptions of parent-infant bedtime interactions and quality of sleep, after hospital discharge, in a group of children diagnosed at birth with congenital heart disease (CHD), as compared with the perceptions of parents in a control group of children who were healthy at birth. More specifically, we evaluated the associations between parental stress, parental perceptions of infant emotion regulation, and infants’ bedtime and sleep routines in each of the two groups. Fifty Italian intact two-parent families (23 boys) of toddlers ageing from 11 to 36 months (M= 23.42, SD=7.10) were recruited. 20 families of CHD children group were recruited from the Department of Cardiology at the Bambino Gesu Children’s Hospital in Rome, Italy; 30 families of the healthy children group were recruited from two childcare units. Parents completed Emotion Regulation Checklist (Shields & Cicchetti, 1997), Parent-Child Sleep Interaction Scale (PSIS; Alfano et al., 2013), Parent-Stress Index-Short Form (PSI-SF; Abidin, 1990) and ad-hoc semi-structured interview on child’s sleep quality. The independent-samples t-test evidenced that parents of healthy children reported significantly higher scores on children's emotion regulation compared with the CHD group Specifically CHD children and healthy children's emotion regulation reported both by mothers (respectively CHD children’s mothers: M= 26.11, SD= 2.9; healthy children’s mothers: M= 28.85, SD= 2.71; t(37) = 3.10, p= .004) and fathers (respectively CHD children’s fathers: M=25.76, SD= 2.79; healthy children’s fathers: M= 27.37, SD= 2.02; t(31)= 2.71, p= .010). Main correlational findings showed in the CHD children’s group that parenting stress total scores were positive related to difficult parent-infant bedtime interactions both for mothers ( r =.58, p < .01) and fathers ( r = .70, p < .01). Results show significant differences in emotion regulation between the two groups. The results of this research will show to the clinicians the aspects of parent-infant bedtime interactions to be addressed in parents of children with CHD.

Parental Mental Health, Fathers\u2019 Involvement and Bedtime Resistance in Infants

BackgroundAround the age of 6 months, difficulties in settling to sleep and frequent night awakenings are generally occurring in 20 to 30% of infants. According to the transactional model parental factors can play a significant role in influencing infant sleep development. The purpose of the current study was to explore the combined effect of infants’ factors (temperament and sleep onset problems), and parental factors (parental mental health in terms of post-partum affective disorders, consistent bedtime routines and fathers’ involvement at bedtime), on infant bedtime difficulties (e.g. fussing, crying or protesting), including both maternal and paternal perspectives.MethodsSixty Italian intact two-parent families of infants (34 boys and 26 girls) ageing from 8 to 12 months (M = 10.73, SD = 2.54) were enrolled in the study. The parents filled out self-report questionnaires to measure the aforementioned variables. To investigate which infant and parental factors predicted infants’ bedtime difficulties, two multiple linear regressions (MR), one for fathers and one for mothers, and relative weight analyses (RWA) were conducted.ResultsWith regard to infants’ bedtime difficulties reported by fathers (R2 = .35) they were explained by infant involvement in constant bedtime routines (β = −.35, p = .030) and paternal involvement at bedtime (β = −.45, p = .007). Instead infants’ bedtime difficulties reported by mothers (R2 = .32) were explained by minutes the child taken to fall asleep (β = .24, p = .04), infant involvement in constant bedtime routines (β = −.31, p = .01) and bedtime paternal involvement (β = −.27, p = .05).ConclusionsThe main results of this study emphasized the protective role of consistent bedtime routines and bedtime paternal involvement in reducing infants’ bedtime difficulties perceived both from mothers and fathers. Future research could help to raise awareness and improve understanding of the familial influences on children’s sleep, providing recommendations for educating families, school professionals, healthcare providers, and the general public on risk and protective factors that could play a meaningful role in infants and children’s developing sleep patterns.

Organized Chaos: Daily Routines Link Household Chaos and Child Behavior Problems

The aim of this study was to examine daily routines as a potential mediator of the relation between household chaos and both child externalizing behavior and bedtime resistant behavior. Studies show that children living in chaotic households exhibit more externalizing behaviors, which when exhibited as early as the toddler and preschool years, are a risk factor for later maladjustment. Understanding the mechanisms linking household chaos to early externalizing behaviors is important since those mechanisms could be targeted as a point of intervention. Using Amazon’s Mechanical Turk (Mturk), parents (n = 120) of a child age 2–5 completed questionnaires online assessing household chaos, frequency of routines, and child behavior problems. There was a significant indirect effect of household chaos to child behavior problems through family routines (B = 0.09, SE = 0.05, CI [0.01, 0.23]) and general child routines (B = 0.15, SE = 0.06, CI [0.05, 0.31]) (independently) and an indirect effect of household chaos to bedtime resistant behavior through children’s bedtime routines (B = 0.12, SE = 0.06, CI [0.03, 0.26]). These findings suggest that household chaos and routines are distinctive constructs and that routines are a mechanism linking household chaos to early child behavior problems. Clinically, these results imply that routines may be a reasonable focus for intervention among families living in chaotic households who have young children exhibiting behavior problems.

The Relative Importance of Sleep Duration and Bedtime Routines for the Social-Emotional Functioning of Chinese Children.

Although the importance of sleep has been widely supported by empirical research, researchers have only recently linked sleep to children's social-emotional development. This study aimed to investigate 2 aspects of sleep-namely, sleep duration and bedtime routines-in relation to the social skills and problem behavior in a group of Chinese school-aged children. This study involved 228 Chinese children (mean age = 8.32 years). Parents reported their child's sleep duration, the consistency of bedtime routines, and social-emotional functioning. Both sleep duration and the consistency of bedtime routines had unique contributions to children's social-emotional functioning. Sex differences were found regarding the sleep-child adjustment link. Sleep duration was negatively associated with child problem behavior for both boys and girls. However, the relationship between bedtime routines and social skills was more pronounced for boys, while the relation between sleep duration and social skills was more evident for girls. Our findings highlight the importance of consistent bedtime routines and adequate sleep for the social-emotional development of Chinese school-aged children.

Shared Reading Practices and Early Literacy Promotion in the First Year of Life.

To describe infant home reading trajectories and environments in the first year and to assess whether receiving books starting in the newborn period, compared with starting at 6 months, alters these trajectories. Two study groups were enrolled in a quasi-experimental sequential cohort study; both groups received shared reading counseling starting in the newborn period and completed surveys throughout the first year. The Standard group received books starting at 6 months, whereas the Early Books group received books starting at 2 weeks. Reading trajectories were assessed both overall and between the study groups. At the 2-week visit, less than half of families in each group had started shared reading with their infant, which rose to >97% by 12 months. Approximately two-thirds of families owned >10 children's books at 2 weeks, which increased to >80% at 12 months. Incorporating shared reading into bedtime routines also increased during the first year. Early versus standard book distribution did not alter these trajectories. Over the first year of life, families almost universally initiated shared reading and increased the number of books in the home. Reading habits established during this time were maintained in both groups. Literacy promotion beginning at the earliest well-child visits may help establish routines that will persist throughout childhood.

Toddler Bedtime Routines and Associations With Nighttime Sleep Duration and Maternal and Household Factors

The aims of this study were to examine (1) relationships among implementing a bedtime routine, nighttime awakenings, and nighttime sleep duration in toddlers from low-income, minority families and (2) differences in maternal and household characteristics between mothers who did versus those who did not implement a nightly bedtime routine for their toddler. Data were collected from mothers of toddlers on maternal and household characteristics and toddler sleep, measured using the Children's HealthWatch Survey and the Extended Brief Infant Sleep Questionnaire (BISQ). A path analysis model was tested to investigate whether nighttime awakenings mediated the relation between implementing a bedtime routine and toddlers' nighttime sleep duration. Chi-square tests were conducted to examine differences in maternal and household characteristics (ie, maternal depressive symptoms, food, housing and energy insecurity) between mothers who did versus those who did not implement nightly bedtime routines over the past 2 weeks. Implementing a bedtime routine was associated with longer toddler sleep duration through a decrease in nighttime awakenings (β = 5.04, 95% confidence interval = 0.61 to 11.35). More consistent sleep routine implementation was associated with fewer nighttime awakenings and longer sleep duration. Maternal depressive symptoms, housing insecurity, and food insecurity were associated with decreased likelihood of implementing a nightly bedtime routine. Maternal depressive symptoms, food insecurity, and household insecurity (factors associated with low socioeconomic status) may be associated with a negative sleep environment and poor toddler sleep quality, potentially because of decreased implementation of bedtime routines. A commentary on this article appears in this issue on page 821.