Bedtime Routines: More evidence and step-by-step guide

By Nestor Lopez-Duran PhD

FRIDAY BRIEFS:

Routines are good. Routines are effective. Routines are adaptive. As a rule of thumb, most parents should use structured routines with their children.

I could end this post right here. The research about routines is so strong  that I feel comfortable breaking this blogs policy of not providing clinical advice when saying that unless you have specific clinical reasons, most parents of infants and toddlers should use bedtime, mealtime, and other daily routines. But in the science-based spirit of this blog, let me talk briefly about one more study showing the benefits and effectiveness of bedtime routines, and then I will explain how to implement a bedtime routine.

This study was conducted by Dr. Jodi Mindell and her colleagues at Childrens Hospital in Philadelphia. The study included 405 mothers with 207 infants and 199 toddlers. The mothers were randomly assigned to a bedtime routine or a control group. After only 3 weeks, the children experiencing the bedtime routines had:

  1. Faster sleep onset
  2. Less night wakening episodes
  3. improved maternal mood!!

Bedtime routines are safe, effective, and usually the standard treatment intervention for toddlers and infants with sleep problems. Routines are so effective, that bedtime sleep problems are one of the most treatable behavioral disorders in early childhood. And as an additional bonus, bedtime routines are associated with positive outcomes in the parents too, including improved marital satisfaction (see for example Pediatrics Vol. 84 No. 5 ).

Often parents say there is no way my kid will follow a routine, or fighting his bed time is a losing battle, he always wins, or I have tried routines and they dont work. This sense that routines wont work is often stronger among parents who dont have a bedtime for their kids and feel that it is now too late to implement a bedtime or a routine.  It is true that routines will not work for every single case. But for the majority of kids, routines will significantly improve sleep problems. The key issue here is knowing how to properly implement a routine.  Thus, let me briefly describe one method that has been found effective, specially with difficult children with no bedtimes (or very late bed times).

For kids with no bedtimes, it is very difficult to implement a bedtime routine with a new sleep time if this is done abruptly. For example, if your toddler is used to running around the house until 10 or 11pm, it is very unlikely that you will be able to get him to sleep at 8pm the day, or even week, you decide to implement a bedtime routine. In this case, one approach is to use a gradual positive bedtime routine procedure. The procedure works like this:

  1. First, identify the time your child usually falls asleep on her own. 9? 10? 11?
  2. Now, build a bedtime routine of 4 to 5 activities that last no more than 30 minutes with the last 15-20 minutes  in bed. For example you can start the routine 30 minutes before the desire sleep time by having the kid brush her teeth, wash her face, put on pajamas, followed by a bedtime story, etc. Make sure that a) this routine is the same every night (same order), b) avoid activities that make your child excited (playing active games, watching TV, etc), c) dont extend the routine or make exceptions ( just 5 more minutes pleeease).
  3. Start the routine 30 minutes before the kids current sleep time. At the end of the routine, simply tell the child its time to sleep. (see below for what to do if the child refuses)
  4. Use this routine at exactly the same time for at least a week. Then start the routine 10 minutes earlier and maintain that time for at least another week. You can continue to change the time every 1-2 weeks until you get the child to sleep at the time you consider best for your kid.

A few additional considerations:

  • If the child refuses to sleep at the end of the routine and tries to get out of bed etc, you would need to use an extinction method. Put the child gently back in bed, give her a kiss, and firmly but softly tell her its time to sleep (avoid saying anything else). Dont fall in the trap of starting negotiations with your kid at this time. It is time to sleep, nothing else. If you have to use the extinction method, please know that initially it will take many many tries until your child finally falls as sleep. It may be a very tough battle, but you will eventually prevail, and remember that you are doing all of this for the benefit of your child.
  • Give your kid a heads up that the routine is about to start 30 minutes before the start of the routine (thats 1 full hour before sleep time).  Then give her a 20, 10, and 5 minute notices. This will give her time to self regulate and prepare for the change. It is easier for the child to transition into the routine after being provided with such notices, than if abruptly interrupted in the middle of an activity.

Routines are relatively easy to implement and research supports that such routines are effective in reducing sleep problems.  Tell us about your experiences implementing bedtime routines.

The reference: Jodi A. Mindell, Lorena S. Telofski, Benjamin Wiegand, & Ellen S. Kurtz (2009). A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood Sleep, 32 (5), 599-606