Study: Irregular Bedtimes Make Children Misbehave

“Children with regular bedtimes less likely to misbehave, research shows,” The Guardian reports. The advice is prompted by a new study into the effects of irregular bedtimes on children’s behaviour.

The researchers studied more than 10,000 children whose behaviour and bedtime patterns were monitored when they were aged three, five and seven years.

It found children who had non-regular bedtimes had more behavioural problems over the years than those who had regular bedtimes. This was assessed using a validated mother- and teacher-completed behaviour questionnaire.

Encouragingly, the association between irregular bedtime and misbehaviour appears to be reversible. Many children with a previous history of ‘acting up’ experienced an improvement in behaviour once their bedtime patterns were better regulated.

child upset about bedtimeOne suggested explanation for the results was that those with non-regular bedtimes were getting less sleep. This could, potentially, affect the development of regions of the brain associated with behaviour regulation. However, they didn’t measure sleep directly so this remains an assumption.

This study alone cannot prove that other factors aside from bedtime patterns weren’t also influencing behaviour. Child behaviour is an incredibly complex area and many factors have the potential to affect it.

With these limitations in mind, setting a regular bedtime schedule is thought by most childcare experts to be an effective method of making sure your child gets the right amount, and improves the quality, of sleep.

Read more Healthy sleep tips for children.

Where did the story come from?

The study was carried out by researchers from University College London and was funded by a grant from the UK Economic and Social Research Council.

The study was published in the peer-reviewed medical journal Pediatrics.

Overall the media reporting of the study appeared accurate. Though the inherent limitation of the study – the fact that other, unaccounted for, factors may have been influencing behaviour (confounders) was not discussed.

What kind of research was this?

This was a cohort study measuring bedtime information and behavioural difficulties of the same group of children over a period of four years.

The study reported that the causal links between disrupted sleep and behavioural problems are not clear. So their study aimed to address the issue by answering the following questions:

  • Are bedtime schedules associated with behavioural difficulties?
  • Do effects of bedtime schedules on behaviour build up over early childhood?
  • Are changes in bedtime schedules linked to changes in behaviour?

A cohort study is useful for measuring changes over time, such as the impact of changes in bedtime patterns and behaviour. Limitations of this approach are discussed in the conclusions section.

A randomised control trial would be a more effective way to assess the impact of bedtime patterns on behaviour but this would be problematic to perform for practical and ethical reasons.

What did the research involve?

Information from 10,230 seven-year-olds from the UK Millennium Cohort Study was analysed – this is an on-going cohort study involving children born around the turn of the millennium. Bedtime information was collected at three, five and seven years, alongside behavioural difficulties scores as rated by mothers and teachers.

At three, five and seven year time points the child’s mother was asked, “On weekdays during term-time, does your child go to bed at a regular time?” (response categories were always, usually, sometimes, and never). These were then categorised into either “regular bedtime” (always or usually) or “non-regular bedtime” (sometimes or never) for analysis. Questions were not asked about bedtimes on weekends.

Behavioural difficulties were assessed by teachers and mothers who were asked to complete a validated questionnaire called the Strengths and Difficulties Questionnaire (SDQ), age four to 15 years version.

The SDQ asks questions about five domains of social and emotional behaviour, namely conduct problems (or in layman’s terms “being naughty”), hyperactivity, emotional symptoms, peer problems, and prosocial behaviour (behaviour intended to benefit others).

Scores from the first four domains are combined to construct a total difficulties score.

Children with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder were excluded from the study.

The analysis took into account observed reductions in behavioural difficulties scores as children get older, alongside numerous other potentially influential factors, known as confounders, such as household income, highest parental education, birth order of the child and psychological distress experienced by the mother.

What were the basic results?

In describing the study cohort the authors noted that children without regular bedtimes and those with later bedtimes (9 PM or later) had more socially disadvantaged profiles. For example, they were more likely to be from the poorest homes, have parents without degree level qualifications, and have mothers with poorer mental health. This was later adjusted for in the statistical analysis.

The main findings were:

  • There was an incremental worsening (“dose-dependent”) in behavioural scores the longer children were exposed to non-regular bedtimes. Behavioural scores got worse compared to those with regular bedtimes as they progressed through age three, to age five to age seven. The behavioural deterioration was reported by both mothers and teachers.
  • Children who changed from non-regular to regular bedtimes had statistically significant improvements in behavioural scores, changes that were described as “nontrivial” by the study authors.
  • For children who changed from regular to non-regular bedtimes between ages five and seven there was a statistically significant worsening in scores.

How did the researchers interpret the results?

The researchers’ main conclusions were that “having regular bedtimes during early childhood is an important influence on children’s behaviour” and that in light of the apparent reversibility of the bad effects “there are clear opportunities for interventions aimed at supporting family routines that could have important impacts on health throughout life”.


This large cohort study indicates that seven-year-old children with non-regular bedtimes have more behavioural difficulties, as reported by both mothers and teachers using a questionnaire, than children who had regular bedtimes.

There appeared to be a dose dependent relationship with the behaviour gap between regular and non-regular bedtimes widening as the children got older (from three to seven years old).

The behaviour-bedtime relationship appeared to be reversible in both directions as children who adopted new regular bedtimes improved behaviour and those who went from regular bedtimes to non-regular showed signs of deterioration.

There are a number of factors that need to be taken into account when considering the evidence provided by the researchers.


The study went to great lengths to adjust for common confounders that could account for differences in behavioural difficulties in children, other than potential lack of sleep due to irregular bedtimes.

Despite their efforts, as behaviour is influenced by so many factors, we cannot be sure that the differences observed are only due to bedtime patterns.

For instance, there may still be important factors, not measured in the study that have influenced these results, such as other unmeasured environmental and lifestyle habits. These could include the child’s diet and exercise, the type of games and other activities they take part in, use of electrical devices such as smartphones or tablets, number of people in the house, mental health history of the father, ethnic background and so on.

What constitutes a meaningful effect?

Another main consideration for this type of study is the magnitude of difference reported in behavioural difficulties between the regular and non-regular bedtime groups, and whether this is meaningful to the person or parents involved.

The study authors stated that a 0.9-point difference in behavioural scores would correspond to a small meaningful difference and that a 2.3-point difference would correspond to a moderate meaningful difference. Additionally, they reported a 1-point difference in behavioural difficulties scores has been shown elsewhere to predict clinically diagnosed problems. It is not clear if these definitions are accurate or whether the parents would agree that these changes were meaningful.

The magnitude of the behavioural differences shown in the study between the two bedtime groups ranged from 0.5 points to 2 points, so using the authors’ guide they appear to be small to moderately meaningful differences.

A change from non-regular to regular bedtimes between ages five and seven corresponded to a behavioural improvement of 1.02 points, suggesting many of the negative effects of non-regular bedtimes may be reversed.

The magnitude of a change from three years to seven years, was slightly less at 0.63 points.

Excluded groups

It should also be noted that none of the children in this study had diagnosed problems such as ADHD, so it is unclear what effect bedtime patterns would have on children with these sorts of chronic conditions.

Loss to follow-up

The study lost touch with approximately 12% of participants in the original cohort. They took reasonable steps to address this missing information in the analysis so this is unlikely to be a source of bias.


A further potential limitation is that the study did not record sleep quality or quantity directly (they used regular bedtimes as a proxy measure for this) and relied on the recall of events by mothers. This may have led to recall bias based on expectations that a set bedtime is something a good mother should be doing. However, this would make it less likely to find differences between the two groups.

The bottom line is that this study suggests there may be a link between non-regular bedtimes and increased behavioural difficulties, and proposed that lack of sleep was the likely causal link.

However, this study alone cannot prove that other factors weren’t also influencing the children’s behaviour or that non-regular bedtimes or lack of sleep were the main cause of the behavioural problems.

If your child’s behaviour is causing you concern you may want to look at their sleeping habits, and if needs be, encourage a more strict weekday sleeping routine. Children need much more sleep than adults, which depending on age can range from 11 hours for a five year old to 10 hours for a nine year old. Read more about How much sleep do kids need?

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.


“Children with regular bedtimes less likely to misbehave, research shows,” The Guardian reports. The advice is prompted by a new study into the effects of irregular bedtimes on children’s behaviour.

Links to Headlines

Links to Science

Kelly Y, Kelly J, Sacker A. Changes in Bedtime Schedules and Behavioral Difficulties in 7 Year Old Children. Pediatrics. Published online October 14 2013

Child Health & Safety News Roundup: 04-11-2016 to 04-17-2016

twitter thumbIn this week’s Children’s Safety News: Tinder’s Underage Section Raising Serious Cyber Safety Concerns

Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 15 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Health Officials Split Over Advice on Pregnancy in Zika Areas

Have No Fear – Allergy Safe Food is Here

Wherever there is a diagnosis of food allergies, there is also a fear of food.
The thought of social events, eating meals that are not from your own kitchen and trusting that someone else is giving you something that will be safe can be almost just as crippling as the diagnosis itself. Walking into a room of food can set off all sorts of internal struggles and anxieties that may simply make it unbearable to even attempt for some people. But what if that room full of food wasn’t scary or dangerous? What if that room full of food was actually a safe haven where all of the foods were clearly labeled, everyone handing out food had gloves on and answered each and every allergy question that you have about that food?GlutenFree Expo

Jen Cafferty, Founder & CEO of The Gluten Free Media Group shares a personal experience: “There was a family that came to the Secaucus, NJ GFAF Expo and when they walked in, their son had tears in his eyes. He was about 10 years old and was crying. I was worried that something was wrong but then he said ‘This is better than Disney! I can eat everything!’”

With multiple locations across the United States, the Gluten Free and Allergen Friendly Expo is the largest event for foodies with food allergies. Seeing the immediate need to offer more products for those with Celiac Disease, gluten sensitivities/ auto-immune/inflammatory disease and Autism, this expo is nothing short of a great way to regain your trust in food and to find new items that you didn’t even know were available for you.

For the price of an expo ticket you get:

  • 1 Day or Weekend entry to the vendor area with 100+ brands
  • A free reusable bag that has a bunch of wonderful items inside to add to it
  • Gluten free samples from the vendors
  • Discounts on many of the products at the event
  • Vendor coupons to help you save after the expo
  • Free classes to help you with a gluten free and allergen-friendly lifestyle
  • You also get to meet your favorite product vendors, authors and bloggers (like me!)

Why I Go

We all need a sense of community to strengthen our food allergy journey. I have personally found that attending these expos allows me to connect with other people on so many different levels. Being able to meet and talk to the product vendors about why they do what they do, what your family needs them for or even to recommend some new ideas brings about a newfound voice that many of us don’t know how to share. Bumping into other attendees and just having a conversation makes us realize that we are all in this together and regardless of how long we have known each other, what we do know is that someone else’s family is instantly our family in any allergic scenario. You may enter with caution because you are so used to fearing what these foods can do to you but when you leave, this will be the same food that GF Pastawill empower you to get through all of those difficult days. Between the delicious never-ending samples of food, the goody bags followed by even more goodies being handed out to you along the way and the personal touches of the expo, you will be reminded that food is fun. How long has it been since you felt comfortable saying that? Where else can you walk, talk, eat and have a picture taken with a giant fork? Whether you go alone or as a family, there is something for people of all age groups to pick up, pick at and pose for.

Our family has been to the Atlanta, GA Gluten Free and Allergen Friendly Expo twice: once as a family (shared here) and this time I was honored to be a part of their press team. The only difference between the two trips- it got even better. Why am I sharing? Because it’s part of my passion to help others with food allergies and I want everyone to feel good about their food allergies. When you feel out of control or lost, there are places to go and people to meet who will help you. Why not enjoy the journey along the way?

For more information on the Gluten Free and Allergen Friendly Expo visit

Information and Tips for Your Underweight Teen Daughter

If you’re underweight, it’s not just your energy that may suffer. How do pallid, blotchy skin, thinning hair and brittle nails sound?

underweight girlYou may have wondered for a while if you’re underweight. Perhaps friends or your parents have mentioned it.

You can check by using our interactive Healthy weight calculator.

If you’re underweight, your GP (*family doctor), practice nurse or school health visitor can give you help and advice.

There could be an underlying medical cause that needs to be checked out.

Or perhaps you haven’t been eating a healthy, balanced diet. That may be due to stress or other emotional problems.

During your teenage years, your body is changing. Sometimes, teenage girls may feel unhappy about these changes, but they are your body’s way of preparing you for pregnancy in later life.

Whatever the situation, if you’re concerned about your weight or your diet, the best thing to do is to tell someone. There’s lots that can be done to help.

Is It an Eating Disorder?

Even if you already know all about healthy eating, there may be other issues that are stopping you from having a healthy diet.

If you feel anxious when you think about food, or you feel you may be using control over food to help you cope with stress, low self-esteem, or a difficult time at home or school, you may have an eating disorder.

People with eating disorders often say that they feel that the disorder is a way of keeping control over their lives. But that’s an illusion: it’s not they who are in control, but the eating disorder.

If you feel you may have an eating disorder, help is available. Tell someone – ideally your parents or guardians, or another adult you trust.

You can learn more in Eating disorders.

Why Are You Underweight?

If our healthy weight calculator has told you that you may be underweight, think about why this might be.

  • Have you been unwell?
  • Have you been eating healthily, or have you been skipping breakfast or lunch and eating snacks on the go?
  • Have you lost your appetite because you’re stressed or worried?
  • Have you been trying to lose weight? Are you more focused on being thin than being a healthy weight?
  • Are you not eating because it gives you a feeling of control?

Why It Matters

Being underweight is bad for you. It’s bad news for your health now and for the future. The consequences include:

  • Lack of energy – being underweight can leave you feeling drained and tired. Not very useful if you’re trying to revise (*study) for exams, play sport or go out with your mates.
  • Nutritional deficiencies – if you’re underweight, you may be suffering from a lack of the vital nutrients your body needs to grow and work properly. Calcium, for example, is crucial for growing young women because it helps to develop strong and healthy bones. If you don’t get enough calcium, you risk having osteoporosis (fragile bone disease) later in life. Iron is also crucial for good health. After your period starts, you lose more iron through your menstrual blood. Other nutritional deficiencies could leave you with unhealthy skin and brittle or thin hair.
  • Weakened immune system – your immune system is not 100% when you’re underweight, so you’re more likely to catch a cold or the flu and other infections.
  • Delayed or interrupted periods – if your period hasn’t started yet, it may be delayed because you’re underweight. Or, if you’re having periods, these may stop if you’re underweight. That’s because being underweight can upset your hormones and stop them from working properly.
  • Damage to future fertility – if your periods stop because you’re underweight, you risk having problems getting pregnant later in life.

A Healthy Diet

If you’re underweight, aim to gradually gain pounds until you achieve a weight that’s healthy for your height and age.

But it’s crucial that you gain weight the right way. Chocolate, cakes, fizzy drinks and other high-calorie foods full of saturated fat and sugar are likely to increase your body fat, instead of your lean body mass.

Instead, use the following healthy eating principles:

  • Meals based on starchy carbohydrates such as wholemeal pasta, brown rice, potatoes or lentils.
  • Five portions of fruit and vegetables a day.
  • Lean protein from (meat, fish, beans and pulses).
  • Three portions of calcium a day. One portion can be a glass of milk, a yoghurt or a matchbox-sized piece of cheese.
  • Cut down on saturated fat found in processed meats, pies, cakes and biscuits.
  • Cut down on sugary foods and drinks, such as chocolate, cakes and biscuits and sugar-rich soft drinks.

If you’re trying to gain weight, eat foods that are healthy and packed with energy:

  • Make time for breakfast. Try porridge with chopped fruit or raisins sprinkled on top. Or eggs on toast.
  • Fruit smoothies or milkshakes make a great snack. You can make them at home and take them to school.
  • A jacket potato (*baked potato) with baked beans or topped with tuna makes a healthy lunch and contains both energy-giving carbohydrate and protein.
  • Peanut butter on toast is a quick, high-energy snack.
  • Try yoghurts and milky puddings, such as rice puddings.

Learn more about healthy eating in Food and diet.

Editor’s Note: *clarification provided for our US readers.


Child Health & Safety News Roundup: 04-04-2016 to 04-10-2016

twitter thumbIn this week’s Children’s Health News: Apple’s new short film starring autistic teen shows how tech transforms lives

Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 20 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Exploring bullying issues with loved ones can be a tough call, use poster creator
Great resource to get the conversation started

Beware the Power of Tools in Little Hands

Вoy with cordless screwdriversKids are fascinated by many things they see their parents do around the house. Things like cleaning, exercising, cooking, and painting just to name a few, but there are fewer things around the house that kids are fascinated by more than tools. Not just regular tools, not just big tools, any tools, and especially power tools. Many of us have taken the time to secure everything in our homes to make sure that the kids are as safe as they can be. But I bet if we look in the garage of most, if not all of us, we will find a battery in a charger that powers some sort of tool, and it will be in pretty close proximity to the tool it powers. Kids are curious and very fast learners. If your child has seen you clip that battery into the tool (like loading a clip into a handgun in their favorite video game or TV show), then there is a good chance they have already figured out how to do it themselves.

Gone are the days when all tools required an extension cord, now virtually every home tool has a battery pack you can charge and reuse over again. Just look at the ads on TV for the battery operated weed eaters, lawn mowers, chain saws, drills, nail guns, the list goes on and on, and this only makes turning on these tools kids find in the garage or tool shed that much easier. Non-power tools were estimated to have caused over 3000 injuries in children in the U.S last year, and power tools were estimated to have caused near 4000 injuries as well. What can we do? The answer like anything else is education and planning. If you have these tools in your home or on the property, please take the time and introduce the children to them and impress upon them how dangerous they are and how nobody ever touches them without an adult around. Much the same way you teach about weapons, scissors, and other dangers in the home, tools should be on that list as well.

Tool safety should be taught and emulated by adults. If you are going to teach your kids about tools then take the time and plan it right. Some things to think about are:

  • Eye protection. This is always a must and if you don’t do it, they won’t want to do it.
  • Proper setting. Make sure you are working in a well-lit, well ventilated area.
  • Proper dress. Make sure kids learn about covering up for protection from debris. Eyes, head, arms, legs.
  • RESPECT for the machine. Kids must understand they are working with dangerous tools.
  • Proper footing. Please don’t have your child stand on a wobbly chair and try using a tool. Good footing is a must.
  • Proper ways to hold and use tools.
  • Proper cleaning and storage.

These are just a few of the things to think about when teaching tool safety. Kids are quick studies and teaching basic safety before an accident may prevent one from occurring. Some major stores like Home Depot and Lowes have great kids workshops that are free and allow the kids to get hands on with tools and start on the road to using and learning about tools. As is true with any dangerous items, locking them up is always best, but not always possible, so do your best to keep them out of reach of the children. And as a side note, beware the charging batteries. There are numerous reports of battery chargers overheating and catching fire. Please read the recommended times to charge the batteries from the manufacturer.

I hope this helps and I hope to see all your kids building great things in the future!

Be Safe!