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Changes in bedtime schedules and behavioral difficulties in 7 year old children.

By Y. Kelly, J. Kelly, and A. Sacker

Pediatrics, Volume 132, Issue 5, 1 November 2013, Pages e1184-e1193

Editor's comments:
Non-regular bedtime schedule is associated with more behavioural difficultieThis study has no specific link with nocturnal enuresis, but it just focuses on regular bedtime schedules.  There is a link between sleep problems and adverse behavioural outcomes, and in this study in 7-year old children it was shown that non-regular bedtimes were associated with more behavioural difficulties.  There were clear dose-response relationships and the effects of not having regular bedtimes appeared to be reversible.


Causal links between disrupted sleep and behavioral problems in nonclinical populations are far from clear. Research questions were as follows: Are bedtime schedules associated with behavioral difficulties? Do effects of bedtime schedules on behavior build up over early childhood? Are changes in bedtime schedules linked to changes in behavior?

Data from 10 230 7-year-olds from the UK Millennium Cohort Study, with bedtime data collected at 3, 5, and 7 years, and behavioral difficulties scores as rated by mothers and teachers were analyzed.

Children with nonregular bedtimes had more behavioral difficulties. There was an incremental worsening in behavioral scores as exposure through early childhood to not having regular bedtimes increased: mother rated (nonregular any 1 age, β = 0.53; nonregular any 2 ages, β = 1.04; nonregular all 3 ages, β = 2.10, P < .001) and teacher rated (β = 0.22, β = 0.73, β = 1.85, P < .001). Difference in differences analysis showed that for children who changed from nonregular to regular bedtimes there were clear nontrivial, statistically significant improvements in behavioral scores: A change between age 3 and 7 corresponded to a difference of β = −0.63, and a change between age 5 and 7 corresponded to a difference of β = −1.02). For children who changed from regular to nonregular bedtimes between ages 5 and 7 there was a statistically significant worsening in scores, β = 0.42.

Having regular bedtimes during early childhood is an important influence on children’s behavior. There are clear opportunities for interventions aimed at supporting family routines that could have important impacts on health throughout life.


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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.