Send That Kid to Bed!

Kids whose parents impose regular bedtimes have fewer behavioral problems, a study in this week's Pediatrics reports.  Well.  As Rick and I discuss on PodMed, we're not surprised, and while Rick espouses a couple of biological underpinnings that imbue this study with a potential scientific basis, I can't help but reflect on my experience as a parent and say, yes, indeed, and btw, such a strategy may also provide you, mom or dad, with precious alone time.  And that may allow you to be a better parent, too.  So what did this study do?

Data from the UK Millennium Cohort Study on 10, 230 children was used.  These kids were enrolled in the study at birth and bedtime data was collected at 3, 5, and 7 years.  Behavioral issues were also rated by mothers and teachers using a tool called the Strengths and Difficulties questionnaire, which measures conduct problems, hyperactivity, emotional symptoms, peer problems, and 'prosocial' behavior.  Teachers were only surveyed at the 7 year assessment while mothers completed the survey at the 3 and 5 year assessment as well.

A seemingly Herculean attempt was made to assess potential confounders to the primary outcome measures.  Family income, mother's age, birth order, how the mother dealt with behavioral transgressions, mother's degree of psychological distress and a host of additional factors were queried.

Not surprisingly, more children whose mothers reported poorer mental health, those with less educated parents and with lower levels of income went to bed later than 9pm or did not have a regular bedtime.  These kids were also more likely to skip breakfast, have a television in their bedroom and watch more hours of television each day. Those children were also more likely to be rated as having behavior problems by both mother and teacher.

One thing that was really fascinating about this study was the clear dose/response relationship between stochastic bedtimes and worse behavior: the more irregular the bedtime the worse the child behaved.  Additionally, when bedtimes were regularized, behavior problems were reduced and the converse was also true: those kids whose bedtimes became irregular over time developed behavior problems alongside, although this relationship did not reach statistical significance.

The authors of the study point out at least two mechanisms whereby sleep irregularity may impact behavior.  One is by disrupting Circadian rhythms, which are slow to adapt to disruptions in daily cycles, and by sleep deprivation's negative impact on homeostasis and brain maturation.  By whatever mechanism, the study informs parents that there is something that is fairly easy for them to employ that is likely to benefit their children: regular bedtimes. That, at least, is a conclusion that my daughters' pediatrician would have enthusiastically embraced.

Other topics this week include use of colchicine in the treatment of pericarditis in NEJM, which Rick now embraces as the standard of care, the prevalence of brain aneurysms in asymptomatic adults in Annals of Internal Medicine, and probiotics to prevent Clostridium difficile diarrhea in the Lancet.  Until next week, y'all live well.

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Send That Kid to Bed! | jhublogs
October 18, 2013 at 2:09 pm

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Stephen in Florida October 21, 2013 at 12:43 am

This is a very interesting study, but I believe that a lot more research would need to be done in this area. It would still seem like there would be some other factors that could help establish causation, as I only see correlation from the results of this study so far. In any case, it should definitely get parents thinking about getting those kids to bed on time, and will be something that I keep in mind.


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