ORIGINAL RESEARCH article
Front. Sleep
Sec. Pediatric and Adolescent Sleep
This article is part of the Research TopicImproving Sleep Health From Infancy Through Early Adulthood: Educational Interventions and Behavior Change StrategiesView all articles
A Pilot Bedtime Routine Intervention for Toddlers in Primary Care: Variation by Caregiver Educational Attainment
Provisionally accepted
- 1Saint Joseph's University, Philadelphia, United States
- 2The Children's Hospital of Philadelphia, Philadelphia, United States
- 3Lehigh University, Bethlehem, United States
- 4Temple University Lewis Katz School of Medicine, Philadelphia, United States
- 5Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, United States
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Background: 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. Objective: 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. Method: Caregivers of 86 toddlers (Mage=12.89 months, 67.4% Black/African American, 23.3% Hispanic/Latine; United States) were randomly assigned to bedtime routine intervention or usual care at their 12-month well-child visit (age-based preventative care). At their 15- and 24-month well visit, 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. Results: 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. Conclusions: 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.
Keywords: Bedtime routines, social-emotional development, behavioral intervention, Education, toddlers
Received: 10 Oct 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Mindell, Lam, Salih, Heere and Williamson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jodi A Mindell, jmindell@sju.edu
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