Bedtime Routines for Young Children

717 Bedtime Routines for Young Children—Mindell et al. INTRODUCTION Sleep problems are one of the most common concerns of parents, occurring in approximately 20–30% of young children,1,2 and one of the most common behavioral issues brought to the attention of pediatricians.3,4 Not only do sleep issues tend to persist,5–7 but there is increasing evidence of the negative consequences of inadequate sleep quality and quantity in children, including cognitive and behavioral deficits that affect daytime functioning,8 as well as psychiatric and health outcomes, such as obesity and metabolic consequences.9,10 A bedtime routine is commonly recommended as part of healthy sleep habits, with more than 90% of pediatricians recommending it for their patients with sleep difficulties.3 However, there is limited research on the importance of a bedtime routine and its effect on outcomes. Prior research has found that daily routines in general lead to predictable and less stressful environments for young children and are related to greater parenting sense of competence and improved daytime behaviors.11 A bedtime routine is one such daily family routine and consists of parents engaging their child in the same activities in the same order on a nightly basis prior to lights out. It is expected that a bedtime routine, Background: Establishment of a consistent bedtime routine (the activities that occur right before lights out) is often recommended as part of healthy sleep habits. However, no studies have investigated the dose-dependent association of a bedtime routine with sleep outcomes, especially in young children for whom they are particularly recommended. Thus, the aim of this study was to examine the associations of a consistent bedtime routine with sleep outcomes in young children (ages 0 through 5 y) in a large global sample and assess whether there is a dosedependent relationship between the frequency of a bedtime routine both concurrently and retrospectively with sleep outcomes. Participants: Mothers of 10,085 children (Australia-New Zealand, Canada, China, Hong Kong, India, Japan, Korea, Malaysia, Philippines, Singapore, Thailand, United Kingdom, United States) completed the Brief Infant/Child Sleep Questionnaire. Results: A consistent bedtime routine was associated with better sleep outcomes, including earlier bedtimes, shorter sleep onset latency, reduced night wakings, and increased sleep duration. Decreased parent-perceived sleep problems and daytime behavior problems were also related to institution of a regular bedtime routine. Furthermore, there was a dose-dependent relationship, with better outcomes associated with increased “doses” of having a bedtime routine, both currently and retrospectively, and was found within both predominantly Asian and predominantly Caucasian cultural regions. Conclusions: These results indicate that having a regular nightly bedtime routine is associated with improved sleep in young children, and suggests that the more consistently a bedtime routine is instituted and the younger started the better.