Study Defines Ideal Children’s Bedtime Routine | Nutrition Fit



Summary: Researchers outline six key measures that should be implemented to optimize your child’s bedtime routine.

Source: University of Manchester

A study by a University of Manchester psychologist has scientifically defined for the first time what constitutes a good bedtime routine for children between the ages of 2 and 8.

The definition, agreed by 59 UK experts is published in Plos One – one of the world’s leading scientific journals – and will provide welcome guidance to parents who want the best for their children at bedtime.

Funded by the Medical Research Council, the definition identifies 6 key areas:

  • Brushing teeth before bed.
  • Time consistency for going to bed.
  • Book reading before bed.
  • Avoiding food/drinks before bed.
  • Avoiding use of electronic devices before bed.
  • Calming activities with child before bed including bath, shower, and talking.

The study also devises two different ways of scoring bedtime routines: one which measures a single routine and the other for activities over 7 days

A parent should aim to score at over 50 points to achieve an effective routine, says Dr George Kitsaras who led the study.

The same scoring system is used for another ‘dynamic measurement’ where depending how many nights a week parents achieve the activities they receive different, weighted scores multiplied by 1.0.

Dr Kitsaras said: “Bedtime routines are important family activities and have important implications on children’s wellbeing, development and health.

“Organisations as diverse as the Book Trust to the BBC and the NHS are all engaged in this debate- but up to now, there has been no real scientific consensus to inform them; we need untie the conflicting signals and messages parents receive.

“This lack of a clear consensus-based definition of limits health professionals’ ability to communicate best practice effectively with families.

“Our definition considers the parental stresses and difficulties that might arise at bedtime while incorporating best practice and available scientific advice.

“This study for the first time provides that expert and scientific guidance.”

The psychologists, dentists, public health specialists and other experts from education, health visiting and sleep research participated in what is known as a Delphi Process, a method of achieving wider consensus by collecting opinions through several rounds of questions.

Eleven experts took part in an initial group, followed by 25 in round 2, 20 in round 3 and 13 in round 4.

This shows a young girl sleeping
The study also devises two different ways of scoring bedtime routines: one which measures a single routine and the other for activities over 7 days. Credit: University of Manchester

Dr Kitsaras added: “All activities around bedtime matter for children’s development and wellbeing. From the wide range of activities around bedtime, our experts considered toothbrushing to be the most important to remember each night.

“There are strong links between inadequate oral hygiene practices and dental decay in children and adults. For children, early childhood caries can lead to higher occurrence of dental disease in later life and, in some cases, untreated childhood caries can lead to extractions under general anaesthetic causing additional problems for children and parents.

“Washing or having a shower each night before bed, on the other hand might be a common practice for families but our experts considered it to be part of a wider umbrella of child-parent interactions rather than a standalone practice we need to specifically target.

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“I have no doubt the debate will continue and our definition might even be refined as more people engage with it.”

About this sleep and neurodevelopment research news

Source: University of Manchester
Contact: Press Office – University of Manchester
Image: The image is credited to University of Manchester

Original Research: Open access.
Defining and measuring bedtime routines in families with young children; a DELPHI process for reaching wider consensus” by Kitsaras et al. PLOS ONE


Defining and measuring bedtime routines in families with young children; a DELPHI process for reaching wider consensus


Bedtime routines are one of the most common family activities. They affect children’ wellbeing, development and health. Despite their importance, there is limited evidence and agreement on what constitutes an optimal bedtime routine. This study aims to reach expert consensus on a definition of optimal bedtime routines and to propose a measurement for bedtime routines.


Four-step DELPHI process completed between February and March 2020 with 59 experts from different scientific, health and social care backgrounds. The DELPHI process started with an expert discussion group and then continued with 3 formal DELPHI rounds during which different elements of the definition and measurement of bedtime routines were iteratively refined. The proposed measurement of bedtime routines was then validated against existing data following the end of the DELPHI process.


At the end of the four round DELPHI process and with a consistent 70% agreement level, a holistic definition of bedtime routines for families with young children between the ages of 2 and 8 years was achieved. Additionally, two approaches for measuring bedtime routines, one static (one-off) and one dynamic (over a 7-night period) are proposed following the end of the DELPHI process. A Bland-Altman difference plot was also calculated and visually examined showing agreement between the measurements that could allow them to be used interchangeably.


Both the definition and the proposed measurements of bedtime routines are an important, initial step towards capturing a behavioural determinant of important health and developmental outcomes in children.


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