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.
Regularly checking if the stove is turned off before leaving home or pressing the car alarm button two or three times just to make sure it is turned on are some of the behaviours most people may display as part of everyday life. People with OCD, however, experience these types of behaviours and associated obsessive thoughts persistently and frequently. As a result, their day to day functioning is impaired and significant distress is caused.
Until recently, OCD was classified as an anxiety disorder due to the large role that anxious thoughts, feelings and behaviours can play. With growing research, OCD now stands alone as a diagnosis and related disorders such as hoarding and trichotillomania (hair pulling) are becoming increasingly recognised. OCD is characterised by obsessive thoughts such as contamination (germs), harm to self or others, symmetry, religion or sexual themes as well as compulsions such as excessive hand washing, checking, counting or praying. In OCD one or both of these will be present and will manifest in a cycle of symptoms. For example, thoughts about the house burning down (obsession) leads to anxiety which may be relieved by checking the stove repeatedly (compulsion). While completing a compulsion can lead some individuals to experience relief, this feeds into the unhelpful thinking pattern around the likelihood of the house burning down and thus increases the likelihood that the compulsion will be completed again and again. These thoughts and behaviours usually need to take up at least one hour per day before a diagnosis will be made.
Children can also suffer from OCD, in fact, most cases are diagnosed between the ages of seven and twelve. As with adults, the presence of some obsessions and compulsions are a typical part of development, however, for some children these can take over their life. About 0.2 – 1% of children will have OCD and about 3% of adolescents. A diagnosis of OCD will usually be considered if the thoughts and behaviours associated with the disorder continue for a long period of time, particularly if children do not seem to be deterred by the consequences of the compulsions such as getting in trouble. These children often tend to believe that performing a compulsion (e.g. excessively washing hands) will prevent a feared outcome (e.g. going to hospital). This is made more complicated by the fact that children generally have trouble distinguishing between healthy thoughts and behaviours and symptoms of OCD. When they do feel that something is wrong they are often too ashamed to tell an adult. For this reason we need to be aware of the warning signs and guide children through the recovery process. If concerned, you should always consult with a health professional like a Quirky Kid Psychologist.
Parents and other caregivers can look for signs that obsessions and compulsions are present. These signs will vary in different children and it is also important to be mindful that these experiences may occur for a number of reasons not related to OCD. They may include:
Reported or observed feelings of ‘stress’
Depression and/or feelings of shame
Slowness in performing tasks (e.g. getting dressed)
Seeming ‘manic’ or needing to be kept busy
Decline in academic performance
Angry outburst or challenging behaviour
Avoiding social situations
Family conflict over small things like setting the table
By being mindful of these signs and talking to your child you can determine if help is needed. A psychologist experienced in both child development and behavioural therapy will be most helpful and a psychiatrist can assist in deciding whether or not medication is appropriate and necessary. OCD is usually treated using Exposure and Response Prevention or ERP which involves exposing the individual to their feared situation (e.g. touching a garbage bin) and prevents them from completing their compulsion (e.g. washing hands). This allows them to learn to ‘sit with’ feelings of anxiety and change patterns of thinking which tend to overestimate the likelihood or severity of feared outcomes (e.g. getting sick). Just talking about the problem is usually not helpful and ERP is a highly effective form of therapy for OCD. Of course, this is best performed under the direction of a qualified professional.
OCD can put a strain on families and take the fun out of life for children who are affected so it is important to know how to help your child while also making sure that you have support for yourself. Although the behaviours can be difficult to deal with, children are not trying to misbehave or be annoying; they can’t help the way they are behaving and need support. On the other hand it is important not to participate in the rituals, for example, by constantly offering reassurance. Instead it is best to help your child to learn how to stop these rituals with the support of a professional. Also, many children find it helpful to externalise the symptoms or disorder of OCD by giving it a nasty nickname and treating it as something outside of them. They can then “boss back” the OCD and take charge of not letting the symptoms rule their life. Overall, it will be important to stick to family routines, avoid laying blame and be supportive of your child. Ensure that you have a support network in place for yourself and your family and that you are taking steps to manage your own stress levels while dealing with this challenge.
OCD in Kids. Centre for Emotional Health, Macquarie University (website)
Wilensky, A. (2006). When Your Child has Obsessive – Compulsive Disorder. PsychCentral (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association.
Obsessive Compulsive Disorder. Australian Psychological Society (website)
Walitza, S., et. al. (2010) Genetics of Early-Onset Obsessive-Compulsive Disorder. European Journal of Child and Adolescent Psychiatry, 19 (227-235)
Ornstein, T. J., et. al. (2010) Neuropsychological Performance in Childhood OCD: A preliminary study. Depression and Anxiety, 27 (372 – 380)
Ivarsson, T. & Larsson, B. (2009) Sleep Problems as Reported by Parents in Swedish Children and Adolescents with Obsessive – Compulsive Disorder (OCD), Child Psychiatric Outpatients and School Children. Informa Healthcare UK ltd. DOI: 10.3109/08039480903075200
Calvo, R. et. al. (2007) Parental Psychopathology in Child and Adolescent Obsessive-Compulsive Disorder. Society of Psychiatry and Psychiatric Epidemiology, 42 (647 – 655).
Children often sleep alongside parents or siblings as they are growing up. This practice is termed “co-sleeping”, and typically, it occurs on a nightly basis for an extended period of time: weeks, months, or in some cases, years. Many families find co-sleeping a good way spend time together and bond as a family, or to reduce their child’s stress around falling asleep or waking during the night. It is also popular among breastfeeding mothers during their child’s infancy.
While sharing a bed might ease pressures on families while children are very young, the habit of co-sleeping can pose problems as children mature. By the time their children are 2 – 2 1/2 years old, most parents will be eager to have them sleep easily through the night in their own beds.
Why should my child learn to sleep alone?
Encouraging independent sleep in children as they mature is important for several reasons:
Extended co-sleeping can discourage children from achieving what’s known as “night time independence”. Children with night time independence are confident that they can fall asleep on their own, and know how to comfort themselves if they are stressed or anxious around sleep – key steps in healthy emotional development.
Frequently, pre-school and school-aged children have fitful sleep cycles. Having a child kicking, tossing and turning in their bed can interrupt parents’ sleep, leading to exhaustion and stress throughout the day.
Parental intimacy is often compromised when their children sleep with them. This can have a detrimental effect on a couple’s relationship, affecting communication and physical closeness.
How do I break the cycle of co-sleeping with my school-aged child?
If your child refuses to sleep alone, or wakes up crying during the night, and only stops when you are near, he might be experiencing separation anxiety at night. This pattern is also known as “night-time separation anxiety”. Night-time separation anxiety is common among children up to 3 years old, but older children can experience it as well.
Here are some things you can do to ease night time separation anxiety and help your child sleep alone:
Develop a regular daily routine. The same waking, nap time, and bedtimes will help your child feel secure, which can help them fall asleep more easily. Have a bedtime routine – for example, bath followed by story time and a brief cuddle. Consistency and clear communication is key.
Keep lights dim in the evening and expose your child’s room to light, preferably natural, as he wakes. These light patterns stimulate healthy sleep-wake cycles.
Avoid putting your child to sleep with too many toys in his bed, which can distract him from sleeping. One or two “transitional objects”, like a favourite blanket or toy, however, can help a child get to sleep more easily.
Don’t use bedtime as a threat. Model healthy sleep behaviour for your child, and communicate that sleep is an enjoyable and healthy part of life.
Avoid stimulants like chocolate, sweet drinks, TV and computer use before bed time. Children ideally need to relax and “wind down” for at least 1 hour before bed time.
Some other strategies to reduce your child’s dependence on co-sleeping include:
Wean your child from your bed over time. For example, you might plan to spend part of the night on a mattress on the floor of your child’s bedroom or sleep with him for a few hours in his bed before returning to your own.
Use a baby monitor to help a child who wakes at night communicate with you or your partner. This will also reduce the likelihood of him walking to your bedroom. If your child communicates to you through the monitor, visit him in his bed to reduce disturbance.
Use rewards, such asThe Quirky Kid Tickets to measure improvements in your child’s independent sleeping. For example, a partial night spent in his own bed will earn him a yellow ticket, while a full night sleeping alone will get him a red one. The child might collect tickets to exchange them for a prize.
We offer a range of services, workshops and individualised consultations to support children with sleeping difficulties. Please contact us for more information.
University of Michigan Health System (2011). Sleep problems. Retrieved September 23, 2011 from http://www.med.umich.edu/yourchild/topics/sleep.htm
Brazelton, T. Berry and Joshua D. Sparrow (2003). Sleep: The Brazelton Way. Perseus Books.
Kimberley O’Brien (2011). Interview on Co-Sleeping with children and strategies for parents.
Keller, M. A. and Goldberg, W. A. (2004), Co-sleeping: Help or hindrance for young children’s independence?. Infant and Child Development, 13: 369–388.
Exams are a time when students of all ages feel more stressed than usual. Stress can also be positive thing as it aids motivation and concentration. However too much stress can make a young person feel overwhelmed, confused, exhausted and edgy and consequently produce a negative impact on study results.
Exam anxiety is a natural reaction to too much pressure and can come from a number of sources including: young people themselves; comparisons with others; wanting to reach too ambitious goals; family members; peers or teachers.
Symptoms of Exam Anxiety
Signs your child may be experiencing exam anxiety include:
Being cranky and irritable;
Complaints of chest pains and/or nausea;
Losing touch with friends;
Difficulty getting motivated.
Suggestions for managing exam stress
Effective Study habits: Effective study and learning habits can help to reduce exam stress in students of all ages. The Quirky Kid Clinic runs a study skills program to help students learn these skills
Diet: Ensure your child is eating regular healthy meals throughout the exam period, drinking lots of water, and that they are monitoring their caffeine or sugar intake.
Lifestyle: Encourage your child to keep up leisure activities such as seeing friends, exercising, or even watching television, as these activities give the brain a much-needed break from studying, which will allow for more effective study in the future.
Sleep: Encourage your child to stop studying at least one hour prior to going to bed, in order to help them unwind and have a more restful sleep.
Relaxation: Relaxation techniques such as breathing and muscle exercises can help your child calm down and manage their stress symptoms in a range of environments and situations. Child Psychologists at the Quirky Kid Clinic can help your child with relaxation exercises in anindividual consultationor during our Why Worry workshop.
Pleasecontact our clinicto make an appointment if you believe your child would benefit from some assistance in dealing with exam stress.
Information for this fact sheet was taken from Kimberley O’Brien, Child Psychologist, ReachOut .com, ParentLine and Kids Help Line}
It is normal for preschoolers and young children to hang back close to their parents when meeting and engaging with someone new and display some for of Social Anxiety.
Most children require some “warm up” time to familiarise themselves with new people, environments and experiences, after which they relax and behave as they usually would. When children show an ongoing difficulty with normal social interchanges such as greetings, making requests or responding to questions, it can be important to investigate and make a decision about the need to intervene about this constant social anxiety.
Where can parents start:
Track where and when the “shyness” occurs and whether it is transient or ongoing. However, when children experience any challenges with normal social interchange it is important to remove any pressure for communication to take place. Instead a small step approach is most effective for increasing comfort and participation in social interchange.
Well intentioned statements such as “I feel sad when you don’t say hello”, through to punishment and negative consequences will reduce the likelihood of the communication occurring.
For example lets have a look a Stella’s behavior:
when she arrives at preschool she will not look at or greet her carers even when prompted, and instead hides behind her parents. After a short period of time however Stella is chatty and social with both adult carers and peers, makes spontaneous requests and answers questions without hesitation. Her social anxiety has been managed by her.
Now, lets look at Jack’s behaviour, for example:
Although his arrival looks just like Stella’s, Jack however does not appear to warm up after settling in and continues having difficulty responding to questions or communicating effectively with adult carers, but is quite happy playing and chatting with his peers. His social anxiety has not been well managed by Jack.
Here are some suggestions to manage social anxiety
Discuss with your child what they are doing currently, for example hiding and not looking and talk to them about being brave and doing just a little bit more!
Think about what a little step might look like, such as holding hands instead of hugging a leg and try and engage your child to give it a go.
Before you get to pre-school try practicing the new step at home. Have toys and other family members play the role of staff and other children and don’t forget to have fun!
Use rewards such as praise, stickers and stamps when children are able to try the new step in “real time”. Talk to preschool staff to let them know what you are up to, so they can notice and praise the child.
Remember that some children love “over the top” praise, where as others prefer more low-key noticing. When a step has been mastered, renegotiate with your child to move up to the next step. Monitor progress and review regularly.
Steps to manage social anxiety should follow a progression from non communicative behavioural changes such as clinging becoming hand holding to non-verbal communication such as looking, smiling, waving or nodding, then indirect communication such as whispering to a parent to say hello to a carer, or showing a movie saying hello on a parent’s smart phone, and lastly direct communication from one word greetings through to talking freely.
Keep encouraging positively and remember this is a carrot only approach, sticks will only exacerbate the problem!
Helping your anxious child: A step by step guide for parents by Ronald Rapee, Ann Wignall, Susan Spence, Vanessa Cobham and Heidi Lyneham
If this is still not working…
If your child is showing an ongoing difficulty with normal social interchange and communication at preschool or outside the home, despite having normal speech development and speaking and communicating freely at other times, it is a good idea to consult your GP, pediatrician or a developmental psychologist and to look into a referral for intervention.
Social anxiety is best treated early by a qualified and experienced psychologist, particularly when it involves impairment in communication.
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