Routines and child development: A systematic review

Comments · 91 Views

Findings mainly indicate that routines are associated with positive developmental outcomes in children, covering cognitive, self-regulation, social–emotional, academic skills, and overall mental and physical health. The results also underline the protective power of routines in challengi

INTRODUCTION

Children worldwide face challenges from adverse experiences influencing brain development, learning, and health . Environmental factors play a crucial role in molding a child's academic success and long-term health, especially in high-risk settings . In this paper, we delve into the importance of routines as a protective factor in such environments. Through a systematic review, we define routines and outline the research, effects, and limitations linked to the study of routines. 

Definition of routines

The term routine is broadly used in literature to describe regular, established patterns of daily activities, such as tasks or chores aimed at bringing order and efficiency to everyday life . These routines can encompass both family-level activities, such as mealtime and chores, and child-level activities, such as preparing for school and bedtime. Family routines involve regular activities with two or more household members, providing order and structure to daily family life . While often used interchangeably with family rituals, routines are predictable patterns of interaction, whereas rituals have symbolic, emotional significance to the family  . Similarly, family routines are distinct from family traditions, such as specific events like reunions  , family culture, which involves shared beliefs passed down generations  , nonconscious habits , and the theoretical, abstract, and general decisions that form rules  . Appendix A complies definitions of routines. For this review, we used Sytsma et al. (2001) definition of child routines as regular, repetitive behaviors involving a child and an adult. This includes both child- and caregiver-initiated routines, covering activities like bedtime, mealtime, and chores.

Theoretical framework

Bronfenbrenner's ecological systems theory highlights how routines play a crucial role in development by shaping the interactions within an individual's environment. This theory, combined with insights from scholars such as Evans, Imber-Black, Fiese, and Masten, reveals the dynamic interplay between risk, resilience, and stability in development. Evans et al. (2013) focus on how accumulated risks affect development, while Imber-Black et al. (1988) and Fiese et al. (2006) explore routines as resilience-building tools. Masten (2001) emphasizes protective factors, such as routines, that promote positive outcomes despite adversity. By synthesizing perspectives, this review aims to highlight how routines serve as protective factors, mitigating risk and bolstering resilience across high-risk environments.

The current review

Past reviews have delved into the role of family routines in areas such as chronic physical health , family dynamics with autism spectrum disorder , psychological well-being  , and early childhood development . However, many of these are either outdated or have a limited study base. There is a notable gap in examining routines in high-risk environments. Given shifts in family dynamics, societal norms, and research advancements, an updated perspective on the role of routines in child development is essential. This review intends to fill this gap, focusing on the link between routines and child development, and the potential mechanisms involved, drawing from both evidence and theory.

METHODS

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and involved a search of PubMed and PsycINFO databases for literature from 1950 to June 2020, using combinations of the following terms: (“routines” OR “family routines” OR “family ritual” OR “child routines”) AND (“child” OR “toddler” OR “pediatric” OR “early” OR “adolescent” OR “youth” OR “young” OR “teen” OR “preschool” OR “primary school” OR “middle school” OR “high school” OR “secondary school” OR “young people”). No restrictions on publication type, date, or language were imposed. Reference lists of selected articles and existing reviews were manually checked for additional relevant studies.

EndNote (Thomson Reuters, USA) was used to merge search results and remove duplicates. Two teams of research assistants extracted data using a set guideline, ensuring reliability through dual screening and resolving disagreements via discussion by the lead author. Our review focused on titles, abstracts, and full texts that met the criteria: (a) used quantitative methods, (b) identified routines as a predictor variable, and (c) involved participants aged 0–18 or their parents. We prioritized peer-reviewed, empirical articles and excluded dissertations, qualitative studies, case studies, and non-empirical content. Studies were included if they analyzed the direct impact of routines on outcomes, excluding those using composite scores , except when detailing routine-specific findings.

Of the initial 4297 search results, 4261 were potentially relevant after removing duplicates and pre-1950 publications. After applying broad criteria, 2498 were considered. Exclusions were made for 2060 studies not prioritizing routines as a primary predictor, 212 with unrelated routines (e.g., dental hygiene routines), 34 lacking child/adolescent outcomes, 11 intervention studies without routines as a primary outcome, and 40 qualitative studies for consistent quantitative focus. An additional 37 studies were identified from references, resulting in 170 studies assessing the impact of routines on child development in various settings. The selection process is detailed in the Appendix .

RESULTS

Following guidelines from the Centre for Reviews and Dissemination  , this narrative synthesis examined the relations within and between the included studies. Our results focus on two themes: the link between routines and child development, and the mechanisms driving this influence. Although no strict guidelines exist for categorizing studies as outcome or mechanism studies, we carefully categorized studies based on the literature. In addition, the review focused on routines, but some studies blurred the line with rituals; we differentiated between them and suggested future research clearly distinguish the two for clarity.  

Routines and child development outcomes

General cognitive ability

Several studies have investigated the link between routines and cognitive functioning in young children, with 10 out of 12 showing positive associations. Early research emphasized the benefits of a stable and predictable home environment for cognitive development (Bradley & Caldwell, 1987; Wachs & Gruen, 1982). For instance, consistent routines in infancy have been correlated with higher cognitive scores (Wachs, 1979), and similar findings are observed in preschoolers (Zajicek-Farber et al., 2014). Longitudinal studies further support this, indicating that regular routines between 12 and 24 months predict better cognitive ability at 31 months (Wachs, 1978) and structured environments at 6 and 24 months lead to improved mental performance at 54 months (Bradley & Caldwell, 1976).

Family routines significantly contribute to positive developmental outcomes in preschoolers from high-risk environments. Kelly et al. (2011) discovered that routines, along with home learning and psychosocial factors, halved the cognitive test score gaps related to income. Similarly, Ferretti and Bub (2014) found that children in poverty with consistent routines at 14 months demonstrated higher cognitive abilities at 36 months. However, two studies reported no significant connection between routines and cognitive outcomes in low-income preschoolers (Churchill & Stoneman, 2004), and among children of parents with alcohol problems (Bennett, Wolin, & Reiss, 1988).

Self-regulatory functions

Out of 18 studies reviewing the impact of routines on children's self-regulatory and executive function skills, 16 found positive correlations while two showed mixed results. Many studies highlight the potential benefits of routines for children's self-regulatory and executive function skills (Anderson et al., 2017; Bater & Jordan, 2017; Ferretti & Bub, 2014; Koblinsky et al., 2006; Muniz et al., 2014; Ren & Fan, 2019; Ren & Xu, 2019; Zajicek-Farber et al., 2014). These findings are further supported by research suggesting that a lack of organization and predictability at home—a related but distinct phenomenon to the lack of routines—significantly predicts poor executive functions in preschoolers (Dumas et al., 2005; Evans et al., 2010). Furthermore, consistent routines in childhood are associated with better emotional and behavioral regulation (Anderson et al., 2017; Zajicek-Farber et al., 2014).

Daily routines have been demonstrated to augment executive functions in children and adolescents, encompassing capabilities such as inhibition, working memory, and self-control (Frisch & Rosenblum, 2014; Piscitello et al., 2019; Toldson et al., 2006). Moreover, routines confer enduring developmental advantages. For instance, the establishment of routines at 30 months is correlated with enhanced delayed gratification at 60 months (Martin et al., 2012), a connection that persists even after accounting for factors contributing to chaos, such as family instability, crowding, and noise. Notably, this study did not identify a significant influence of routines on attentional skills. Ferretti and Bub (2014) observed that the presence of routines at 14 months led to improvements in children's self-regulation by 36 months, covering facets such as impulse control, aggression management, inhibitory control, attention, and working memory. Furthermore, the adherence to routines during adolescence has been positively associated with emotional self-regulation in early adulthood (Barton et al., 2019).

Research suggests that routines can have a positive effect on families in high-risk situations, promoting children's self-regulation and abilities. This includes children from low-income families (Barton et al., 2019; Brody & Flor, 1997; Bocknek, 2018; Koblinsky et al., 2006; Miller et al., 2017), those with depressed parents (Manczak et al., 2017), and families displaced from their home countries (Elsayed et al., 2019).

While family routines can promote children's self-regulation and abilities, they are not a cure-all. For instance, inadequate sleep can diminish the positive impact of family routines on emotion regulation in toddlers from low-income families (Bocknek et al., 2018). While more routines predicted better emotion regulation for toddlers who slept for at least 11 h, there was no such effect for children experiencing inadequate sleep, highlighting the importance of contextual factors when examining the impact of routines on child development.

Social and emotional skills

In a review of 24 studies investigating the relations between routines and children's social and emotional skills, 23 reported positive associations, while one found no significant relations. Various studies substantiate the positive association between routines and children's enhanced social and emotional skills (Ferretti & Bub, 2017; Fulkerson et al., 2006; Ren & Hu, 2019). Children engaged in more family routines exhibit advanced emotional understanding, empathy, and maintain enriched relationships with peers and adults (Muniz et al., 2014). Moreover, the establishment of routines in families tends to foster elevated self-confidence, self-esteem, and self-reliance in children and adolescents (Pressman & Imber, 2011; Taylor, 1996). Additionally, children experiencing predictable home routines exhibit heightened cooperation and compliance and demonstrate increased willingness to engage, which can augment their social competence (Keltner, 1990; Toldson et al., 2006).

Routines can be a significant predictor of social competence in children who are exposed to high-risk environments (Keltner, 1990; Toldson et al., 2006). Higher family routines have been found to be positively associated with greater prosocial skills, such as cooperation and responsibility, among children living in poverty (Ferretti & Bub, 2017; Koblinsky et al., 2006). Moreover, the presence of regular and predictable routines in the home environments of elementary school-age children from divorced families has been found to associate with enhanced socioemotional skills and improved peer relations 2 years after the observation period (Guidubaldi et al., 1987). Nonetheless, the relations between routines and social skills have yielded inconsistent findings. Churchill and Stoneman (2004) reported that social outcomes in low-income preschoolers were not significantly related to the number of routines in the home.

Academic skills

Much research also focused on how routines support broader outcomes, such as academic skills. Among the academic outcomes studied, 26 studies were identified, with three reporting no significant relations and three presenting mixed results. In fact, having daily routines, such as assigning household chores, maintaining consistency in sleep schedule, and having dinner together, is a common characteristic among families with successful children in school (Fiese et al., 2002; Henderson & Berla, 1994).

Preschool children from families with consistent routines show better academic outcomes, including greater interest in school (Keltner, 1990), larger vocabularies (Hale et al., 2011; Martin et al., 2012; Snow & Beals, 2006), and enhanced literacy and math skills (Dove et al., 2015; Ferretti & Bub, 2017; Fiese & Everhart, 2008; Martin et al., 2012; Serpell et al., 2002; Weigel et al., 2010). Likewise, routines benefit older children and adolescents, leading to academic achievement (Eisenberg et al., 2004), literacy and math skills (Hofferth & Sandberg, 2001), and increased academic self-efficacy and school engagement (Fulkerson et al., 2006; Taylor & Lopez, 2005).

Longitudinal studies highlight the significance of routines in children's development and success. Childhood routines at 36 months are associated with improved problem-solving and language skills at 60 months (Zajicek-Farber et al., 2014), and regular preschool routines correlate with higher kindergarten reading and math scores (Ferretti & Bub, 2017). Bedtime routines at 36 months predict better language skills at 60 months (Hale et al., 2011). Family routines at ages 10–14 and 16–18 are linked to later academic success (Roche & Ghazarian, 2012) and higher university enrollment rates between ages 19 and 21 (Barton et al., 2019).

Research has also explored the impact of routines on academic performance in children living in high-risk environments. Studies have found positive links between routines and improved academic achievement (Budescu & Taylor, 2013; Roche & Ghazarian, 2012; Taylor, 1996), enhanced school engagement (Seaton & Taylor, 2003; Yoshikawa et al., 2003), and better literacy and math skills (Coley et al., 2013; Ferretti & Bub, 2017; Hale et al., 2011; Zajicek-Farber et al., 2014) among children from lower-income families.

Routine disruptions can negatively affect children's well-being post-divorce (Hetherington et al., 1979), but consistent routines can lessen stress and improve outcomes (Fiese et al., 2002). For instance, regular bedtime routines are associated with improved academic performance and fewer absences post-divorce (Guidubaldi et al., 1986). Despite exposure to domestic violence, children with consistent routines showed better school readiness (David et al., 2015), though this effect diminishes with high levels of violence. Similarly, when new jobs disrupt family routines, children's school engagement declines (Yoshikawa et al., 2003).

Research on the link between family routines and academic outcomes has shown some mixed results. Some studies found no correlation between routines and school engagement, mealtime routines, and academic performance (Bartle-Haring et al., 2012; Miller et al., 2012; Taylor, 1996). Another one reported a positive link with girls' math skills but not with overall teacher-reported outcomes for preschoolers (Churchill & Stoneman, 2004), and a weakened association in families experiencing destabilizing events (Roche & Ghazarian, 2012). Additionally, no predictive relationship was found between family routines and language skills in children exposed to cocaine prenatally (Bono et al., 2008).

Mental health

Out of the 73 identified studies on mental health outcomes, 14 showed mixed results, three found no significant relations, and two indicated negative effects. Maintaining consistent routines at home has been linked to improved mental health in children, leading to reductions in internalizing and externalizing problems (Bridley & Jordan, 2012; Fiese et al., 2006; Larsen & Jordan, 2019). Adherence to established routines is linked to reduced symptoms of internalizing problems such as depression and suicidality, as well as decreased instances of externalizing behaviors such as impulsivity and aggression (Eisenberg et al., 2004; Fulkerson et al., 2006; Lanza & Drabick, 2011; Sen, 2010). Moreover, a higher number of routines is inversely related to the severity of ADHD symptoms (Piscitello et al., 2019; Stoppelbein et al., 2019).

Longitudinal studies highlight the positive impact of routines on mental health. Childhood routines in preschool have been linked to fewer conduct problems and less hyperactivity in kindergarten (Ferretti & Bub, 2017). Establishing bedtime routines at age 3 predicts decreased anxious, depressed, withdrawn, and aggressive behaviors at age 5 (Hale et al., 2011). Children with consistent bedtimes at ages 3, 5, and 7 experienced a gradual decrease in behavioral difficulties, which corresponded to an increase in instances of irregular bedtimes (Kelly et al., 2013). Additionally, adolescents involved in family routines show fewer delinquent behaviors and better mental well-being over 3 years (Hair et al., 2008).

Research shows that routines can benefit the mental health of children and adolescents in high-risk environments (Bachman et al., 2012; Coley et al., 2013; Ferretti & Bub, 2017; Koblinsky et al., 2006; Lanza & Taylor, 2010; Loukas & Prelow, 2004; Prelow et al., 2007). For instance, family routines correlate with fewer behavior problems in children of Mexican-origin immigrants (Landale et al., 2015) and reduced externalizing problems in adolescent girls facing cumulative risk factors (Loukas & Prelow, 2004). Routines also lessen psychological distress in adolescents experiencing physical and psychological abuse (Thakur & Cohen, 2020), delinquency in African-American adolescents from lower-resource homes (Budescu & Taylor, 2013), and children's behavioral issues in families experiencing daily hassles (Bridley & Jordan, 2012). The presence of routines can diminish, while their absence can intensify, the effects of daily stressors on children's internalizing behaviors (Kliewer & Kung, 1998).

In addition, routines influence children's development across various family contexts. For instance, reduced family routines due to maternal work conflict are linked to increased externalizing problems in children (McLoyd et al., 2008). Regular routines can mitigate the effects of parental depression on children's behavior, with low routines correlating with higher child maladjustment (Ivanova & Israel, 2006; Manczak et al., 2017; McLoyd et al., 2008). In families affected by maternal HIV/AIDS, frequent family routines are associated with lower levels of internalizing and externalizing behaviors in adolescents over time (Li et al., 2018; Murphy et al., 2009).

Furthermore, research shows that routines can reduce behavioral problems in children across diverse family structures, including single parent (Brody & Flor, 1997), divorced (Guidubaldi et al., 1986; Portes et al., 1992), and remarried families (Greeff & Du Toit, 2009). Family therapy often employs routines to support families during transitions and conflicts (Imber-Black et al., 1988), while daily routines can foster cohesion in blended families (Whiteside, 1989). Higher work–family conflict and maternal depressive symptoms in single-mother households led to more externalizing problems in children due to reduced family routines, a pattern not observed in two-parent households (McLoyd et al., 2008).

Moreover, daily routines have been linked to improved well-being and mental health in families and children with chronic conditions (Boyd et al., 2014; Crespo et al., 2013), such as Down syndrome (Murphy et al., 2017), Rett syndrome (Epstein et al., 2016), and pediatric cancer (Santos et al., 2012201520162017). Children with asthma in families with more routines experience less anxiety (Markson & Fiese, 2000), fewer behavioral issues (DeMore et al., 2005), and better quality of life (Fiese et al., 2005). Conversely, children with autism spectrum disorder (ASD) face more behavioral problems without routines (Henderson et al., 2011; Larson, 2006; Stoppelbein et al., 2016). Siblings of children with disabilities adjust better in families with consistent routines (Giallo & Gavidia-Payne, 2006). However, one study found routines improved parents' quality of life but not children's well-being (Peterson-Sweeney, 2008).

Some studies found no impact of routines on children's behavioral issues (Seaton & Taylor, 2003; Stoppelbein et al., 2016), externalizing (Bono et al., 2008; Martin et al., 2012), or internalizing behaviors (Bachman et al., 2012; Hofferth & Sandberg, 2001

Comments