Sleep Behaviors In Children Research Articles

Maternal Symptoms of Anxiety and Depression and Child Nocturnal Awakenings at 6 and 18 Months.

We aim to estimate the pathways between maternal symptoms of anxiety and depression and child nocturnal awakenings via structural equation modeling using a sibling design. Structural equation modeling on data from 14,926 sibling dyads or triads from the Norwegian Mother and Child Cohort Study. At 6 months, we estimated the association between maternal symptoms of anxiety and child nocturnal awakenings to be owing to several nonsignificant pathways. Child nocturnal awakenings at 18 months, however, were influenced by concurrent maternal symptoms of anxiety (β = .10) and depression (β = .12). Neither maternal symptoms of anxiety (β = .04) nor depression (β = -.00) was influenced by concurrent child nocturnal awakenings. Our findings suggest that maternal mental health influences child sleep behavior at 18 months after birth, and not vice versa. This is in support of hypotheses on maternal mental health influencing child sleep during toddlerhood.

Feasibility of a Swimming Intervention to Improve Sleep Behaviors of Children With Autism Spectrum Disorder

Children with ASD experience high rates of sleep disturbance, but there are limited interventions addressing sleep in this population. We investigated the feasibility and acceptability of a specialized swim program, Sensory Enhanced Aquatics, for children with ASD. Additionally, we examined the extent to which the physical activity intervention impacted children’s sleep behavior as well as specific child characteristics in those most responsive to intervention. We used a pre-post intervention design to test the effects of an 8-week swim intervention on sleep of ten children aged 5-12 years. Caregivers completed measures of sleep disturbance, autism severity, and sensory processing. Findings showed that children differentially responded to the swim intervention based on autism severity and sensory processing. Children with increased sensory sensitivity and decreased autism severity showed decreased sleep disturbance following the intervention. Results showed that the intervention was feasible and highly acceptable. Sensory Enhanced Aquatics differentially improved the sleep behaviors of children with ASD based on specific child characteristics. This is relevant to recreational therapist who may need to match intervention to child characteristics for best response. Subscribe to TRJ

The Impact of Aquatic Exercise on Sleep Behaviors in Children With Autism Spectrum Disorder

The purpose of this pilot study was to determine if participation in an aquatic exercise program improves sleep in children with Autism Spectrum Disorder (ASD). Participants included 8 children. An A-B-A withdrawal design was utilized. Each phase lasted for 4 weeks. The treatment included 60 min of aquatic exercise 2X/week. Phone calls to parents of the participants were made throughout the duration of the study. Parents were asked questions related to sleep latency, nighttime wakenings, and sleep duration. A one way repeated-measures analysis of variance (ANOVA) was utilized to determine if differences existed between phases. Statistically significant difference existed for sleep latency ( p < .001) and sleep duration ( p < .001). These results suggest that participation in aquatic exercise may improve the sleep habits of children with ASD.

Are parenting behaviors associated with child sleep problems during treatment for acute lymphoblastic leukemia?

Sleep disturbance is a recognized common side effect in children treated for acute lymphoblastic leukemia (ALL). Although associated with treatment factors such as hospitalization and corticosteroids, sleep problems may also be influenced by modifiable environmental factors such as parenting behaviors. The purpose of this study was to examine sleep problems in children undergoing treatment for ALL compared to healthy children and whether parenting practices are associated with sleep difficulties. Parents of 73 children aged 2–6 years who were (1) in the maintenance phase of ALL treatment (ALL group, n = 43) or (2) had no major medical illness (healthy control group, n = 30) participated in the study. Parents completed questionnaires measuring their child's sleep behavior and their own parenting practices. Parents of children undergoing ALL treatment reported significantly more child sleep problems; 48% of children with ALL compared to 23% of healthy children had clinical levels of sleep disturbance. Parents of the ALL group also reported significantly more lax parenting practices and strategies associated with their child's sleep including co‐sleeping, comforting activities, and offering food and drink in the bedroom. Results of multivariate regression analysis indicated that, after controlling for illness status, parent–child co‐sleeping was significantly associated with child sleep difficulties. Strategies employed by parents during ALL treatment may be a potential modifiable intervention target that could result in improved child sleep behaviors. Future research aimed at developing and testing parenting interventions aimed to improve child sleep in the context of oncology treatment is warranted.

Parent knowledge of child sleep: a pilot study in a children's hospital cohort

Objectives/BackgroundParent knowledge about child sleep may influence parent efforts to support healthy sleep in their children. The present study aimed to describe parent knowledge of child sleep in a hospital cohort and potential correlates including barriers to children's bedtime, information seeking about child sleep, and demographics such as child age, parent education, and household income. MethodsIn total, 115 parents of children aged 2–12 years attending hospital inpatient wards or day ward were approached individually and invited to complete the questionnaire. Questionnaire items were modified measures in published articles, identified through literature review, or developed from clinical experience. ResultsParents on average answered half of the knowledge questions accurately, and knowledge about child sleep was positively correlated with education and household income. Parents who sought information from books or the Internet had greater knowledge about child sleep than parents who did not endorse these sources of information. The accuracy of parent estimations of their child's sleep requirements varied: 55% were within recommendations, while 26% underestimated their child's sleep requirements, 19% overestimated. Parents who correctly estimated their child's sleep requirements had higher education and income on average and were more likely to parent younger children (age 2–5 years). Parents who overestimated or underestimated sleep requirements were more likely to identify greater barriers to their child's bedtime. ConclusionOverall knowledge of child sleep in this sample was poor, consistent with samples from North American communities. Future studies should examine whether knowledge about child sleep and barriers to children's bedtimes are related to actual child sleep behaviors or parent practices to support their children to achieve a healthy sleep.

Family Chaos and Child Functioning in Relation to Sleep Problems Among Children at Risk for Obesity

This study evaluated the influence of child and family functioning on child sleep behaviors in low-income minority families who are at risk for obesity. A cross-sectional study was utilized to measure child and family functioning from 2013 to 2014. Participants were recruited from Head Start classrooms while data were collected during home visits. A convenience sample of 72 low-income Hispanic (65%) and African American (32%) families of preschool-aged children were recruited for this study. We assessed the association of child and family functioning with child sleep behaviors using a multivariate multiple linear regression model. Bootstrap mediation analyses examined the effects of family chaos between child functioning and child sleep problems. Poorer child emotional and behavioral functioning related to total sleep behavior problems. Chaos associated with bedtime resistance significantly mediated the relationship between Behavioral and Emotional Screening System (BESS) and Bedtime Resistance. Families at high risk for obesity showed children with poorer emotional and behavioral functioning were at higher risk for problematic sleep behaviors, although we found no link between obesity and child sleep. Family chaos appears to play a significant role in understanding part of these relationships. Future longitudinal studies are necessary to establish causal relationships between child and family functioning and sleep problems to further guide obesity interventions aimed at improving child sleep routines and increasing sleep duration.

Multi-center study on the effects of television viewing on sleep quality among children under 4 years of age in China

To explore the current television viewing situation among children less than 4 years of age in our country and investigate effects of television viewing on sleep quality. According to the"Hospital of Province-City-County"sampling technical route, a total of 1 046 full term healthy children at the age of 4-48 months were sampled by stratified cluster random sampling method from 8 provinces in China from 2012-2013. The information of television viewing and family and personal information was investigated by Shanghai Children's Medical Center Socio-demographic Questionnaire. Brief Infant Sleep Questionnaire (BISQ) and Brief Child Sleep Questionnaire (BCSQ) were employed to assess the sleep behaviors of children 0-3 years old and over 3 years old respectively.The effects of television viewing on sleep quality were analyzed by multiple linear regression analysis. The children's average age was (20±13) months, with boys accounted for 53.3% (558/1 046). The percentage of children who viewed television was 70.3% (735/1 046). Moreover, 58.7% (408/695) of infants and young children under the age of 2 viewed TV per day, and 19.9% (70/351) of 2 years and older infants and young children viewed television ≥2 hours per day. With the increase of age, the percentage of children who viewed television time gradually increased (P<0.001). Child sex, geographic area, paternal education, and family structure were not associated with television viewing time among children aged 4-48 months. However, the presence of a bedroom TV(χ(2)=13.682, P=0.001) and maternal employment (χ(2)=15.053, P=0.005) were commonly correlated with long screen-watching time among children. After adjusting for age, gender, mother' education level, and working state, it was revealed by multiple linear regression analysis that television viewing was not only positively correlated with later bedtime (t=5.49, P<0.001) and shorter night sleep duration (t=-3.49, P=0.001) but also significantly associated with longer sleep onset latency (t=2.63, P=0.009). The percentage of children under 4 years of age who viewed television is very high in our country, and many infants under 6 months of age exposed to TV environment. Bedroom TV and mother full-time job were associated with higher proportion of children viewing TV. In early childhood, television viewing was positively correlated with later bedtime, shorter sleep duration and longer sleep onset latency. There is a need for parents and pediatricians to pay more attention to the behavior of children viewing TV and improve sleep quality.

Short sleep duration as a risk factor for childhood overweight/obesity: a large multicentric epidemiologic study in China

Objectives and settingThe present study was designed to examine the association of sleep duration with obesity/overweight in a multicentric urban sample of Chinese children. Participants and designA random sample of 17,696 children aged 7.00-11.99 years participated in a cross-sectional multicentric survey. MeasurementsThe Chinese version of the Children's Sleep Habits Questionnaire was used to collect information on children's sleep behaviors. Body mass index (BMI) was calculated as weight (kilograms)/height squared (square meters). Sex, age, and BMI were used to define overweight and obesity based on the definition recommended by the Working Group on Obesity in China. ResultsThe prevalence of obesity and overweight in Chinese school-aged children was 10.7% and 10.3%, respectively. Hierarchical multiple linear regression models revealed a significant association between shorter sleep duration (hours/day) and increased BMI (β = −0.120; P = .019). Multivariate logistic regression models demonstrated that, compared with sleep duration ≥10 hours/d, mean sleep duration <9 hours/d experienced increased likelihood of overweight/obesity (odds ratio = 1.21; P = .005). Moreover, sleep-schedule variability, independent of sleep duration, was found to be associated with overweight/obesity (odds ratio = 1.11; P = .016). ConclusionsSleep duration and sleep-schedule variability, along with television viewing, homework schedule, and snack eating, were linked to overweight/obesity among elementary school children in this population-based sample.

Good Sleep Health in Urban Children With Asthma: A Risk and Resilience Approach.

To identify children demonstrating "good" sleep health in a sample of urban children with persistent asthma; to compare sociocontextual, asthma clinical characteristics, and sleep behaviors in children with "good" versus "poor" sleep health; and to examine protective effects of family-based health behaviors on sleep health. Participants were 249 Black (33%), Latino (51%) and non-Latino White (16%) children with asthma, ages 7-9 years, and their primary caregivers. 32 percent of children had "good" sleep health. Well-controlled asthma and better lung function were more likely in this group. In the context of urban risks, sleep hygiene appeared to be a protective factor associated with better sleep quality. The protective effect of asthma management functioned differently by ethnic group. This study identifies protective processes that may guard against urban risks to optimize sleep health in children with asthma. Intervention programs can be tailored to consider specific supports that enhance sleep health in this high-risk group.

Effect of a rapid maxillary expansion on snoring and sleep in children: a pilot study

Aim:The aim of this study was to assess the efficacy of the McNamara rapid palatal expansion device for the treatment of sleep disorders in children.Methods:The sample enrolled 12 children aged 4–11 years. Children with snoring and bruxism whose parents did not agree to tonsil surgery were included in the study. During the initial evaluation, a questionnaire addressing sleep was administered, and plaster models were made for the construction of the McNamara rapid maxillary expansion device. The expansion period was 7–15 days, and the McNamara device was removed after 6–8 months. The same questionnaire was administered again after 30 days of use of the orthopedic appliance. The data were analyzed using the McNemar test, with the level of significance set to 5% (P<0·05).Results:Significant improvements were found in tiredness upon waking (P = 0·002), mood (P = 0·008), lip seal (P = 0·031), drooling during sleep (P = 0·031), snoring (P = 0·001), and bruxism (P = 0·0062).Conclusion:The use of non-invasive methods, such as rapid maxillary expansion, can be an effective treatment for snoring and other undesirable sleep behaviors in children.

Cognitive benefits of last night's sleep: daily variations in children's sleep behavior are related to working memory fluctuations.

Recent studies have suggested substantial fluctuations of cognitive performance in adults both across and within days, but very little is known about such fluctuations in children. Children's sleep behavior might have an important influence on their daily cognitive resources, but so far this has not been investigated in terms of naturally occurring within-person variations in children's everyday lives. In an ambulatory assessment study, 110 elementary school children (8-11years old) completed sleep items and working memory tasks on smartphones several times per day in school and at home for 4weeks. Parents provided general information about the children and their sleep habits. We identified substantial fluctuations in the children's daily cognitive performance, self-reported nightly sleep quality, time in bed, and daytime tiredness. All three facets were predictive of performance fluctuations in children's school and daily life. Sleep quality and time in bed were predictive of performance in the morning, and afternoon performance was related to current tiredness. The children with a lower average performance level showed a higher within-person coupling between morning performance and sleep quality. Our findings contribute important insights regarding a potential source of performance fluctuations in children. The effect of varying cognitive resources should be investigated further because it might impact children's daily social, emotional, and learning-related functioning. Theories about children's cognitive and educational development should consider fluctuations on micro-longitudinal scales (e.g., day-to-day) to identify possible mechanisms behind long-term changes.

Assisted conception, maternal personality and parenting: Associations with toddler sleep behaviour.

To explore the role of maternal personality (hardiness), sleep-related cognitions and bedtime involvement in child sleep behaviour during the second post-natal year in a sample of spontaneous and assisted conception first-time mothers. Mothers (n = 134 (spontaneous (n = 81); assisted (n = 53) conception)) reported on a resilience measure (hardiness) during pregnancy and child sleep at 7 and 19 months post-partum. At 19 months post-partum, mothers also reported on their cognitions and involvement around their child's bedtime, and half the sample used Actigraph monitors (Acitiwatch-16, Mini Mitter Co. Inc, Bend, OR, USA) to validate maternal report of child sleep. No significant differences were found between spontaneous and assisted conception mothers on any of the study variables; therefore, assisted and spontaneous samples were combined. Structural equation modelling confirmed that lower pre-birth maternal hardiness was associated with more problematic sleep-related cognitions (β = 0.23, P < 0.01) and involvement at bedtime (β = 0.29, P < 0.01) and poorer child sleep outcomes (β = -0.33, P < 0.001) during toddlerhood, even after considering concurrent maternal mood and child temperament. Pre-birth maternal hardiness rather than mode of conception contributes to parenting cognitions and behaviour around child sleep and, ultimately, toddlers' sleep outcomes. Findings suggest that targeting negative maternal perceptions of control and efficacy through clinical interventions could benefit toddlers' sleep.

In a randomized case–control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program

Objectives. We tested the hypothesis that sleep training would improve emotional, social and behavioural functioning in children with attention-deficit/hyperactivity disorder (ADHD) compared to children with ADHD without such intervention and to healthy controls. Methods. Forty children with ADHD were randomly assigned to intervention and control conditions. Parents of 20 children with ADHD were instructed and thoroughly supervised in improving their children's sleep schedules and sleep behaviour. Parents of the other 20 children with ADHD and parents of 20 healthy children received general information about sleep hygiene. At baseline and 12 weeks later, parents and children completed questionnaires related to children's sleep and psychological functioning. Results. Relative to the control groups, children in the intervention group improved sleep quantitatively and qualitatively (F values < 3.33, P values < 0.05). The intervention group children reported improvements in mood, emotions, and relationships (F values < 2.99, P values < 0.05). Parents reported that their children improved in physical and psychological wellbeing, mood, emotions, relationships, and social acceptance (F values < 3.02, P values < 0.05). Conclusions. Training and monitoring parents of children with ADHD in regulating and supervising children's sleep schedules leads to positive changes in the emotions, behaviour and social lives of these children.

Evaluation of a sleep education program for low-income preschool children and their families.

To evaluate a novel sleep education program for low-income preschool children and their families. Randomized trial of an educational intervention. Community-based. Head Start preschool families (n = 152) in greater Lansing and Detroit, Michigan. Classrooms or Head Start sites were randomized to an intervention group (prompt intervention) versus a control group (delayed intervention). Parents attended a one-time, 45-min sleep education program and preschoolers received 2 w (320 total min) of classroom sleep curriculum. Parent knowledge, attitudes, self-efficacy, and beliefs were assessed as the primary outcomes just before the 45-min sleep intervention, immediately postintervention, and approximately 1 mo postintervention. Parents reported their child's bedtimes and wake times on 7-day sleep diaries at baseline and at 1-mo follow-up. Average weeknight sleep durations and bedtimes served as secondary outcomes. Linear mixed models showed a time × treatment effect for parents' knowledge, attitudes, and self-efficacy (each P < 0.05) but not beliefs. These improvements were found immediately postintervention but were not retained at 1-mo follow-up. Children in the intervention group improved their weeknight sleep duration at 1-mo follow-up by 30 min (11.0 ± 0.9 h vs. 10.5 ± 1.0 hours at baseline) compared to controls (10.4 ± 0.9 h versus 10.5 ± 0.9 h at baseline) (P = 0.04 for difference between groups). Children did not show statistically significant improvements in bedtime. Educational interventions in early childhood can have an effect on parents' sleep knowledge, attitudes, and self-efficacy, and on children's sleep behavior. However, repeated exposure to the new information may be important for parents as well as their children.

Protective Effects of Parental Monitoring of Children’s Media Use

Children spend more time with electronic media than they do in any other activity, aside from sleep. Many of the negative effects that stem from media exposure may be reduced by parental monitoring of children's media use; however, there lacks a clear understanding of the mechanisms and extent of these protective effects. To determine the prospective effects of parental monitoring of children's media on physical, social, and academic outcomes. Prospective cohort design. Data were collected by in-home and in-school surveys in 2 communities in Iowa and Minnesota, where 1323 third- (n = 430), fourth- (n = 446), and fifth- (n = 423) grade students participated. A primary caregiver and teachers also provided data about the student. Participants in the current study were recruited to participate in a social ecological model-based obesity prevention program. Body mass index, average weekly sleep, school performance, prosocial behavior, and aggressive behavior. RESULTS Structural equation modeling revealed that parental monitoring of children's media influences children's sleep, school performance, and prosocial and aggressive behaviors and that these effects are mediated through total screen time and exposure to media violence. Parental monitoring of media has protective effects on a wide variety of academic, social, and physical child outcomes. Pediatricians and physicians are uniquely positioned to provide scientifically based recommendations to families; encouraging parents to monitor children's media carefully can have a wide range of health benefits for children.

Homework Schedule: An Important Factor Associated With Shorter Sleep Duration Among Chinese School-Aged Children

This study was designed to examine the hypothesis that homework schedule has adverse impacts on Chinese children's sleep–wake habits and sleep duration. A random sample of 19,299 children aged 5.08 to 11.99 years old participated in a large, cross-sectional survey. A parent-administered questionnaire was completed to quantify children's homework schedule and sleep behaviors. Generally, it was demonstrated that more homework schedule was significantly associated with later bedtime, later wake time, and shorter sleep duration. Among all sleep variables, bedtime and sleep duration during weekdays appeared to be most affected by homework schedule, especially homework schedule during weekdays.

Sleep, School Performance, and a School-Based Intervention among School-Aged Children: A Sleep Series Study in China

BackgroundSufficient sleep during childhood is essential to ensure a transition into a healthy adulthood. However, chronic sleep loss continues to increase worldwide. In this context, it is imperative to make sleep a high-priority and take action to promote sleep health among children. The present series of studies aimed to shed light on sleep patterns, on the longitudinal association of sleep with school performance, and on practical intervention strategy for Chinese school-aged children.Methods and FindingsA serial sleep researches, including a national cross-sectional survey, a prospective cohort study, and a school-based sleep intervention, were conducted in China from November 2005 through December 2009. The national cross-sectional survey was conducted in 8 cities and a random sample of 20,778 children aged 9.0±1.61 years participated in the survey. The five-year prospective cohort study included 612 children aged 6.8±0.31 years. The comparative cross-sectional study (baseline: n = 525, aged 10.80±0.41; post-intervention follow-up: n = 553, aged 10.81±0.33) was undertaken in 6 primary schools in Shanghai. A battery of parent and teacher reported questionnaires were used to collect information on children’s sleep behaviors, school performance, and sociodemographic characteristics. The mean sleep duration was 9.35±0.77 hours. The prevalence of daytime sleepiness was 64.4% (sometimes: 37.50%; frequently: 26.94%). Daytime sleepiness was significantly associated with impaired attention, learning motivation, and particularly, academic achievement. By contrast, short sleep duration only related to impaired academic achievement. After delaying school start time 30 minutes and 60 minutes, respectively, sleep duration correspondingly increased by 15.6 minutes and 22.8 minutes, respectively. Moreover, intervention significantly improved the sleep duration and daytime sleepiness.ConclusionsInsufficient sleep and daytime sleepiness commonly existed and positively associated with the impairment of school performance, especially academic achievement, among Chinese school-aged children. The effectiveness of delaying school staring time emphasized the benefits of optimal school schedule regulation to children’s sleep health.

The significance of aspects of screening for obstructive sleep apnoea in children with Down syndrome

The sleep problems of children with intellectual disabilities remains a relatively neglected topic in spite of the consistent reports that such problems are common, often severe and persistent with potentially serious consequences for the children and their families. Children with Down syndrome (DS) are a case in point. They often suffer from obstructive sleep apnoea (OSA), early detection of which is recommended because of its potentially adverse effects on development. This study is concerned with aspects of assessment that have been considered important in helping to recognise OSA in children with DS. The relationships between different objective measures, and between these measures and parental reports of their child's sleep and daytime behaviour, were explored. Overnight recordings were carried out on a group of children with DS (n = 31) involving video and audio recording, oximetry and activity monitoring during sleep. Parents also completed questionnaires concerning their child's sleep and daytime behaviour. Parents' reports of restless sleep and noisy breathing were supported by objective measures of activity during sleep and audio recording respectively. No significant association was found between objective measures of restlessness during sleep and 'snoring' (see later for definition), nor were objective measures of restlessness related to reductions in overnight blood oxygen levels. However, the objective measure of snoring was significantly associated with reductions in overnight blood oxygen levels. All three of the objective measures were significantly associated with parental reports of various types of disturbed daytime behaviour. The findings have implications for aspects of screening for OSA in children with DS and for the interpretation of the relevance of the results to the children's daytime behaviour.

Comparison of sleep questionnaires in the assessment of sleep disturbances in children with autism spectrum disorders

The purpose of this study was to compare two parent completed questionnaires, the Modified Simonds & Parraga Sleep Questionnaire (MSPSQ) and the Children's Sleep Habits Questionnaire (CSHQ), used to characterize sleep disturbances in young children with autism spectrum disorders (ASD). Both questionnaires have been used in previous work in the assessment and treatment of children with ASD and sleep disturbance. Parents/caregivers of a sample of 124 children diagnosed with ASD with an average age of six years completed both sleep questionnaires regarding children's sleep behaviors. Internal consistency of the items for both measures was evaluated as well as the correlation between the two sleep measures. A Receiver Operating Characteristics (ROC) curve analysis was also conducted to examine the predictive power of the MSPSQ. More than three quarters of the sample (78%) were identified as poor sleepers on the CSHQ. Cronbach's alpha for the items on the CSHQ was 0.68 and Cronbach's alpha for items on the MSPSQ was 0.67. The total scores for MSPSQ and CSHQ were significantly correlated (r=.70, p<.01). After first identifying the poor sleepers based on the CSHQ, an area under the curve was 0.89 for the MSPSQ. Using a cut off score of 56 on the MSPSQ, sensitivity was .86 and specificity was .70. In this sample of children with ASD, sleep disturbances were common across all cognitive levels. Preliminary findings suggest that, similar to the CSHQ, the MSPSQ has adequate internal consistency. The two measures were also highly correlated. A preliminary cut off of 56 on the MSPSQ offers high sensitivity and specificity commensurate with the widely used CSHQ.

Parenting Services May Be an Opportunity for Improving Bedtime Routines Among At-Risk Preschoolers

Several interventions aimed at improving children's sleep behaviors have been successful. However, a less expensive alternative with broader coverage might be for existing parenting programs to incorporate sleep promotion into their curricula. This study examines approximately 1,800 low-income children according to whether their mothers received 5 types of parenting services in the child's first 3 years of life: case management, home visiting, parent–child groups, parenting classes, and parenting support groups. Children whose mothers participated in a parent–child group or parenting class by the child's 10th month of life, or in case management between the child's 11th and 19th months of life, were more likely to have a regular bedtime at age 3. Children whose mother participated in a parent–child group between the child's 11th and 19th months of life were more likely to have a regular bedtime routine (i.e., bathing or reading a story) at age 3. Home visiting and parent support groups were not associated with children's sleep-related behaviors. Further research should explore the potential for integrating sleep-related behaviors into the curriculum for case management, parent–child groups, and parenting classes in children's first 3 years of life.