Guest blogging today with regular contributor W. Douglas Tynan, PhD, is Meghan Walls, PsyD, a pediatric psychologist at Nemours/AI duPont Hospital for Children.
Do your children go to bed at the same time every night? Do they get the same set amount of hours of sleep before waking in the morning? Does it matter?
A Pediatrics study released online today takes a distinctive stance on these questions: Certainly. Researchers from University College in London, England analyzed data from more than 10,000 children in the UK Millennium Cohort Study, with bedtime data collected at 3, 5, and 7 years, as well as reports from the children's mothers and teachers on behavioral problems.
They found that not only did inconsistent bedtimes yield more difficult behaviors, but that it worked in a dose-response pattern. That is, for each year the child had inconsistent bedtime, behavior became worse. The good news is that leaves room for change; a set bedtime can improve behavior.
While knowing our children should sleep regularly and well is not a novel development, the connection between regular bedtimes and behavior is new. The researches posit that a consistent and regular bedtime itself, not just the quantity of sleep that occurs, helps children regulate circadian rhythms, be generally less sleep deprived, and have significantly decreased behavior problems.
Further, the article also focuses on an important and possibly overlooked fact, as author Yvonne Kelly writes, "Children without regular bedtimes and those with later bedtimes (9 p.m. 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." It makes sense then, that in pediatric practices, especially within these communities, sleep should be an important aspect of patient care.
My everyday practice is within a low income, urban primary care setting. It is common for families to come in to see their physician about their child's difficult behavior. The physicians often send them my way with their main concern being behavior. There are many facts that I need to know about the patient families, but sleep is one of my first pointed questions. I don't just ask "What time does your child usually go to bed?" because that gives parents a chance to estimate and likely present their situation more ideally. Instead, I ask, "What time did your child go to bed last night?" The number of parents who respond with a bedtime of between 10:30 p.m. to 1:30 a.m. is absolutely staggering. Further, there is no set bedtime. A school aged child needs 10 to 12 hours of sleep per night to be well rested. Many do not get that many hours.
One of the most profound sleep cases that I've seen came in a few months ago. Two parents were convinced that their 8-year-old child had ADHD and probably worse. He woke up every day screaming and hitting at them. He couldn't focus in class. He was a force to be reckoned with come evening. I asked them about sleep. They seemed confused that I wanted to know about bed time when they were coming for help with behavior. I learned that his bed time ranged anywhere from 9:30 p.m. until 3:30 a.m. with no set schedule.
On school days, this meant about three to four unregulated hours of sleep some nights. He watched television until he drifted off, often woke up from a loud noise or bright flash from the screen, and he'd have to try to fall asleep again. I asked them, for one week, to work on sleep hygiene, setting an appropriate consistent bed time (we counted back 10 hours from wake up and made that their goal), and turning off the TV at least 30 minutes before bedtime.
The child is a different kid now. There is no morning screaming. He gets up and ready for school without a problem. Some concerns still remain about attention, but now we can focus on that instead of his sleep deprivation. It's not a "quick" fix, but it should be one of the first things that we try to change if sleep seems to be problematic for a child. These parents praise sleep for the change in their son.
When I hear about how difficult it is for parents to handle their kids' behavior, my mind always goes to sleep first. Is your child going to bed on time? What is their bedtime? How can we get them on track with solid consistent sleep before we decide what behavioral disorder may be present?
Children who are sleep deprived often have poor behavior, and we already know that appropriate sleep buffers against a number of difficulties for children, including negative behaviors, learning difficulties, and weight gain. The latest study is another reminder for practitioners and parents alike to aim our efforts in the right direction: solid, consistent sleep hygiene and set bedtimes are an essential part of childhood health and mental health.
Interested in how to get your child on track? Check out these helpful tips and links:
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