Sleep Blog 3a: Recommendations and Strategies to Help Children Get Sufficient Sleep By Kirsten Ellingsen, Ph.D.

There are many reasons that children and teenagers do not get enough sleep.  Illness, medication side effects, anxiety, parent behavior and expectations, FOMO, an inconsistent sleep routine, and bedroom environment can each contribute to the amount and the quality of sleep for a child.  The consequences of not getting adequate sleep were presented in an earlier blog about sleep along with the recommended number of hours of sleep by child age (see https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-babies-and-kids-need). Below are some general recommendations to help foster sufficient sleep for children. A subsequent blog next month will outline recommendations for teenagers.
 
Sleep problems or issues for children are common. It is important to consider how child health, temperament, parent values and behavior, and setting might all influence sleep. *If problems are significant and longstanding it might be important to determine if your child has an underlying medical condition or sleep disorder that needs to be addressed.
 
Parent behavior matters. Parents can facilitate better sleep by establishing a calm and consistent bedtime routine. Start a bedtime routine early enough in the evening to facilitate sleep (an overtired child can make it harder to fall asleep; start the routine 30 minutes earlier if a child takes longer than 30 minutes to fall asleep). Create special bedtime rituals with your children. Also, discuss clear and reasonable expectations.
 
Sleep environments are also important. Dark, cool, and quiet rooms that have a comfortable bed (or crib) help facilitate and maintain sleep.  Using a white noise machine also helps reduce distractions and night waking.
 
Age specific recommendations for increasing quality sleep are provided below.
 
Toddlers: Common problems include reluctance or resistance to go to sleep, night awakenings, fears, and trouble falling back to sleep after waking up.
 
Establish a consistent bedtime routine. Start with helping your child relax, consider quiet play without any television or loud noise for 60 minutes before bedtime. Reading stories. Give a bath. Listening to soft music. Routines only need to be 5-30 minutes, but should be consistent to help create positive sleep associations. Aim for the same bedtime every night.

• Special stuffed animals, blankets, and pacifiers can help with sleep soothing to fall asleep independently or fall back asleep in the middle of the night. 

 

• Allow children to make some decision in the routine, picking books, deciding what pajamas to wear, selecting music or songs you sing.

 

• End with a standard loving and comforting good night phrase.

 

• Toddlers might have difficulty falling asleep or staying asleep if they are teething or having bad dreams. Offer comfort and stay until calm. Again, if a child is sick or in distress be sensitive to his or her needs, offer comfort, and address these important issues. Also, make sure the room is safe. Use a baby monitor if the child is in another room. Remove any potentially dangerous objects a child could reach (blinds, strings, framed pictures) and bumpers or large stuffed animals that can be used to help climb out of a crib.

 
Preschool Children: Common problems include resistance to go to sleep, night awakenings, sleepwalking, night terrors, and nighttime fears.
 
Continue to maintain a consistent bedtime routine with a similar start time each night. Include toileting, brushing teeth, bathing or washing. Read books.  Proactively offer water. Use a nightlight if needed. Recommended practice is to leave your child’s room before he or she falls asleep and if your child gets up and comes to your room, help the child return to his or her bed and say good night again. Use minimal words. Keep the noise level low in the home so that TV or other sounds do not wake your child (particularly the first hour after he or she falls asleep). Preschool children may no longer nap during the day, but still benefit from rest and quiet time in the afternoon.

• Explain expectations and limits clearly
• Create a dark, cool, quiet room
• Tell your child you will check on him or her
• Make a chart with bed time routine and allow a “last request”
• Use a reward chart to track sleep and measure progress
• Use a clock to let the child know when he or she can come out of their bed in the morning (e.g., the Ok to Wake Clock).

 
Elementary School Age: Academic work, extracurricular activities, screen time, and worry can contribute to reduced sleep. Children might develop a fear of dark or concerns about being alone in the middle of the night.
 
The following recommendations are from www.nemours.org to help develop good sleep habits for school age children:

• Provide a nightlight for your child within reach of bed to use
• Use a white noise, quiet fan or humidifier to reduce noise outside the room
• Give notice before bedtime and continue to implement a predictable and consistent schedule and routine
• Talk with your child about healthy sleep habits and the importance of sleep
• Keep computers and TVs out of the bedroom
• Stop all screen time an hour before bedtime
• Avoid caffeine

 
TIPS to address fears or anxiety:
 
If your child is still not able to sleep, ask what might be bothering them or what they are thinking about (e.g., nervous about a test, excited for a party, teasing at camp). 
 
If prolonged talking about daily worries is a problem at bedtime it might be helpful to set up a designated time earlier the day to discuss these concerns.
 
If your child is afraid of sleeping in the dark, play games with flashlights to increase comfort.
 
Another good habit to start is ending the day on a “good note”.  This might involve you as a parent writing down positive behaviors you observed during the day (being brave by trying something new, listening to your request, getting along well with a sibling) or asking your child to remember something positive they enjoyed or that was good that happened during the day (this can also be helpful for children who tend to be negative or think in absolutes).
 
If your child has ongoing or prolonged sleep challenges despite implementing these recommended practices, please talk with your pediatrician. If you need support identifying or implementing contact a therapist with experience supporting healthy sleep practices.
 
References and Resources:
 
https://kidshealth.org/en/parents/sleep.html#catbehavior
https://www.nemours.org/services/health/growuphealthy/sleep/families.html
https://my.clevelandclinic.org/health/articles/14302-sleep-in-toddlers--preschoolers
https://aasm.org/study-shows-that-children-sleep-better-when-they-have-a-nightly-bedtime-routine/
https://www.psychologytoday.com/us/blog/dont-worry-mom/201310/8-tips-improve-your-childs-sleep
https://my.clevelandclinic.org/health/articles/14302-sleep-in-toddlers--preschoolers
 
For safety considerations and more recommendations for infants and toddlers see:

• https://kidshealth.org/en/parents/sleep12yr.html#catbehavior
• https://kidshealth.org/en/parents/sleep.html#catbehavior