Tag Archives: Evidence

Don’t let the kids get jet-lag: why regular bedtimes are key to a happy healthy childhood

The very best of sleep medicine and research is being presented at the World Sleep Congress in Prague this week. Among that research are findings from work by Child of our Time Editor, Professor Yvonne Kelly and colleagues at the ESRC International Centre for Lifecourse Studies. They have been trying to find out what it is about sleep that matters most when it comes to giving children the best possible start in life. Here Yvonne explains what they have found to date and why regular bedtimes are key to a healthy happy childhood.

What happens in the early years has profound implications for what happens later on in life. Thousands of research papers, many of them using the wonderful rich data in the British Birth Cohort studies, have documented the enduring impacts of the way we live our lives as children on how we fare later on. Children who get a poor start in life are much more likely to experience poor outcomes as adults, whether that’s to do with poor health or their ability to enjoy work and family life later on.

So what has all that got to do with getting enough sleep as a toddler you might ask? Well our research shows it is one of a number of important factors related to getting children off to the best possible start in life and here’s why.

Recommended sleep

The National Sleep Foundation recommends that toddlers should get around 11 to 14 hours sleep every day. For 3-5 year-olds, the recommendation is 10-13 hours and it suggests 9-11 hours for children once they’re at primary school. But is it all about the number of hours sleep children get, or is there more to it than that? Those are the questions we have been addressing in our research into children’s sleep and how it ties in with how they get on at home and at school across the first decade of their life.

Digging into one of those studies mentioned earlier, the Millennium Cohort Study, which has followed the lives of some 20,000 children since the turn of the century, we found that it’s not just the number of hours a child sleeps that matters, but also having consistent or regular bedtimes.

First we looked at the relationship between regular and irregular bedtimes and how the children got on in a range of cognitive tests. The results were striking. Children with irregular bedtimes had lower scores on maths, reading and spatial awareness tests.

Parents who took part in the MCS were asked whether their children went to bed at a regular time on weekdays. Those who answered “always” or “usually” were put in the regular bedtime group, while those who answered “sometimes” or “never” were put in the irregular bedtime group.

Interestingly, the time that children went to bed had little or no effect on their basic number skills, and ability to work with shapes. But having no set bedtime often led to lower scores, with effects particularly pronounced at age three and the greatest dip in test results seen in girls who had no set bedtime throughout their early life.

The key to understanding all this is circadian rhythms. If I travel from London to New York, when I get to there I’m likely to be slightly ragged because jet lag is not only going to harm my cognitive abilities, but also my appetite and emotions. That’s for me, an adult. If I bring one of my children with me and I want them to do well at a maths test having just jumped across time zones, they will struggle even more than I will. The body is an instrument, and a child’s is especially prone to getting out of tune.

The same thing happens when children go to bed at 8 p.m. one night, 10 p.m. the next and 7 p.m. another — we sometimes call this a “social jet lag effect.” Without ever getting on a plane, a child’s bodily systems get shuffled through time zones and their circadian rhythms and hormonal systems take a hit as a result.

Bedtimes and behaviour

Having established the importance of sleep to a child’s intellectual development, we turned our attention to the relationship between regular bedtimes and their behaviour.

At age 7, according to parents and teachers, children in the MCS who had irregular bedtimes were considerably more likely to have behaviour problems than their peers who had a regular bedtime. In addition, the longer a child had been able to go to bed at different times each night, the worse his or her behaviour problems were. In other words the problems accumulated through childhood.

One really important piece of good news was that we found that those negative effects appeared to be reversible, so children who changed from not having to having regular bedtimes showed improvements in their behaviour. There seems to be a clear message here that it’s never too late to help children back onto a positive path and a small change could make a big difference to how well they get on. Of course, the reverse was also true so the behaviour of children with a regular bedtime who switched to an irregular one, worsened.

Bedtimes and obesity

In a follow up study, which looked at the impact of routines including bedtimes on obesity, we reported that children with irregular bedtimes were more likely to be overweight and have lower self-esteem and satisfaction with their bodies.

In fact, of all the routines we studied, an inconsistent bedtime was most strongly associated with the risk of obesity, supporting other recent findings which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

So we have a body of robust evidence now that shows very clearly that regular bedtimes really matter when it comes to a child’s health and development over that important first decade of their life.

Providing that evidence in the form of advice to parents and all those caring for young children alongside recommended hours of sleep could make a real difference, helping protect our children from ‘social jet-lag’ and getting them off to a flying start instead.

Equally protected children: one step closer

In 2015 UCL researchers Anja Heilmann, Yvonne Kelly and Richard Watt produced a report, which showed that there was ample evidence that physical punishment can damage children and escalate into physical abuse. Together with the children’s charities that commissioned the report, they called for urgent action to provide children with the same legal protection against violence that British adults enjoy. The report was at the heart of Scottish MSP John Finnie’s proposed Children (Equal Protection from Assault) Bill which the Scottish Government have just announced that they will support in their programme for the coming year. The Bill would make Scotland the first UK country to outlaw all physical punishment by removing the defence of “justifiable assault” of children, and giving them the same protection as adults. Lead researcher, Anja Heilmann, reflects on the news and what she hopes it might mean for the human rights of children in Scotland and elsewhere.

On 11 May 2017, John Finnie MSP proposed a Bill to the Scottish Parliament to “give children equal protection from assault by prohibiting the physical punishment of children by parents and others caring for or in charge of children”.

After a three month consultation, which received more than 650 responses, the majority positive (75 per cent), that Bill became part of the Scottish Government’s plans for the next year, as Nicola Sturgeon announced she would not oppose it.

If passed, the Bill will prohibit the physical punishment of children by ending the existing common-law position that physical punishment by parents can be defended as reasonable chastisement and therefore be lawful. The Bill will not create a new criminal offence, as the common law offence of assault will apply (with a modification removing the reasonable chastisement defence).

It’s a far cry from similar efforts made in Scotland in 2002 to prohibit the physical punishment of children under the age of three. Back then, not only did a majority of MSPs reject the idea, but it was branded as “ridiculous” and an unwelcome intrusion into family life by many parents and the media.

15 years on it seems attitudes may have changed significantly. In the foreword to the Bill, John Finnie himself said:

“We would no longer consider it acceptable…. to allow our children to roam freely in the back of the car when going on a journey. Neither would we dream of taking them to a cinema if they had to watch a film through a fug of cigarette smoke … Attitudes towards these and many other fundamental societal issues have dramatically changed.”

Those attitudes changed as the result of a clear presentation of the evidence – the hard facts about the damage that those behaviours could cause.

We believe that, in this case, our evidence has made it clear for all to see that hitting children can not only damage them, but it carries the risk of escalation into physical abuse. It is a clear violation of international human rights law and children should and must be afforded the same rights as adults in this respect.

Overwhelming evidence

The evidence for the detrimental effects of physical punishment is vast and consistent. In short, our summary of the available evidence showed that physical punishment was related to increased aggression, delinquency and other anti-social behaviour over time. It also showed the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

There was also a clear link between physical punishment and more serious child maltreatment and negative effects continued into adulthood, including problems of drug and alcohol dependency.

Half-hearted responses to recent human rights rulings condemning the physical punishment of children need to become wholehearted changes to the law, not tinkering that does just enough to meet the minimum requirements of those judgments rather than properly respect the rights of children.

The UN Committee on the Rights of the Child is unequivocal – all forms of corporal punishment of children are unacceptable. Let’s hope the Scottish Parliament can find the courage to make that statement a reality and show the rest of the UK the way.

As Martin Crewe of Barnardo’s Scotland stated:

“This is a huge step forward and sends a very clear message about the kind of Scotland we want to see for our children.”

Personally, I am hoping it’s a kind of Scotland and indeed UK, we WILL see in the not too distant future and I appeal to all MSPs to listen to the evidence and support the Bill.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Why reading is key to giving our kids a great start in life

A growing body of research is pointing to how important and valuable reading is in giving children the best possible start in life, not just for academic success but more broadly including for a child’s mental health and happiness.

In this special episode of the Child of our Time Podcast, Professor Yvonne Kelly is joined by Jonathan Douglas, CEO of the National Literacy Trust and researcher Christina Clark, also from the  Trust. They discuss important new evidence about the benefits of reading for individual children and in addressing social inequalities.

Useful links

Screen use at seven: overweight at 11. Why it’s time to say no to a TV in the bedroom for children

Since the launch of the Childhood Obesity Strategy in 2016, there has been much attention focused on the so-called ‘Sugar Tax’. The March 2017 Budget saw confirmation that sugary soft drinks would be taxed in an attempt to combat rising levels of obesity. This is an important move that has been met with widespread approval from public health professionals. Still, obesity is hugely complex and there are many other things at play in addition to the sugary drinks and snacks that children may consume. Researchers at UCL have been looking in detail at different factors associated with obesity and, in a recent paper, find that children who have a television in their bedroom have higher BMI and more body fat than those who do not. Lead researcher, Anja Heilmann, explains the research and why saying no to a TV in the bedroom could be another important strategy in combatting childhood obesity.

As our TV screens have got flatter, our children have got fatter. There is no getting away from it! Screen-based activities play a central role in our children’s lives. At a very young age, they have unparalleled access to television screens, computers, game consoles and a host of mobile devices. Among 5 to 11 year-olds, TV is still the most consumed medium, with gaming coming second.

At the same time, childhood obesity is not just a national, but a global health worry. In 2014/15 a third of 11 year-old children in England were overweight and a fifth were obese.

Research has repeatedly reported a link between TV viewing and obesity, but although some has hinted at the idea that a television in a child’s bedroom might exacerbate the problem, the evidence here has been rather contradictory. Other plausible pathways could include eating unhealthy snacks whilst watching TV, exposure to food advertising and insufficient and poor quality sleep.

Using information from the Millennium Cohort Study (MCS), which has followed the lives of more than 18,000 children born around the turn of the century, we had the opportunity to see whether having a TV in their bedroom when they were age 7 was, in any way, linked with a child being overweight when they were 11 years old. In other words, we wanted to get to grips with whether there were implications over a child’s lifetime of their screen use and if so, what those implications were.

Useful information

Using trained interviewers, the MCS collects a wide range of useful information including the independently measured height, weight and body fat of a child. These provided us with a set of obesity-related measurements: weight, Body Mass Index (BMI) and Fat Mass Index (FMI), a powerful set of measures for overweight and obesity.

When the children were age seven, parents were asked if their son or daughter had a TV in their bedroom, how many hours they spent watching TV or DVDs and how much time they spent playing on a computer.

 At age 7, more than half of the 12,556 boys and girls we looked at in our research had a TV in their room and it was these children who were more likely to be overweight when they turned 11 when we compared them with those without a TV. They were also more likely to have higher BMI and FMI. In total, a quarter of the boys and nearly a third of the girls were overweight at age 11 and the links between having a TV in the bedroom and overweight were stronger for the girls.

Another strength of the research is that we controlled for the child’s BMI at age 3 and maternal BMI, that way adjusting for genetic factors, as well as food environment in the family. We also adjusted for family income and mother’s education – both of which are important as overweight/obesity is socially patterned, as is TV use.

Interestingly, there was no link between overweight and the time a child, whether they were a boy or a girl, spent playing on a computer.

Clear link

So, given the size of our sample and the robustness of the methods employed here, we can say with considerable confidence that there is a clear link between having a TV in the bedroom as a young child and being overweight a few years down the line. For girls, this represents a 30 per cent increase in the risk of being overweight at 11 compared with their peers who do not have one. For boys the risk increases by around 20 per cent.

Another interesting point to note is that the size of this risk or effect is about the same as that of other things shown to be linked with obesity, such as not being breastfed and being physically inactive.

Nevertheless, policy makers looking to create and implement strategies to reduce obesity should certainly consider building access to television screens in children’s bedrooms into their thinking. Specific initiatives focused on young girls could also be important.

Meanwhile, for parents who may consider it a good idea for a young child to have their own TV in their bedroom or feel under pressure to provide one, the message is quite clear: resist the idea and you may be doing even more to set your child on a healthier path into their teenage years and beyond.

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study is research by Anja Heilmann, Patrick Rouxel, Emla Fitzsimons, Yvonne Kelly, and Richard Watt and is published in the International Journal of Obesity.

Tackling the childhood obesity epidemic: Can regular bedtimes help?

Nearly one in five 10 and 11-year-olds in England is obese, according to NHS figures. With childhood obesity posing not just a nationwide, but a worldwide health threat, public health researchers around the globe are striving to establish which aspects of a young child’s life might set them on a path to being obese later on. Associate Professor Sarah Anderson from The Ohio State University College of Public Health and colleagues from University College London outline the first research to try to disentangle the role of children’s routines and behaviour at age 3 on obesity at age 11 and show that bedtime routines and learning to manage emotions really do matter.

The UK’s Chief Medical Officer Professor Dame Sally Davies has warned that the health of millions of children is in jeopardy and is concerned that being overweight is becoming the norm. She fears half the population could be obese by 2050 at a cost of billions of pounds to the health service and wider economy.

The latest statistics highlight a stark contrast between the wealthiest and poorest families, with childhood obesity rates in the most deprived areas more than double those in the most affluent areas.

Despite the publication in August 2016 of the Government’s long-awaited childhood obesity strategy, charities and health organisations remain highly critical, describing it as a watered-down effort that puts business interests ahead of those of public health. Even the recent introduction of the so-called ‘sugar-tax’ on soft drinks has been met with scepticism in some quarters.

To help inform public health strategies going forward, our researchers looked at the bedtime, mealtime and tv/video routines of very young children and their emotional and behavioural development to see if, at this early stage, it is possible to identify those most at risk of becoming obese.

The study includes information on nearly 11,000 children collected through the UK Millennium Cohort Study (MCS). When the children were three, their parents reported whether children always, usually, sometimes, or never or almost never had a regular bedtime and mealtime, and the amount of television and video they watched each day.

They were also asked a series of questions about the child’s behaviour during the previous six months. Questions were about how children cope with emotions and their persistence and independence in play, including how easily the child became frustrated and whether they sought help from adults when faced with a difficult task. This was to get an idea of how well the child was able to ‘self-regulate’ their behaviour in these areas.

Regular routines

Children with regular bed and mealtimes and who watched less television were better able to control their emotions than their peers with less regular and consistent routines.

At 11-years-old, 6.2 per cent (682) of the children in the MCS were obese, with obesity more common in lower income and less educated families.

Of the routines we studied, inconsistent bedtime was most strongly associated with the risk of obesity, supporting recent findings by our UCL colleagues which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11, stressing the importance of adequate sleep for preventing childhood obesity.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

Regular bedtimes and obesity

Surprisingly, toddlers with irregular meal times had a lower risk of obesity at age 11. Once other routines were factored in, television viewing was not related to obesity, although it is important to note that computer use was not taken into account, and the media environment for young children today is different than it was when children in MCS were young.

There was also a clear link between lower levels of emotional self-control in early childhood and obesity later on. Children with poor emotion regulation at age 3 were over 50 per cent more likely to be obese when studied at age 11.

Children’s level of persistence and independence was not linked to later obesity, however, and it is possible that this could be explained by the relative immaturity of the parts of the brain responsible for a child’s cognitive compared with their emotional development at this young age.

Strongest risk

Our study is the first to look at the relationship between a child’s routines, their ability to regulate their emotions and behaviour and how these factors work together to predict obesity.

The two strongest risk factors for obesity were irregular bedtime and a poor ability to control emotions and these were completely independent of each other. In other words, the link between bedtimes and obesity could not be explained away by a child’s inability to regulate their emotions.

There is a need to look more closely at the timing and regularity of children’s mealtimes and how they impact obesity later on, as we think there may be a lot more factors at play than we have considered here. We also need to better understand how the development of emotional and cognitive self-regulation interacts with metabolic, behavioural and social pathways to obesity.

However, our study supports previous research showing that children’s emotional regulation develops within a family context which includes routines.

One message from our study is crystal clear. To be effective, obesity strategies must target early childhood, and must find a way to support parents, especially those from the most deprived areas, to introduce and maintain consistent bedtimes and other home routines, as well as help children regulate emotions and respond to stress.

Another key message is that one size does not fit all. There is a lot going on in children’s lives that is important for their health and development. Saying that, it would seem that getting our children to bed at the same time every night could be a simple, cost-effective tool in the tool-kit to get them off to a good start and maybe in the larger battle against obesity.

Self-regulation and household routines at age three and obesity at age 11: Longitudinal analysis of the Millennium Cohort Study is research by Sarah Anderson from The Ohio State University College of Public Health; Amanda Sacker and Yvonne Kelly from University College London and Robert Whitaker of Temple University, Philadelphia.

Be prepared: the mental health benefits of scouting and guiding

Being a scout or a guide when we are young might be a good experience for us in all sorts of ways, but can those positive effects be long lasting though our lives and if so, how? Research using the 1958 Birth Cohort shows a strong link between being a scout or a guide when young and better mental health later in life. Professor Richard Mitchell from the University of Glasgow talks to the Child of our Time Podcast about the research, what he and colleagues from Edinburgh found and what he thinks it tells us.

Photo credit: One-and-Other Girl Guides UK

Giving children the best possible start – what matters most?

Child of our Time Editor Yvonne Kelly spoke to a 500-strong audience of politicians and professionals in Gothenburg recently on what matters when it comes to giving children the best possible start in life.

Yvonne was the keynote speaker at the conference hoping to identify the best strategies for making Gothenburg a more equal and socially sustainable city.

Yvonne, Professor of Lifecourse Epidemiology at the ESRC International Centre for Lifecourse Studies at UCL  explained which factors are most closely linked with a child’s health and well-being and presented her research findings on children’s verbal skills, behaviour, bedtimes, reading and obesity.

Better start for children

Giving children the best possible start in life is the topic of a keynote talk today by our editor Yvonne Kelly.

Yvonne will be presenting a range of new evidence from the ESRC International Centre for Lifecourse Studies  to politicians, business leaders, and other professionals and key decision makers at an event discussing how Gothenburg can be made an equal and socially sustainable city.

Yvonne will talk about the factors which are most closely linked with a child’s health and well-being and present findings on children’s verbal skills, behaviour, bedtimes, reading and obesity. She will make the case that signs of social inequalities are evident early in a child’s life and that it is important to intervene early to tackle those inequalities.

Early puberty: a question of background?

New research examining the connections between early puberty in girls and their socioeconomic and ethnic backgrounds is being presented to an international audience of researchers in Germany today.

Early puberty in 11-year-old girls: Millennium Cohort Study findings is work led by Child of our Time editor Yvonne Kelly using information on 5,839 girls from the Millennium Cohort Study.

The findings, presented at the Society for Longitudinal and Life Course Studies 2016 conference in Bamberg indicate clearly that socioeconomic and ethnic disparities are apparent in the UK and are important for all those interested in the short and long term implications for early puberty on women’s health and well being.

Girls growing up – questions of early puberty

The early onset of puberty in girls has been linked with better bone health in older women, but it is also associated with a host of negative outcomes including teenage pregnancy and serious ill health in mid-life. With girls over the last few decades starting their periods earlier and earlier, this is a real cause for concern. A better understanding is needed of who is affected and how if this trend is to be reversed and the long-term health of girls and women is to be secured. Researchers at the ESRC International Centre for Lifecourse Studies at UCL have investigated whether a girl’s socioeconomic background or ethnicity are associated with early puberty and have looked in detail at more commonly supposed links with weight and stress. Yvonne Kelly explains more.

Sexual activity whilst still young, teenage pregnancy, mental health problems, heart disease and breast cancer later in life are just some of the things linked to early puberty in girls. Over the last few decades, girls have started their periods much earlier with the average age falling from puberty has age falling to 12.9 years in 2015.

This research is the first to look over time at whether and how a girl’s social and economic circumstances and her ethnicity might be linked to the early onset of puberty. We suspected that any link that did emerge would, most likely, be explained away by other factors such as being overweight or suffering from stress.

Using information on 5,839 girls from the Millennium Cohort Study, which has been tracking the lives of nearly 20,000 children born at or around the start of the century, it was possible to know, at age 11 whether they had started their period or not.

Details of their birth weight, ethnicity, family income when they were aged 5 and height and weight when they were 7 were also available. This rich information gathered across 11 years of the girls’ lives really enabled us to put together a detailed picture over time of how these factors come together to influence the early onset of puberty.

The girls’ mothers completed questionnaires any social or emotional problems their daughter might be facing, and their own mental health.

Puberty facts and figures

Nearly one in ten of the girls, a total of 550, had started their period at age 11, with girls from the poorest families twice as likely as their most well-off peers to have done so (14.1 per cent v 6.8 per cent). Those from the second poorest group were also nearly twice as likely to have started their period.

Indian, Bangladeshi and Black African girls were most likely to have started their period at age 11, with Indian girls three and a half times more likely than their White counterparts to have done so.

Other factors

On average, girls who were heavier at age 7 and suffered stress in early childhood were more likely to have begun menstruating. Those who had started their periods early also tended to have mothers with higher stress levels, were from single parent families, and tended to have had some social and emotional difficulties themselves.

However, even when we took all these things into account, girls from the poorest and second poorest groups were still one and a half times more likely to have started their periods early.

As far as ethnicity was concerned, income, excess body weight and stress accounted for part or all of the differences in most cases. Interestingly, though with most Indian girls coming from more advantaged backgrounds than their White peers, the likelihood of them having started their period was not explained after we took all the above factors into account.

Lived experiences

Our findings highlight the different lived experiences of ethnic minority groups in the UK: for example Indians are relatively advantaged whereas Pakistanis tend to be materially disadvantaged, Bangladeshis and Black Africans are materially and psychosocially disadvantaged and have a tendency to be overweight compared with the majority ethnic group. They also demonstrate the complex and potentially opposing factors at play for the onset of puberty.

All that considered, we can say with considerable confidence that socioeconomic and ethnic disparities are indeed apparent in the UK. Given the short and long term implications for early puberty on women’s health and well being, improving our understanding of these underlying processes could help identify opportunities for interventions with benefits right across the lifecourse, not just for the girls in our study, but for future generations.

It was also encouraging to note that in the decade or so covered by the data we used, there appears to have been no further decline in the average age that girls begin puberty.

Early puberty in 11-year-old girls: Millennium Cohort Study findings is research by Yvonne Kelly, Afshin Zilanawala, Amanda Sacker, Robert Hiatt andRussell Viner and is published in Archives of Disease in Childhood.

Photo credit: Afla