Bedtime routines for young children: a dose-dependent association with sleep outcomes
Open accessAbstract
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 dose-dependent 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.
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Increased bedtime routine consistency and engagement in positive, healthy bedtime routine activities are critical for improved developmental outcomes.
“increased bedtime routine consistency [23,40] and engagement in positive, healthy bedtime routine activities [19,25,26] are critical in conferring improved developmental outcomes.”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [23]
The Discussion (page unavailable) reports that more consistent bedtime routines were associated with better sleep and fewer parent-reported daytime behavior problems in young children. The Procedure section shows that the study asked about routine frequency, not the activities within routines. It does not establish that consistency or particular healthy activities are critical causes of improved developmental outcomes; the Introduction mentions cognitive development only when describing another study. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCross-sectional associations between bedtime routines and sleep outcomes have been found within the United States and internationally.
“Cross-sectional associations have been found within the United States [17,26,47] and internationally [23,30,48,49].”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [23]
A dose-dependent relationship exists between bedtime routine and sleep benefits: as the number of nights per week a child followed the same bedtime routine increased, linear improvements occurred across sleep outcomes.
“a dose-dependent relationship emerged between a bedtime routine and these sleep benefits. As the number of nights per week that a child followed the same bedtime routine increased, there were linear improvements across the sleep outcomes”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [23]
Preschoolers with both a current and a history of a consistent bedtime routine showed the best sleep outcomes.
“preschoolers with both a current and a history of a consistent bedtime routine showed the best sleep outcomes.”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [23]
The results of the global study held in both infant/toddler and preschool age groups, in both predominantly Asian and predominantly Caucasian cultural regions, and when controlling for maternal education.
“the results of this study held in both the infant/toddler and preschool age groups, in both predominantly Asian and predominantly Caucasian cultural regions, and when controlling for maternal education”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [23]
In a global study of 10,085 children ages 0 to 5 years from 14 countries or regions, having a bedtime routine is associated with earlier bedtime, shorter sleep onset latency, longer nighttime sleep duration, fewer night awakenings, and decreased caregiver-perceived child sleep problems.
“having a bedtime routine is associated with an earlier bedtime, shorter sleep onset latency, longer nighttime sleep duration, fewer night awakenings, and decreased caregiver-perceived child sleep problems [23].”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [23]
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- Authors
- Mindell, J. A., Li, A. M., Sadeh, A., Kwon, R., & Goh, D. Y. T.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Chinese University of Hong Kong (HK)
- Tel Aviv University (IL)
- Johnson & Johnson Asia Pacific, Division of Johnson & Johnson Pte, Ltd
- National University of Singapore (SG)
- Corresponding author
- Mindell, Jodi A.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-05-01
- Volume
- 38
- Issue
- 5
- Pages
- 717-722
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC4402657
- OpenAlex
- W2000642163
- Cited by
- 218
- References
- 25
- Citations by year
- 2026: 20 · 2025: 22 · 2024: 19 · 2023: 21 · 2022: 23 · 2021: 29 · 2020: 23 · 2019: 18 · 2018: 13 · 2017: 20 · 2016: 10
- FWCI
- 21.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johnson and Johnson
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- bedtime routines, young children, sleep outcomes, dose-response relationship, sleep latency, nocturnal awakenings, sleep duration, bedtime timing, cross-cultural comparison
- MeSH terms
- Child Behavior, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Mothers, Surveys and Questionnaires, Sleep, Time Factors, United States, Wakefulness, Infant Behavior, Internationality, White People, Asian People, Sleep Medicine Specialty
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