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

Sleep. 2015 May 1;38(5):717-22. doi: 10.5665/sleep.4662.


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.

Keywords: bedtime routine; infant; preschooler; sleep; toddler.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asian People / statistics & numerical data
  • Child Behavior / physiology*
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant Behavior / physiology
  • Infant, Newborn
  • Internationality
  • Male
  • Mothers / psychology
  • Sleep / physiology*
  • Sleep Medicine Specialty / methods
  • Surveys and Questionnaires
  • Time Factors
  • United States
  • Wakefulness / physiology
  • White People / statistics & numerical data