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How to Overcome Sleeping Challenges with Your Young Child

Lots of young children find it difficult to settle down to sleep and will wake up during the night.

For some people, this might not be a problem. But if you or your child are suffering from lack of sleep, there are some simple techniques you can try.

Every child is different, so only do what you feel comfortable with and what you think will suit your child.

If your child won’t go to bed

If your child won’t go to sleep without you

More sleep tips for under-fives

Help your disabled child to sleep

Help with children’s sleep problems

If your child won’t go to bed

  • Decide what time you want your child to go to bed.
  • Close to the time that your child normally falls asleep, start a 20-minute “winding down” bedtime routine. Bring this forward by 5-10 minutes a week – or 15 minutes if your child is in the habit of going to bed very late – until you get to the bedtime you want.
  • Set a limit on how much time you spend with your child when you put them to bed. For example, read only one story, then tuck your child in and say goodnight.
  • Give your child their favourite toy, dummy (*pacifier) (if they use one) or comforter before settling into bed.
  • Leave a beaker (*cup) of water within reach and a dim light on if necessary.
  • If your child gets up, keep taking them back to bed again with as little fuss as possible.
  • Try to be consistent.
  • You may have to repeat this routine for several nights.

If your child won’t go to sleep without you

This technique can help toddlers (over 12 months) or older children get used to going to sleep without you in the room.

It can also be used whenever your child wakes in the middle of the night.

Be prepared for your child to take a long time to settle when you first start.

You can use strokes or pats instead of kisses if your child sleeps in a cot and you can’t reach them to give them a kiss.

  • Have a regular, calming bedtime routine.
  • Put your child to bed when they are drowsy but awake and kiss them goodnight.
  • Promise to go back in a few moments to give them another kiss.
  • Return almost immediately to give a kiss.
  • Take a few steps to the door, then return immediately to give a kiss.
  • Promise to return in a few moments to give them another kiss.
  • Put something away or do something in the room then give them a kiss.
  • As long as the child stays in bed, keep returning to give more kisses.
  • Do something outside their room and return to give kisses.
  • If the child gets out of bed, say, “back into bed and I’ll give you a kiss”.
  • Keep going back often to give kisses until they are asleep.
  • Repeat every time your child wakes during the night.

See more tips from Barts Health NHS Trust on helping young children to sleep (PDF, 219kb).

More sleep tips for under-fives

  • Make sure you have a calming, predictable bedtime routine that happens at the same time and includes the same things every night.
  • If your child complains that they’re hungry at night, try giving them a bowl of cereal and milk before bed (make sure you brush their teeth afterwards).
  • If your child is afraid of the dark, consider using a nightlight or leaving a landing (*hallway) light on.
  • Don’t let your child look at laptops, tablets or phones in the 30-60 minutes before bed – the light from screens can interfere with sleep.
  • When seeing to your child during the night, be as boring as possible – leave lights off, avoid eye contact and don’t talk more than necessary.
  • Avoid long naps in the afternoon.

Help your disabled child to sleep

Sometimes children with long-term illnesses or disabilities find it more difficult to sleep through the night. This can be challenging both for them and for you.

Contact a Family has more information about helping your child sleep.

The Scope website also has sleep advice for parents of disabled children.

More help with children’s sleep problems

It can take patience, consistency and commitment, but most children’s sleep problems can be solved.

If your child is still having problems sleeping, you can talk to your health visitor.

They may have other ideas or suggest you make an appointment at a children’s sleep clinic, if there’s one in your area.

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





Study: Can Music Help Premature Babies Sleep and Feed?

music-and-premature-babies“Playing music to premature babies ‘helps them sleep and improves their breathing’,” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies.

While positive effects were found, it is still unclear whether this will lead to tangible health improvements.

The researchers in this study speculate that being born premature could be traumatic (from an acoustic perspective) for two reasons:

  • The baby is prematurely separated from the sound of the mother’s heartbeat and the sounds they were accustomed to in the womb
  • The baby is ‘plunged’ into the noisy environment of a neo-natal intensive care unit

Researchers wanted to see whether exposing premature babies to more comforting sounds could help compensate for these proposed sources of trauma.

They investigated three types of live music therapy, administered with the help of a certified music therapist:

  • A lullaby or any other song chosen by the parent that was modified to be like a lullaby, preferably sung by a parent
  • An instrument designed to replicate womb sounds
  • An instrument that sounded like a heartbeat

The researchers found that the therapies were associated with slowing of infants’ heartbeats, calmer breathing, and improved feeding and sleep patterns. The therapies were also associated with decreased stress levels in the parents.

It is unclear whether music therapy does improve premature babies’ health outcomes. For example, if infants receiving music therapy are able to leave hospital earlier or have better long-term health outcomes.

Where did the story come from?

The study was carried out by researchers from the Beth Israel Medical Centre, New York and was funded by the Heather on Earth Music Foundation, a non-profit organisation that provides funding for music therapy programmes in children’s hospitals.

The study was published in the peer-reviewed journal Pediatrics. This article was open access, meaning that it can be accessed for free in full from the journal’s website.

This research was well-covered by the Daily Mail. The paper also contains an aside (presumably included in an accompanying press release) that one parent chose to sing a ‘lullabied’ version of Marvin Gaye’s soul classic ‘I Heard It Through the Grapevine’ and another chose 70’s funk standard ‘Pick up the Pieces’ by Average White Band.

What kind of research was this?

This was a randomised crossover trial that aimed to determine whether three different live music interventions in premature infants could affect:

  • Physiological functions, such as heart and respiratory rates, oxygen saturation levels and activity levels
  • Developmental function such as sleep patterns, feeding behaviour and weight gain

The three interventions administered with the help of a certified music therapist were:

  • A lullaby, either Twinkle, Twinkle Little Star or any other song chosen by the parent which was modified to be like a lullaby, preferably sung by a parent
  • An ‘ocean disc’ musical instrument, which is a round disc containing metal beads that aims to replicate womb sounds
  • A ‘gato box’, a 2- or 4-tone wooden box or drum that is played with the fingers to provide a rhythm in a manner that simulates the heartbeat sound that the baby would hear in the womb

The ocean disc and the gato box were played live and were coordinated to the infant’s breath rate. All infants received each of the three possible treatments (lullaby, gato box, ocean disc) as well as a control where no sound stimulation was given.

A randomised crossover trial is similar to a randomised control trial, but after a participant has received one treatment they are swapped over to another treatment arm, meaning that all participants received all three treatments and the control.

The trial design does have the disadvantage that the benefits obtained from one treatment might still be present when a second treatment is tested.

What did the research involve?

The researchers recruited 272 premature infants aged at least 32 weeks old with respiratory distress syndrome, clinical sepsis and/or small size for gestational age in neonatal intensive care units.

The infants received each of the three possible treatments (lullaby, gato box or ocean disc) or no explicit sound stimulation (to act as a control).

Each treatment was given twice during the two-week trial (three treatments per week). The day each treatment was given and the time of day (morning or afternoon) was randomised. If the infant received an intervention in the morning, the control was given in the afternoon and vice versa. The interventions were delivered by music therapists in conjunction with parents.

Heart rate, oxygen saturation, respiratory rate and activity level were measured at one-minute intervals during the 10-minute phase before the intervention, the 10-minute phase during, and the 10-minute phase after the intervention.

The researchers also analysed the infants’ vital signs, feeding behaviours, and sleep patterns daily during the two-week period.

In addition, self-perceived stress levels in parents of infants in neonatal intensive care were assessed before and after the two-week trial.

What were the basic results?

Activity Level

The percentage of ‘quiet-alert time’ (one of several states of alertness ascribed to newborns) increased during a lullaby. After the lullaby, it decreased.

Heart Rate

All three interventions showed a significant effect over time (before, during, after) on heart rate. Heart rate decreased the most during the lullaby and gato box interventions, and after the ocean disc treatment.

Respiratory Rate

The ocean disc also decreased the number of inspirations per minute during and after the treatment.

Developmental Behaviours

Use of the ocean disc was associated with increased ‘positive sleep patterns’ and ‘sucking pattern behaviour’ increased after the gato box treatment.

Parental Stress

The music interventions were also associated with a decrease in parents’ perception of stress.

How did the researchers interpret the results?

The researchers conclude that the live sounds and lullabies applied by a certified music therapist can influence cardiac and respiratory function, may improve feeding behaviours and sucking patterns, and may increase prolonged periods of quiet-alert states. These interventions also decrease the stress felt by parents of premature infants.

Conclusion

This research has found that live music therapies may slow infants’ heartbeats, calm their breathing, improve sucking behaviour important for feeding, improve sleep patterns and promote states of quiet alertness.

Different interventions led to different patterns of improvement, but all three types of musical therapy appeared to have a positive effect on the infant. The therapies also seemed to help the parents of premature infants feel less stressed.

Although this research is interesting, it is still unclear whether music therapy can lead to tangible health improvements, for example, the researchers did not measure whether infants receiving music therapy were able to leave hospital earlier or had better long-term health outcomes.

There are also practical considerations in that access to musical therapists is likely to be limited.

Despite these limitations, the study seems to provide a degree of evidence that the deep-seated human instinct to sing lullabies to your baby does them good.

For more information, read Getting your baby to sleep

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

Summary

“Playing music to premature babies ‘helps them sleep and improves their breathing'” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies. While positive effects were found, it is still unclear.

Links to Headlines

Links to Science





Sleep Apnea and Snoring in Kids – When Should You Worry?

You’re in the den watching the late news, your child is in bed and you hear snoring that seems louder and more interrupted than usual. What does it mean? Should you be concerned with snoring?

Well that depends on whether it’s upper airway restriction and mostly just noise or worse, i.e. sleep apnea.

Here’s the problem. Small diameter tubes can get less air through them than large tubes. That is the key to air flow and breathing well. Also, air flow and easy breathing relate directly to oxygen getting to the lungs and then to the brain. The actual airway size is not diagnostic for whether your child has obstructive sleep apnea (OSA) in every case. But, OSA is more likely to occur in patients with smaller airways. A smaller sized airway doesn’t have to even result in OSA for it to be a problem. What matters is when that airway is partially or totally blocked during the night by the tongue, enlarged tonsils or adenoids, small nares or swollen sides of the mouth and throat. When this happens it is a serious medical problem.

Children who struggle to breathe have far less energy than those with a normal airway. Studies have shown that many, many problem stem from oxygen deprivation at night while sleeping: high blood pressure, mental fogginess, ADD, heart disease and much more. Neurological changes become permanent after a while so need to be addressed as soon as they are found. A disruption in the normal four stages of sleep makes a child grumpy, irritable, and even unruly. Sleep problems can then turn into muscle and growth problems. Normal sleep is essential for brain health.

A change of a few millimeters in airway opening can dramatically affect air flow. We know that arrested growth of anatomic structures in the head and neck cause a blocked airway due to scar tissue, genetic disorders, obesity, enlarged tonsils, adenoids, allergies and such. As dentists we want to see open airways for normal growth. Physicians must play an important role in helping keep the airway open and normal during the growth years or permanent damage is done. The diagnosis of whether it’s snoring or sleep apnea must come from a proper sleep study.

An early intervention to enlarge the airway diameter and openness in childhood will often result in the patient not developing OSA as an adult. We see this from the use of expansion appliances that make the palate wider, move the front teeth forward and by allowing the lower jaw to come forward and not be “trapped” back in a choked position against the throat. When the tongue has enough room and is held naturally in a forward position, the airway can work naturally and not be blocked all night long. From this you can see that orthodontics and orthopedic development of the jaws is far more critical than just making the teeth look pretty and straight.

When looking for a dentist or orthodontist for your child always ask if they know about the treatment of sleep apnea in adults and children and how to prevent OSA as well as treat it accurately.

Why Teens are Always Tired…and What You Can Do

Trouble getting up on school days, dozing off in class, marathon lie-ins at weekends … You’d be forgiven for thinking teenagers sleep their lives away.

why-teens-are-always-tiredIn fact, the opposite is true. Sleep experts say teens today are sleeping less than they ever have. This is a worry, as there’s a link between sleep deprivation and accidents, obesity and cardiovascular disorders.

Physiological changes, social pressures and external factors such as TVs and other stimulating gadgets in the bedroom contribute to late nights and mood swings.

Lack of sleep also affects teenagers’ education, as it can leave them too tired to concentrate in class and perform to their best ability in exams.

Teen Sleep Thieves

Our sleep patterns are dictated by light and hormones. When light dims in the evening, we produce a chemical called melatonin, which gives the body clock its cue, telling us it’s time to sleep.

“The problem is that society has changed,” says Dr Paul Gringras, consultant paediatrician and director of the Evelina Paediatric Sleep Disorder Service at Guy’s and St Thomas’ Hospital in London.

“Artificial light has disrupted our sleep patterns. Bright room lighting, TVs, games consoles and PCs can all emit enough light to stop the natural production of melatonin.”

Other distractions include mobile phones and instant messaging, which teens may use well into the night.

These all worsen the usual changes taking place in the body during adolescence, which means teenagers fall asleep later in the evening.

“That wouldn’t be a problem if there was no need to get up early in the morning for school,” says Dr Gringras.

“The early-morning wake-ups mean they’re not getting the average eight to nine hours of sleep. The result is a tired and cranky teenager.”

Several school districts in the US have introduced later start times for pupils in an effort to improve their performance, although results have been mixed.

How the Body Clock Affects Sleep

“Catching up on sleep at weekends isn’t ideal. Late nights and long lie-ins further disrupt the body clock,” says Dr Gringras.

In severe cases, an individual’s body clock can be so different to everyone else’s that they can’t fall asleep until late at night. This condition is called delayed sleep phase syndrome (DSPS). It’s similar to the feeling of jet lag and is a disorder of the body’s timing system.

Treatment for DSPS includes bright light therapy – such as exposure to a bright light for about half an hour every morning – and chronotherapy, which involves restoring the individual’s natural sleep phase.

“Sometimes we give a small dose of melatonin in the evening, about an hour or so before bedtime,” says Dr Gringras. “Over the long term, this helps to reset the body clock.”

“However tired they feel, they should avoid lie-ins at the weekend. They should get exposure to outdoor light,” he says.

Getting Help for Sleep Problems

A range of services for sleep problems can be accessed through the NHS. Your GP (*pediatrician or family doctor) can tell you more about this.

Dr Gringras says: “Your doctor will also be able to give you basic advice on addressing sleep issues and, where appropriate, recommend a sleep clinic.”

Find your local NHS sleep medicine services.

See Sleeping tips for teenagers for more advice.

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

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”.

Conclusion

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.

Confounders

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.

Self-reporting

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.

Summary

“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

Study: Kids’ Bedtimes May Impact their Test Scores

“Set bedtimes can lead to cleverer children,” the Daily Express reports, while BBC News and others report that late nights “sap children’s brain power”. But looking at the study these headlines are based on, it appears that most of these claims are misleading.

Essential Sleep Habits for KidsThe news comes from a large UK study looking at whether regular bedtimes affect children’s reading, maths and spatial ability scores at age seven.

The study found that irregular bedtimes at age three were independently associated with slightly lower cognitive scores at age seven. It also found that in all three tests, girls (but not boys) who had irregular bedtimes at age seven had slightly lower scores than those with regular bedtimes.

The researchers suggest that disrupted sleep patterns may hamper kids’ concentration, and that lack of sleep may disrupt the brain’s ability to learn.

However, regularity of bedtimes is hard to measure and may be caused by underlying factors, such as a chaotic family life, which may contribute towards lower cognitive functioning.

While the researchers attempted to adjust for these factors (known as confounders), this is unlikely to have completely removed their influence.

Is your child a problem sleeper?

If you regularly have problems getting your child to sleep, it’s worth reading about some of the common sleep problems in children.

Exhausted parents may also find these healthy sleep tips useful.

Where did the story come from?

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

It was published in the peer-reviewed Journal of Epidemiology and Community Health.

As might be expected, the study was widely covered in the media, with some reports stressing the advantages of set bedtimes. For example, ITV News claimed regular bedtimes could “boost brain power”, a headline that is not supported by this study’s findings.

The results actually suggest that irregular bedtimes may disrupt the normal pattern of child development – set bedtimes neither “boost” nor disrupt “brain power”.

And while most news reports were basically fair, some of the claims overinterpreted the study’s results. Researchers tested the children’s maths, reading and spatial ability only once. While important, this is hardly a reliable measure of how clever the children were, or of the “power” of their brains.

What kind of research was this?

This was a large cohort study of more than 11,000 seven year olds in the UK. It looked at whether there were any links between regular bedtimes in early childhood and cognitive test scores at age seven.

A cohort study enables researchers to follow large groups of people for lengthy periods, and to study any associations between lifestyle (such as bedtimes) and a particular outcome (such as cognitive test scores). However, on its own it cannot prove a direct cause and effect relationship (causality).

The researchers say that in childhood, reduced or disrupted sleep at key times of development could have an important impact on health throughout life. But most research into sleep and cognitive function has been done in adults and adolescents.

The researchers also say that busy family lives and full-time employment could leave parents and carers feeling as if they do not have enough time with their children. This means there could be an increasing number of parents or carers who delay bedtimes or do not stick to a routine.

What did the research involve?

The researchers used a sample of children from the Millennium Cohort Study. This is an ongoing nationally representative cohort study looking at health outcomes in children who were born in the UK between 2000 and 2001.

Families were visited at home when the children were aged nine months, and three, five and seven years old. During these visits, parents were asked a range of questions about socioeconomic circumstances and family routines.

When the children were aged three, five and seven, their mothers were asked whether they always, usually, sometimes or never went to bed at a regular time on weekdays and during term time. Information about bedtimes at weekends was not collected by the researchers. For five and seven-year-olds with regular bedtimes, researchers also asked what time they went to bed.

At age seven, trained interviewers carried out cognitive assessments of the children. Using established tests, the interviewers assessed three aspects of cognitive performance – reading, maths and spatial ability (the capacity to think about objects in two or three dimensions, such as using a map to navigate).

The researchers conducted two analyses:

  • Whether the time a child goes to bed and the consistency of his or her routine was associated with performance in tests at the same age (a cross-sectional analysis)
  • Whether there was any association between test performance at seven and bedtimes at the earlier ages of three and five – this was to see if there was any “cumulative effect” of bedtime on cognitive ability, or if there were “sensitive periods” during early childhood where bedtime is more critical, for example, if a disruption of bedtime routine in early childhood leads to future problems

The researchers created various models to take account of confounders that might influence the results of the study, including:

  • Child’s age
  • Mother’s age
  • Family income
  • Educational qualifications of parents
  • Mother’s psychological health
  • Methods of discipline
  • Daily activities
  • Hours spent watching TV or using a computer

The researchers used three types of statistical model:

  • Model A, which adjusted the results for the child’s age
  • Model B, which adjusted for factors known to have an effect on cognitive development, such as parental education or whether parents read to or tell their child stories daily
  • Model C, which adjusted the results for factors known to effect quantity and quality of sleep, such as whether a child has a TV in their bedroom

What were the basic results?

The researchers found that irregular bedtimes were most common at age three. At this age, around one in five children went to bed at varying times. By age seven, more than half the children went to bed regularly between 7.30 and 8.30pm.

  • At age seven, girls who did not have a regular bedtime performed worse than those who did in tests for reading, maths and spatial ability. This result was found in all three statistical models. The same association was not found in boys of the same age.
  • Irregular bedtimes at age three were independently associated with lower reading, maths and spatial ability scores at age seven in both girls and boys.
  • Girls who never had regular bedtimes at ages three, five and seven had significantly lower reading, maths and spatial scores at seven years than girls who did have regular bedtimes. For boys, this was the case for those with irregular bedtimes at any two of the ages.

The researchers found that children who had irregular or later bedtimes tended to come from more socially disadvantaged backgrounds. They were also more likely to have mothers with poor mental health and have more unfavourable routines, such as skipping breakfast or having a TV in the bedroom. However, time pressures, parental employment and whether parents felt they spent enough time with their child were not associated with later or inconsistent bedtimes.

How did the researchers interpret the results?

The researchers suggest that inconsistent bedtime schedules might affect cognitive development by disrupting circadian rhythms or by affecting the brain’s “plasticity” – the ability to acquire and retain information.

They also suggest that the effect is cumulative and that age three could be a sensitive period where cognitive development is affected by late or inconsistent bedtimes. They say girls might be more susceptible to irregular bedtimes than boys.

They also suggest that inconsistent bedtimes during childhood could have knock-on effects throughout life.

They add that policies are needed to better support families to “provide conditions in which young children can flourish”.

Conclusion

This was a large nationally representative sample of children who were followed for several years, so the results are more likely to be reliable than small, short studies.

Getting regular sleep is important for children’s health, and children require more sleep than adults, so it is not surprising that children going to bed late at age seven also perform worse in mental tests.

Of concern, too, is the suggestion that irregular bedtimes at earlier ages might affect children’s mental performance at the age of seven.

However, it should be noted that the study has the following limitations:

  • Children were only tested for cognitive ability once
  • Not having a regular bedtime at three was associated with only a small difference in test scores at seven
  • It is possible that other factors, such as social deprivation, affected test scores, although the authors tried to take these into account
  • The study relied on parental recall of bedtimes, which might affect the reliability of the reported data
  • As the authors point out, direct data on the children’s actual sleep quantity and quality was not available – a study recording this could have led to more accurate results

Bedtime routines are important for children. Anyone who has persistent problems getting young children to bed should talk to their GP.

Read more about common sleep problems in children.

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

Summary

“Set bedtimes can lead to cleverer children,” the Daily Express reports, while BBC News and others report that late nights “sap children’s brain power”. But looking at the study these headlines are based on, it appears that most of these claims are overstated.

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