Early Childhood Bedtime Routines and Adolescent Objective Sleep: Facilitators, Barriers, and Mechanisms

Abstract

Improving sleep is a public health need, given the implications poor sleep has for the health of children and the wide disparities in sleep based on race and economic class (Hale et al., 2020). Consistent bedtime routines started before the age of five have been identified as one of the most beneficial practices for children's sleep and are often used in interventions and recommended by pediatricians (Mindell & Williamson, 2018). However, many parents experiencing poverty can find maintaining a bedtime routine challenging due to employment constraints and other factors (Adams et al., 2024). Moreover, adolescence is a period of increased vulnerability to sleep disturbances (Crowley et al., 2019), and the self-regulation fostered by early childhood bedtime routines may help preserve sleep quality and improve health (Staples et al., 2015). This dissertation examines predictors, mediators, and objective sleep outcomes of early childhood bedtime routines using data from Years 3, 9, and 15 of the Future of Families and Child Wellbeing Study (FFCWS), a birth-cohort study primarily focused on children born to unmarried parents. Bedtime routines at Year 3 were assessed through maternal-reported bedtime routine use, consistency, and four bedtime routine activity categories: physical contact, communication, hygiene, and nutrition. The first study tests maternal non-standard employment (i.e., night, weekend, variable shifts), child externalizing behavior, and maternal social capital as predictors and moderators of bedtime routine use, consistency, and activity type at age three. Results showed that maternal non-standard employment was associated with a lower probability of using a bedtime routine and communication activities. However, higher levels of social capital mitigated these differences, with greater social capital being linked to a higher probability of bedtime routine use and engagement in hygiene activities. Additionally, children with higher levels of externalizing behavior were more likely to have bedtime routines and use hygiene and nutrition activities. The second study tests whether mother-child closeness at Year 9 mediates the relationship between bedtime routines at age three and objective sleep and sleep variability at age 15. Mother-child closeness was reported by the child using a single-item measure at Years 9 and 15. Adolescent sleep was measured at Year 15 using actigraphy. Findings did not support a direct effect of mother-child closeness on adolescent sleep or a mediation effect between bedtime routines and sleep outcomes. However, results showed that engagement in communication activities (e.g. reading) at age three was associated with a more consistent sleep schedule at age 15, as reflected in less variability in time in bed and total sleep minutes. Communication activities were also marginally associated with less variability in wake after sleep onset (WASO). Additionally, physical contact activities at age three (e.g., cuddling) were associated with significantly better average sleep quality, including higher sleep efficiency and lower WASO, at age 15. Taken together, the current study illustrates that bedtime routines are sensitive to family contexts and a useful tool for promoting sleep across development.