Toddlers may sleep better in cribs until age 3

(Reuters Health) - Parents who wait to start the crib-to-bed transition until toddlers are 3 years old may find that both they and their children get better sleep, researchers say.

In a survey of parents and caregivers across five countries, those who delayed the transition from crib to bed longer were more likely to report less resistance at bedtime, fewer night awakenings and longer sleep duration for children, the study authors report in the journal Sleep Medicine.

“Research during the last decade has shown how important healthy sleep is across the lifespan, but especially during childhood,” said lead study author Ariel Williamson of Children’s Hospital of Philadelphia in Pennsylvania.

In previous studies, Williamson and colleagues have found that toddlers deprived of sleep tend to have a more difficult time with tasks, temper tantrums and self-regulating behaviors.

“At this age, parents and caregivers are the ones paying attention to, and being affected by, their toddlers’ sleep,” Williamson told Reuters Health by phone. “It’s important to record a caregiver’s report as much as objective measures of sleep.”

Williamson and colleagues collected data from 1,983 caregivers with toddlers aged between 18 and 36 months living in Australia, Canada, New Zealand, the United Kingdom and the United States. The data was submitted by caregivers using the Johnson’s Bedtime baby sleep app, a free smartphone application offered by Johnson & Johnson. J&J Consumer Inc also funded the study.

The research team found that rates of crib-sleeping decreased steadily with age, with 63 percent of toddlers sleeping in a crib from ages 18 to 24 months, as compared to 34 percent still in a crib at 24 to 30 months and 13 percent from 30 to 36 months.

Crib sleeping was associated with going to bed earlier, falling asleep sooner, waking up less often during the night, sleeping for longer stretches during the night and resisting less at bedtime.

“What stuck out to us was how remarkably consistent the benefits were at each toddler age group,” Williamson said. “This is what we see clinically as well.”

In future studies, Williamson and the research team will use the app to investigate how parents start the crib-to-bed transition and what motivates them. In some cases, parents with another baby on the way begin to move their toddler to a bed so they can use the crib again. Others start the transition because their toddler climbs out of the crib or seems physically too big to stay in the current crib.

“Adults tend to see cribs as cages, but that’s not how children see them,” said Lisa Meltzer, a pediatric psychologist at National Jewish Health in Denver, Colorado, who wasn’t involved in the study.

“Children like small spaces as they feel safe and comfortable with them,” she said by email. “If you watch young children play, they like to play under the table or in large boxes.”

Other researchers are interested in developing a protocol that helps families make the crib-to-bed transition, since it could cause some sleep problems that didn’t exist previously.

“Some strategies that already exist for helping kids to stay in bed, such as role-playing games, could also prepare children for that transition,” said Sarah Honaker, a sleep psychologist at Riley Hospital for Children in Indianapolis, Indiana, who wasn’t involved in the study.

Sleep experts and pediatricians tend to recommend an adjustable crib that transitions lower to the ground as the child ages, Honaker said. This helps the toddler get comfortable with a sleeping arrangement that feels more like a bed and reduces injuries and falls if the child tries to climb out of the crib.

“A 3-year-old is more likely to have the cognitive development to remember the rules of staying in bed,” she said in a phone interview. “Buying a crib with an adjustable mattress can prevent parents from having to make a transition that their child may not be developmentally ready to make.”

SOURCE: Sleep Medicine, online November 1, 2018.