Bedtime Routines Research Articles

Experiences of sleep hygiene education as an intervention for sleep problems in children with developmental disabilities: Findings from an exploratory study

Accessible summary Sleep hygiene education (SHE) is a “behavioural” intervention which helps parents create the best sleeping conditions for their child. It is often used to improve sleep problems that children with developmental disabilities have. SHE includes advice around creating bedtime routines, creating a calming bedroom environment and eating healthily. Lots of health and social care professionals use SHE, but there are not many research papers which show the best way to support parents to try out the advice. This research tells the story of nine parents and eleven professionals who have used SHE to help improve children’s sleep problems. Their experiences are important in the research literature and will help services such as community children’s learning disability teams improve the way SHE is used in the future. AbstractBackgroundSleep hygiene education (SHE) is a familiar intervention for addressing behavioural sleep problems in children with developmental disabilities that involves advising parents on sleep‐promoting behaviours; however, it is supported by a limited evidence base.Materials and methodsThis exploratory study aimed to enhance qualitative understanding and explore stakeholder perceptions about experience, current practice and ideas around the implementation of SHE. Parents of children with developmental disabilities and sleep problems (N = 9) and sleep practitioners (N = 11) took part in semi‐structured interviews and focus groups, and data were thematically analysed.Results and discussionThe analysis identified four parent themes: Beliefs about sleep problems; Getting professional help; Ways of knowing about sleep; and Visions of sleep support. Two practitioner themes were also identified: Sleep service accessibility and Inconsistent sleep support.ConclusionThe findings provide further insight into how parents of children with developmental disabilities experience sleep problems, and how SHE is currently implemented. These have implications for both policy and practice.

Sprouts Growing Healthy Habits: Curriculum Development and Pilot Study.

High rates of childhood obesity and the impact this has on children's health make it important to establish a healthy lifestyle during the early school years. This pilot study explored the impact of a newly developed healthy habits curriculum. The Sprouts: Growing Healthy Habits curriculum presents topics such as energy balance, healthy sleep habits, and food groups through short activities and interactive book-reading. A nonrandomized controlled experimental study design was used to assess impact. Fifty-seven children between 5 and 6 years of age participated from two elementary schools (36 from the intervention school, 21 from the control school). Knowledge was assessed pre- and post-intervention in five content areas (farm to table, bedtime routines, portion size, energy expenditure, sugar content of beverages) using card sorting, ranking, and sequence activities. Within- and between-school comparisons were conducted using differences between groups and mixed modeling approaches. Within the intervention school, significant increases in knowledge were observed for farm to table, sugar content of beverages, and bedtime routines. For the control school, there was a significant increase in knowledge of portion sizes. Considering between-schools, only change in knowledge of bedtime routines remained significant, with greater increases in the intervention school. Results seem promising given the short dosage of curriculum. Increases in knowledge of healthy habits in early childhood may help in promoting healthy behaviors and combatting the effects of obesity.

Qualitative study on parents’ perspectives of the familial impact of living with a child with autism spectrum disorder who experiences insomnia

BackgroundSleep is an essential aspect of life and it is estimated that 40–80% of individuals with Autism Spectrum Disorder (ASD) present with insomnia. Insomnia relates to difficulties initiating and/or maintaining sleep which can be distressing for the child with ASD and their family. Despite the high prevalence of insomnia in children with ASD there is little qualitative data on parents' perspective on the impact it has on the family unit. MethodsThis study presents findings from a series of three focus groups representing 15 families of children with ASD who experience insomnia. Focus groups were audio recorded and transcribed intelligent verbatim. NVivo 9 software was used to enable a content analysis. Text was coded and according to its content emerging themes were identified. Six main themes to include anxiety, dietary implications, bedtime routines, social exclusion, familial implications, and educational consequences emerged. ResultsThe findings are discussed in relation to future considerations that may contribute to the development of best practice for sleep interventions for children with ASD. ConclusionsQualitative data which considers parents’ perceptions of familial impact of insomnia may provide in-depth information for sleep clinicians working with families which could inform clinical decisions.

Sleep and new media usage in toddlers.

Several studies over the years have demonstrated the association between lack of sleep in children and certain physical, psychological, and behavioral disorders. The aim of this study was to disentangle the association between new screen-based electronic devices and sleep problems in toddlers, adjusting for other covariates already known to be associated with sleep quality. We conducted a cross-sectional study with the aid of a national sample of 1117 toddlers. Parents reported children's sleeping habits such as total sleep time and sleep onset latency, recreational activities, bedtime routines, and temperament. An ordered logistic regression was run to assess the associations between new media exposure and two sleep outcomes (total sleep time and sleep onset latency). Everyday use of a tablet or smartphone raised the odds of a shorter total sleep time (OR 1.95 [1.00-3.79], p < 0.05) and a longer sleep onset latency (OR 2.44 [1.26-4.73] p < 0.05) irrespective of other factors, such as temperament (restlessness, sociability), or traditional screen exposure (watching TV or playing videogames).Conclusion: New media usage is a factor associated in toddlers with sleeping fewer hours and taking longer to fall asleep, irrespective of other confounding factors. What is known • Studies have found an association between sleep behavior and the use of computers and video games in early childhood. • The blue light emitted from TV screens suppresses endogenous melatonin. What is new • The study found an association between daily new media (tablet and smartphone) usage and sleep quality in toddlers • New media usage exposes toddlers to the risk of fewer hours of sleep and taking longer to fall asleep, irrespective of other factors.

Night-to-night variability in the bedtime routine predicts sleep in toddlers

The present study examined relations between nightly bedtime routines and sleep outcome measures in a sample of 185 toddlers aged 30 months. Parents reported on their toddler’s sleep duration and the length and activities included in the bedtime routine each night for approximately 2 weeks. Toddlers wore actigraphs to track their sleep during the same time period. Correlation, mean difference, and regression analyses indicated that toddlers experienced different bedtime routines and exhibited differences in parent reported sleep duration between weeknights and weekends. Multi-level models revealed that variability in the bedtime routine on an individual night most consistently affected parent reported sleep duration on that night. Differences in the bedtime routines between weeknights and weekends also affected actigraph recorded sleep duration and sleep efficiency. Results suggest that keeping consistent bedtime routines between weeknights and weekends is important for optimal sleep outcomes.

Longitudinal associations of childhood bedtime and sleep routines with adolescent body mass index.

Having a regular, age-appropriate bedtime and sufficient sleep from early childhood may be important for healthy weight in adolescence. This study aimed to (1) identify heterogeneous groups of children by bedtime and sleep routines and (2) test longitudinal associations of childhood bedtime and sleep routine groups with adolescent body mass index (BMI). We analyzed longitudinal data from the Fragile Families and Child Wellbeing Study, a national birth cohort from 20 US cities (N = 2196). Childhood bedtime and sleep routines were assessed by mothers' reports of their children's presence and timing of bedtimes, adherence to bedtimes, and habitual sleep duration at ages 5 and 9. At age 15, these adolescents reported their height and weight, which were used to calculate BMI z-score. Latent Class Analysis revealed four groups of childhood bedtime and sleep routines: No Bedtime Routine Age 5 (Group 1), No Bedtime Routine Age 9 (Group 2), Borderline Bedtimes Ages 5 and 9 (Group 3), and Age-Appropriate Bedtime and Sleep Routines Ages 5 and 9 (Group 4, reference). Compared with adolescents in the reference group, those in the No Bedtime Routine Age 9 (Group 2) had +0.38 SD greater BMI (95% CI = [0.13 to 0.63]), above the level for overweight (1.02 SD BMI/85th percentile). Associations persisted after adjusting for age 3 BMI and sociodemographic characteristics. Results demonstrate heterogeneity in childhood bedtime routine groups and their associations with adolescent BMI. Future studies should focus on whether childhood sleep behavior interventions promote healthier sleep and weight in later life course stages.

Examining sleep hygiene factors and sleep in young children with and without autism spectrum disorder

Objective/backgroundSleep problems are common in young children, especially young children with autism spectrum disorder (ASD). Sleep hygiene is a set of practices, which promote good sleep. However, other than bedtime routines and schedules, sleep hygiene is not often examined in this age group, or in ASD. The aim of this study was to examine sleep problems in young children with and without ASD and their relationship to sleep hygiene practices. ParticipantsParents (N = 101) of young children aged 2–5 years (M = 47.5 mths, SD = 1.3) were surveyed. Children included 28 with ASD, 2 with global developmental delay, and 71 who were typically developing. MethodsA survey of sleep and sleep hygiene practices and the Children’s Sleep Habits Questionnaire (CSHQ) examined via parent-report sleep problems and their relationship with thermal comfort, screen time, and diet. ResultsMore than half of all children (55.4%; 78.6% of children with ASD) had a sleep problem. Children with ASD and a sleep problem slept fewer hours than other children, but they did not differ on their CSHQ score. Areas of sleep hygiene associated with poorer sleep for children with and without ASD included thermal comfort factors and screen usage. ConclusionsThese results suggest that too much screen time may be related to sleep problems for young children with and without ASD. Parents also may need advice about maintaining appropriate thermal comfort for their sleeping child. Although these findings provide preliminary relationships and require replication and specific intervention recommendations, these results are particularly important for children with ASD who are at high risk for poor sleep.

Maternal Perceived Work Schedule Flexibility Predicts Child Sleep Mediated by Bedtime Routines

Rigid work schedules are negatively associated with adults’ sleep. Less is known about whether parents’ work schedule flexibility influences their children’s sleep. We examined associations of mothers’ perceived work schedule flexibility with their children’s sleep over time and whether these associations were mediated by bedtime routine adherence. Two-waves of data were drawn from the Fragile Families and Child Wellbeing Study, a sample of socioeconomically disadvantaged households in large US cities (N = 1040). When the focal children were ages 5 and 9, mothers reported their work schedule flexibility and their child’s bedtime adherence, sleep duration, and difficulty getting to sleep. Cross-sectionally, higher levels of maternal perceived work schedule flexibility were associated with longer child sleep duration and a lower likelihood of having difficulty getting to sleep; these associations were mediated by greater child bedtime adherence. Longitudinally, increases in mothers’ perceived work schedule flexibility from child ages 5 to 9 predicted increases in child bedtime adherence at age 9, which, in turn, predicted increases in child sleep duration at age 9. Increases in perceived work schedule flexibility also predicted a decreased likelihood of children having difficulty getting to sleep, but this association was not mediated by changes in child bedtime adherence. These results suggest that mothers’ perceived work schedule flexibility may be a social determinant of child sleep health, largely through influencing bedtime adherence. Future interventions could consider how to improve bedtime practices in families with working mothers, including by increasing work schedule flexibility perceived by working parents to promote child sleep health.

Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children's Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States.

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers’ beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children’s healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families’ lives such as parents’ work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children’s sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents’ work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

Inclusion of Sleep Promotion in Family-Based Interventions To Prevent Childhood Obesity.

Sleep promotion in childhood may reduce the risk of obesity, but little is known of its inclusion in family-based interventions. This study examines the proportion and context of family-based interventions to prevent childhood obesity that promote child sleep. We drew on data from a recent systematic review and content analysis of family-based interventions for childhood obesity prevention published between 2008 and 2015, coupled with new data on sleep promotion strategies, designs, and measures. Out of 119 eligible family-based interventions to prevent childhood obesity, 24 (20%) promoted child sleep. In contrast, 106 (89%) interventions targeted diet, 97 (82%) targeted physical activity, and 63 (53%) targeted media use in children. Most interventions that promoted sleep were implemented in clinics (50%) and home-based settings (38%), conducted in the United States (57%), and included children 2-5 years of age (75%). While most interventions utilized a randomized controlled design (70%), only two examined the promotion of sleep independent of other energy-balance behaviors in a separate study arm. Sleep was predominately promoted by educating parents on sleep hygiene (e.g., age-appropriate sleep duration), followed by instructing parents on responsive feeding practices and limiting media use. One intervention promoted sleep by way of physical activity. A large number promoted sleep by way of bedtime routines. Most interventions measured children's sleep by parent report. Results demonstrate that sleep promotion is underrepresented and variable in family-based childhood obesity interventions. While opportunities exist for increasing its integration, researchers should consider harmonizing and being more explicit about their approach to sleep promotion.

Parental stress and bedtime routines in toddlerhood

...parental stress can lead to critic bedtime routines. Primary care practitioners can play an instrumental role in helping families institute positive sleep practices and improving sleep in toddlers.

0827 Bedtime Routines, Nighttime Awakenings and Sleep in Low-Income Toddlers

0827 Bedtime Routines, Nighttime Awakenings and Sleep in Low-Income Toddlers

Bedtime routines child wellbeing & development

BackgroundBedtime routines has shown important associations with areas associated with child wellbeing and development. Research into bedtime routines is limited with studies mainly focusing on quality of sleep. The objectives of the present study were to examine the relationship between bedtime routines and a variety of factors associated with child wellbeing and to examine possible determinants of bedtime routines.MethodsA total of 50 families with children between 3 and 5 years old took part in the study. Data on bedtime routines, parenting styles, school readiness, children’s dental health, and executive function were collected.ResultsChildren in families with optimal bedtime routines showed better performance in terms of executive function, specifically working memory (t (44)= − 8.51, p ≤ .001), inhibition and attention (t (48)= − 9.70, p ≤ .001) and cognitive flexibility (t (48)= − 13.1, p ≤ .001). Also, children in households with optimal bedtime routines scored higher in their readiness for school (t (48)= 6.92, p ≤ .001) and had better dental health (U = 85.5, p = .011). Parents in households with suboptimal bedtime routines showed worse performance on all measures of executive function including working memory (t (48)= − 10.47, p ≤ .001), inhibition-attention (t (48)= − 10.50, p ≤ .001) and cognitive flexibility (t (48)= − 13.6, p ≤ .001). Finally, parents with optimal bedtime routines for their children deployed a more positive parenting style in general (i.e. authoritative parenting) compared to those with suboptimal bedtime routines (t (48)= − 6.45, p ≤ .001).ConclusionThe results of the present study highlight the potentially important role of bedtime routines in a variety of areas associated with child wellbeing and the need for further research.

Differences in sleep problems between Japanese and Chinese preschoolers: a cross-cultural comparison within the Asian region

Study objectivesPrevious studies have performed cross-cultural comparisons of differences in childhood sleep problems between Asian and Western countries. However, whether such differences can be observed among Asian countries remains unclear. The present study aimed to investigate differences in the pattern of sleep problems between Japanese and Chinese preschoolers. MethodsData were collected from one city in Japan and 10 cities in China. The present study recruited 438 Japanese and 1020 Chinese preschoolers aged four and five years. Sleep problems and patterns were assessed on the basis of parental reports using the Children's Sleep Habits Questionnaire (CSHQ). ResultsAnalysis of covariance revealed no significant difference in total CSHQ scores between Japanese and Chinese preschoolers, thus indicating that the total severity of sleep problems did not differ between the groups. Japanese preschoolers exhibited higher scores on the bedtime resistance subscale of the CSHQ than Chinese preschoolers. Conversely, Chinese preschoolers exhibited higher subscale scores for night wakings and sleep-disordered breathing. In addition, Japanese preschoolers exhibited earlier bedtimes and wake times and shorter total sleep times than Chinese preschoolers. ConclusionsOur findings indicate that the patterns of sleep problems in preschoolers differ between Japan and China and that such differences may be due to differences in cosleeping practices, bedtime routines, and/or environmental conditions. Thus, investigators studying sleep in preschoolers should consider regional differences in the pattern of sleep problems, even among Asian countries.

Massage-based bedtime routine: impact on sleep and mood in infants and mothers

Establishment of a consistent bedtime routine is often recommended to families with young children with sleep difficulties. However, there are limited studies assessing specific bedtime routines in the treatment of infant and toddler sleep disturbances. Thus, the purpose of this study was to examine the impact of a massage-based bedtime routine on infant sleep, maternal sleep, and maternal mood. A total of 123 mothers and their 3- to 18-month-old infant were randomly assigned to a routine (one-week baseline of usual bedtime routine, two-weeks intervention) or control group (three-weeks of their usual bedtime routine). All mothers completed the Brief Infant Sleep Questionnaire (BISQ) on a weekly basis and measures of maternal sleep and mood (eg, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Edinburgh Postnatal Depression Scale). This bedtime routine resulted in improvements in child and mother night wakings, maternal perceptions of child sleep and mood (ie, sleep problem, bedtime ease, and morning mood), and improvements in maternal sleep quality. No comparative changes were seen in the control group. Notably, other than number of night wakings for both the child and the mother, there were no changes in other sleep patterns including sleep onset latency, duration of night wakings, longest stretch of sleep, or sleep duration. This study supports recommending a massage-based routine in those families, with the codicil that improvements in maternal perceptions and maternal sleep will be noted, with few improvements in sleep itself other than night wakings.

All tucked up

Make sleep and bedtime routines a focus for activities which practise being still and moving to music and rhyme. Invite children to a pyjama party and play pillow games that build gross motor skills.

Investigation of dose-dependent association between bedtime routines and sleep outcomes in infants and toddlers

Objective: To investigate the current bedtime routine among Chinese children less than 3 years of age and explore its dose-dependent association with sleep duration and sleep quality. Method: Healthy full-term born children aged 0-35 months were selected by stratified cluster random sampling method from 8 provinces in China following the "Hospital of Province-City-County" sampling technical route during 2012-2013.Brief Infant Sleep Questionnaire(BISQ) was used to assess sleep conditions of these children.Children's personal and family information was obtained by Shanghai Children's Medical Center Socio-demographic Questionnaire.Both of these questionnaires were filled in by parents. The effects of bedtime routine on children's sleep duration and quality were analyzed by multivariate analysis of variance. Result: The children's average age was(12±10) months(n=1 304), of whom 689 were males (52.8%, 689/1 304). There were 48.5%(632/1 304)of the parents reported that their children had not established regular sleep routines. There was a consistent dose-dependent association between bedtime routine and sleep duration, as well as other indicators for sleep quality (all P<0.05). The more regular the sleep routines, the longer the sleep duration, the earlier the children went to sleep, the shorter the sleep onset latency, the fewer the nighttime wakeup and the shorter the nighttime waking.The nighttime sleep duration was significantly longer for those with a bedtime routine 'every night' than those who 'never' had a bedtime routine (9.5(95%CI: 9.4-9.6)vs. 8.9(95%CI: 8.6-9.3)h, t=3.345, P=0.001). Compared with children who never had bedtime routines, children with regular bedtime routines had fewer night wakeup (1.3(95%CI: 1.2-1.4) vs. 2.4( 95%CI: 2.0-2.9), t=3.182, P=0.001) and shorter night waking duration(16.6(95%CI: 14.6-18.8) vs. 59.2 (95%CI: 47.0-72.7)min, t=6.383, P<0.01). Conclusion: The percentage of children who have established regular bedtime routine is low in China. There is significant dose-dependent association between regular bedtime routine and sleep outcomes, especially sleep quality. The more regular the sleep routines, the better the sleep quality.

How to help children get all the sleep they need

Karen Faux finds out how organisation Sleep East can help both parents and professionals to establish healthy bedtime routines and sleep patterns for young children, using one-to-one counselling and interactive workshops.

Sleep problems in the first year of elementary school: The role of sleep hygiene, gender and socioeconomic status

ObjectivesTo determine (1) the relationship between sleep hygiene practices and parent-reported child sleep problems in students in the first year of elementary school, (2) whether the relationship differed by (a) gender and (b) SES and (3) in a multivariate explanatory model. DesignCross-sectional survey of a population-based sample. SettingForty-five elementary schools in metropolitan Melbourne, Australia. ParticipantsFamilies of children aged 4–6 years in the first year of elementary school in Melbourne, Australia. MeasurementsExposures: Parent-reported child sleep hygiene, gender and data linkage to community-based disadvantage. Outcome: Parent-reported child sleep problems. Analyses: Logistic regression models were used to examine each aim. ResultsOf 6635 approached parents, 4901 (74.30%) participated. In the final model, using audio devices at bedtime was associated with increased risk of child sleep problems (OR 2.12, 95% CI 1.60, 2.81) as was an inconsistent bedtime routine on school nights (OR 2.52, 95% CI 1.76, 3.60) and non-school nights (OR 1.66, 95% CI 1.09, 2.55). Boys with an inconsistent bedtime routine on non-school nights had a higher risk (OR 2.07, 95% 1.49, 2.88) than girls (OR 1.61, 95% CI 1.15, 2.28). SES was not associated with sleep problems. ConclusionInconsistent bedtime routines and audio device use were each associated with an increased risk of parent-reported sleep problems. Associations did not differ based on SES but did for boys and girls in terms of inconsistent bedtimes on weekends. Behavioral sleep interventions targeting sleep hygiene could have similar benefits for all children, regardless of socio-economic status.

Bedtime Rituals and Routines of Turkish Children and Perceptions of Their Mothers

Bedtime Rituals and Routines of Turkish Children and Perceptions of Their Mothers