Study offers tips for healthy sleep for pre-schoolers

It’s a simple problem that drives some parents crazy: How do I get my pre-schooler to sleep? Now an innovative study by University of Auckland research fellow Samantha Marsh is pointing to some easy tips that seem to work.

Parents of children aged between 2 and 4 years old were taught simple techniques for improving their connections with their kids – from songs to imaginative playtime to establishing routines like a pre-bedtime bath. The results of the three-month study have just been published in PLOS One, a peer-reviewed, open access journal. 

The research pointed to improvements in sleep and eating – both key factors driving New Zealand’s epidemic of childhood obesity. Scientists know that lack of sleep affects hormones related to appetite and metabolism and is a strong predictor of obesity. The exact role that sleep plays in obesity may be difficult to unwind, since a child with healthy sleep patterns may live in a household that also values good nutrition and exercise – and who knows which is having the biggest effect?

"A lot of pre-schoolers have sleep issues and parents really struggle with them, so it’s exciting to see something that helps,” said Marsh, herself the mother of two young children with a busy schedule. “The best thing is that parents really liked the programme.”

The ‘3 Pillars Study’ was focused on three things – sleep, family meals, and play. Twenty-seven Auckland parents attended a half-day workshop of parenting advice and received support via a website, while another 27 were in a control group. The quality of the children’s sleep was assessed by their parents, based on factors including how easily the child fell asleep, night-time awakenings, and length of sleep, and the focus was purely on sleep at night, rather than naps during the daytime.

Marsh, who works at the National Institute for Health Innovation in the School of Population Health at the Faculty of Medical and Health Sciences, says the study is unique in that rather than focusing on bodyweight or specific energy balance-related behaviours, the emphasis was on strengthening the parent-child connection. Creating a strong, positive relationship was prioritised over short-term outcomes, such as getting a child to eat.

The aim was to avoid parents fixating on short-term goals, which can result in practices that increase obesity risk in the long term – such as bribing children to eat healthy food. Instead, creating a supportive emotional environment around meals, sleep, and play was promoted as the ideal context for children to develop healthy behaviours. Parents were encouraged to switch focus from outcomes – “eat your vegetables!” -- to processes, such as fostering a happy family dinner-time. 

Early childhood is a critical period for the development of obesity. Children who are overweight at 5 years of age are four times more likely to develop obesity between the ages of 5-14 years compared to children with a healthy weight. Obesity in early childhood is strongly associated with increased rates of premature death in later life and obesity seems to worsen the effects of Covid-19.

Recent research from the Growing up in New Zealand study points specifically to sleep as promoting resilience to obesity in vulnerable New Zealand children. Results from the pilot study are preliminary, and more research is warranted to establish the long-term effectiveness of this relationship-based approach in children from different cultures and family contexts, according to Marsh. Ultimately, any programme aimed at promoting health-related behaviours in New Zealand families must be appropriate and meet the specific needs of those families who need it most, she said.