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Bedtime routines contribute to well-being in children

British researchers recently investigated the link between a child’s bedtime routine and a host of factors associated with children’s well-being.


Studies have demonstrated a link between bedtime routines and a child’s quality of sleep, dental health, and school performance—all factors that are linked to child development, well-being, and parenting.

Most studies have focused on the association between bedtime routines and quality of sleep and found that better quality bedtime routines are associated with better quality of sleep and sleep duration in both children and adults. Other studies have shown that a child’s bedtime routine is important in their development of healthy attitudes towards reading, learning, and the school environment. For instance, children who engage in bedtime reading with parents as part of the bedtime routine have demonstrated improved language capacity, reading and literacy rates, and overall better readiness for school, which is a factor closely associated with healthy attitudes toward school.

Dental health has been found to have a link with bedtime routines through oral hygiene behaviours. Good oral hygiene behaviours as part of a bedtime routine have been associated with improved oral health and a lower prevalence of cavities in children and adults. There is also an association between emotional and psychological well-being in parents and children, with those children having a non-regular bedtime routine experiencing more frequent behavioural difficulties than other children and lower levels of anxiety, anger, and fatigue being reported by parents with optimal bedtime routines.

No clear definition of an optimal bedtime routine

Despite these findings, there is currently no clear policy defining an optimal bedtime routine. As most research in this area has focused on the association between bedtime routines and sleep quality, British researchers sought to fill the knowledge gap by examining the association between optimal bedtime routines and other key indicators of child well-being and development. These included (a) greater readiness for school, (b) better dental health and (c) higher executive function in preschool-age children. The researchers selected these three areas because of their associations with further child development, general well-being, achievement and impact on quality of life. The secondary focus of the study was to explore whether optimal bedtime routines were more likely in families whose parents had (a) higher executive function and (b) positive parenting styles. The findings were recently published in BMC Public Health.

The researchers recruited parents of children between three and five years of age. The participants were recruited from February to May 2017 through one of two avenues: (a) participants in an active study on general dental anaesthetic teeth extraction or (b) via general dental practices.

A total of 50 families participated in the study; data were collected from one parent and one child from each family. Data was collected over the course of two visits, the first consisting of the parent-related assessment, and the second including child-related assessments. In between visits, the parents received interactive text questionnaires to their mobile phones for five nights.

The questionnaires assessed the quality of each night’s bedtime routine, focusing on five target areas, identified from previous studies:

(a) consistency (bedtime within the space of an hour each night)
(b) tooth brushing
(c) no snacks/drinks before bed
(d) no electronic devices before bed
(e) book reading

The researchers assessed school readiness in children, child dental health, and executive function in both children and adults. They first assessed executive function using the National Institute of Health (NIH) Toolbox and focused on three key areas: (a) attention/inhibition, (b) working memory and (c) cognitive flexibility/shifting. The second assessment focused on perceived executive functioning on a day-to-day basis and was done using the Behavioral Rating Inventory of Executive Function (BRIEF). Additionally, the researchers obtained data for the study’s secondary objective by assessing parenting styles using the short version of the Parenting Style and Dimension Questionnaire (PSDQ), which identifies three parenting styles: authoritative, authoritarian, and permissive.

A bedtime routine was associated with better health

Overall, the study results indicate that an optimal bedtime routine is associated with better dental health, cognitive function, and school readiness. These routines were more likely in households where parents were authoritative and had good executive function. This finding is consistent with previous studies that have shown that positive parenting has a strong positive association with higher executive function. A solid conclusion cannot be drawn from the results, as the nature of executive function and factors associated with its development are complex. This observation, however, provides a starting point for further investigation. These unique findings also provide a starting point to further examine different parenting styles and executive function in relation to optimal or suboptimal bedtime routines, in the context of other important factors.

The main limitation of this study is its cross-sectional design which does not account for other factors which could have affected the observed associations. A second limitation is the missing information on metrics such as the child psychosocial development, parental psychological well-being, and child’s quality of sleep, which could have direct and/or indirect effects on the associations identified in the study.

In summary, the study’s findings point to the importance of bedtime routines in promoting wellbeing in children. This makes it essential to gain a better understanding of the facets of an optimal bedtime routine to better support those with suboptimal bedtime routines.

Written by Sara Alvarado BSc, MPH

Reference: Kitsaras, G., Goodwin, M., Allan, J., Kelly, M. and Pretty, I. (2018). Bedtime routines child wellbeing and development. BMC Public Health 18: 386.



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