Impact of Bedtime Routines on Sleep and Development in Toddlers

Not Applicable

Completed

• Conditions: Sleep; Child Development; Sleep Disturbance
• Interventions: Behavioral: Bedtime Routine Education

• Registration Number: NCT04592172
• Lead Sponsor: Saint Joseph's University, Philadelphia

Brief Summary

Investigators will recruit up to 100 families (children aged 12.0 to 14.9 months and their primary caregivers) at their scheduled 12-month well child care infant visit at Temple Pediatric Care. The purpose of this randomized controlled trial is to examine the impact of implementation of a bedtime routine program, Connect, Calm, \& Comfort: 3 Cs for Bedtime ZZZs, to promote better sleep and improve developmental outcomes in toddlers from primarily low-income families.

Detailed Description

A bedtime routine is a key factor in the promotion of not only healthy sleep, but also potentially of broad development and wellbeing in early childhood. A bedtime routine, in and of itself, embodies the characteristics of nurturing care and early child stimulation especially for at-risk children. It is consistent with the Lancet Early Childhood Series Steering Committee emphasizing the need for nurturing care, which includes adequate health, nutrition, security and safety, responsive caregiving, and early learning opportunities, to help young children (ages 0-5 years) reach their full developmental potential, and to build a strong foundation for subsequent development, health, and wellbeing. Common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent-child attachment, and family functioning, among other outcomes. Although studies have been conducted on the relationship between bedtime routines and sleep, there have been few studies looking at bedtime routines and other developmental outcomes.

Study Timeline

• Study First Submitted: 2020-09-04
• Study First Submitted QC: 2020-10-16
• Study First Posted: 2020-10-19
• Study Start: 2020-11-20
• Status Verified: 2022-11
• Primary Completion: 2022-11-04
• Study Completion: 2022-11-04
• Last Update Submitted: 2022-11-07
• Last Update Posted: 2022-11-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• Presenting to a well child visit
• Child between 12.0 to 14.9 months of age
• English-speaking
• Caregiver is legal guardian of infant
• Caregiver is primary caregiver of infant

Exclusion Criteria

• Non-English speaking
• Absence of primary caregiver at both the 12-month and 15-month well-child visit

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Bedtime Routine Education	Bedtime Routine Education	50 families will be randomly assigned to receive the bedtime routine intervention, 3 Cs for Bedtime ZZZs delivered by research assistants at the 12-month and 15-month well-child visits, in additional to receiving usual clinical care. The intervention will take approximately 30-45 minutes to implement at each study visit. Research assistants will be trained and supervised by board-certified Behavioral Sleep Medicine providers. This intervention focuses on developing an individualized bedtime routine, including such activities as a bath, teeth-brushing, reading stories, singing songs, and cuddling, based on parent's preferences. Families will receive appropriate materials for their bedtime routine, including a CuddleBright kit, bedtime books, toothbrush/toothpaste, and the created bedtime chart to take home.

Primary Outcome Measures

Name	Time	Method
Change in sleep outcomes	15-month and 24-month visits	Caregivers will report on their toddlers sleep in the previous 2 weeks at baseline (12 months of age) and at 15-months and 24-months, using the well-validated and widely used Brief Infant Sleep Questionnaire-Revised (Short Form) (BISQ-R). The BISQ-R contains items related to the child sleep environment (e.g., sleep space, location, and arrangement) and patterns (e.g., bedtime, sleep onset latency, night awakening frequency and duration, wake time). Items also assess caregiver-perceived child sleep problems (e.g., overall sleep problem severity, bedtime resistance severity). The BISQ-R has 3 subscales, Infant Sleep, Parent Behavior, and Parent Perception. Scores range from 0-100, with higher scores denoting better sleep.

Secondary Outcome Measures

Name	Time	Method
Developmental outcomes	15-month and 24-month visits	The Ages \& Stages Questionnaires (ASQ) is an age-specific, reliable and well-validated measure to predict developmental outcomes. Caregivers will report on their infant/child's communication and personal-social skills. Each domain consists of 6 questions and each question is scored with 10 points for "yes," 5 for "sometimes," and 0 for "no," yielding scores ranging from 0 to 60 for each domain. Lower scores denote potential developmental concerns.
Treatment acceptability	15-month and 24-month visits	Caregivers randomized to the bedtime routine education arm will complete the treatment acceptability/bedtime routine evaluation form. Caregivers will rate 7 statements related to the perceived helpfulness/efficacy and acceptability of the intervention using a 5-point Likert scale from strongly disagree to strongly agree, with total scores ranging from 0 to 35. Higher scores indicate higher perceived helpfulness and acceptability of the intervention.
Socio-emotional outcomes	15-month and 24-month visits	The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) is a screener derived from the longer ITSEA. It is a parent questionnaire that assesses the social-emotional development of children ranging in age from 12 to 36 months. Caregivers will rate each statement that best describes the child's behavior in the past month, with scores ranging from 0 to 84. Higher scores denote possible social-emotional/ behavioral concerns.
Parent stress	15-month and 24-month visits	The Parenting Stress Index (PSI) Short form is a 36-items reliable measure to assess total parenting stress with high internal consistency. It consists of three subscales: parental distress, parent-child dysfunctional interaction, and difficult child. Statements on this measure are rated on a 5-point Likert scale from strongly agree to strongly disagree, with scores ranging from 36 to 180. Higher scores denote higher level of stress in parent-child relationship.

Trial Locations

Locations (1)

Temple Pediatrics; 🇺🇸 Philadelphia, Pennsylvania, United States