Bedtime Routines Research Articles

Meeting families where they sleep: a collaborative approach to improving sleep health for urban children.

Meeting families where they sleep: a collaborative approach to improving sleep health for urban children.

Rest and Readiness

Rest and Readiness

The Efficacy of Massage as a Nightly Bedtime Routine on Infant Sleep Condition and Mother Sleep Quality:: A Randomized Controlled Trial

The Efficacy of Massage as a Nightly Bedtime Routine on Infant Sleep Condition and Mother Sleep Quality:: A Randomized Controlled Trial

Sleep and parenting in ethnically diverse Pacific families in southern New Zealand: A qualitative exploration

ObjectivesChildren's sleep has been shown to vary by ethnicity, but little is known about children's sleep in multiethnic households. In New Zealand, Pacific families are increasingly ethnically diverse, due to intermarriage and to people identifying as more than 1 ethnicity. Thus, the objective of this work was to explore children's sleep habits, and sleep-related parenting practices, in ethnically diverse Pacific families (EDPF). DesignTen qualitative interviews with adult members of EDPF were undertaken. Open-ended questioning was used. SettingInformal, conversational interviews conducted in homes and workplaces in southern New Zealand. ParticipantsFifteen adults from 10 EDPF. MeasurementsInterviews were recorded and transcribed. Thematic open coding was used to analyze transcripts and identify themes. ResultsSleep practices such as bedtime routines and preferred sleep environments varied both within and between EDPF. The EDPF in this sample responded to the context in which they lived, and the demands of everyday life in New Zealand, when managing children's sleep. Respectful communication between parents was key to navigating cultural differences and resolving areas of tension. The families in this study aspired to instill strong multi-cultural knowledge and identities in their children. Some families had sought out resources to help with this, but they were often either difficult to find, or expensive. ConclusionsA variety of sleep habits and related parenting practices were observed in this small sample of EDPF, who recognized that raising children in multi-ethnic families was associated with distinct opportunities as well as challenges.

Audiobook routines: identifying everyday reading by listening practices amongst young adults

PurposeThis article explores, identifies and conceptualises everyday audiobook reading practices amongst young adults.Design/methodology/approachSemi-structured interviews were conducted with ten Swedish audiobook users aged 18–19. The material was analysed using qualitative content analysis and focused on their audiobook use during an average weekday, as this was the time that they listened the most. The theoretical framework consists of theories on practice, time and everyday routine.FindingsFive timespaces emerged when audiobook practices were most prevalent: morning routines, commuting routines, school routines, after school routines and bedtime routines. Within these timespaces, several practices could be identified and conceptualised. Three mobile practices were commute listening, exercise listening and chore listening while more stationary practices were homework listening, schoolwork listening and leisure listening. An unexpected finding was how audiobooks routinely were used to aid respondents’ wellbeing. This wellbeing listening was used to alleviate stress, loneliness and help listeners relax or fall asleep. Furthermore, respondents switch between Music, Audiobooks and Podcasts, which is conceptualised as MAP-switching.Originality/valueThere is a scarcity of research on audiobook use, and this paper contributes with new knowledge on audiobook reading practices, how audiobooks fit into everyday routine and provides concepts to aid further research on audiobook practices.

Impact of insufficient sleep on dysregulated blood glucose control under standardised meal conditions

Aims/hypothesisSleep, diet and exercise are fundamental to metabolic homeostasis. In this secondary analysis of a repeated measures, nutritional intervention study, we tested whether an individual’s sleep quality, duration and timing impact glycaemic response to a breakfast meal the following morning.MethodsHealthy adults’ data (N = 953 [41% twins]) were analysed from the PREDICT dietary intervention trial. Participants consumed isoenergetic standardised meals over 2 weeks in the clinic and at home. Actigraphy was used to assess sleep variables (duration, efficiency, timing) and continuous glucose monitors were used to measure glycaemic variation (>8000 meals).ResultsSleep variables were significantly associated with postprandial glycaemic control (2 h incremental AUC), at both between- and within-person levels. Sleep period time interacted with meal type, with a smaller effect of poor sleep on postprandial blood glucose levels when high-carbohydrate (low fat/protein) (pinteraction = 0.02) and high-fat (pinteraction = 0.03) breakfasts were consumed compared with a reference 75 g OGTT. Within-person sleep period time had a similar interaction (high carbohydrate: pinteraction = 0.001, high fat: pinteraction = 0.02). Within- and between-person sleep efficiency were significantly associated with lower postprandial blood glucose levels irrespective of meal type (both p < 0.03). Later sleep midpoint (time deviation from midnight) was found to be significantly associated with higher postprandial glucose, in both between-person and within-person comparisons (p = 0.035 and p = 0.051, respectively).Conclusions/interpretationPoor sleep efficiency and later bedtime routines are associated with more pronounced postprandial glycaemic responses to breakfast the following morning. A person’s deviation from their usual sleep pattern was also associated with poorer postprandial glycaemic control. These findings underscore sleep as a modifiable, non-pharmacological therapeutic target for the optimal regulation of human metabolic health.Trial registrationClinicalTrials.gov NCT03479866.Graphical abstract

Bedtime Routines of Young Children, Parenting Stress, and Bedtime Resistance: Mediation Models.

This study examined if inconsistent bedtime routines are a mechanism through which high levels of parenting stress are related to bedtime resistant behaviors. Bedtime resistant behavior is a common problem in young children. Although previous studies have linked parenting stress to problematic behaviors at bedtime, understanding how and why that may be has been subject to limited empirical investigation. Caregivers (N = 118) of a child age 2-5 were recruited on Amazon's mechanical turk. There was a significant indirect effect of parenting stress on bedtime resistance through bedtime routines as well as a significant indirect effect of bedtime routines on bedtime resistant behavior through parenting stress. These findings suggest that there is a bidirectional relationship between inconsistent routines and parenting stress. Clinically, these results suggest that implementing a consistent routine at bedtime may improve both parent (less stress) and child (less bedtime resistance) functioning.

Factors associated with consistent bedtime routines and good sleep outcomes

ABSTRACT Bedtime routines have “strong” support for addressing bedtime behavior problems and sleep; however, little research has examined factors associated with bedtime routines and sleep quality. Parents of 155 children ages 3 to 5 were surveyed about their children’s bedtime routines, bedtime anxiety, compliance, and sleep quality. Regression models supported a simple indirect effect of bedtime routine consistency on sleep quality through bedtime anxiety, but not through compliance at bedtime. In a serial model, consistent bedtime routines were related to sleep quality through first bedtime anxiety and then compliance near bedtime. Clinically, results suggest that if parents can alleviate child anxiety around bedtime through routines, compliance around bedtime, and a good night sleep may follow.

Bedtime Routine Characteristics and Activities in Families with Young Children in the North of England.

Bedtime routines have been shown to have significant associations with health, wellbeing and development outcomes for children and parents. Despite the importance of bedtime routines, most research has been carried out in the United States, with little information on bedtime routine characteristics and activities for families in other countries such as the United Kingdom and England in particular. Additionally, little is known about the possible effects of weekends vs. weekdays on the quality of bedtime routines. Finally, traditional, retrospective approaches have been most used in capturing data on bedtime routines, limiting our understanding of a dynamic and complex behaviour. The aim of this study was to explore bedtime routine characteristics and activities in families in the North of England with a real-time, dynamic data collection approach and to examine possible effects of weekend nights on the quality of bedtime routines. In total, 185 parents with children ages 3 to 7 years old provided data around their bedtime routine activities using an automated text-survey assessment over a 7-night period. Information on socio-economic and demographic characteristics were also gathered during recruitment. A small majority of parents managed to achieve all crucial elements of an optimal bedtime routine every night, with 53% reporting brushing their children’s teeth every night, 25% reading to their children every night and 30% consistently putting their children to bed at the same time each night. Results showed significant differences between weekend (especially Saturday) and weekday routines (F(1, 100) = 97.584, p < 0.001), with an additional effect for parental employment (F(1, 175) = 7.151, p < 0.05). Results highlight variability in bedtime routine activities and characteristics between families. Many families undertook, in a consistent manner, activities that are closely aligned with good practices and recommendations on what constitutes an optimal bedtime routine, while others struggled. Routines remained relatively stable during weekdays but showed signs of change over the weekend. Additional studies on mechanisms and elements affecting the formation, development and maintenance of bedtime routines are needed alongside studies on supporting and assisting families to achieve optimal routines.

Parenting Practices, Bedtime Routines, and Consistency: Associations with Pediatric Sleep Problems.

Investigate the direct and moderating effects of daytime parenting practices on the relationship between bedtime routines and pediatric sleep problems. A community sample of 407 parents with children 2-10 years old completed measures of parenting practices (i.e., laxness and over-reactivity) and bedtime routines (i.e., consistency and reactivity to changes in routines). Sleep problems (i.e., severity and signaled night waking) were assessed by a parent-report questionnaire and sleep diaries. Higher parenting laxness (β = .13) and less bedtime routine consistency (β = -.34) significantly predicted sleep problem severity. Laxness moderated the relationship between bedtime reactivity and sleep problem severity: when bedtime reactivity was high, higher parental laxness was associated with more severe sleep problems. Daytime parenting practices are important to consider when children are reactive to changes in bedtime routines, as permissive or inconsistent daytime parenting practices were found to be associated with more severe sleep problems. Future research should examine the effects of parenting practices and bedtime routines on problematic signaled night waking in a clinical sample of children.

Secondhand smoke exposure is longitudinally associated with shorter parent-reported sleep duration during childhood

BackgroundSecondhand smoke exposure has been cross-sectionally associated with worse sleep health outcomes in children and shorter sleep duration in adolescents. ObjectivesWe assessed longitudinal and cross-sectional associations between secondhand smoke (SHS) exposure and shorter sleep duration in children from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort. We additionally examined whether associations would persist after controlling for potential confounders. ParticipantsMothers (n = 4898) were recruited using a stratified random sample of large United States cities and oversampling for nonmarital births. MeasurementsMothers were asked about whether they smoked during pregnancy, whether their child spent time with someone who is smoking, and their child's weekday sleep duration. Sociodemographic factors, asthma diagnosis, and bedtime routines were assessed as potential confounders. Data collected at ages 3, 5, and 9 years were analyzed using multivariable regression models (N = 1912; 51.6% boys). ResultsSHS exposure at age 3 predicted 15.0 fewer minutes at age 5 (P = .001) and 12.3 fewer minutes at age 9 (P = .003). SHS exposure at age 9 was cross-sectionally associated with 14.4 fewer minutes of sleep duration at age 9 (P = .002). Findings persisted after controlling for potential confounders. ConclusionThese results provide associational support for the hypothesis that SHS exposure may have long-term consequences for childhood sleep duration. Future studies should investigate the relationship between SHS exposure and shorter sleep duration using objective measurements of serum cotinine and sleep actigraphy and by exploring potential mechanisms.

Bedtime routines and objectively assessed sleep in infants.

To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability. This was a prospective observational study conducted between November 2012 and November 2016. Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b=-23.55, p<0.01). Infants with a bedtime routine of <3-4 nights per week were associated with more variable night-time sleep duration than a bedtime routine of 5-6 nights per week (b=-7.81, p<0.05) or every night (b=-8.47, p<0.05). A bedtime routine of at least 5 nights a week and initiated no later than 9 PM was associated with longer and less variable night-time sleep in infancy. Findings suggest that a consistent bedtime routine implemented in accordance with age-appropriate bedtimes should be addressed as part of anticipatory guidance in the well-child clinics. Future studies should include infant sleep variability as an outcome in addition to the conventional mean-level sleep variable analyses to more thoroughly characterize bedtime routine effects.

Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment.

A new diagnosis of pediatric cancer may disrupt family functioning. The current study aimed to describe changes in family rules and routines during the first year of pediatric cancer treatment, and to explore associations with demographics, illness factors, and caregiver distress. This exploratory mixed-methods, cross-sectional study examined 44 primary caregivers of youth in treatment for a new cancer diagnosis in 2019 and 2020, before the onset of the COVID-19 pandemic. Caregivers completed validated questionnaires assessing demographic and child illness characteristics, psychosocial distress, and cancer-related stressors, and participated in a semi-structured interview about family rules and routines. Caregivers reported changes in bedtime, mealtime, and school routines, relaxed behavioral expectations and rules around screen time, and new rules and routines around treatment, medications, and infection control. Caregivers with elevated levels of psychosocial distress reported more changed routines than caregivers with low levels of psychosocial distress. Caregivers who endorsed more cancer-related stressors reported more new rules and routines than those who reported fewer cancer-related stressors. Demographic and illness factors were not significantly associated with the number of changed, new, or stable family rules and routines. Families may relax rules and routines during the first several months of diagnosis, and this may be related to side effects of treatment and limited caregiver capacity. The long-term impact of changes in family rules and routines during cancer treatment warrants further study given that accommodating parenting strategies have been associated with adverse short- and long-term child health and behavior outcomes.

Bedtime Oral Hygiene Behaviours, Dietary Habits and Children's Dental Health.

Background: Oral hygiene behaviours as well as dietary habits before bed can affect children’s dental health resulting in higher prevalence of dental disease. Dental disease can affect children’s health, development and even school performance. If left untreated, dental disease can progress and it can lead to extractions under general anaesthetic causing further distress for children and families. Consistent and appropriate oral hygiene behaviours and dietary habits can prevent dental diseases from occurring in the first place. Objective: This cross-sectional study examines the relationship between oral hygiene behaviours, dietary habits around bedtime and children’s dental health. Methods: A total of 185 parents with children between the ages of 3 and 7 years from deprived areas participated in the study. Data on bedtime routine activities were collected using an automated text-survey system. Children’s dental health status was established through examination of dental charts and dmft (decayed, missed, filled teeth) scores. Results: In total, 52.4% of parents reported that their children’s teeth were brushed every night. The majority of children (58.9%) had dmft scores over zero. In total, 51 (46.7% of children with dmft score over 0 and 27.5% of all children) children had active decay. The mean dmft score for those experiencing decay was 2.96 (SD = 2.22) with an overall mean dmft score of 1.75 (SD = 2.24). There were significant correlations between frequency of tooth brushing, frequency of snacks/drinks before bed and dmft scores (r = −0.584, p < 0.001 and r = 0.547, p = 0.001 respectively). Finally, higher brushing frequency was associated with a lower likelihood of a dmft score greater than 0 (Exp(B) = 0.9). Conclusions: Despite families implementing oral hygiene behaviours as part of their bedtime routines those behaviours varied in their consistency. Results of this study highlight the need for additional studies that consider bedtime routine-related activities and especially the combined effects of oral hygiene practices and dietary habits due to their potentially important relationship with children’s dental health.

Associations of language-based bedtime routines with early cognitive skills and academic achievement: A follow-up from kindergarten to middle school.

This study aimed to investigate the extent to which language-based bedtime routines (LBR) reported by parents before kindergarten were associated with early cognitive skills at kindergarten and subsequent academic achievement in typically developing children. We followed a community-based sample of 664 French-speaking adolescents from kindergarten (5-6years) to the end of middle school (15years). Kindergarten measures included a parental questionnaire aimed at assessing the presence or absence of any kind of LBR, such as storytelling, looking at children's books, reading a story, listening to songs, or singing nursery rhymes, as well as family contextual characteristics. Children also performed standardized assessments of oral language, pre-reading skills, and non-verbal reasoning. In middle school, children sat a national diploma typically used as an indicator of general academic achievement in Grade 9. After adjusting for family characteristics, the presence of language-based bedtime routines (57%) predicted cognitive-academic skills in kindergarten, and was positively associated with academic achievement at Grade 9, related to the beneficial effect on children's vocabulary in kindergarten. The presence of language-based bedtime routines may provide an indicator of positive parental behaviour including exposure to literacy activities, contributing to children's early cognitive development and subsequent academic achievement.

640 Regular bedtime routines and biological obesity risk among 9-year old children from the Fragile Families Child and Wellbeing Study

Abstract Introduction Obesity rates among Hispanic (26%) and Black (22%) children are considerably higher compared to their white counterparts (14%), which evidence suggests may be attributable to biological, behavioral, and psychosocial factors affecting the family unit. Bio-behavioral factors in the household may affect child health behaviors, including sleep, a known predictor for obesity. Hispanic and Black children report shorter sleep duration, later bedtimes, and are often lacking in bedtime routines, compared to white children. Evidence suggests that early childhood routines are highly predictive of overweight status in children. Herein, we investigate whether bedtime routines are associated with the genetic allele for obesity in a racially diverse sample of children. Methods Data for the present analysis emanated from wave 5 (Year 9--2007–2010) cohort of the Fragile Families Child and Wellbeing Study dataset. During home visits, interviews with children’s mother and father during home visits, around the target child’s ninth birthday collected data on home routines and other parent-child relationship and school connectedness topics. Saliva samples were also collected at Year 9 to assess telomere length and DNA methylation levels and changes. The independent variable was regular bedtime routine, and biological variable for fat mass and obesity (rs9939609) was the dependent variable. Adjusted covariates included child’s age and BMI, and parent household income. Results Analysis of the final sample of 466 children showed 52% of the children were male and were 9 years old, on average; 35% were White, 46% Black, 20% Hispanic, 4% Asian and 5% other. The median family income was $42,500. The child’s sleep measures captured was ‘children have a regular bedtime routine’ was associated with (β = -0.137, p = 0.01) decrease in the odds of having the genetic allele for obesity. Conclusion Regular bedtime routines among 9-year old Black and Hispanic children may be associated with genetic alleles related to fat mass and obesity. Regular bedtime routines could aid in promoting healthy weight in children. Support (if any) NIH (T32HL129953, K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453.

172 Sleep Disparities in Preschool-Aged Children

Abstract Introduction Sleep is known to be associated with socioeconomic status (SES) in older children and adults with those from lower SES households often experiencing poorer sleep quality. Whether this disparity exists in early childhood is relatively unknown, despite being an important age marked by sleep transitions and the establishment of lifelong sleep habits. Furthermore, it is a critical period for cognitive development and learning, which are supported by sleep. Here, we explore associations between sleep and SES in a preschool population. We hypothesized that children from lower SES households would exhibit shorter overnight sleep, longer and more frequent naps, and shorter 24-hr sleep. Additionally, we considered racial and ethnic disparities in sleep which can be confounded with SES in some samples. Methods Child (n=441; M age=51.9mo; 45.4% female) sleep was measured objectively using actigraph watches, worn for 3-16 days (M=9.5 days). Caregivers reported child demographics and household data. Race/ethnicity of our sample was 72% White, 10.2% Black, 17.8% other or more than one race, and 28.4% identified as Hispanic. 20.1% of our sample was categorized as low SES. Effects of SES and race/ethnicity on continuous sleep measures were assessed using multiple regression models, with age and gender as covariates. Nap habituality was assessed using chi-square tests. Results Lower SES was associated with shorter nighttime sleep duration, longer nap duration, and shorter 24-hr sleep duration (p’s&amp;lt;.001). Children from lower SES households were also more likely to nap habitually (p=.04) as were Hispanic children (p&amp;lt;.001). Hispanic children also tended to have longer nap bouts (p=.002). Hispanic and Black children on average had shorter overnight sleep durations than White children (p’s&amp;lt;.04), but their 24-hr sleep did not differ. Conclusion SES-related sleep disparities were present in this preschool population, with lower SES children exhibiting poorer sleep. When controlling for SES, Hispanic children tended to sleep less overnight which was compensated for by longer, more frequent naps. This underscores the necessity of naps for some children to achieve adequate sleep. Future directions will explore the relationship between parenting factors and sleep, such as bedtime routines and parent knowledge surrounding child sleep needs. Support (if any) NIH R01 HL111695

141 Screen-based activities predict delayed sleep timing within and between adolescents

Abstract Introduction Daytime and evening screen use have been associated with poor sleep health among adolescents, especially delayed sleep timing. However, most studies only investigate associations between adolescents rather than within the same person across multiple nights. Our multilevel modeling approach allows for assessment of connection between screen use and subsequent sleep timing. Methods We analyzed approximately five days of data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort (n=475 adolescents, 15.4±0.5 years old). Adolescents wore wrist actigraphy devices and completed daily surveys reporting how many hours across the day they engaged in screen-based activities (e.g., communicating with friends, playing video games) and whether they engaged in screen-based activities in the hour before bed. Screen use was separated into within- and between-person variables predicting sleep onset and midpoint that night. Multilevel models with random intercepts for each sleep outcome adjusted for school days, bedtime routines, adolescent demographics, and family socioeconomic status. Results Within-person results showed that on days when adolescents played video games more than their daily average±SE (79±3 min) sleep onset was delayed (5±2 min, p&amp;lt;0.01) and midpoint was delayed (4±2 min, p&amp;lt;0.03) for each additional hour. Between-person results showed that adolescents who played video games had delayed sleep onset (9±4 min, p&amp;lt;0.02) and midpoint (7±3 min, p&amp;lt;0.04) for each hour spent playing across the day. Adolescents who spent time using screens to communicate with friends had delayed sleep onset (11±3 min, p&amp;lt;0.01) and midpoint (9±3 min, p&amp;lt;0.01) for each hour across the day. Adolescents who were more likely to use screens to communicate with friends or play video games before bed had delayed sleep onset (29±13 min, p&amp;lt;0.03) and midpoint (24±12 min, p&amp;lt;0.05). Other screen-based activities such as watching videos were not associated with sleep timing. Conclusion Daytime and evening screen-based activities may not uniformly delay sleep. Adolescents who engage in social or interactive screen-based activities may delay sleep timing more than day-to-day variation alone. Future research should evaluate how attributes of screen-based socializing and interactivity affect sleep health. Support (if any) R01HD073352 (to LH), R01HD36916, R01HD39135, R01HD40421

Read, speak, sing: Promoting early literacy in the health care setting.

This statement will help health care providers assess and advise on early literacy with families in almost any practice setting. It defines emergent literacy skills, including early language learning and storytelling, and explores the benefits of reading, speaking, and singing with infants and toddlers for both children and caregivers. Book sharing at bedtime and other language-related routines positively affect family, relational, and social-emotional health. Early exposure to any language, when spoken at home, can benefit literacy learning in other languages children may encounter. Specific recommendations for clinicians counselling families on early literacy are included.

Time Equivalency and Child Adiposity: The Biggest Bang for the Buck.

* Abbreviations: HRQoL — : health-related quality of life MVPA — : moderate-vigorous physical activity The public health, medical, and research community has increased focus on childhood obesity over the past few decades and for good reason. Obesity prevalence is at an all-time high,1 and rates of severe obesity continue to increase.2 Activity, both sedentary and physical, are key contributors to the development and treatment of obesity.3–5 Increasing physical activity while decreasing sedentary activity is an obvious goal in improving the weight and health of children. Unfortunately, the majority of children in the United States are not receiving the recommended amounts of physical activity and surpassing suggested limits on sedentary activity.6 Because there are finite hours in a day, increasing time spent on 1 activity will require doing less of another (ie, replacing one activity with another). In the case of activity, it is assumed that increased time spent engaged in physical activity is always beneficial, without the recognition that it may detract from other important life and health components (eg, sleep and school work). Exploring how individuals allocate their time may provide insight into how one can increase time spent in a beneficial behavior (eg, exercise), without stealing that time from an activity that is also beneficial (eg, sleep). In their study, Ng et al7 approached this topic through the lens of time and in relation … Address correspondence to Michelle I. Cardel, PhD, MS, RD, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2197 Mowry Rd, Gainesville, FL 32607. E-mail: mcardel{at}ufl.edu