Consistent bedtime routines in infancy improve children's sleep habits through age 2

Consistent bedtime routines and activities such as reading books and cuddling with caregivers beginning when infants are 3 months old promote better sleep habits through age 2, a recent study suggests.

Researchers at the University of Illinois Urbana-Champaign found that greater numbers of bedtime-related activities at age 3 months predicted longer sleep duration at 12 months. Likewise, when caregivers engaged in more bedtime-related activities with their infants at 12 months, the children slept longer and had fewer sleep problems at ages 18 months and 24 months.

The findings, reported in the journal Sleep, underscore the importance of bedtime routines in promoting positive sleep outcomes, said lead author Barbara H. Fiese, the co-director of STRONG Kids 2, a program at the U. of I. that promotes nutrition and healthy habits in families with young children.

"Although bedtime routines have been associated with better sleep outcomes for older children and adults, our study is one of the first to look at their effects on children during the first two years of life," said Fiese, who is also a professor emerita of human development and family studies. "These findings suggest that as early as 3 months of age it is important to establish simple bedtime routines such as book reading and a regular bedtime to promote good sleep habits at age 2."

Fiese's team surveyed 468 mothers beginning when their infants were 3 months old, and again when the children were 12 months, 18 months and 24 months old. The mothers were asked about their child's sleep habits, including their bedtime, wake time, the amount of time the child took to fall asleep and the number of times they awoke during the night.

The mothers also reported on the bedtime-related activities they engaged in with their child, including hygiene-related activities such as bathing and brushing their teeth, along with putting on their pajamas, reading or listening to stories and saying goodnight to family members.

The researchers tracked the consistency of families' bedtime practices, such as their putting the child to bed at approximately the same time every evening and how frequently they engaged in bedtime-related activities.

Parents' reported bedtimes for the children covered a wide range, from about 6 p.m. to about midnight, the researchers found. On average, however, the children went to bed at about 9:30 p.m. at three months of age and closer to 9 p.m. at 24 months.

Sleep problems more than doubled, from 4.9% at age three months to 10.6% at age 24 months, according to the parents' reports and those of national surveys, Fiese said.

Nighttime waking declined steadily as the children got older, with more than 43% of the infants waking during the night at age three months to just over 15% at age 24 months.

The researchers found that girls were more likely than boys to have sleep problems at 12 months and experienced more nighttime waking at 24 months.

"When bedtime routines were consistent, parents reported that the children slept longer from age 12 months onward, and there was less nighttime waking and fewer sleep problems at 18 months," said co-author Kelly Freeman Bost, a professor of child development.

"Similar associations were found with bedtime-related activities, which increased in frequency as the children got older. When parents engaged in a greater number of these activities, children had better sleep outcomes, including longer sleep duration at ages 18 months and 24 months."