Early Childhood Research Quarterly 49 (2019) 18–27

Contents lists available at ScienceDirect

Early Childhood Research Quarterly

Night-to-night variability in the bedtime routine predicts sleep in

toddlers夽
Amanda Prokasky a,∗ , Matthew Fritz b , Victoria J. Molfese c , John E. Bates d
a
162F Prem S. Paul Research Center at Whittier School, University of Nebraska-Lincoln, Lincoln, NE 68583-0858, United States
b
31 Teachers College, University of Nebraska-Lincoln, Lincoln, NE 68588-0345, United States
c
231S.1 Louise Pount Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0236, United States
d
1101 E. 10th St., Indiana University, Bloomington, IN 47405, United States

a r t i c l e i n f o a b s t r a c t

Article history: The present study examined relations between nightly bedtime routines and sleep outcome measures
Received 1 August 2018 in a sample of 185 toddlers aged 30 months. Parents reported on their toddler’s sleep duration and the
Received in revised form 5 February 2019 length and activities included in the bedtime routine each night for approximately 2 weeks. Toddlers wore
Accepted 19 May 2019
actigraphs to track their sleep during the same time period. Correlation, mean difference, and regression
Available online 14 June 2019
analyses indicated that toddlers experienced different bedtime routines and exhibited differences in
parent reported sleep duration between weeknights and weekends. Multi-level models revealed that
Keywords:
variability in the bedtime routine on an individual night most consistently affected parent reported sleep
Bedtime routines
Toddler sleep
duration on that night. Differences in the bedtime routines between weeknights and weekends also
Actigraph affected actigraph recorded sleep duration and sleep efficiency. Results suggest that keeping consistent
Multilevel modeling bedtime routines between weeknights and weekends is important for optimal sleep outcomes.
Published by Elsevier Inc.

1. Introduction & Mindell, 2007). The National Sleep Foundation recommends

that children at ages one to two get 11–14 h of sleep each night
Adequate sleep in young children is associated with healthy and children at ages three to five get 10–13 h of sleep each
mental and physical development, and positive daytime func- night (Hirshkowitz et al., 2015). School-age children and adoles-
tioning. Toddler and preschool children with poor or short sleep, cents who sleep less than the recommended amount (9–11 h and
inconsistent sleep schedules, or other sleep problems such as snor- 8–10 h, respectively) display poorer in school performance, as well
ing or difficulty breathing, night waking, difficulty falling asleep, as poorer cognitive and behavioral functioning (Dewald, Meijer,
and daytime sleepiness, have been shown to exhibit more behav- Oort, Kerkhof, & Bögels, 2010; Geiger, Achermann, & Jenni, 2010;
ior problems, such as hyperactivity (Touchette et al., 2009), lower Paavonen et al., 2009). Thus, adequate sleep appears to be impor-
physical and psychosocial health-related quality of life (Hiscock, tant for children’s behavior, school performance, and mothers’
Canterford, Ukoumunne, & Wake, 2006), and smaller gains in pre- mood.
kindergarten letter knowledge skills (Molfese, Beswick, Molnar, A consistent sleep schedule, defined as going to bed and waking
Jacobi-vessels, & Gozal, 2009). Sleep problems in young children up at the same time every day, is widely regarded as important for
can also negatively impact parents (Mindell, Telofski, Wiegand, ensuring young children get adequate sleep, yet inconsistent sleep
& Kurtz, 2009), with mothers of infants and toddlers who expe- schedules are relatively common in young children. For example,
rience sleep disturbances displaying elevated levels of depressed in a study of over 800 German children aged 0–6 years, Randler,
mood (Hiscock & Wake, 2001; Lam, Hiscock, & Wake, 2003; Meltzer Fontius, and Vollmer (2012) found that, in general, children went
to bed later and woke up later on the weekends compared to
weeknights and that the difference in bedtime and wake time
夽 This research was supported by a grant from the National Institute for Child between weeknight and weekend became larger with age. Such
Health and Human Development (grant number HD073202). inconsistencies in sleep schedules have been linked to lower sleep
∗ Corresponding author at: Nebaska Center for Research on Children, Youth, Fam- quality as well as behavior problems. In a study of 48 five-year-
ilies and Schools, University of Nebraska-Lincoln, Lincoln, NE 68583-0858, United old Japanese children, Iwata, Iwata, Iemura, Iwasaki, and Matsuishi
States.
(2012) found that children with more inconsistent sleep sched-
E-mail addresses: aprokasky@unl.edu (A. Prokasky), Matt.fritz@unl.edu
(M. Fritz), Vmolfese2@unl.edu (V.J. Molfese), batesj@indiana.edu (J.E. Bates). ules took longer to fall asleep, fell asleep later, and slept less on

https://doi.org/10.1016/j.ecresq.2019.05.004
0885-2006/Published by Elsevier Inc.
 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27 19

weeknights than children with more consistent sleep schedules. et al. (2009) and Touchette et al. (2009) studies asked parents to
Similarly, in a sample of 1622 Australian school-aged children report how much their child slept on average. Although obtaining
ages 5–10 years, Biggs, Lushington, van den Heuvel, Martin, and global ratings of children’s sleep and/or bedtime routines is com-
Kennedy (2011) found that inconsistent sleep schedules were mon, it may be subject to bias in the estimates of children’s sleep
associated with more hyperactivity and internalizing behavior time or consistency of the bedtime routine. Parents may be moti-
problems, including worry, nervousness, and somatic complaints. vated to report their children going to bed earlier than they actually
In a study of Head Start preschool-aged children, Bates et al. (2002) do on any given night or that they follow a consistent bedtime rou-
found that more variability in amount of nightly sleep time and tine because it is socially desirable. However, daily reports of the
bedtimes was related to children’s difficulties at preschool, as mea- bedtime routine and sleep via sleep diaries may help to ameliorate
sured by teacher ratings of positive and problem behaviors, even this bias and also minimize the amount of error that occurs in the
after controlling for family stress and parenting practices. retrospective reporting of events.
The research considered here so far has emphasized regularity Daily sleep diary reports have been used in a few studies of
versus inconsistency in sleep itself. However, sleep is not function- children’s sleep and/or bedtime routines. In addition to the BISQ,
ally independent of children’s waking lives. A particularly relevant Mindell et al. (2009) also used a daily sleep diary in which par-
aspect of waking life involves the events preceding bedtime. The ents reported over three weeks on their child’s bedtime, time to
transition to sleep requires reduction of vigilance (Dahl, 1996), and fall asleep, and night wakings. Iwata et al. (2012) employed acti-
a bedtime routine—a typical sequence of activities supportive of graph measures of child sleep and daily sleep diaries collected over
sleep—could foster that. A bedtime routine has been operationally seven nights and averaged the nightly recordings separately for
defined as the set of predictable activities that parents engage in weeknights and weekends to obtain their measures of bedtime,
with their children in the hour or so before lights out and before the sleep latency, and night wakings. Bates et al. (2002) used daily
child falls asleep (Mindell & Williamson, 2017; Mindell, Li, Sadeh, sleep diaries collected and averaged across four weeks to obtain
Kwon, & Goh, 2015). Multiple studies have shown the relevance their measures of sleep and bedtime variability.
of a consistent bedtime routine for young children’s sleep. Staples, Researchers using daily reports of sleep or the bedtime routine
Bates, and Petersen (2015) found that greater adherence to a bed- most often averaged the nightly reports over several nights. Averag-
time routine was concurrently associated with more night time ing over nights is likely to improve precision of estimates of typical
sleep at 36 and 42 months old (r = 0.30 and r = 0.29, respectively). In routines compared to a single night’s data or a parent’s global rat-
an intervention study of 405 mothers and their children, ages seven ing, but at the same time, it fails to take advantage of the possibility
to 36 months, Mindell et al. (2009) found that a consistent bedtime that there is important information in day-to-day fluctuations. Only
routine significantly improved children’s sleep onset latency and two studies have employed daily reports to examine variability in
sleep consolidation (longest continuous sleep period), decreased nightly sleep or the bedtime routine in young children (Bates et al.,
the number of night wakings, and improved mother’s self-reported 2002; Staples et al., 2015). Both suggest that variability in the bed-
mood as measured by the Profile of Mood States (McNair, Lorr, & time routine or sleep are more important in relation to different
Droppleman, 1971). A large, cross-cultural study of over 10,000 outcomes than are overall measures of sleep or the bedtime routine,
parents of children ages 0–5 in 14 countries found that bedtime but neither study examined the nightly level associations between
routines had a dose-dependent association with sleep such that bedtime routines and sleep.
better sleep outcomes (including earlier bedtimes, shorter sleep A further question about implications of bedtime routine vari-
onset latency, decreased wakefulness, and more total sleep time) ability, is whether toddlers sleep less on specific nights in which
were associated with the number of nights per week that a bedtime they experience a bedtime routine that is discrepant from the
routine was implemented (Mindell et al., 2015). usual one. This question is more specific than the previous studies’
Conversely, irregular bedtime routines can have a negative questions, and aims at a more detailed understanding of processes
impact on children’s sleep. In a study of over 5000 infants and involved in children’s sleep than attained so far. The authors are
toddlers ages 0–36 months, Sadeh, Mindell, Luedtke, and Wiegand aware of only one study that has used daily reports to examine the
(2009) had parents report how often their child had the same bed- nightly level associations between sleep, activities and psychologi-
time routine in a typical 7-day week on a five point likert-type cal well-being in 750 14–15 year old adolescents. Using hierarchical
scale, ranging from “1 = never” to “5 = every night”. They found that linear modeling, Fuligni and Hardway (2006) found that not only
greater irregularity in the bedtime routine was associated with was adolescents’ sleep time highly variable across individual nights,
more frequent night wakings. Therefore, the first purpose of this but also that activities engaged in during the day, such as studying
study is to examine overall relationships between bedtime routines or experiencing stressful demands, led to reduced sleep on those
and sleep in toddlers, and investigate whether toddlers experi- nights. While the activities in which adolescents were engaged in
enced differences between weeknights and weekends in measures this study were not a part of a bedtime routine, these results taken
of bedtime routine or sleep. together with the previous work linking bedtime routines to sleep
Bedtime routines can be measured in many ways, and the in young children lend support for the hypothesis that bedtime
method used could affect inferences from findings. A majority of routines on individual nights have the potential to impact sleep
studies examining relations between bedtime routines and sleep on those same nights. Therefore, the second purpose of this study
have relied on a global parental report of sleep (e.g. “What times is to use daily reports of bedtime routines and daily measures of
does your child typically go to bed each night?”) or the bedtime rou- sleep to investigate whether a bedtime routine or variability in the
tine (e.g. “Do you have or follow a regular bedtime routine?”). For bedtime routine on a particular night impacts measures of sleep on
example, both Mindell et al. (2015) and Sadeh et al. (2009) used the that same night.
Brief Infant Sleep Questionnaire (BISQ; Sadeh, 2004), which asked Researchers typically measure children’s sleep in two ways:
parents to report on sleep via the question “how much total time parent report (either via daily sleep diaries or global ratings as
does your child spend sleeping during the night?”, and regularity of described above) and actigraphy. Actigraphy is a non-invasive
the bedtime routine via the question “in a typical 7-day week, how method for monitoring periods of rest and activity, and involves
often does your child have the exact same bedtime routine?” with wearing a small portable device resembling a watch that records
possible responses ranging from “never” to “every night”. Parents in movement. Actigraphy has been established as a valid and reliable
the Biggs et al. (2011) study reported on their child’s usual, earliest, method for measuring children’s sleep (Acebo et al., 2005; Sadaka
and latest bedtimes during the past week, while both the Molfese et al., 2014; Sadeh & Acebo, 2002; Sadeh, Lavie, Scher, Tirosh, &
20 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27

Epstein, 1991). When actigraphy is used, it is frequently accom- When toddlers turned 30 months old, project staff contacted
panied by a daily sleep diary, which is used to aid in scoring the interested families and an initial home visit was scheduled. At the
actigraph data to provide accurate estimates of children’s sleep. initial home visit, the parents were given study materials includ-
However, estimates of sleep from parent report and actigraphy ing questionnaires and a daily sleep diary to be completed on their
are not always in agreement. Several studies have noted that par- toddler. Toddlers were given a sweatband to wear containing an
ents consistently overestimate the amount of sleep their child gets actigraph used to record their sleep. Parents were instructed to
each night when compared to actigraph records (Dayyat, Spruyt, have their toddler wear the actigraph on their non-dominant wrist
Molfese, & Gozal, 2011; Molfese et al., 2015; Nelson et al., 2014). A continuously throughout the day and night, except when the acti-
social desirability response set may partly impact parents’ report- graph could get wet (e.g. bath or swimming). If the toddler resisted
ing of their children’s sleep, as parents may be motivated to report wearing the actigraph on their wrist, parents were instructed that
their children getting sufficient sleep, since lack of sleep is often the actigraph could be placed on the upper arm or ankle. One week
blamed for behavioral difficulties. However, part of the measured after the initial home visit, the parent and toddler visited the lab
difference can also be attributed to parents being unaware of their (to perform tasks considered in future reports), and data from the
child’s night wakings or when their child actually falls asleep or actigraph were downloaded and daily sleep diary completion was
wakes up in the morning. In contrast, actigraph recordings use an checked. One week after the lab visit, a second home visit was con-
algorithm developed and validated for use with pediatric popula- ducted, during which project staff observed the child’s bedtime
tions (Sadeh, Alster, Urbach, & Lavie, 1989) to determine accurate routine for the one to two hour period leading up to the toddlers’
sleep onset and wake times, as well as subtracting out any night bedtime (until lights out). At the end of this visit, the actigraph and
wakings, among other sleep measures. Although we do not assume daily sleep diaries were collected from the parent.
that the method gives perfectly accurate measures, actigraphy is
generally considered to be an objective measure of children’s sleep, 2.3. Measures
especially in comparison to parent report. Nevertheless, actigraphy
is subject to drawbacks as well including device failure (acti- 2.3.1. Sleep
graph unexpectedly breaks or quits collecting data), participant 2.3.1.1. Actigraphy. Toddlers’ sleep was measured continuously for
noncompliance (child refusing to wear actigraph), and wrongfully the two weeks between the first and second home visits using a
scoring active sleepers or car naps as wake periods (Sadeh & Acebo, Micro-Mini Motion Logger actigraph (Ambulatory Monitoring, Inc.,
2002). Given the limitations, actigraphy is usually accompanied by Ardsley, New York), which is a small wristwatch-like device that
parental report of sleep. Understanding how actigraphy and par- records motion and activity levels via an accelerometer. Actigra-
ent report data mesh is of methodological and conceptual value. phy is a non-invasive method for tracking rest and activity periods
Therefore, the third purpose of this study is to utilize both parent that has been established as a valid and reliable method for measur-
report and actigraph records of children’s sleep and compare how ing children’s sleep (Acebo et al., 2005; Sadaka et al., 2014; Sadeh
they each relate to the bedtime routine. & Acebo, 2002; Sadeh et al., 1991). Using the ActionW 2.7 software
(Ambulatory Monitoring Inc., Ardsley, New York), actigraph data
were scored using the Sadeh algorithm (Sadeh et al., 1989), which
2. Method
has been validated against polysomnography in toddler popula-
tions (Sadeh et al., 1991).
2.1. Sample
Only actigraph data that corresponded with a night for which
sleep diary data were available were used. The number of nights
Participants were 185 (86 female) typically developing toddlers
available with actigraph data ranged from 0 to 14 (Mean = 11.48,
aged 30 months and their primary caregiver who were participating
SD = 3.21). Ten toddlers were excluded due to actigraph failure
in a larger study on the relations between toddler sleep, tem-
(device unknowingly shut down and did not collect data), loss of
perament, and self-regulation. Participants were recruited from a
the actigraph, or no corresponding sleep diary data.
mid-size city in the Midwest United States. The majority of toddlers
Five actigraph variables are used in the present study: i.) Acti-
were White (83.7%), and also multiracial (8.2%), Hispanic (3.3%),
graph Recorded Sleep Duration—the amount of time spent sleeping
Asian (2.7%), Black (1.6%), and Native American (1.1%), and unre-
during the sleep period (measured in minutes by the actigraph, and
ported (1 toddler), which reflect the larger community from which
converted to and reported in hours to aid in comparison to the par-
the sample was drawn. The majority of primary caregivers (94.6%
ent reported sleep duration), spanning from sleep onset (the time
mothers; herein referred to as parents) were married (83.8%) and
the toddler fell asleep as determined by the actigraph algorithm)
ranged in age from 21 to 46 years old (M = 32.13, SD = 4.67). Par-
to sleep offset (the time the toddler woke up as determined by the
ents’ education levels ranged from college degree (83.7%) to some
actigraph algorithm), ii.) Sleep Efficiency—the percent of time spent
college (13.6%) to high school diploma (2.7%); one parent did not
sleeping during the sleep period (from sleep onset to sleep offset
report education level. Family income was reported in $5000 incre-
as determined by the actigraph algorithm), iii.) Wake Minutes—the
ments and ranged from less than $10,000 per year to more than
number of minutes spent awake during the sleep period, iv.) Wake
$125,000 per year, with a mean of $70,000–$75,000 per year, and
Episodes—the number of wake episodes during the sleep period,
12.7% of families reporting income of more than $125,000 per year;
and v.) Sleep Latency—the amount of time in minutes from when
four parents did not report income.
the parent reported the child in bed to the toddler’s sleep onset as
determined by the actigraph.
2.2. Procedure
2.3.1.2. Sleep Diary. Parents recorded their toddler’s bedtime each
Participants were recruited from local childcare centers and night of the two week protocol, as well as the time their toddler
pediatrician offices, through personal contacts, and the distribution woke up the next morning. Parents also recorded each night in the
of flyers at child-friendly events and locations. Families with tod- sleep diary whether the actigraph was worn, when it was tem-
dlers who were within the required age range (not yet 30 months porarily removed (e.g. for bath), and any naps or night wakings the
old) and lived within one hour of the testing site were invited to par- toddler experienced during the 14-day testing period. This infor-
ticipate. Data were collected at three ages: 30, 36, and 42 months of mation was used to aid in scoring the actigraph data and to compute
age; only the data collected at 30 months of age are reported here. a parent-reported measure of nightly sleep duration measured in
 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27 21

hours. The sleep diary also included space for parents to write in Table 1
Research questions and corresponding analyses.
anything unusual about each night’s bedtime or sleep, such as their
child being sick or sleeping in an unfamiliar place (e.g. at grand- Research question Analyses
parents house). However, these instances of unusual events in the 1. What are the overall relationships • Mean difference and
sleep diaries were rare across all children and days of sleep diary between bedtime routines and sleep in correlational analyses
data available. Since the primary focus of the present study was to toddlers, and do toddlers experiences • Aggregate-level regression
examine relations between the nightly bedtime routine and nightly differences in the bedtime routine or analyses
sleep measures between weeknights and
sleep, rather than factors influencing the routine or the sleep, data
weekends?
on unusual events were not included in analyses. 2. Does variability in the bedtime routine • Multi-level models
on a particular night impact sleep
2.3.2. Bedtime routine measures on that same night?
3. How do parent report and actigraph • Comparisons were
Parents reported on the bedtime routine each night in the
records of children’s sleep compare to embedded within all
sleep diary, including routine start time and the specific activities each other in their relations to the analyses
included in the routine. Parents were provided with six common bedtime routine?
bedtime routine activities to check off if completed: shower/bath,
pajamas/pj’s, story, water, TV, and brush teeth. Four additional
spaces were provided for parents to write in their own activities weekends and for comparison of parent reported sleep duration
(e.g. pray). The write-ins resulted in 24 additional activities engaged versus actigraph recorded sleep duration.
in by families during the bedtime routine. These additional activ- Second, all bedtime routine predictors and sleep outcome mea-
ities could be grouped into nine categories: pray/read scripture, sures were averaged across the two-week reporting period and
singing, potty/diaper change, snack/treat/meal, snuggle/rocking, multiple regression analyses were run to examine aggregate-
play, music/white noise machine, special object (including blan- level associations between bedtime routines and sleep measures,
ket, stuffed animal or pacifier), and other (mostly family specific, controlling for gender, ethnicity, and income, based on previous
such as trim nails, talk about day, phone calls to family, night walk). research that has identified differences in the implementation of
Providing drinks of juice, milk, or a bottle were combined with the bedtime routines based on gender, ethnicity and income (Hale,
original “water” category to form a “drink” category; reading was Berger, Lebourgeois, & Brooks-Gunn, 2009; Henderson & Jordan,
combined with the original “story” category; and YouTube, iPad, 2010; Milan, Snow, & Belay, 2007; Mindell et al., 2015). Sepa-
and movie watching were combined with the original “TV” cate- rate regression models were run for each sleep outcome measure
gory to form a new “technology use” category. This data reduction (actigraph recorded sleep duration, parent reported sleep duration,
resulted in 15 categories of bedtime routine activities that parents sleep efficiency, sleep latency, wake episodes, and wake minutes)
reported in the sleep diaries: bathe, pj’s, read, drink, technology, and routine predictor (routine length, routine length variability,
brush teeth, pray, sing, potty, snack, snuggles, play, music, special routine activity total, and normal routine deviation) pair to exam-
object, and other. ine the individual relations between the bedtime routine variables
Four variables were calculated for each night from the nightly and sleep outcome measures.
bedtime routine information. Routine Length (RL), measured in min- Third, in order to examine associations between bedtime rou-
utes, was calculated as the difference between the parent reported tines and sleep measures within individual nights, and to examine
routine start time and time in bed, while Routine Length Variabil- whether these associations differed by weeknight versus weekend,
ity (RLV), also measured in minutes, was calculated as the absolute multilevel models were run. In the multilevel models, the bedtime
difference between the average routine length across the 14 nights routine variable (routine length, routine length variability, routine
and the routine length for each individual night. Routine Activity activity total or normal routine deviation) and a dummy code indi-
Total (RAT) was calculated as the total number of bedtime rou- cating if the night was a weeknight were entered as predictors of a
tine activities performed each night. To capture variability in the given sleep measure at Level 1 and three time-invariant covariates
bedtime routine, a Normal Routine Deviation (NRD) variable was (gender, ethnicity, and income) were entered at Level 2. All Level 1
calculated. First a “normal” routine was identified for each child effects were allowed to be random, resulting in the following model
which included all activities (from the list of 15 categories iden- being fit for each combination of the four bedtime routine predictor
tified above) that occurred on at least 10 of the 14 nights. Next, variables and the six sleep outcome variables:
for each night, deviation from the “normal” routine was calculated For variable combinations where the Level 1 interaction was
such that a score of 1 was added for each bedtime routine activity not found to be significant, the results from the model that did not
that occurred and was not part of the normal routine, and for each contain the interaction term are reported.
bedtime routine activity that didn’t occur and was part of the nor-
mal routine. Therefore, higher scores indicate more deviation from 3. Results
the normal routine each night.
3.1. Mean difference and correlational analyses
2.4. Statistical analysis
Descriptive statistics for the bedtime routine predictors and
Three types of analyses were conducted (see Table 1 for research sleep outcome measures are found in Table 2. Parents reported
questions and corresponding analyses). First, mean difference and their toddlers’ average sleep duration to be 10.53 h, while the acti-
correlation analyses were computed in order to examine over- graph recorded toddlers’ average sleep duration to be 8.36 h across
all relationships between the bedtime routine predictors (routine the two week reporting period, a statistically significant difference
length, routine length variability, routine activity total, and normal of 2.17 h (t = 24.01, p < 0.001). Independent samples t-tests were
routine deviation), and the parent reported and actigraph recorded conducted to test for differences in these variables between gender
sleep outcome measures (parent reported sleep duration, actigraph and ethnicity (Caucasian vs. non-Caucasian). Because income was
recorded sleep duration, sleep efficiency, sleep latency, wake min- reported as a categorial variable with 25 levels, it was not included
utes and wake episodes), averaged across the two-week testing in the mean difference analyses. The results revealed that girls had
period. These analyses also allowed for examination of differences significantly longer bedtime routines than boys and girls bedtime
in the bedtime routine and sleep measures on weeknights versus routine length varied significantly more across the two weeks
22 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27

Table 2
Descriptive statistics and mean differences on study variables by covariates.

Overall Mean differences

Mean (SD) Gendera Ethnicityb Weeknightc

Bedtime routine predictors:

Routine length 43.20 (16.2) −6.30* −2.88 0.80
Routine length variability 18.60 (9.12) −3.00* −0.90 −1.69
Routine activity total 4.16 (1.04) −0.30 0.29 0.19*
Normal routine deviation 2.19 (0.88) −0.04 0.01 −0.16

Sleep outcome measures:

Parent reported sleep duration 10.53 (0.64) −0.02 0.14 −0.20**
Actigraph recorded sleep duration 8.36 (1.01) 0.06 0.17 0.10
Actigraph recorded sleep efficiency 86.91 (8.14) 0.35 0.69 0.83
Actigraph recorded sleep latency 33.21 (16.57) −0.57 1.67 2.22
Actigraph recorded wake episodes 5.76 (5.66) 0.06 −0.18 −0.14
Actigraph recorded wake minutes 75.48 (46.44) −0.95 −1.59 −5.94*

Note. Routine length, routine length variability, sleep latency, and wake minutes are reported in minutes. Actigraph recorded sleep and parent reported sleep are reported
in hours. Sleep efficiency is reported as a percentage.
*
p < 0.05.
**
p < 0.01.
a
Positive values indicate males are higher.
b
Positive values indicate Caucasians are higher.
c
Positive values indicate weeknights are higher.

than did boys. Paired samples t-tests were conducted to test for and parent reported sleep duration on weeknights, with longer rou-
differences in these variables between weeknights and weekends tines (r = −0.18, p = 0.01), more variable routine lengths (r = −0.23,
and found that children completed more bedtime routine activ- p = 0.002), and more deviation from the normal bedtime routine
ities on the weeknights than the weekends. In addition, parents (r = −0.21, p = 0.005) related to less parent reported sleep duration,
reported less sleep and the actigraph recorded more wake minutes and more routine activities related to more parent reported sleep
on the weekends than weeknights. There were no other significant duration (r = 0.19, p = 0.01). In addition, more deviation from the
differences. normal bedtime routine was related to less wake minutes on the

Results of Pearson correlations for the four bedtime routine

variables, averaged across the two weeks, and parent reported weeknights (r = −0.16, p = 0.03). None of the bedtime routine mea-
sleep duration were that longer routines (r = −0.15, p = 0.04) and sures were related to the actigraph recorded sleep measures on the
more variable routine lengths (r = −0.18, p = 0.01) were related to weeknights, nor were bedtime routines related to either parent-
less parent reported sleep duration. More routine activities were report or actigraph sleep measures on the weekends.
related to more parent reported sleep duration (r = 0.18, p = 0.02),
and more deviation from the normal bedtime routine was related 3.2. Aggregate-level analyses
to less parent reported sleep duration (r = −0.23, p = 0.002). None of
the bedtime routine variables were related to actigraph-recorded The aggregate-level regression analyses were computed on the
measures of sleep. bedtime routine predictors and sleep outcome measures aver-
In order to determine if there were differences in the relations aged across the two-week data collection period. Both the tests
between variables on weeknights versus weekends, correlations of mean differences and correlation analyses revealed some dif-
were computed between variables separately for weeknights and ferences between weeknights and weekends on the relationships
weekends. A similar pattern emerged between bedtime routines between bedtime routines and sleep measures, indicating a poten-
tial moderating effect of weeknight. Since weeknight/weekend
 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27 23

Table 3
Regression analyses on aggregate models – weeknight.

Sleep outcomes B (SE)

Actigraph recorded Parent reported Actigraph recorded Actigraph recorded Actirgraph Actigraph recorded
sleep duration sleep duration sleep efficiency sleep latency recorded wake wake minutes
episodes

Predictors
Routine length −0.21 (0.28) −0.41 (0.18)* 1.24 (2.29) −3.54 (4.83) 1.28 (1.56) −7.34 (13.00)
Gender −0.12 (0.16) 0.07 (0.10) −1.30 (1.30) 0.40 (2.74) 0.08 (0.89) 5.78 (7.37)
Ethnicity 0.09 (0.22) 0.09 (0.14) −0.27 (1.77) 0.05 (3.74) 0.17 (1.21) 2.97 (10.07)
Income 0.00 (0.01) −0.02 (0.01)* 0.10 (0.09) −0.43 (0.19)* −0.05 (0.06) −0.66 (0.50)

Routine length variability −0.23 (0.55) −1.00 (0.34)** 5.83 (4.54) −15.93 (9.55) −1.94 (3.11) −39.51 (25.73)
Gender −0.12 (0.16) 0.09 (0.10) −1.47 (1.30) 1.00 (2.73) 0.34 (0.89) 7.43 (7.37)
Ethnicity 0.08 (0.22) 0.07 (0.13) −0.27 (1.76) 0.06 (3.71) 0.22 (1.21) 3.03 (10.00)
Income 0.00 (0.01) −0.02 (0.01)* 0.11 (0.09) −0.44 (0.18)* −0.06 (0.06) −0.69 (0.50)

Routine activity total 0.05 (0.07) 0.11 (0.05)* 0.01 (0.61) 1.17 (1.28) −0.10 (0.42) 1.10 (3.45)
Gender −0.15 (0.16) −0.01 (0.10) −1.11 (1.28) −0.23 (2.70) 0.24 (0.88) 4.76 (7.28)
Ethnicity 0.08 (0.22) 0.08 (0.14) −0.24 (1.77) 0.04 (3.73) 0.20 (1.21) 2.86 (10.07)
Income 0.00 (0.01) −0.02 (0.01)* 0.10 (0.09) −0.44 (0.19)* −0.05 (0.06) −0.66 (0.50)

Normal routine deviation 0.05 (0.09) −0.13 (0.06)* 1.44 (0.71)* −2.05 (1.50) −0.52 (0.49) −9.26 (3.99)*
Gender −0.14 (0.15) 0.03 (0.10) −1.18 (1.26) 0.13 (2.68) 0.25 (0.87) 5.49 (7.13)
Ethnicity 0.07 (0.14) 0.09 (0.14) −0.36 (1.75) 0.13 (3.72) 0.25 (1.21) 3.59 (9.92)
Income 0.00 (0.01) −0.01 (0.01)* 0.09 (0.09) −0.41 (0.18)* −0.05 (0.06) −0.59 (0.49)
*
p < 0.05.
**
p < 0.01.

is a time-varying variable, however, the interaction between between bedtime routines and sleep outcomes, based on averages
weeknight and the aggregate bedtime routine predictors are of daily reports that were recorded across the two week reporting
impossible to test. Therefore, in order to avoid a potential masking period. The daily-level analyses were used to examine associations
effect of averaging across weeknights and weekends, it was decided between bedtime routines and sleep outcomes within individual
to run the aggregate-level regression models for weeknights and nights, in order to determine if the bedtime routine on an indi-
weekends separately. Table 3 contains results from the aggregate- vidual night impacted any sleep measures on that night. Table 4
level regression models for weeknights only; results for weekends, contains the results from the multilevel models that were run for
not reported here, were similar in that coefficients were in the same the daily level analyses and are discussed below.
direction, but smaller and all were non-significant. For complete-
ness and comparison, the aggregate-level regression models were
also run aggregating across the two weeks (including weeknights
and weekends); results including weeknights and weekends aver- 3.3.1. Bedtime routine length
aged together were similar to the results for weeknights, but again, In the multilevel models containing bedtime routine length as
coefficients were smaller and fewer were significant, as would be a predictor, parent reported sleep duration was the only sleep
expected if the bedtime routine and sleep variables have somewhat outcome that was significantly related to any of the predictors
different relations in the weeknight versus weekend segments of (see Table 4). Specifically, routine length, weeknight, and income
the week. were all significant predictors of parent reported sleep duration
Results from the aggregate-level regression analyses revealed such that increases in routine length on an individual night and
that on weeknights parent reported sleep duration was most con- higher incomes, as well as the night being a weeknight, predicted
sistently associated with bedtime routines, with the overall models less parent reported sleep duration that night, controlling for all
predicting parent reported sleep duration from the four bedtime other variables. The Level 1 interaction between routine length and
routine variables all being significant and explaining 5%–8% of the weeknight was not significant for any of the sleep outcomes.
variance in parent reported sleep. Specifically, longer routines,
more variable routine lengths, fewer bedtime routine activities,
and greater deviation from the normal routine each predicted
less parent reported sleep duration on the weeknights. Income 3.3.2. Routine length variability
was a significant covariate in all four models with higher incomes In the models containing routine length variability as a predic-
predicting less parent reported sleep duration. Income was also tor, significant effects were found for both parent reported sleep
a significant predictor of actigraph recorded sleep latency, with duration and actigraph recorded sleep efficiency (Table 4). Specif-
higher incomes predicting lower sleep latency, although over- ically, routine length variability, weeknight, and income were all
all percentage of variance explained in these models were not significant predictors of parent reported sleep duration such that
significant. Finally, greater deviation from the normal routine the more the routine length varied on an individual night from
predicted greater actigraph recorded sleep efficiency and fewer the average routine length, the higher the family income, as well
actigraph recorded wake minutes, although again, the overall vari- as the night being a weeknight, all predicted less parent reported
ance explained in these models were not significant. sleep that night, controlling for all other variables. For sleep effi-
ciency, the Level 1 interaction between routine length variability
and weeknight was statistically significant, indicating that the
3.3. Daily-level analyses effect of routine length variability on sleep efficiency on a weekend
(B = −2.08, p > 0.05), was not the same as on a weeknight (B = 1.21,
The mean difference, correlation, and aggregate regression p > 0.05), controlling for all of the other variables, even though the
analyses reported above were used to examine overall relations effect was not significant for either weekends or weeknights.
24 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27

Table 4
Results from multilevel models.

Sleep outcomes B (SE)

Actigraph recorded Parent reported Actigraph recorded Actigraph recorded

sleep duration sleep duration sleep efficiency sleep latency

Routine length (RL)

Intercept 8.46 (0.26)*** 11.06 (0.17)*** 86.24 (2.09)*** 37.28 (4.42)***
RL −0.07 (0.06) −0.34 (0.06)*** 0.38 (0.45) −2.03 (1.43)
Weeknight 0.11 (0.06) −0.20 (0.06)** 0.71 (0.45) 2.21 (1.43)
Gender −0.18 (0.15) 0.01 (0.09) −1.34 (1.23) 0.94 (2.57)
Ethnicity 0.02 (0.21) 0.09 (0.13) −0.37 (1.71) 1.30 (3.51)
Income −0.00 (0.01) −0.01 (0.007)* 0.07 (0.08) −0.31 (0.17)
RL × weeknight – – – –

Routine length variability (RLV)

Intercept 8.46 (0.26)*** 10.96 (0.16)*** 86.52 (2.07)*** 36.62 (4.39)***
RLV −0.15 (0.09) −0.46 (0.08)*** −2.08 (1.40) −1.90 (2.27)
Weeknight 0.11 (0.06) −0.22 (0.06)*** −0.26 (0.66) 1.96 (1.39)
Gender −0.17 (0.15) 0.01 (0.09) −1.14 (1.22) 0.88 (2.52)
Ethnicity 0.02 (0.21) 0.09 (0.13) −0.19 (1.68) 1.32 (3.49)
Income −0.00 (0.01) −0.01 (0.01)* 0.10 (0.08) −0.31 (0.17)
RLV × weeknight – – 3.29 (1.59)* –

Routine activity total (RAT)

Intercept 8.42 (0.26)*** 10.55 (0.19)*** 86.07 (2.17)*** 31.03 (4.42)***
RAT −0.00 (0.02) 0.07 (0.02)** 0.03 (0.13) 1.27 (0.41)**
Weeknight 0.13 (0.06)* −0.21 (0.06)*** 0.79 (0.43) 1.06 (1.33)
Gender −0.15 (0.15) −0.04 (0.09) −0.93 (1.25) −0.08 (2.45)
Ethnicity −0.02 (0.21) −0.09 (0.13) −0.54 (1.73) 1.71 (3.42)
Income −0.00 (0.01) −0.01 (0.01)* 0.08 (0.09) −0.33 (0.17)*
RAT × weeknight – – – –

Normal routine deviation (NRD)

Intercept 8.42 (0.26)*** 10.66 (0.18)*** 86.19 (2.11)*** 35.54 (4.37)***
NRD −0.01 (0.02) 0.09 (0.04)* −0.04 (0.16) 0.35 (0.51)
Weeknight 0.12 (0.06)* −0.001 (0.09) 0.80 (0.42) 2.46 (1.40)
Gender −0.16 (0.15) −0.03 (0.09) −1.17 (1.22) 0.23 (2.49)
Ethnicity 0.02 (0.21) 0.03 (0.13) −0.07 (1.71) 1.70 (3.43)
Income −0.00 (0.01) −0.01 (0.01)* 0.08 (0.08) −0.32 (0.17)
NRD × weeknight – −0.09 (0.03)** – –

Note. None of the models with number of wake episodes or number of wake minutes as outcome variables were significant, and are thus not reported here.
*
p < 0.05.
**
p < 0.01.
***
p < 0.001.

3.3.3. Routine activity total duration, such that more actigraph recorded sleep duration was
In the models containing the number of routine activities as predicted on weeknights compared to weekends, controlling for
a predictor, there were significant effects on actigraph recorded the other variables. Normal routine deviation, income, and the Level
sleep duration, parent reported sleep duration, and actigraph 1 interaction between normal routine deviation and weeknight
recorded sleep latency. Specifically, there were significant effects were all significant predictors of parent reported sleep duration,
of weeknight versus weekend on actigraph recorded sleep dura- such that higher income predicted lower parent reported sleep
tion, such that children were predicted to have longer actigraph duration and a higher routine deviation on an individual night
recorded sleep duration on weeknights compared to weekends, predicted higher parent reported sleep duration on that night, if
controlling for the other variables. There were significant effects that night were a weekend (B = 0.09, p < 0.05), but there was no
of routine activity total and income on actigraph recorded sleep relationship on weeknights (B = 0.00, p > 0.05).
latency, such that higher number of total routine activities on an
individual night was related to longer sleep latency, but higher 3.3.5. Wake episodes, wake minutes, and cross-level interactions
income predicted shorter sleep latency, controlling for all other None of the models for number of wake episodes or number of
variables. Finally, there were significant effects of routine activity wake minutes had significant effects and thus are not reported in
total, weeknight, and income on parent reported sleep duration, Table 4. In addition, the moderating effect of the Level 2 covari-
such that higher total number of routine activities on an indi- ates (gender, ethnicity, and income) on the Level 1 predictors of
vidual night predicted higher parent reported sleep duration that interest (routine length, routine length variability, routine activ-
night, while lower parent reported sleep duration was predicted ity total, normal routine deviation, and weeknight) were tested for
on weeknights and as the parent’s income increased. None of the each sleep outcome measure. The only model that had significant
Level 1 interactions were significant for total number of routine effects including these cross-level interactions had severe conver-
activities. gence problems that could be not remedied and therefore will not
be interpreted here.
3.3.4. Normal routine deviation
In the models containing normal routine deviation as a 4. Discussion
predictor, there were significant effects on actigraph recorded
sleep duration and parent reported sleep duration. Specifically, This study investigated what role nightly bedtime routines
weeknight was a significant predictor of actigraph recorded sleep play in toddler sleep by examining aggregate and daily relations
 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27 25

between bedtime routines and sleep measures in toddlers. Daily adherence to a nightly bedtime routine was not associated with
reports of the nightly bedtime routines and several sleep measures actigraph recorded sleep duration at 30 months, but was at 36
were averaged across a two week reporting period to explore over- and 42 months. That study did not include a measure of parent
all relations between bedtime routines and sleep outcomes, and reported sleep duration, so comparisons between parent reported
then daily reports were analyzed individually to examine within- and actigraph recorded sleep duration can not be made.
night relations between bedtime routines and sleep outcomes. In contrast, more routine activities completed each night and
Three main findings emerged: Parents’ estimates of their toddlers’ more deviation from the normal routine each night predicted more
nighttime sleep were more than two hours per night greater than parent reported sleep duration on weeknights. At first glance, this
actigraph estimates sleep duration. Across all levels of analyses seems paradoxical given that the more routine activities completed
bedtime routines were most consistently related to parent reported would be assumed to increase the length of the bedtime routine,
sleep duration, in contrast to actigraph recorded sleep measures; which, as discussed, is actually associated with less parent reported
and differences between bedtime routines on weeknights and sleep. However, it may be that parents who complete more bed-
weekends are associated with differences in toddler sleep between time routine activities each night believe that more activities or
weeknights and weekends. Each finding will be discussed in further “steps” in the routine help to settle their child better so they fall
detail below. asleep quicker, leading to less time awake in bed after lights out.
The different levels of analyses used in the present study yielded Or it could also reflect a child who’s workng more cooperatively
largely concordant results, although there were a few notable dif- with the routine, allowing more steps in the allocated time, and
ferences suggesting that relationships between bedtime routines greater sense of agency and security in the child. This does not
and toddler sleep may be more nuanced than can be captured explain why greater deviation from the normal routine predicts
by employing a single method of analysis. All levels of analysis more parent reported sleep, unless it is the case that parents try
were consistent in identifying differences in parent reported versus out multiple bedtime routine activities when their children resist
actigraph recorded sleep duration and relations between bedtime bedtime.
routine variables, weeknight, and parent reported sleep duration, Only one of the actigraph sleep variables was predicted by the
but were less consistent in showing relations between bedtime rou- bedtime routine – sleep efficiency. More routine activities per-
tines and actigraph recorded measures of sleep. Mean difference formed predicted higher sleep efficiency, which may indicate that
and correlation analyses indicated that parents’ estimates of the the more steps in a bedtime routine do indeed help children fall
amount of sleep their child was getting were significantly greater asleep faster, leading to less time awake in bed, and thus higher
than actigraph estimates. This is consistent with prior research sleep efficiency. However, to our knowledge no other research
indicating parents overreporting on their child’s sleep when com- has been conducted examining the relations between the bed-
pared to more objective measures such as actigraphy (e.g. Molfese time routine and sleep efficiency, and more research is needed to
et al., 2015; Nelson et al., 2014). To the extent that this represents understand how bedtime routine activities impact sleep efficiency,
children actually sleeping less than what their parents believe, at including whether it is the total number of steps or if it’s the con-
least in certain cases, this could have health or behavioral impli- tent of those steps (e.g. reading and snuggling versus bathing and
cations. Given the National Sleep Foundation’s recommendations brushing teeth) or affective qualities of the parent-child interaction
for sleep (11–14 h for toddlers, 10–13 h for preschoolers), parents that matter more.
may (wrongly) assume their child is getting “enough” sleep because Differences in the bedtime routine between weeknights and
their sleep falls within these guidelines. Given that average night- weekends also seemed to play a role in the prediction of nightly
time sleep duration as measured via actigraphy was a little over sleep. Weeknight was a significant predictor in all four bedtime rou-
8 h, this means the majority of toddlers in the present study are tine models predicting parent reported sleep duration, as well as
not meeting the National Sleep Foundation’s recommendations. As in the prediction of actigraph recorded sleep duration for the mod-
a result, parents of children displaying behavioral difficulties may els including routine activity total and normal routine deviation.
not even consider inadequate sleep as a potential area for inter- In addition, weeknight interacted with routine length variability
vention in their children’s difficult behavior, and may not talk with to predict sleep efficiency, and normal routine deviation to predict
their pediatricians about addressing possible sleep problems. parent reported sleep duration. Even at this young age, 30 month
The only significant models from the aggregate regression anal- old toddlers seem to be experiencing differences in bedtime rou-
yses involved bedtime routine variables predicting parent reported tines and sleep between weeknights and weekends, and part of this
sleep duration. The daily-level analyses utilizing multilevel model- may be attributed to their parents’ work schedules. Parents who
ing revealed that the nightly bedtime routine and nightly variability work a traditional 40-h work week may be more regimented in
in the bedtime routine were most consistently related to parent bedtime routines during the week, and more lax in implementing
reported sleep duration as compared to actigraph recorded sleep the normal routine or a consistent bedtime on the weekends. This
duration. Specifically, longer bedtime routines and more variable reasoning is supported by findings from Randler et al. (2012) who
bedtime routine lengths on weeknights led to less parent reported found that parents try to enforce regular bedtimes on weekdays,
sleep duration. This may be because longer routines naturally push but would prefer their children to go to bed later and wake up later
the actual bedtime later, leading to reduction in time in bed avail- on the weekends.
able for sleep. For parents who work full time outside the home Alternatively, parents may view the weekend as a “catch-up”
and send their children to childcare, morning rise times are less period, where they allow their toddler to sleep in to catch up on
flexible than nightly bedtimes because parents need to arrive at sleep they may have missed during the week. Indeed, the mean
work the same time every day, meaning their children need to wake differences seem to confirm this, showing that parents report their
up at around the same time every morning. So, on nights when a toddlers getting more sleep on the weekends. Interestingly, the
longer bedtime routine pushes the actual bedtime later, parents objective measures of sleep via actigraphy showed no differences
may assume their toddlers are getting less sleep on that night. in total amount of sleep between weeknights and weekends; the
The fact that longer routines and more variable routine lengths only difference was for actigraph recorded wake minutes, indicat-
did not relate to objective measures of sleep assessed via actig- ing children had more wake minutes on weekends, consistent with
raphy, however, suggest that toddlers may not be missing out on findings from Iwata et al. (2012). So, toddlers may be spending more
sleep to the extent their parents think they are. This finding is time in bed, albeit awake, leading to their parents reporting more
consistent with those from Staples et al. (2015) who found that sleep on the weekends, even though actual sleep is not increasing.
26 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27

Some ancillary findings also warrant mention. While not lier than desired in order for parents to get to work at a specific time.
hypothesized, we did explore whether gender, ethnicity, and Alternatively, in higher income families, there are more resources
income characteristics influenced the findings. We did find that available for extra activities such as swim lessons or trips to chil-
girls were reported to have longer and more variable routine dren’s museums or zoos, or technology such as ipads or tablets,
lengths than boys, and toddlers in families with higher income was both of which may push bedtimes later if attended or used during
related to lower parent reported sleep duration. Both findings were the evening.
somewhat surprising given what is currently known from the lit-
erature base on sleep and bedtime routines in young children. Few
studies have examined relations between gender and sleep out- 4.1. Implications
comes in young children, and at this point, results are mixed. In a
population-based longitudinal study of over 14,000 live births in There are some important implications from the present study
England, Blair et al. (2012) found that while infant and toddler girls to consider. Some parents may not be adequately aware of or
went to bed at the same time as boys, they consistently got five to concerned about their toddler’s sleep, because their perception
ten more minutes of sleep at night than boys, a statistically signif- is that their toddler is sleeping more than they actually are.
icant difference. In contrast, an online survey of over 3000 US and Given the importance of adequate and high quality sleep for the
Canadian parents found no differences in sleep duration between developing child, information about objectively-measured versus
boys and girls aged 0 to three (Sadeh et al., 2009). parent-reported sleep amounts, the importance of consistent
However, the authors know of only one study to examining nightly bedtime routines, and differences in toddler sleep between
relations between child-level characteristics including gender and weeknights and weekends should all be shared with parents, pedia-
bedtime routines, the focus of the present study. In a sample of tricians and other professionals working with children and families.
over 3000 three-year-old children, Hale et al. (2009) found that in Encouraging consistent bedtime routines and more awareness of
comparison to parent-level factors such as maternal race, age, and their toddler’s sleep in general is an easy point of entry for pedia-
education, as well as household level factors including poverty sta- tricians and other professionals into discussions with parents about
tus and number of adults and bedrooms in the house, child-level their children’s development.
factors including age, birth weight, and gender were unrelated to
bedtime routines. However, because that sample was comprised
of primarily low-income and ethnic minorities, those findings may 4.2. Limitations and future directions
not generalize to the present study’s higher income, and primarily
White sample. Several limitations to the present study warrant mention. First,
We can offer a few suggestions as to why might girls have longer parents reported on both bedtime routines and sleep duration on
and more variable routine lengths than do boys. It may be that the same sleep diary, which may have inflated relations between
or parents perceive girls as needing or wanting more cuddle time the two due to shared method variance. This is a concern given the
during the bedtime routine. Perhaps the girls are a little more ver- consistent relations found between bedtime routines and parent
bally adept, which allows them to manage parents more effectively. reported sleep in comparison to actigraph recorded sleep measures
Or, parents perceive boys as being more difficult to settle, forcing in this study. However, we believe this limitation is attenuated by
parents to stick to a more regimented bedtime routine, thus reduc- the fact that daily reports were taken and averaged across a two
ing routine length variability. Alternatively, parents may perceive week reporting period, rather than using global reports of the bed-
boys as needing more sleep than girls to protect against behavior time routine and sleep duration (e.g. “how much sleep does your
problems during the day, and so parents may use a shorter routine child get at night?”). In addition, if a parent perceives their child as
with boys to ensure earlier sleep onset times. To better under- not getting enough sleep, they may be inclined to alter the bedtime
stand gender differences in bedtime routine lengths more research routine in some way to improve or increase their child’s sleep. Thus,
is needed, including possible qualitative examinations into parent when considering how parents implement the bedtime routine
perceptions of gender differences, sleep, and bedtime routines. on a nightly basis, parent perception of their child’s sleep dura-
The finding that higher incomes were related to less parent tion may be just as important as actual, objectively measured sleep
reported sleep duration was unexpected, because in general, lower duration.
incomes are associated with shorter sleep duration. For example, in Second, the way that variability in bedtime routines were aggre-
a study of over 2000 Canadian children ages 1.5–5 years, Touchette gated in this study did not allow examination of individual or
et al. (2009) found that shorter sleep duration measured via par- specific bedtime routine activities, such as reading or technology
ent report was associated with “insufficient income”, defined as a use, as they relate to sleep outcomes. Future research should exam-
family spending 20% more of their income on food, shelter, and ine individual routine activities to determine whether and how
clothing than the average family. Another study of 493 toddlers they may relate to sleep outcomes. Finally, information on whether
aged 30 months found that SES, as measured by the Hollingshead children in this study went to childcare full time or part time during
Four-Factor Index (Hollingshead, 1975), was weakly but positively the week or stayed at home with a parent was not available for all
correlated (r = 0.16) with an actigraph sleep duration composite children, and thus this important covariate could not be included
consisting of average sleep period, average duration of time in bed, when examining weeknight versus weekend differences in bed-
and average minutes asleep in bed (Hoyniak et al., 2018). Results time routines and sleep. It may be that children who do not attend
may not be directly comparable however, because the present childcare full time due to their parents work schedule do not have
study used raw actigraph measures as opposed to an actigraph as variable bedtime routines or sleep patterns, because there’s no
sleep composite, and a direct measure of household income as a need for a “catch-up” period on the weekend. Conversely, it is plau-
proxy for SES, instead of a composite Hollingshead index, which sible that children who do not attend childcare full time during
takes occupational prestige and educational attainment into con- the week may have more variable bedtime routines and sleep pat-
sideration. In the present study, which consists of primarily high terns because they are not constrained to wake up at a certain time
income families, both parents are likely working full time jobs, and each morning so that their parents can get to work on time. Future
parental work schedules naturally put contrainsts on children’s research on bedtime routines and sleep should include information
sleep schedules, particularly what time children wake up in the on toddlers who attend childcare full time versus toddlers who stay
mornings. Parents may perceive needing to wake their toddlers ear- at home with a parent.
 A. Prokasky et al. / Early Childhood Research Quarterly 49 (2019) 18–27 27

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