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Institution of a bedtime routine improves sleep in infants and toddlers, maternal mood

Westchester, Ill. A study in the May 1 issue of the journal SLEEP demonstrates that the use of a consistent bedtime routine contributes to improvements in multiple aspects of infant and toddler sleep, bedtime behavior and maternal mood.

Results indicate that the establishment of a nightly bedtime routine produced significant reductions in problematic sleep behaviors for infants and toddlers. Improvements were seen in latency and sleep onset and in the number and duration of night wakings. Toddlers were less likely to call out to their parents or get out of their crib/bed during the night. Sleep continuity increased and there was a significant decrease in the number of mothers who rated their child's sleep as problematic. Maternal mood also significantly improved.

According to the study, sleep problems are one of the most common concerns of parents of young children; approximately 20 to 30 percent of infants and toddlers experience sleep difficulties. Previous studies have found that successful treatment of children's sleep problems with behavioral interventions also result in improvements in parental well-being.

According to principal investigator, Jodi Mindell, PhD, professor of psychology at Saint Joseph's University in Philadelphia, PA., creating a bedtime routine is an easy change that can significantly improve both the child's sleep and the mother's quality of life.

"There is no question that maternal mood and children's sleep impact one another. The better a child sleeps and the easier bedtime is, the better a mother's mood is going to be," said Mindell. "In addition, a mom who is not feeling tense, depressed, and fatigued is going to be calmer at bedtime, which will help a child settle down to sleep."

Data were collected from 405 mothers and their infant or toddler,(206 infants between the ages of 7 and 18 months and 199 toddlers between the ages of 18 and 36 months), who then participated in two age-specific three week studies. Families were randomly assigned to a routine or control group. The first week of the study served as a baseline, during which the mothers followed their child's usual bedtime weeks. During the following two weeks mothers were instructed to conduct a specific bedtime routine, while the control group continued with their child's normal bedtime procedure.

All children included in the study had a small to severe sleep problem, as identified by the mother. Problems included more than three nightly wakings, awakening for longer than 60 minutes per night, or having a total daily sleep duration of less than nine hours. All mothers completed an expanded version of the Brief Infant Sleep Questionnaire (BRISQ), and provided subjective data concerning their child's sleep habits.

Parents in the infant routine group were given a three-step bedtime procedure to follow that included a bath, a massage and quiet activities (such as cuddling and singing); lights were to be turned out within 30 minutes of the end of the bath. Mothers then proceeded to put the child to sleep as they normally did, by either putting the child to bed while awake or rocking them to sleep. Thus, the only instituted change was the routine. The toddler group followed the same routine, except that mothers were instructed to apply lotion rather than give the child a massage.

Research shows that daily routines in general lead to predictable and less stressful environments for young children and are related to parenting competence, improved daytime behaviors and lower maternal mental distress.

Authors of the study were surprised by the fact that sleep during the night improved, with a decrease in the number and duration of wakings and improved sleep consolidation. Sleep may have improved because the use of a routine may have decreased arousal level, resulting in improved sleep throughout the night. Inclusion of the bath may also have positively impacted sleep quality, as previous studies have found that a bath before bed helped adults get to sleep by lowering the core body temperature.

According to the researchers involved in the study, primary care practitioners play a critical role in helping families implement positive sleep practices and improving sleep in infants and toddlers.

The results of this study highlight the importance of pediatricians emphasizing the importance and ease of creating a bedtime routine as a preventative measure and treatment option for young children with sleep problems.

Contact: Kelly Wagner
American Academy of Sleep Medicine

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