Challenges with sleep, whether it be difficulties with settling, night-time wakefulness, or fears and worries about sleeping independently, are some of the most common reasons children are referred to the Quirky Kid Clinic. Many families relate to feeling exhausted, frustrated and confused when they have a child or children who have difficulties with their sleep. Naturally, while sleeping can be a significant issue when our children are very young, many parents hope and expect children will grow into healthy sleeping patterns as they grow, however, for around a third of Australian school-aged children, this is not the case (Sleep Health Foundation).
Impact of poor sleeping patterns in children
Poor sleeping patterns can have a wide ranging impact on children and their family. Children who do not get enough sleep find it more difficult to function during the day and may be more prone to behavioural issues and feeling worried and not themselves (Wells & Vaughn, 2012). Children at the Quirky Kid Clinic who experience sleeping difficulties commonly report that they find it hard to concentrate and learn at school and often feel more agitated and frustrated. Parents also report increased stress and frustration at home and frequently report that they cycle between feeling sympathetic and angry towards their child.
How much sleep should a child have?
One of the most frequently asked questions raised by parents is how much sleep does their child need. While we know that sleep needs vary from individual to individual and that many aspects of sleep are related to our genetic makeup (such as how well we function after a bad night’s sleep), as a general guideline, school-aged children (5-12 years) require between 9-11 hours of sleep a night-time and that as children get older, they need less sleep (Sleep Health Foundation). Generally speaking, our sleep needs stabilise around the age of 20 years, meaning that prior to this age, our sleep needs can be quite variable.
What causes poor sleep in children?
While we know that there can be many causes of sleep-related problems, which can include underlying physical issues (such as Obstructive Sleep Apnoea and Restless Leg Syndrome), the Australian Sleep Health Foundation reports that the majority of sleep-related challenges among school-aged children are related to more psychological and behavioural issues. Some of the psychological factors which may make it difficult for children to sleep include feeling anxious or depressed and some of the behavioural issues include having an inconsistent bedtime routine and a bedroom environment which is not conducive to sleep (Yang, Lin & Cheng, 2013).
One of the most common issues for children who find it difficult to sleep is that they worry, which often escalates upon bed-time. While night-time fears are very common and part of development, some children worry more often and more intensely than others, which can result in poor quality sleep (Kushnir & Sadeh, 2012). Children often also find themselves worrying about not being able to sleep, which creates a cycle of sleeplessness as they body’s anxiety-reaction creates physiological changes which are contrary to a calm, sleep-focused state.
A recent study by Mindell, Meltzer, Carskadon and Chervin (2009) examined the sleeping habits of children up to ten years old and highlighted environmental and behavioural factors which appear to be impacting on a range of sleep-related measures, such as how resistant children are going to bed, how long it takes to fall asleep, how long children sleep for and how disturbed sleep is during the night. Overall, the study found that going to bed late (after 9pm) and having a parent present upon falling asleep was related to more time taken to fall asleep, less overall sleep and more night-time wakening. Additionally, the presence of a TV in the bedroom and having caffeine, interfered with children getting off to sleep and getting enough overall sleep. This study points to the importance of facilitating predictable bedtime routines for children as a way of ensuring children get a good quality sleep and enough sleep.
So What can we do about improving sleep patterns in children?
- See your family doctor
If your child is having difficulty sleeping, the first point of call is to see your local GP for a thorough examination to ensure the sleep-related difficulty is not caused by any underlying physical problem.
- See your psychologist
Behavioural and psychological factors related to sleep issues in children can often be addressed by a Psychologist. A Psychologist may help a family put in place a more consistent nighttime routine, address any fears or worries that may be impeding sleep and provide support to the family with what can be a very frustrating and challenging issue.
- Make some changes to the family’s sleeping habits
Having good sleeping habits is typically referred to as having good sleep hygiene. There are some important things that can help to set up the best environment for your child to enjoy a peaceful nights sleep, which include:
Have a routine: Having consistent bed times and wake times can help set the internal body clock and develop healthy sleep-wake patterns. Ensure your child ‘winds down’ for an hour before bedtime (eg. reads quietly, has a bath) and is not overstimulated by TV, music and/or a busy household. While staying up late has been shown to significantly impact on the quantity and quality of children’s sleep, trying to put your child to bed too early can also disturb their sleep. Listen to your child and look for the signs that they are ready for bed (rubbing their eyes, yawning). Help your child wake at a regular time each morning, this will help their body clock re-adjust and learn to fall asleep more efficiently in the evenings.
Have a ‘before-bed’ routine: Things that our children do in the afternoons can also impact on their sleep. Avoid caffeine in the afternoons (beware that many soft drinks and chocolates contain caffeine) and time dinner so children are not going to bed with full tummies but are also not going to bed hungry. Research is also suggesting that the exposure to bright blue light from computers, devices and phones can reduce the levels and delay the onset of melatonin, a sleep-promoting hormone, so plenty of time between computer/device use and bed is important.
Set up their room: Ensure your child’s room is not too hot or cold and that their mattress, blankets and pillow comfortable. Take out any distractions from their room (eg. TV’s, devices, computer, pets) and cover their clock so they are not clock-watching. Avoid using your child’s room as a time-out area, so as not to develop any negative associations with their room.
Develop an action plan if your child cannot get to sleep: Help your child know what to do if they can’t sleep. Kids from the Quirky Kid Clinic report that they find using relaxation and imagery exercises helpful as well as games they can play from bed that are designed to tire their minds out. One such game involves using a torch to find objects starting with each letter of the alphabet, in their room. Discuss the nature of sleep with your child and explain how getting up, going into bright light, watching TV, eating etc can wake their bodies up so it is important to try and remain in their bedroom where it is peaceful for their bodies. Remember to reward your child for utilising their action plan and help them problem solve any difficulties they may be having.
Setup Worry Time: If your child worries in bed and has difficulty switching their minds ‘off’, it can be helpful to set aside some time to talk about their worries in the afternoon, well before bedtime. This ensures your child feels heard and can help children debrief and problem solve around their worries so they are not doing it in bed. If children start to worry in bed, gently remind children to let their thoughts ‘float’ away and that they will be discussed during worry time the next day.
Assess your own expectations and reactions: Be realistic about your child’s sleep needs and remember that children’s sleep needs can very extremely variable. Remember that sleep challenges are very common and are treatable and that feeling frustrated and angry are normal and common reactions. Develop a support network of people you can debrief with and who can help you remain calm and consistent with your child.
Kushnir, J & Sadeh, A. (2012). Assessment of brief interventions for nighttime fears in preschool children. European Journal of Pediatrics, 171, 67-75.
Mindell, J., Meltzer, L., Carskadon, M & Chervin, R. (2009). Developmental aspects pf sleep hygeine: Findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Medicine, 10, 771-779.
Ng, A., Dodd, H., Gamble., A. & Hudson, J. (2013). The Relationship Between Parent and Child Dysfunctional Beliefs About Sleep and Child Sleep. Journal of Child Family Studies, 22, 827-835.
Wells, M. & Vaughn, B. (2012). Poor Sleep Challenging the Health of a Nation. Neurodiagn Journal, 52, 233-249.
Yang, C., Lin, S & Cheng, C. (2013)/ Transient Insomnia Versus Chronic Insomnia: A Comparison Study of Sleep-Related Psychological/Behavioral Characteristics. Journal of Clinical Psychology, 69 (10), 1094-1107.