Regular bedtime routine associated with better sleep outcomes in young children

A multinational study suggests that having a regular bedtime routine is associated with better sleep in young children up to 6 years of age, and the positive impact on sleep increases with the consistency of the nightly routine.

Participants included 10,085 mothers from 14 countries reported that less than 50 percent of their infants, toddlers and preschoolers had a regular bedtime routine every night. The study found that children with a consistent bedtime routine had better sleep outcomes, including earlier bedtimes, shorter amount of time in bed before falling asleep, reduced night wakings, and increased sleep duration. Children with a bedtime routine every night slept for an average of more than an hour longer per night than children who never had a bedtime routine. Institution of a regular bedtime routine also was associated with decreased sleep problems and daytime behavior problems, as perceived by mothers.

"Creating a bedtime routine for a child is a simple step that every family can do," said principal investigator and lead author Jodi Mindell, PhD, professor of psychology at Saint Joseph's University and associate director of the Sleep Center at Children's Hospital of Philadelphia. "It can pay off to not only make bedtime easier, but also that a child is likely to sleep better throughout the entire night."

Study results are published in the May issue of the journal Sleep.

According to the American Academy of Sleep Medicine, positive bedtime routines involve the institution of a set sequence of pleasurable and calming activities preceding a child's bedtime. The goal is to establish a behavioral chain leading up to sleep onset. Activities may include giving your child a soothing bath, brushing teeth and reading a bedtime story.

"It's important that parents create a consistent sleep schedule, relaxing bedtime routine and soothing sleep environment to help their child achieve healthy sleep," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler.

The study also found that the frequency of having a bedtime routine was associated with better sleep outcomes in a dose-dependent relationship.

"For each additional night that a family is able to institute a bedtime routine, and the younger that the routine is started, the better their child is likely to sleep," said Mindell. "It's like other healthy practices: Doing something just one day a week is good, doing it for three days a week is better, and doing it every day is best."

Mothers participated in the study by completing a validated, online questionnaire that included specific questions about their child's daytime and nighttime sleep patterns, bedtime routines and behavior. The questionnaire was translated into each language and back-translated to check for accuracy.

"The other surprising finding is that we found that this effect was universal," said Mindell. "It doesn't matter if you are a parent of a young child in the United States, India, or China, having a bedtime routine makes a difference."