Sleep duration, bedtime routines, and autonomy in preschool children attending a paediatric outpatient clinic in Valencia, Spain: An exploratory cross-sectional study

Abstract

Background: Sleep in early childhood is a critical determinant of physical, neurological, and emotional development. However, many preschool-aged children do not achieve recommended sleep durations, often due to modifiable environmental and behavioural factors. This study aimed to explore the association between family routines, pre-sleep habits, sleep environment, and sleep quality in children aged 3 to 5 years.

Methods: An exploratory cross-sectional study was conducted using an ad hoc questionnaire administered to parents of children aged 3 to 5 years attending a paediatric outpatient clinic. Descriptive statistics were used to summarise the data. Associations between categorical variables were analysed using Pearson’s chi-square test, likelihood ratio, odds ratios, and Somers’ D coefficients. For group comparisons, either a one-way ANOVA or the Kruskal–Wallis test was used. Statistical significance was set at P<.05.

Results: A total of 91 questionnaires were analysed. Only 23% of children met the recommended night-time sleep duration on weekdays. Sleeping in an individual or sibling-shared bedroom was more common than sleeping in the parents’ room. A total of 73.3% of children required parental presence to fall asleep, and 29% experienced two or more night-time awakenings. Early bedtime (before 21:00) was associated with longer sleep duration. Regarding pre-sleep habits, 86.8% of children never or only occasionally used electronic devices after dinner, while 70.3% of caregivers reported bedtime reading as usually or always.

Conclusion: Family routines, the physical environment, and parental involvement strongly influence sleep hygiene in preschool children. Early and structured interventions are recommended to promote sleep autonomy and healthier sleep patterns.