Q&A: Bedtime, naptime routines improve infant sleep

Key takeaways:

• Almost two-thirds of parents had a bedtime routine for their young infant.
• Babies and parents slept better and longer with a bedtime routine.

Implementing bedtime and naptime routines for newborns may improve infant and parent sleep and help families with bonding, according to a study published in Sleep Health.

Previous research has shown that bedtime routines are beneficial for babies and toddlers, but very little research has looked into the youngest infants aged 0 to 3 months, according to Jodi A. Mindell, PhD, a clinical psychologist and professor at Saint Joseph’s University and Children’s Hospital of Philadelphia.

“We've known about the importance of bedtime routines in infants for a long time, and to me, it is a perfect package,” Mindell told Healio. “We really never looked at what's happening in the first few months of life, and I've always felt that those few months are really the foundation for sleep health.”

Mindell, Mack and colleagues surveyed parents (67% women) of 135 babies aged 1 to 15 weeks (54.8% boys; mean age, 8.2 weeks) from the United Kingdom and United States about whether they had a bedtime or naptime routine and what they thought about it. They used questions from the Brief Infant Sleep Questionnaire to evaluate infants’ sleep and two validated measures to measure parents’ sleep quality and next day functioning.

Parents reported their babies slept for an average of 8 hours and 30 minutes overnight and woke up 3.19 times throughout the night. During the day, parents reported their infants napped 3.96 times, which added up to an average of 5 hours and 40 minutes of daytime sleep.

According to the researchers, 61.9% of parents had a bedtime routine, which they implemented an average of 5.67 days each week. Bedtime routines lasted a mean of 43 minutes compared with the 18 minutes it took for parents without a bedtime routine to prepare their baby for sleep. Only 20% of parents reported implementing a naptime routine, which took an average of 19 minutes, the authors wrote.

Babies with a bedtime routine fell asleep nearly 40 minutes earlier than babies without a bedtime routine, and they tended to sleep for longer stretches before waking up, according to the researchers. Additionally, parents who implemented a bedtime routine for their infant reported fewer sleep disturbances compared with parents who did not have a bedtime routine.

Healio spoke with Mindell and M. Catherine Mack, PhD, director of baby care research and development for Kenvue Brands, to learn more about the findings and how to encourage parents to establish bedtime and naptime routines for their families.

Healio: Were any of the findings surprising to you?

Mindell: Findings from studies are often surprising! Two out of three parents had a bedtime routine for their infant — which I expected, given that it was in the United Kingdom and the United States, where bedtime routines are fairly common — but I was surprised that more than half of them had started it by 4 weeks of age.

The other thing that surprised me was how few families — 20% — had a naptime routine. We know that a very high percentage of parents report having a problem around naps, so this shows us that there is an incredible gap between what’s being done and what could be done that could help families and babies sleep better.

Healio: What were the greatest benefits of sleep routines for infants and their parents?

Mindell: Families who had a bedtime routine for their infants reported that their babies were awake almost an hour less overnight, and the parents had fewer sleep disturbances at night, which is really incredible. The parents also reported that they really liked the bedtime routine, they thought it was easy and simple to implement, and that it helped with bonding. When we looked at the naptime routines, we saw something very similar, in which babies slept better if they had a naptime routine. Fewer parents thought it was easy to implement, but a similar percent thought it helped with bonding.

Healio: How should health care providers talk about bedtime and naptime routines with their patients’ families?

Mack: We've heard from pediatricians and nurses that managing their infants’ sleep is one of the most common questions that they get from their patients’ families. It would be important for health care professionals to talk to their patients about the benefits of a bedtime routine. It does not need to be this big, scary thing. It is a routine that you consistently do with your baby, and the more often that you do it, the more benefits you get. We know from previous research that the more consistent you are with the bedtime routine, the more benefits that your baby is going to have. And, as we all know, if the baby sleeps, the parents sleep!

Mindell: For pediatricians or pediatric providers, they don’t need to recommend “you need to do this every night,” because for many families, that is just not reasonable, and it is such a major leap. Instead, they could recommend “just add one more night a week” to make it more doable.

Healio: Can you provide examples of activities parents can implement in these routines with their babies?

Mack: The bedtime routine can definitely evolve as the infants needs change. When infants are younger, a lot of the bedtime routines include rocking, cuddling, feeding, changing into a sleep sack, massaging or applying lotion and then a bath as well. One of our first pieces of research was to evaluate the benefits of a three-step bedtime routine, which involved a warm bath, a massage and then some quiet time. This can evolve when they get older to include things like reading or singing. All of these activities would be considered calming and soothing and enhance the connection between the parent at the baby.

Mindell: A naptime routine can be very similar to a bedtime routine; you want it to be a message to your baby that it is time to sleep. If you think about the three-step bedtime routine, you can do a three-step naptime routine. You could wash up— you may not always have time for a bath — then apply lotion and sing a song or talk about the day. It is really important to have a naptime routine to signal to your baby that now is time for sleep.

Mack: Speaking of consistency and signaling to your baby that it is time to sleep, this is where a fragrance can play a role. A lotion or wash with a particular fragrance could be a part of the routine that signals the baby that it is time to sleep. This is another way to bring portions of the bedtime routine into the naptime routine.

For more information:

Jodi A. Mindell, PhD, can be reached at [email protected].

M. Catherine Mack, PhD, can be reached at [email protected].