Study: Irregular Bedtimes Make Children Misbehave

Last updated on April 25th, 2016 at 12:27 pm

“Children with regular bedtimes less likely to misbehave, research shows,” The Guardian reports. The advice is prompted by a new study into the effects of irregular bedtimes on children’s behaviour.

The researchers studied more than 10,000 children whose behaviour and bedtime patterns were monitored when they were aged three, five and seven years.

It found children who had non-regular bedtimes had more behavioural problems over the years than those who had regular bedtimes. This was assessed using a validated mother- and teacher-completed behaviour questionnaire.

Encouragingly, the association between irregular bedtime and misbehaviour appears to be reversible. Many children with a previous history of ‘acting up’ experienced an improvement in behaviour once their bedtime patterns were better regulated.

child upset about bedtimeOne suggested explanation for the results was that those with non-regular bedtimes were getting less sleep. This could, potentially, affect the development of regions of the brain associated with behaviour regulation. However, they didn’t measure sleep directly so this remains an assumption.

This study alone cannot prove that other factors aside from bedtime patterns weren’t also influencing behaviour. Child behaviour is an incredibly complex area and many factors have the potential to affect it.

With these limitations in mind, setting a regular bedtime schedule is thought by most childcare experts to be an effective method of making sure your child gets the right amount, and improves the quality, of sleep.

Read more Healthy sleep tips for children.

Where did the story come from?

The study was carried out by researchers from University College London and was funded by a grant from the UK Economic and Social Research Council.

The study was published in the peer-reviewed medical journal Pediatrics.

Overall the media reporting of the study appeared accurate. Though the inherent limitation of the study – the fact that other, unaccounted for, factors may have been influencing behaviour (confounders) was not discussed.

What kind of research was this?

This was a cohort study measuring bedtime information and behavioural difficulties of the same group of children over a period of four years.

The study reported that the causal links between disrupted sleep and behavioural problems are not clear. So their study aimed to address the issue by answering the following questions:

  • Are bedtime schedules associated with behavioural difficulties?
  • Do effects of bedtime schedules on behaviour build up over early childhood?
  • Are changes in bedtime schedules linked to changes in behaviour?

A cohort study is useful for measuring changes over time, such as the impact of changes in bedtime patterns and behaviour. Limitations of this approach are discussed in the conclusions section.

randomised control trial would be a more effective way to assess the impact of bedtime patterns on behaviour but this would be problematic to perform for practical and ethical reasons.

What did the research involve?

Information from 10,230 seven-year-olds from the UK Millennium Cohort Study was analysed – this is an on-going cohort study involving children born around the turn of the millennium. Bedtime information was collected at three, five and seven years, alongside behavioural difficulties scores as rated by mothers and teachers.

At three, five and seven year time points the child’s mother was asked, “On weekdays during term-time, does your child go to bed at a regular time?” (response categories were always, usually, sometimes, and never). These were then categorised into either “regular bedtime” (always or usually) or “non-regular bedtime” (sometimes or never) for analysis. Questions were not asked about bedtimes on weekends.

Behavioural difficulties were assessed by teachers and mothers who were asked to complete a validated questionnaire called the Strengths and Difficulties Questionnaire (SDQ), age four to 15 years version.

The SDQ asks questions about five domains of social and emotional behaviour, namely conduct problems (or in layman’s terms “being naughty”), hyperactivity, emotional symptoms, peer problems, and prosocial behaviour (behaviour intended to benefit others).

Scores from the first four domains are combined to construct a total difficulties score.

Children with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder were excluded from the study.

The analysis took into account observed reductions in behavioural difficulties scores as children get older, alongside numerous other potentially influential factors, known as confounders, such as household income, highest parental education, birth order of the child and psychological distress experienced by the mother.

What were the basic results?

In describing the study cohort the authors noted that children without regular bedtimes and those with later bedtimes (9 PM or later) had more socially disadvantaged profiles. For example, they were more likely to be from the poorest homes, have parents without degree level qualifications, and have mothers with poorer mental health. This was later adjusted for in the statistical analysis.

The main findings were:

  • There was an incremental worsening (“dose-dependent”) in behavioural scores the longer children were exposed to non-regular bedtimes. Behavioural scores got worse compared to those with regular bedtimes as they progressed through age three, to age five to age seven. The behavioural deterioration was reported by both mothers and teachers.
  • Children who changed from non-regular to regular bedtimes had statistically significant improvements in behavioural scores, changes that were described as “nontrivial” by the study authors.
  • For children who changed from regular to non-regular bedtimes between ages five and seven there was a statistically significant worsening in scores.

How did the researchers interpret the results?

The researchers’ main conclusions were that “having regular bedtimes during early childhood is an important influence on children’s behaviour” and that in light of the apparent reversibility of the bad effects “there are clear opportunities for interventions aimed at supporting family routines that could have important impacts on health throughout life”.

Conclusion

This large cohort study indicates that seven-year-old children with non-regular bedtimes have more behavioural difficulties, as reported by both mothers and teachers using a questionnaire, than children who had regular bedtimes.

There appeared to be a dose dependent relationship with the behaviour gap between regular and non-regular bedtimes widening as the children got older (from three to seven years old).

The behaviour-bedtime relationship appeared to be reversible in both directions as children who adopted new regular bedtimes improved behaviour and those who went from regular bedtimes to non-regular showed signs of deterioration.

There are a number of factors that need to be taken into account when considering the evidence provided by the researchers.

Confounders

The study went to great lengths to adjust for common confounders that could account for differences in behavioural difficulties in children, other than potential lack of sleep due to irregular bedtimes.

Despite their efforts, as behaviour is influenced by so many factors, we cannot be sure that the differences observed are only due to bedtime patterns.

For instance, there may still be important factors, not measured in the study that have influenced these results, such as other unmeasured environmental and lifestyle habits. These could include the child’s diet and exercise, the type of games and other activities they take part in, use of electrical devices such as smartphones or tablets, number of people in the house, mental health history of the father, ethnic background and so on.

What constitutes a meaningful effect?

Another main consideration for this type of study is the magnitude of difference reported in behavioural difficulties between the regular and non-regular bedtime groups, and whether this is meaningful to the person or parents involved.

The study authors stated that a 0.9-point difference in behavioural scores would correspond to a small meaningful difference and that a 2.3-point difference would correspond to a moderate meaningful difference. Additionally, they reported a 1-point difference in behavioural difficulties scores has been shown elsewhere to predict clinically diagnosed problems. It is not clear if these definitions are accurate or whether the parents would agree that these changes were meaningful.

The magnitude of the behavioural differences shown in the study between the two bedtime groups ranged from 0.5 points to 2 points, so using the authors’ guide they appear to be small to moderately meaningful differences.

A change from non-regular to regular bedtimes between ages five and seven corresponded to a behavioural improvement of 1.02 points, suggesting many of the negative effects of non-regular bedtimes may be reversed.

The magnitude of a change from three years to seven years, was slightly less at 0.63 points.

Excluded groups

It should also be noted that none of the children in this study had diagnosed problems such as ADHD, so it is unclear what effect bedtime patterns would have on children with these sorts of chronic conditions.

Loss to follow-up

The study lost touch with approximately 12% of participants in the original cohort. They took reasonable steps to address this missing information in the analysis so this is unlikely to be a source of bias.

Self-reporting

A further potential limitation is that the study did not record sleep quality or quantity directly (they used regular bedtimes as a proxy measure for this) and relied on the recall of events by mothers. This may have led to recall bias based on expectations that a set bedtime is something a good mother should be doing. However, this would make it less likely to find differences between the two groups.

The bottom line is that this study suggests there may be a link between non-regular bedtimes and increased behavioural difficulties, and proposed that lack of sleep was the likely causal link.

However, this study alone cannot prove that other factors weren’t also influencing the children’s behaviour or that non-regular bedtimes or lack of sleep were the main cause of the behavioural problems.

If your child’s behaviour is causing you concern you may want to look at their sleeping habits, and if needs be, encourage a more strict weekday sleeping routine. Children need much more sleep than adults, which depending on age can range from 11 hours for a five year old to 10 hours for a nine year old. Read more about How much sleep do kids need?

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Children with regular bedtimes less likely to misbehave, research shows,” The Guardian reports. The advice is prompted by a new study into the effects of irregular bedtimes on children’s behaviour.

Links to Headlines

Links to Science

Kelly Y, Kelly J, Sacker A. Changes in Bedtime Schedules and Behavioral Difficulties in 7 Year Old Children. Pediatrics. Published online October 14 2013

Child Health & Safety News Roundup: 04-11-2016 to 04-17-2016

Last updated on April 20th, 2016 at 11:48 am

twitter thumbIn this week’s Children’s Safety News: Tinder’s Underage Section Raising Serious Cyber Safety Concerns https://t.co/zc6Q7iyoWr

Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 15 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Health Officials Split Over Advice on Pregnancy in Zika Areas   https://t.co/QduPC2PPD2

Kids and Enteroviruses (Gastrointestinal Tract Illnesses)

Last updated on April 27th, 2016 at 10:02 am

girl child abdominal pain on a gray backgroundEnteroviruses: Now you see the word that describes those viral infections that affect the gastrointestinal tract to one degree or another. These become more prevalent during the warmer months of the year, and therefore may affect a lot of children of early school age during the beginning and end of the school or nursery year.

Your child or toddler may experience vomiting, diarrhea, abdominal pain and fever in one combination or another, but these illnesses, as a rule, tend to be short and mild.  In general the diarrhea usually does not contain blood or mucous as these are found in the diseases that are usually caused by bacterial agents.  The stools are usually clear to yellow/brown and may be watery or just very soft.  Vomiting, fever, and diarrhea usually occur simultaneously but the vomiting is first, followed in rapid order by diarrhea and possibly fever. There are literally hundreds of named viral illness that can cause these symptoms including an enterovirus that you are familiar with; poliovirus is an enterovirus that is usually mild but until the advent of polio vaccine, this virus was capable of infecting the brain and causing any number of disturbing and sometimes permanent symptoms.  It should be said at this point that even though these are usually mild illnesses they are all capable of very rare brain invasion.

I have spoken of the symptoms of these illnesses and it is now important to help parents decide what are the symptoms that should be evaluated by a doctor.  The younger the child or  infant, the shorter period of time with these symptoms are needed to cause dehydration.

Signs of dehydration in an infant or child are (but not limited to):  fussiness, decreased volume of urine or frequency of urination, dryness of the tongue surface- not necessarily the lips, a lack of interest in his/her surroundings and listlessness.

In other words parents always know when their child is acting really sick.  A short talk with your Pediatrician will determine whether your child should be seen in the doctor’s office or things may be managed at home.

Certainly severe dehydration is very rare and has very significant symptoms that probably will not be missed by a parent.

As with all viral illnesses, the best way to prevent spread in the home starts and ends with good vigorous hand washing.  Children will probably be contagious about one day prior to symptoms (you can’t know) and a day after any fever decreases to normal.  If your child is in diapers, you will want to keep him/her at home until the diarrhea at least slows, and your child is acting normal with normal temperature.

Have No Fear – Allergy Safe Food is Here

Last updated on April 25th, 2016 at 12:26 pm

Wherever there is a diagnosis of food allergies, there is also a fear of food.
The thought of social events, eating meals that are not from your own kitchen and trusting that someone else is giving you something that will be safe can be almost just as crippling as the diagnosis itself. Walking into a room of food can set off all sorts of internal struggles and anxieties that may simply make it unbearable to even attempt for some people. But what if that room full of food wasn’t scary or dangerous? What if that room full of food was actually a safe haven where all of the foods were clearly labeled, everyone handing out food had gloves on and answered each and every allergy question that you have about that food?GlutenFree Expo

Jen Cafferty, Founder & CEO of The Gluten Free Media Group shares a personal experience: “There was a family that came to the Secaucus, NJ GFAF Expo and when they walked in, their son had tears in his eyes. He was about 10 years old and was crying. I was worried that something was wrong but then he said ‘This is better than Disney! I can eat everything!’”

With multiple locations across the United States, the Gluten Free and Allergen Friendly Expo is the largest event for foodies with food allergies.  Seeing the immediate need to offer more products for those with Celiac Disease, gluten sensitivities/ auto-immune/inflammatory disease and Autism, this expo is nothing short of a great way to regain your trust in food and to find new items that you didn’t even know were available for you.

For the price of an expo ticket you get:

  • 1 Day or Weekend entry to the vendor area with 100+ brands
  • A free reusable bag that has a bunch of wonderful items inside to add to it
  • Gluten free samples from the vendors
  • Discounts on many of the products at the event
  • Vendor coupons to help you save after the expo
  • Free classes to help you with a gluten free and allergen-friendly lifestyle
  • You also get to meet your favorite product vendors, authors and bloggers (like me!)

Why I Go

We all need a sense of community to strengthen our food allergy journey. I have personally found that attending these expos allows me to connect with other people on so many different levels. Being able to meet and talk to the product vendors about why they do what they do, what your family needs them for or even to recommend some new ideas brings about a newfound voice that many of us don’t know how to share. Bumping into other attendees and just having a conversation makes us realize that we are all in this together and regardless of how long we have known each other, what we do know is that someone else’s family is instantly our family in any allergic scenario. You may enter with caution because you are so used to fearing what these foods can do to you but when you leave, this will be the same food that GF Pastawill empower you to get through all of those difficult days. Between the delicious never-ending samples of food, the goody bags followed by even more goodies being handed out to you along the way and the personal touches of the expo, you will be reminded that food is fun. How long has it been since you felt comfortable saying that? Where else can you walk, talk, eat and have a picture taken with a giant fork? Whether you go alone or as a family, there is something for people of all age groups to pick up, pick at and pose for.

Our family has been to the Atlanta, GA Gluten Free and Allergen Friendly Expo twice: once as a family (shared here) and this time I was honored to be a part of their press team. The only difference between the two trips- it got even better.  Why am I sharing? Because it’s part of my passion to help others with food allergies and I want everyone to feel good about their food allergies.  When you feel out of control or lost, there are places to go and people to meet who will help you.  Why not enjoy the journey along the way?

For more information on the Gluten Free and Allergen Friendly Expo visit http://gfafexpo.com/.

Information and Tips for Your Underweight Teen Daughter

Last updated on April 19th, 2016 at 01:20 am

If you’re underweight, it’s not just your energy that may suffer. How do pallid, blotchy skin, thinning hair and brittle nails sound?

underweight girlYou may have wondered for a while if you’re underweight. Perhaps friends or your parents have mentioned it.

You can check by using our interactive Healthy weight calculator.

If you’re underweight, your GP (*family doctor), practice nurse or school health visitor can give you help and advice.

There could be an underlying medical cause that needs to be checked out.

Or perhaps you haven’t been eating a healthy, balanced diet. That may be due to stress or other emotional problems.

During your teenage years, your body is changing. Sometimes, teenage girls may feel unhappy about these changes, but they are your body’s way of preparing you for pregnancy in later life.

Whatever the situation, if you’re concerned about your weight or your diet, the best thing to do is to tell someone. There’s lots that can be done to help.

Is It an Eating Disorder?

Even if you already know all about healthy eating, there may be other issues that are stopping you from having a healthy diet.

If you feel anxious when you think about food, or you feel you may be using control over food to help you cope with stress, low self-esteem, or a difficult time at home or school, you may have an eating disorder.

People with eating disorders often say that they feel that the disorder is a way of keeping control over their lives. But that’s an illusion: it’s not they who are in control, but the eating disorder.

If you feel you may have an eating disorder, help is available. Tell someone – ideally your parents or guardians, or another adult you trust.

You can learn more in Eating disorders.

Why Are You Underweight?

If our healthy weight calculator has told you that you may be underweight, think about why this might be.

  • Have you been unwell?
  • Have you been eating healthily, or have you been skipping breakfast or lunch and eating snacks on the go?
  • Have you lost your appetite because you’re stressed or worried?
  • Have you been trying to lose weight? Are you more focused on being thin than being a healthy weight?
  • Are you not eating because it gives you a feeling of control?

Why It Matters

Being underweight is bad for you. It’s bad news for your health now and for the future. The consequences include:

  • Lack of energy –  being underweight can leave you feeling drained and tired. Not very useful if you’re trying to revise (*study) for exams, play sport or go out with your mates.
  • Nutritional deficiencies – if you’re underweight, you may be suffering from a lack of the vital nutrients your body needs to grow and work properly. Calcium, for example, is crucial for growing young women because it helps to develop strong and healthy bones. If you don’t get enough calcium, you risk having osteoporosis (fragile bone disease) later in life. Iron is also crucial for good health. After your period starts, you lose more iron through your menstrual blood. Other nutritional deficiencies could leave you with unhealthy skin and brittle or thin hair.
  • Weakened immune system – your immune system is not 100% when you’re underweight, so you’re more likely to catch a cold or the flu and other infections.
  • Delayed or interrupted periods – if your period hasn’t started yet, it may be delayed because you’re underweight. Or, if you’re having periods, these may stop if you’re underweight. That’s because being underweight can upset your hormones and stop them from working properly.
  • Damage to future fertility – if your periods stop because you’re underweight, you risk having problems getting pregnant later in life.

A Healthy Diet

If you’re underweight, aim to gradually gain pounds until you achieve a weight that’s healthy for your height and age.

But it’s crucial that you gain weight the right way. Chocolate, cakes, fizzy drinks and other high-calorie foods full of saturated fat and sugar are likely to increase your body fat, instead of your lean body mass.

Instead, use the following healthy eating principles:

  • Meals based on starchy carbohydrates such as wholemeal pasta, brown rice, potatoes or lentils.
  • Five portions of fruit and vegetables a day.
  • Lean protein from (meat, fish, beans and pulses).
  • Three portions of calcium a day. One portion can be a glass of milk, a yoghurt or a matchbox-sized piece of cheese.
  • Cut down on saturated fat found in processed meats, pies, cakes and biscuits.
  • Cut down on sugary foods and drinks, such as chocolate, cakes and biscuits and sugar-rich soft drinks.

If you’re trying to gain weight, eat foods that are healthy and packed with energy:

  • Make time for breakfast. Try porridge with chopped fruit or raisins sprinkled on top. Or eggs on toast.
  • Fruit smoothies or milkshakes make a great snack. You can make them at home and take them to school.
  • A jacket potato (*baked potato) with baked beans or topped with tuna makes a healthy lunch and contains both energy-giving carbohydrate and protein.
  • Peanut butter on toast is a quick, high-energy snack.
  • Try yoghurts and milky puddings, such as rice puddings.

Learn more about healthy eating in Food and diet.

Editor’s Note: *clarification provided for our US readers.

 

Child Health & Safety News Roundup: 04-04-2016 to 04-10-2016

Last updated on April 19th, 2016 at 01:19 am

twitter thumbIn this week’s Children’s Health News: Apple’s new short film starring autistic teen shows how tech transforms lives https://t.co/Qxzrrb8Nqx

Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 20 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Exploring bullying issues with loved ones can be a tough call, use poster creator
 Great resource to get the conversation started