What are Sleep Problems in Childhood?
Sleep problems in childhood include trouble falling asleep, staying asleep, or waking up early.
Sleep is foundational and one of the most important aspects of daily living for the whole family. Sometimes children with developmental delays may struggle the most with sleep. But, sleep is an issue that impacts many families and children of various ages.
Having a child who does not sleep well can be very stressful. You may find that your child always needs just one more thing before they can go to bed. For example, ‘I need a glass of water,’ ‘I need six stuffed animals in my bed,’ or ‘Mom, can I sleep in your room?’ may be frequent phrases around your house.
Parents may be frustrated and exhausted. Siblings may get annoyed by the sound of a little sister crying at midnight.
Poor sleep habits may impair your child’s daily functioning. The following day, they may fall asleep at school or have learning problems due to chronic drowsiness. Health problems may result due to lack of sleep. For example, some kids keep getting sick with every little bug that goes around due to poor sleep habits. Nightmares may prevent a child from falling asleep for fear of recurrence.
Getting a better night’s sleep means the world to many families. It can have a huge impact on mood, productivity, family harmony, and daily functioning.
Symptoms of Sleep Problems in Children
- You dread bedtime: your child is hard to put down leaving bedtime miserable for your family sleep problems are likely an issue. We would like bedtime to be a calm and welcome routine with stories, cuddling, time to talk, and an easy transition to lights out
- Nightly interruptions: your child is often saying “Mommy, I can’t sleep!”
- Tantrums: if your child throws a fit when you start the bedtime routine or mention the word bedtime, sleep is likely a problem for your family
- Clinginess, excuses, feigned illness: your child uses any excuse to avoid going to bed
- Nightmares or night terrors: your child keeps coming into your room in tears, reporting that they had a nightmare, or having a constant pattern of night terrors
- Long bedtime routine: it takes your child 2 hours or more to get your child to bed
- Constant nighttime waking: your child has poor sleep habits causing everyone in your house to lose sleep and wake up grumpy
- Sleeping in another bed: your child is always sleeping in a sibling’s or parent’s room
Causes of Sleep Problems in Children
Clinically, several reasons can explain why your child cannot sleep.
Circadian rhythms: Some children have difficulty with their circadian rhythms. The typical patterns of when a person gets sleepy and wakes up in the morning are not working well. Establishing a very consistent pattern and schedule that does not change day-to-day can be important here.
Developmental delays & diagnoses: Children with neurological differences that result in developmental delays often have trouble sleeping. Children with diagnoses of Attention Deficit Hyperactivity Disorder, Mood Disorders, or Autism Spectrum Disorder often struggle with sleep.
Gifted children: Often, these children do not sleep well. Some children have trouble turning off their brains and do not sleep as much.
Medical reasons: With children sleep apnea, restless legs syndrome, or childhood insomnia are possible medical reasons for sleep problems. Signs of sleep apnea are: restricted breathing, gasping for air, and snoring. If your child has any of those issues, a meeting with your pediatrician is warranted. The children’s hospital can do a sleep study to understand this further. Restless legs may be related to ferritin levels and iron deficiency.
Anxiety: With children another common sleep problem is anxiety. If your child is anxious, their worries will likely impair their sleep. If your anxious child is sleepy or wakes up a lot, it is helpful to find out what they are thinking about before bed. Is there a test tomorrow? Are there friendship problems? Relaxation techniques may help. A phobia of the dark, for example, could also impact sleep.
Nightmares: If your child has bad dreams and can remember them, check in to see if the dreams have any particular theme. For example, the dreams may all be about showing up late for things or being unprepared. Your child may have dreams about being embarrassed or made fun of at school. These may be signs of anxiety or perfectionism. In that case, a psychologist may be able to help your child with anxiety, which will likely improve sleep.
What to Do About Sleep Problems in Children
If your child can’t sleep, your nighttime routine is the most important place to start. Certainly, issues can be occurring beyond the routine. That said, parents are well-advised to begin a nighttime ritual as the first-line intervention.
- Bedtime must be consistent. Your child’s bedtime should not vary by more than an hour. If your child’s bedtime is 8:30, then 8:00 is about the earliest he can fall asleep, and 9:00 is about the latest. Pushing past your child’s bedtime or requiring your child to go to bed too early is asking for trouble. It disturbs your child’s sleep-wake cycle
- Limit or eliminate light. Light signals the brain to wake up. If devices such as an alarm clock or computer with a light are in the room, remove them or cover them up so that your child can sleep. Night-lights can be used (if necessary), but darker rooms help to facilitate sleep
- Limit or eliminate all screens. Yes! Screens include computers and phones. Staring at a bright, changing, or moving screen will wake your child’s brain, making it much more difficult to fall asleep. The phone should be out of your child’s room for sleep time. Receiving updates and text messages is highly disruptive to sleep
- Use ‘sleep-onset association’ tools. Sleep-onset association refers to cues in our environment that signal sleep. Cozy pajamas, warm blankets, and fluffy pillows can all become associated with sleep. Reading a story, listening to soft music, or quietly drawing can be added to the bedtime routine to help your child’s body begin to wind down. This association is why kids with sleep problems should not do homework or eat in their beds. Beds are just for sleeping. They should sleep in their beds and not on the couch. Heavy or weighted blankets may be helpful. Pleasant sounds and smells can help trigger the body’s impulse to sleep. Find ‘sleep signals’ that work for your child. Provide them consistently as part of the bedtime routine
- Keep it brief and boring. If your child comes in reporting that she can’t sleep, comfort her briefly and put her back to bed. This approach may take many attempts before she goes to sleep. Yet, a quick and simple ‘good night, honey’ and kiss on the cheek sends the message to your child that they are just fine. You are being consistent in your expectations and follow-through.
When to Seek Help for Sleep Problems in Children
If your child is struggling with sleep to the point that it is getting in the way of their learning, relationships, or happiness, it’s time to seek professional help.
Sleep is so important to your life and to your child’s life that it cannot be overlooked. Seeing a professional is the best way if you have tried the tactics above and are not getting the progress you need to see.
Further Resources on Sleep Problems in Children
- Occupational therapist (OT): to help with general adaptive skills, including sleep
- Psychologist or neuropsychologist: to help with anxiety, depression, ADHD; may conduct sleep study; may provide therapy for phobias that restrict sleep
- Pediatrician or neurologist: to consider medical conditions, such as sleep apnea or unexplained extreme drowsiness
- Children’s hospital: to conduct a sleep study if needed. Your local hospital may have a sleep center with expertise in pediatric sleep disorders. They can conduct a sleep study, prescribe medication, or provide sleep tools like a CPAP machine
- Cognitive-behavioral therapist: to help you develop a plan and reinforcement schedule to work with your child on sleep if all medical causes have been ruled out
- ABA therapist: to work on healthy sleep behaviors. An ABA therapist can come into your home. They can help you with more specifics around developing sleep association hygiene and the bedtime routine. Positive reinforcement may be really helpful. These therapists tend to be good at implementing behavior plans
Similar Conditions to Sleep Problems
- General anxiety: children who worry a lot tend to have difficulty falling asleep
- Phobias: children who are afraid of monsters, spiders, or the dark may have trouble sleeping
- Depression: children who have emotional symptoms of sadness or depression often sleep too much or not enough
- Non-compliance: children may refuse to sleep in their beds or go to bed on time because they are in the habit of being defiant or disobedient. In this case, the child does not have a ‘condition.’ Instead, they require more clear rules, expectations, and follow-through from parents to learn good sleep habits
References on Sleep Problems in Children
Huebner, Dawn & Matthews, Bonnie (2008). What to do when you dread your bed: A kid’s guide to overcoming problems with sleep (What to do guides for kids).
Peters, Daniel (2013) From worrier to warrior: A guide for conquering your fears.
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, Fifth edition (DSM-V).
Richard Schwab (2016) Professor of Medicine: University of Pennsylvania. Wharton Business Radio XM: Episodes: 10/11/2016 @12:00 PM, 7/19/2016 @12:00 PM. https://businessradio.wharton.upenn.edu/programs/the-business-of-health-care/guests/
Gates, Mariam & Hinder, Jane (2015). Good Night Yoga. A pose by pose bedtime story.