Improving child sleep quality and duration involves optimizing sleep behaviors. The combination of consistent bedtime routines, appropriate bedtimes, and calm pre-bedtime activities significantly helps children get the sleep they need. Additionally, the ability of a child to fall asleep and return to sleep independently, without bed sharing, is shown to improve the child’s and caregiver’s sleep quality significantly.

Important sleep markers to measure improvement in child sleep include total night sleep, time to fall asleep, night wakings requiring assistance, and sleep efficiency. These parameters help in understanding sleep difficulties.

Number of Night Wakings: This measure is the total number of times a child woke during the night and required caregiver assistance to return to sleep after initially falling asleep and before final morning wake time.

How did the sleep parameter “number of assisted night wakings” change from the initial assessment to the outcome? See below for this pre- and post-sleep measure from 422 interventions with FSI clients in twenty-seven countries, consecutively reported by our child sleep consultants below.

 Figure 1. Paired comparison of nightly assisted wakings before (Initial) and after (Outcome) the intervention (N = 422). The dashed diagonal line represents the line of equality (no change). Points below the line indicate a reduction in wakings.

●   The mean number of assisted night wakings decreased from 3.99 initially to 0.46 at outcome.

●   The maximum number of ten or more initial assisted night wakings in the group decreased from 10.0 to 4.0.

●       Two of 422 children increased night waking from 2 to 6 and from 4 to 6.

Figure 2. Side-by-side boxplot comparing nightly assisted wakings before (Initial) and after (Outcome) the intervention (N = 422). The orange lines represent the group medians, which dropped from 4.0 to 0.0. The boxes encompass the middle 50% of the sample data, showing a consolidation toward zero assisted night wakings post-intervention. Open circles indicate individual statistical outliers.

• The Statistics: (W = 329.5), (p < 0.001), (N = 422)
• Effect Size: Rank-biserial correlation (r = 0.99)

Practical Impact: The intervention produced an exceptionally large practical effect. On a scale from 0 (no impact) to 1 (complete impact), the rank-biserial correlation was 0.99, indicating that the reduction in assisted night wakings was not only statistically significant but also highly meaningful for families after FSI sleep consultant interventions.

These findings suggest that Behavioural child sleep consultations with FSI graduates can support children and caregivers in helping the child to develop the ability to resettle independently after a night waking, or to sleep through the night.

Our next blog will address the Component for Healthy Child Sleep – Wake Up Time