title: Bedtime routines for young children: a dose-dependent association with sleep outcomes.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Sleep Center, Children's Hospital of Philadelphia and Department of Psychology, Saint Joseph's University, Philadelphia, PA.
authors.forename: Jodi A
authors.initials: JA
authors.lastname: Mindell
authors.affiliation: Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Albert M
authors.initials: AM
authors.lastname: Li
authors.affiliation: School of Psychological Sciences, Tel Aviv University, Tel Avi, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sadeh
authors.affiliation: Johnson & Johnson Asia Pacific, Division of Johnson & Johnson Pte, Ltd.
authors.forename: Robert
authors.initials: R
authors.lastname: Kwon
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Daniel Y T
authors.initials: DY
authors.lastname: Goh
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D002652:Child Behavior / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000502:physiology; D007231:Infant, Newborn; D038622:Internationality; D008297:Male; D009035:Mothers / Q000523:psychology; D012890:Sleep / Q000502:physiology*; D056508:Sleep Medicine Specialty / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014851:Wakefulness / Q000502:physiology; D044465:White People / Q000706:statistics & numerical data
keywords: bedtime routine; infant; preschooler; sleep; toddler