Elsevier

Sleep Medicine Reviews

Volume 40, August 2018, Pages 93-108
Sleep Medicine Reviews

Theoretical Review
Benefits of a bedtime routine in young children: Sleep, development, and beyond

https://doi.org/10.1016/j.smrv.2017.10.007Get rights and content

Summary

This paper presents a conceptual model and reviews the empirical evidence to support a nightly bedtime routine as a key factor in the promotion of not only healthy sleep, but also of broad development and wellbeing in early childhood. A bedtime routine embodies the characteristics of nurturing care and early child stimulation, which are deemed to be essential for positive outcomes, especially for at-risk children. Furthermore, common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent–child attachment, and family functioning, among other outcomes. These bedtime routine components include activities in the broad domains of nutrition (e.g., feeding, healthy snack), hygiene (e.g., bathing, oral care), communication (e.g., reading, singing/lullabies) and physical contact (e.g., massage, cuddling/rocking). A bedtime routine can provide multiple benefits to child and family functioning at a time of day that many parents are present with their children. Although additional research on hypothesized routine-related child outcomes and mechanisms of action are needed, promoting a bedtime routine may be a feasible and cost-effective method to promote positive early childhood development worldwide, particularly for socioeconomically disadvantaged and other at-risk young children.

Section snippets

Definition, prevalence, and components of a bedtime routine

Childhood routines refer to observable, predictable, and repetitive behaviors that occur daily or weekly in the context of caregiver–child interactions in the home environment [21], [22]. For the purposes of this paper, a bedtime routine is defined as the predictable activities that occur in the hour or so before lights out, and before the child falls asleep [23]. Activities that occur as the child is falling asleep, such as rocking or feeding to sleep, are not conceptualized as part of the

A conceptual model for the benefits of a bedtime routine for broad child development

Research demonstrates that increased engagement in general, everyday routines is associated with positive child outcomes, including enhanced language development, academic achievement, and social-emotional and behavioral functioning [21], [33], ∗[34]. Everyday routines can also benefit family functioning, with some research indicating that routines are associated with higher levels of marital satisfaction [35] and lower levels of maternal distress [36]. Additionally, engaging in regular

Benefits of a bedtime routine on sleep

Although simply following the same general daily routines in early childhood has been associated with increased sleep duration [46], research has demonstrated that engaging in a regular bedtime routine is particularly beneficial for multiple aspects of early childhood sleep [19]. Cross-sectional, longitudinal, and intervention studies (Table 1), have provided robust evidence that following a bedtime routine is associated with a number of positive sleep outcomes, including an earlier bedtime,

Benefits of a bedtime routine beyond improved sleep

As noted above, we hypothesize that having a bedtime routine has benefits beyond improved sleep, including the broad domains of child mood and emotional–behavioral regulation, parent and family stress/functioning, and child literacy-related outcomes (see Fig. 1 and Table 1). To our knowledge, the conceptual model outcomes of child self-care/health and parent–child bonding/attachment have yet to be examined in the context of bedtime routine research.

Several studies have shown that a bedtime

Benefits of bedtime routine activities

In the following sections, we present evidence from the broader literature on early child development to identify how each bedtime routine activity within the broader domains of 1) nutrition, 2) hygiene, 3) communication, and 4) physical contact can contribute to positive developmental outcomes. While we provide examples of common activities and related literature within each domain (e.g., reading in the communication domain), we acknowledge that activities may vary across cultures and contexts

Implications

Bedtime is a time when most caregivers are present and can engage interactively with their children. An adaptive bedtime routine generates rich opportunities to support positive early childhood developmental outcomes, and is a clear framework for promoting nurturing care (adequate health, nutrition, security and safety, responsive caregiving, and early learning opportunities) and early child stimulation ∗[1], [3]. A bedtime routine provides the seemingly obvious benefits to sleep and to

Future directions for research

There are a number of areas for future empirical focus. For example, more intervention studies on both typically developing children and those with neurodevelopmental conditions are needed to examine causal effects and potential mechanisms of a bedtime routine in general, and for specific bedtime routine activities, on broader outcomes. These studies are particularly important given that observational studies cannot disentangle the effects of a bedtime routine on child outcomes from the effects

Future directions for practice

We propose that the implementation of a consistent bedtime routine is beneficial for many aspects of sleep in early childhood, including sleep onset latency, sleep duration, and sleep quality and consolidation, and has benefits that are just as important for overall child development and wellbeing, including health, emotional–behavioral development, literacy, parent–child interactions, and family functioning, to name just a few. Thus, our hope is that a nightly bedtime routine that includes

Acknowledgments

Dr. Williamson was supported during this study by postdoctoral fellowship T32HL007953-17 from the National Heart, Lung, and Blood Institute.

Conflicts of interest

Dr. Mindell has acted as a consultant and received grant support from Johnson & Johnson Consumer Inc. However, this paper is an independent endeavor with no relevant financial relationships. There has been no financial support or review of content of this paper.

References (140)

  • C. Koulouglioti et al.

    The longitudinal association of young children's everyday routines to sleep duration

    J Pediatr Health Care

    (2014)
  • J.A. Mindell et al.

    Young child and maternal sleep in the Middle East

    Sleep Med

    (2017)
  • K. Minde et al.

    Sleep problems in toddlers: effects of treatment on their daytime behavior

    J Am Acad Child Adolesc Psychiatry

    (1994)
  • T. Field et al.

    Mothers massaging their newborns with lotion versus no lotion enhances mothers' and newborns' sleep

    Infant Behav Dev

    (2016)
  • P.J. Morgane et al.

    Effects of prenatal protein malnutrition on the hippocampal formation

    Neurosci Biobehav Rev

    (2002)
  • C.G. Victora et al.

    Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

    Lancet

    (2016)
  • S. Nicolaidis

    Metabolic mechanism of wakefulness (and hunger) and sleep (and satiety): role of adenosine triphosphate and hypocretin and other peptides

    Metabolism

    (2006)
  • T.B. VanItallie

    Sleep and energy balance: interactive homeostatic systems

    Metabolism

    (2006)
  • J.M. Hess et al.

    What is a snack, why do we snack, and how can we choose better snacks? A review of the definitions of snacking, motivations to snack, contributions to dietary intake, and recommendations for improvement

    Adv Nutr Int Rev J

    (2016)
  • N. Tinanoff et al.

    Update on early childhood caries since the Surgeon General's Report

    Acad Pediatr

    (2009)
  • C. Okunseri et al.

    Children's oral health assessment, prevention, and treatment

    Pediatr Clin North Am

    (2015)
  • J.J. Heckman

    Skill formation and the economics of investing in disadvantaged children

    Science

    (2006)
  • World Bank, UNICEF, World Bank Group

    UNICEF urge greater investment in early childhood development, Washington, DC

    (2016)
  • K. Turnbull et al.

    Behavioral sleep problems and their potential impact on developing executive function in children

    Sleep

    (2013)
  • J.A. Mindell et al.

    Sleep and social-emotional development in infants and toddlers

    J Clin Child Adolesc Psychol

    (2016)
  • B. Sivertsen et al.

    Later emotional and behavioral problems associated with sleep problems in toddlers: a longitudinal study

    JAMA Pediatr

    (2015)
  • K.B. Williams et al.

    A developmental cascade model of behavioral sleep problems and emotional and attentional self-regulation across early childhood

    Behav Sleep Med

    (2017)
  • X. Chen et al.

    Is sleep duration associated with childhood obesity? A systematic review and meta-analysis

    Obesity

    (2008)
  • L.J. Meltzer et al.

    Sleep problems and sleep disorders in pediatric primary care: treatment recommendations, persistence, and health care utilization, Journal of clinical sleep medicine

    JCSM Off Publ Am Acad Sleep Med

    (2014)
  • H. Hiscock et al.

    Improving infant sleep and maternal mental health: a cluster randomised trial

    Arch Dis Child

    (2007)
  • H. Hiscock et al.

    Infant sleep problems and postnatal depression: a community-based study

    Pediatrics

    (2001)
  • L.J. Meltzer et al.

    Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study

    J Fam Psychol

    (2007)
  • H. Hiscock et al.

    Adverse associations of sleep problems in Australian preschoolers: national population study

    Pediatrics

    (2007)
  • A.A.O. Pediatrics

    Bright futures: guidelines for health supervision of infants, children, and adolescents

    (2008)
  • T. Combs-Orme et al.

    Anticipatory guidance and early child development: pediatrician advice, parent behaviors, and unmet needs as reported by parents from different backgrounds

    Clin Pediatr (Phila)

    (2011)
  • B.H. Fiese

    Routines of daily living and rituals in family life: a glimpse at stability and change during the early child-raising years

    Zero Three

    (2002)
  • S.E. Sytsma et al.

    Development and initial validation of the child routines inventory

    J Psychopathol Behav Assess

    (2001)
  • J.A. Mindell et al.

    Bedtime routines for young children: a dose-dependent association with sleep outcomes

    Sleep

    (2015)
  • J.A. Mindell et al.

    Behavioral treatment of bedtime problems and night wakings in infants and young children

    Sleep

    (2006)
  • L. Hale et al.

    Social and demographic predictors of preschoolers' bedtime routines

    J Dev Behav Pediatr

    (2009)
  • J.A. Henderson et al.

    Development and preliminary evaluation of the bedtime routines questionnaire

    J Psychopathol Behav Assess

    (2010)
  • S. Milan et al.

    The context of preschool children's sleep: racial/ethnic differences in sleep locations, routines, and concerns

    J Fam Psychol

    (2007)
  • J. Yoo et al.

    The impact of health-promoting behaviors on low-income children's health: a risk and resilience perspective

    Health Soc Work

    (2010)
  • S. Baldridge

    Family stability and childhood behavioral outcomes: a critical review of the literature

    J Fam Strengths

    (2011)
  • B.H. Fiese et al.

    A review of 50 years of research on naturally occurring family routines and rituals: cause for celebration?

    J Fam Psychol

    (2002)
  • M. Spagnola et al.

    Family routines and rituals: a context for development in the lives of young children

    Infants Young Child

    (2007)
  • J. Leiferman et al.

    Mothers' mental distress and parenting practices with infants and toddlers

    Archiv Women's Ment Health

    (2005)
  • Y. Yoon et al.

    Parenting stress, dinnertime rituals, and child well-being in working-class families

    Fam Relat

    (2015)
  • M.Y. Ivanova et al.

    Family stability as a protective factor against psychopathology for urban children receiving psychological services

    J Clin Child Adolesc Psychol

    (2006)
  • J. Rijlaarsdam et al.

    Early family regularity protects against later disruptive behavior

    Eur Child Adolesc Psychiatry

    (2015)
  • Cited by (195)

    • Sleep Problems in Autism Spectrum Disorder

      2024, Pediatric Clinics of North America
    • Trauma Informed Best Practices and Resiliency

      2024, Child and Adolescent Psychiatric Clinics of North America
    • Sleep problems in infants: How to treat them

      2024, Journal de Pediatrie et de Puericulture
    View all citing articles on Scopus

    The most important references are denoted by an asterisk.

    View full text