Children and Sleep
Healthy sleep is essential for children of all ages. Sleep quality and duration play a key role in a child’s physical and mental health. Unfortunately, a large number of children have trouble falling or staying asleep. According to current estimates, as many as 50% of preschoolers and 40% of adolescents experience sleep problems. If left unchecked, these problems can negatively impact a child’s growth and development.
Understanding your child’s sleep needs can help you ensure they follow a consistent bedtime routine and get an adequate amount of high-quality sleep each night. It’s also important to recognize signs your child isn’t sleeping enough on a regular basis. These include feeling tired even after a full night of sleep and frequently waking up in the middle of the night.
Why Sleep Is Important for Children
A sufficient amount of high-quality sleep has been linked to overall happiness in children. Numerous studies have shown that a consistent bedtime routine helps promote emotional and behavioral regulation. One study found children between 12 and 36 months were more likely to exhibit behavioral problems and be less happy at daycare if they experienced sleep problems at home.
In children, sleep can also impact the following:
- Attention: Quality sleep can improve attention and alertness in children, especially those who have been diagnosed with attention deficit hyperactivity disorder.
- Mood: Children with sleep problems are more likely to show signs of low mood and, in turn, display behavioral problems.
- Cognitive functioning: Children who do not get enough high-quality sleep may perform poorly with cognitive tasks compared to their more well-rested peers.
- Academic performance: Inadequate sleep and poor sleep quality can negatively affect learning and memory, and are two common factors for children and adolescents who perform poorly in school.
Infants and young children need the most sleep, so naps often play an important role in their sleep cycle and overall health. Regular napping in tandem with a healthy sleep schedule can improve the following:
- Language skills: Adequate sleep and a healthy nap schedule are believed to positively influence language acquisition and vocabulary growth in infants and toddlers.
- Memory consolidation: Studies suggest a refreshing midday nap can help young children process and consolidate memories from earlier in the day.
- Motor skills and reaction time: Preschoolers who nap on a regular basis tend to exhibit stronger motor function and faster reaction time compared to those who don’t.
Unhealthy sleep also may also increase a child’s risk of developing certain medical conditions and mental health disorders. Inadequate sleep in children has been linked to obesity and diabetes, hypertension, depression, and a greater risk of being involved in an accident. For teenagers, not getting enough quality sleep is also associated with a higher risk of self-harm and suicide attempts. Conversely, too much sleep can lead to some of the same issues, including obesity, diabetes, hypertension, and mental health issues.
If your child does not sleep enough or sleeps too much, you should make an appointment with your family doctor or another healthcare provider.
How Many Hours of Sleep Do Kids Need?
The amount of sleep children need changes as they age. Although sleep guidelines for children vary depending upon the source, most recommendations from sleep experts fall within the same general range. The following sleep recommendations are based on findings from a multidisciplinary panel organized by the National Sleep Foundation:
|Age Group||Recommended Hours of Sleep Per Day|
|Newborns (0 to 3 months)||14 to 17 hours|
|Infants (4 to 11 months)||12 to 15 hours|
|Toddlers (1 to 2 years)||11 to 14 hours|
|Preschoolers (3 to 5 years)||10 to 13 hours|
|School-age Children (6 to 13 years)||9 to 11 hours|
|Teenagers (14 to 17 years)||8 to 10 hours|
Helping Children Get Enough Sleep
The best ways to help your child get enough sleep will change and evolve as they get older. This process should begin as soon as they arrive home after delivery, and continue throughout their childhood and adolescence.
Newborns (0-3 Months)
Since newborns need up to 17 hours of sleep per day, their sleep is segmented throughout the day and night. Children under 2 months follow a 24-hour cycle of sleeping and waking. Most newborns only stay awake for one to three hours at a time, during which they eat, before falling asleep again.
While still in the womb, unborn babies begin establishing the circadian rhythm that guides their sleep cycle. Their circadian clock continues to develop after they are born. Since light greatly influences circadian rhythms, exposing newborns to sunlight during the day and dimming lights in the home at night to mimic natural darkness can reinforce circadian development. Most infants have fully or mostly developed circadian rhythms by the age of 3 to 4 months.
Many parents help their newborns sleep by putting them to bed when they are tired, rather than after they have fallen asleep. Newborns often show they are tired by crying or rubbing their eyes. Maintaining a quiet indoor environment in the evening and keeping the lights off during nighttime feedings can help a baby feel sleepy at night.
Infants (4-12 Months)
Infants need 12 to 15 hours of sleep per day. An infant’s circadian rhythm will probably be fully developed by the 4-month mark and their sleep cycle will start to become primarily nocturnal. However, they still need naps to reach their recommended hours of daily sleep. Infants up to 12 months old may take up to four naps per day, which last 30 minutes to 2 hours each.
Between 4 and 6 months, infants sleep about 6 to 8 hours at a time. This number gradually increases to 10 to 12 hours between the ages of 6 to 9 months. Establishing a consistent bedtime routine for infants can help them get enough sleep each day.
Some babies may display separation anxiety by crying or becoming fussy when put to bed. Speaking softly or gently touching them before leaving the room can help alleviate their anxiety, but removing them from bed may exacerbate the problem. Keep the lights out if the baby wakes up during the night – this teaches them to fall asleep without your help.
Toddlers (1-2 Years)
While toddlers need less sleep than newborns or infants, daytime naps are common and nighttime awakenings may still occur. Most toddlers get by with one daily nap by the time they reach 18 months of age. Morning or early afternoon naps are less likely to interfere with nightly sleep.
This age range is a good time to begin establishing a bedtime routine that relaxes toddlers and prepares them for sleep. Important elements of a healthy bedtime routine include:
- Follow a consistent pattern: Your child should bathe, brush their teeth, and perform other pre-bedtime tasks in the same order each night. They should also go to bed at the same time. This consistency will help cement their routine.
- Engage in relaxing activities: Reading or taking a bath before bed can help your toddler relax. They should avoid rousing activities that are not conducive for sleep.
- Set limitations: Your toddler should understand they are not to leave their room after “lights-out.” Be gentle yet firm if they break this rule, and reward them for falling asleep on their own.
- Allow the process to take time: Establishing a bedtime routine may take months. Moving to a new house, the birth of a new sibling, and other stressors may prolong the process, so be patient with your toddler during this time.
Preschoolers (3-5 Years)
Most preschoolers need 10 to 13 hours of sleep per day. They receive most of this sleep at night, but many preschoolers also take a daily nap. Naps typically decrease in duration between 1.5 and 4 years of age, and most children stop napping altogether by age 5.
Sleep problems have been observed in roughly 25% of children under the age of 5 years. Some of these issues are chronic and may suggest underlying factors, while others are acute and temporary – but in either case, these problems can have a negative effect on both the child and the other members of their family.
Up to 50% of children begin to experience nightmares between the ages of 3 and 6. Although they peak later in childhood, the onset of nightmares can be troubling and disruptive to their sleep. Parasomnias such as sleepwalking, sleep talking, confusional arousals, and night terrors are also common. Another factor that may affect sleep is bedwetting. While older children may also wet the bed, the issue is most prominent for 5-year-olds.
School-Age Children (6-13 years)
The recommended amount of sleep for school-age children is 9 to 11 hours per night. Since most kids in this age range do not regularly take daytime naps, they receive all of their sleep at night. Their sleep time gradually decreases because they go to bed later but still wake up for school at the same time each morning.
Since their sleep routines largely mirror those of adults, school-age children can benefit from practicing healthy sleep hygiene. The term sleep hygiene refers to habits and behaviors that influence how well – or poorly – you sleep. Current guidelines for good sleep hygiene include the following:
- Follow a consistent sleep schedule: Kids should go to bed and wake up at the same times, even on the weekends and during breaks from school. Depending on their academic level, following this schedule may be tricky with homework and extracurricular activities.
- Avoid large meals in the evening: Heavy meals before bed can make falling asleep harder. A light snack can satisfy evening food cravings without disrupting sleep.
- Don’t take afternoon naps: Napping in the afternoon may be tempting some days, but lengthy snoozes later in the day can interfere with your child’s sleep cycle and make it more difficult for them to sleep at night.
- Relax before bed: Taking a shower or bath, reading, or listening to music are a few evening activities that help kids relax and prepare for sleep.
- Limit nighttime screen exposure: Televisions, smart phones, tablets, and computers all emit blue light through their screens. This blue light is believed to suppress production of melatonin, a natural hormone that induces feelings of sleepiness at night as part of your circadian cycle. A little screen time is OK, but too much can cause sleep problems.
- Avoid lying in bed awake: If your child wakes up during the night and can’t fall back asleep, lying in bed may exacerbate the problem. They should get up and read or find another relaxing activity for the next 20 minutes or so.
Understanding the importance of sleep hygiene and engaging in healthy sleep practices at a younger age can help children adjust to adolescence, a period when getting enough sleep becomes more difficult.
Teenagers (13-17 Years)
Since teenagers need 8 to 10 hours of sleep each night, they should spend at least one-third of their day resting. Unfortunately, this is easier said than done. The average adolescent in the U.S. loses 90 minutes of time spent asleep on school nights for each year between grade 6 and their senior year of high school. Multiple surveys have found that roughly two-thirds of high school students sleep 7 hours or less each school night.
There are a few reasons why teenagers don’t get enough sleep. These include school schedules and homework, extra-curricular activities, and increased exposure to technology. Teens who work are also vulnerable to sleep problems since they tend to wake up earlier and sleep less at night. Over time, a chronic lack of sleep can negatively affect a teen’s academic performance and increase their risk for mental health disorders such as depression and anxiety.
The sleep hygiene principles for school-age kids listed above also apply to teenagers. Additional sleep hygiene guidelines that are more relevant for teens include:
- Practice healthy light exposure: Teens can optimize their circadian clock by exposing themselves to bright light in the morning and avoiding light near bedtime.
- Keep cell phones out of the bedroom: Tempting as it might be to sleep with their phone within easy reach, teens should keep their phone elsewhere in the house to avoid blue light exposure in bed. The same goes for tablets, laptops, and other devices with screens.
- Don’t consume caffeine in the afternoon and evening: Coffee, energy drinks, and caffeinated soft drinks are popular among teens, but the stimulating effects of these beverages can last up to six hours. Adolescents should abstain from caffeinated drinks after school and into the evening.
- Avoid smoking: Smoking tobacco products poses a wide range of health risks, including sleep problems. Teens who smoke may take longer to fall asleep and feel tired the next day. Smoking has also been linked to sleep fragmentation and disruptions to healthy sleep cycles.
Sleep recommendations for teens change once they reach the age of 18. According to current guidelines, young adults between the ages of 18 and 25 should get 7 to 9 hours of sleep each night.
Childhood Sleep Problems
As many as 50% of children experience some sort of sleep problem before reaching adulthood. Some childhood sleep problems also affect adults while others are much more common for kids and teenagers. Signs your child isn’t getting enough quality sleep include:
- Feelings of sleepiness during the day
- Irritability or low mood
- Behavioral issues
- Learning problems and poor grades
Sleep-deprived teenagers are also at higher risk of being involved in car accidents. Identifying the warning signs of childhood sleep problems is important for parents. You should consult a trusted physician if you suspect your child is not getting enough sleep or showing signs of a sleep disorder.
Obstructive Sleep Apnea
Roughly 1% to 5% of children have obstructive sleep apnea (OSA), a condition characterized by pauses in breathing during sleep that produce loud snoring or choking sounds. Children with sleep apnea often feel tired or drowsy during the day and may display irritability, hyperactivity, or trouble concentrating.
OSA occurs when an obstruction physically blocks the breathing passages and hinders airflow. Many cases of pediatric sleep apnea occur due to enlarged tonsils or adenoids, which can be surgically removed during childhood. Obesity is another common cause of pediatric sleep apnea. Other factors may be an enlarged tongue, small jaw, irregular shapes on the roof of the mouth, or conditions such as Down syndrome that cause poor muscle tone. A doctor can help diagnose the condition and provide treatment recommendations.
Behavioral Insomnia in Childhood
People with insomnia have difficulty falling asleep or remaining asleep during the night. This sleep disorder affects up to 30% of children. Most behavioral insomnia in children are categorized as one of two types, though many children exhibit symptoms of both:
- Sleep-onset association: Children with sleep-onset association insomnia struggle to fall or stay asleep whenever there is a disruption to their normal bedtime routine. Falling asleep can be a time-consuming process, and children may frequently wake up during the night.
- Limit-setting: If your child has sleep problems related to limit-setting, they may push back, stall, or outright refuse when told to go to bed. They also resist falling back asleep after waking up during the night.
The best way to treat behavioral insomnia in childhood is to learn about healthy sleep patterns, sleep hygiene, and how to set bedtime boundaries for your child. A consistent nap and sleep schedule can be effective. Some parents also treat their child’s insomnia tendencies using the extinction method, during which they either ignore their child’s cries at night or periodically check-in at timed intervals.
Delayed Sleep Phase Disorder
The condition known as delayed sleep phase disorder affects up to 16% of adolescents, as well as a large number of young adults. People with this disorder – often referred to as “night owls” – have a tough time going to bed and waking up at socially acceptable times, with most deviating from these times by at least two hours.
Changes to the circadian rhythms shifts that occur during adolescence as well as increased socialization with other teens may both play a role. For many teens with delayed sleep phase disorder, improved sleep hygiene can be an effective treatment method. Healthy light exposure in the evening is particularly crucial, as is following a consistent sleep-wake schedule.
Restless Legs Syndrome
Restless legs syndrome (RLS) creates an uncomfortable feeling in the legs when the body is at rest. People with RLS feel as though they must constantly move their legs in order to alleviate the sensation. Roughly 2% of children have RLS. The condition can be difficult to diagnose unless two or more of the following predictors are present:
- The child’s sleep is disturbed
- An immediate family member also has RLS
- The child displays at least five periodic limb movements per hour during a sleep study
Other potential symptoms may include trouble falling asleep, aches and pains, and refusing or not wanting to go to bed at the scheduled time. Some children also experience RLS due to iron deficiency, a treatable condition.
Parasomnia is a broad term that refers to unusual sleep behaviors. Common parasomnias for children include:
- Somnambulism: Also known as sleepwalking, somnambulism affects 17% of children. The highest incidence rate occurs in males and kids between the ages of 8 and 12. Kids who sleepwalk do not easily wake up, and their behavior while asleep can be unusual, unpredictable, and downright dangerous. Sleeping more at night and scheduling wake-up times can help decrease sleepwalking episodes. Many kids eventually “grow out” of their sleepwalking tendencies.
- Confusional arousals: Confusional arousals – or “sleep drunkenness” – cause kids to behave inappropriately while asleep. Those experiencing these arousals may be slow to respond and speak in a slurred manner upon waking with no memory of the arousal event. Roughly 17% of kids between the ages of 3 and 13 experience these arousals, but they typically resolve spontaneously and are much less common in children 15 and older.
- Night terrors: As many as 6.5% of children experience night terrors, which cause them to experience intense fear while asleep. Kids with night terrors often struggle to wake up and need extra assurance once they do. Most of these cases resolve with age, though night terrors also affect 2.2% of adults.
- Nightmares: Most children and adults have nightmares from time to time, but for very young children these can be frightening events that disturb sleep. Nightmares and other dreams usually occur during the latter stages of a sleep cycle, and children may be afraid to fall back asleep after an upsetting dream. Parents should take time to console their child whenever they have a nightmare.
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