Abstract Introduction Studies have demonstrated the importance of consistent bedtime routines for toddler sleep, yet few studies have considered whether specific routine behaviors (e.g., reading, playtime, massage) are associated with toddler sleep onset time and sleep duration once broader contextual factors are considered. This study evaluated associations between theoretically-based bedtime routine behaviors and toddler sleep (both actigraphy-estimated and parent-reported) in a large sample of Mexican American toddlers. Methods 238 mothers (age: 30.8+6.1 years; education: 12.4+2.8 years) of Mexican American toddlers (56% boys; 12-16 months) completed the Brief Infant Sleep Questionnaire (BISQ), and toddlers wore an actigraph for 7 nights. Bedtime routine behaviors (from BISQ items) were categorized into language-based (books, prayers, singing), touch-based (rocking, massage), and stimulating (screens, TV, play). Outcomes were actigraphic sleep-onset time and sleep duration, and parent-reported bedtime (BISQ). Covariates included parent-reported bedtime difficulty and BISQ bedtime routine consistency; child sleep location, age and sex; and parental age and education. Hierarchical regressions tested associations between bedtime routine behaviors and sleep. Results Bedtime routine behaviors were not significantly associated with actigraphic sleep-onset time (ps.22). Instead, greater bedtime routine consistency (β=−0.159, p=.047) and higher parental education (β=−0.141, p.001) were associated with earlier sleep onset, while greater bedtime difficulty was associated with later sleep onset (β=0.297, p=.045). Similarly, bedtime routine behaviors were not significantly associated with parent-reported bedtime (ps.06), but greater routine consistency (β=−0.127, p=.002), older parent age (β=−0.026, p=.008), and higher parent education (β=−0.092, p.001) were associated with earlier reported bedtimes. Finally, language-based behaviors (β=−0.154, p=.006), touch-based behaviors (β=−0.188, p=.007), and bedsharing (β=−0.461, p.001) were associated with shorter actigraphic sleep duration, while higher parent education was associated with longer actigraphic sleep duration (β=0.045, p=.019). Conclusion Contrary to expectation, specific bedtime routine behaviors were not associated with actigraphic sleep onset time or subjective bedtime. Instead, findings highlight the importance of having a consistent bedtime routine and contextual factors, such as parent age, parent education, and bedsharing, when examining toddler sleep onset times and sleep duration. While future studies should consider bedtime routine behaviors in broader, more generalizable samples of toddlers, clinicians should emphasize the importance of consistent bedtime routines to ensure healthy toddler sleep. Support (if any) R01HL163859
Thompson et al. (Fri,) studied this question.