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Toddler Sleep Issues May Lead to Later Problems

An established routine of bath, book, then bed can improve the quantity and quality of children's sleep.

Innovation Story

Toddler Sleep Issues May Lead to Later Problems

Mass General’s chief of General Pediatrics discusses why sleep is so important for young children and advises parents on how to improve their child’s sleep.

Jennifer Nejman Bohonak
January 13, 2018

Childhood sleep researcher Elsie Taveras, MD, MPH, and her team have discovered that toddlers who don’t sleep enough are more likely to have attention, social and behavioral problems years later in elementary school.

The Massachusetts General Hospital researchers analyzed the sleep habits of children between the ages of 6 months and 7 years old using data from Project Viva, a long-term study of 1,046 children. They also interviewed the mothers and reviewed parent and teacher assessments of behavior.

Kids who did not get enough sleep scored poorly on behavioral and attention assessments. And it was not only children diagnosed with attention deficit hyperactivity disorder (ADHD), which is known to interfere with sleep.

“ADHD is at one extreme,” says Dr. Taveras, chief of General Pediatrics at Mass General and an Ofer and Shelly Nemirovsky MGH Research Scholar. “But there is a subpopulation of children with insufficient sleep whose executive functioning skills and behavior mirror those of children with an ADHD diagnosis. Their struggles are also affecting their quality of life.”

Elsie Taveras, MD, MPH
Elsie Taveras, MD, MPH

Social Factors that Affect Sleep

In her recent study, Dr. Taveras learned more about how a family’s situation influences sleep.

Researchers found children living in homes with lower household incomes and whose parents had lower education levels were more likely to sleep less than nine hours at ages 5 and 7. Other factors associated with insufficient sleep included watching more television and having a higher body mass index. African American children overall slept fewer hours than their white counterparts.

Dr. Taveras says the next step is to create interventions to help support parents in developing healthy sleep practices for their children and themselves. Such interventions could include help with establishing home routines, meditation and stress management, and community resources to support parents.

Critical Time for Sleep

Parents can still influence sleep patterns during the toddler and preschool years.

Dr. Taveras once thought the critical time to establish good sleep patterns was from birth to age 2. Her new research suggests parents can also influence sleep during the toddler and preschool years, which can improve outcomes seen in school-age kids.

Insufficient sleep also puts a child at risk for obesity, Dr. Taveras’ research has noted. It’s possible that not getting enough sleep makes it difficult for children to regulate their eating and behavior, Dr. Taveras says, adding this conclusion requires more research. To explore the topic further, Dr. Taveras and her team will use a National Institutes of Health grant to follow 500 newborn babies and their parents for two years.

Dr. Taveras is the new executive director of the Kraft Center for Community Health at Mass General. The center’s initiatives include increasing access to high quality care for disadvantaged populations. The center supported Dr. Taveras’ study, The First 1000 Days, which counsels mothers about their babies’ sleep as well as their own.

What Parents Can Do

Dr. Taveras’ research supports the idea that establishing a routine can improve a child’s quality and quantity of sleep.

The routine for Dr. Taveras’ two children is the 3 “B”’s — bath, book and bed. Most routines take 30 to 45 minutes and may include drinks of water, snacks, reading aloud or brief showers, she adds.

Most bedtime routines take 30 to 45 minutes.

It can be challenging for families to fit dinner, homework, activities and parent-child bonding into the evening, Dr. Taveras acknowledges, adding that there is no one routine for every family. “But parents should know that pushing bedtime later will affect how the child functions at school the next day, and, possibly in years to come,” she says.

Sleep recommendations:

  • 6 months to two years old: 12 hours or longer
  • 3 to 4 years old: 11 hours or longer
  • 5 to 7 years old: 10 hours or longer

Tips for parents:

  • Make bedtime the same time each night.
  • Establish a routine.
  • Remove screens from the child’s bedroom including televisions, smartphones and computers.
  • Turn off the television one hour prior to bedtime.
  • No caffeinated beverages or sugary snacks before bedtime.
  • Use a nightlight and/or quiet music.
  • If you have concerns about your child’s sleep, talk to your pediatrician.

To make a donation to support the research and patient care of Dr. Taveras, or to learn more and contribute your own ideas to helping families establish healthy sleep practices, please contact us.