# A pilot bedtime routine intervention for toddlers in primary care: variation by caregiver educational attainment

## TL;DR

A bedtime routine intervention for toddlers may improve sleep and reduce caregiver stress, especially for families with lower educational attainment.

## Contribution

This pilot study explores a bedtime routine intervention's effects beyond sleep, focusing on families with lower educational attainment.

## Key findings

- The intervention improved sleep consolidation and social-emotional outcomes for toddlers of caregivers with lower educational attainment.
- Caregivers in the intervention were more likely to include reading in bedtime routines at 15 months.
- The intervention was found to be acceptable and feasible, with 85% of participants completing both sessions.

## Abstract

A consistent bedtime routine (≥5 nights per week) is an empirically supported intervention associated with better sleep outcomes. However, few studies have examined the impacts of a bedtime routine on outcomes beyond sleep, and among families of lower educational attainment.

This pilot randomized controlled trial (RCT) examined initial outcomes (sleep, development, caregiver stress), feasibility, and acceptability of a primary care-based bedtime routine intervention for toddlers, and explored variation in outcomes by caregiver educational attainment.

Caregivers of 86 toddlers (Mage = 12.89 months, 67.4% Black/African American, 23.3% Hispanic/Latine; United States) were randomly assigned to a bedtime routine intervention or usual care at their 12-month well-child visit (age-based preventative care). At their 15- and 24-month well visits, child sleep (Brief Infant Sleep Questionnaire–R SF), social-emotional development (Brief Infant-Toddler Social and Emotional Assessment), caregiver stress (Parenting Stress Inventory-SF), and intervention acceptability were assessed.

There were no differences in outcomes between the groups, however, the intervention positively impacted sleep consolidation, social-emotional outcomes, and caregiver stress, primarily at 24 months of age, for toddlers of caregivers with lower educational attainment. Additionally, families in the intervention were more likely to include reading in their bedtime routine at 15 months. Caregivers assigned to the intervention also reported strong acceptability and 85% completed both sessions.

This pilot study suggests that bedtime routine intervention for toddlers is acceptable, feasible, and results in increased integration of reading at 15 months of age. Caregivers of lower educational attainment in the intervention condition reported improvements in aspects of child sleep health, social-emotional concerns, and caregiver stress, highlighting the potential for this intervention to reduce sleep health disparities. Future research should continue to examine potential bedtime routine benefits beyond sleep in larger-scale RCTs.