Sleep in
Children
“My
child wakes up frequently at night”, “my child resist going to his
bedroom when it is his bedtime”, “my child feels sleepy and tired
in the daytime”, “my child refuses to sleep in his room” these are
some examples of the common complaints we hear from parents. Most
parents complain about the sleep pattern of their children and may
wonder what sleep pattern is normal for their children. Sleep
problems during night in children affect the parents more than
their children. That results in sleep deprivation and tension in
the parents which leads them to adopt wrong behaviors and patterns
that may perpetuate the problem.
Sleep in children is a dynamic process that is evolving and
changing as the child is older. During their growth, children may
learn good or bad sleep habits. Once these habits are established,
they may continue for months or years.
The First Year of Life:
Newborn infants sleep an average of 16-18 hours daily divided into
4-5 periods. By two months, the baby sleeps more at night giving
the parents sometime for rest. Although sleeping time shifts
gradually toward night sleep, the baby continues to nap during the
daytime. Between ages 3-6 months, the baby needs around 3 naps
daily, and that changes gradually to 2 naps per day from age 6-12
months and 1 nap around the first birth day with a total sleep
time of 12-14 hours. Unfortunately, an increase in nighttime
wakings is common in the second half of the first year. This
problem may persist into the first and second years of life. The
good news is that children usually outgrow these problems with no
medical or developmental problems.
These are some hints that can assist the parents helping their
baby adapting a regular sleep schedule in the first year.
• Train your baby to consider nighttime as sleep time and day time
as a wake time. This can be done by confining playing and
entertaining the baby to the daytime only.
• Help your baby learning the association between bed and
sleeping. This can be achieved by taking the baby to his bed at
bedtime and resisting the temptation to let him sleep in the
living room or the parent’s arms.
• Lights should be low in the bedroom
• If the baby wakes up at night, do not show him attention. If he
starts crying, be calm and reassure him, or change the diaper if
necessary. Do not turn on lights, keep conversation and noise to
minimum and do not loose your temper. If you give the baby a lot
of attention on awakening and crying, he will be conditioned to
that and will use that behavior as a way of attracting the
parent’s attention.
• Infants fed large quantities at night not only show continued
wakings, but frequent wakings, often three to eight per night. By
6 months, all full-term healthy normally growing babies have the
capacity to obtain satisfactory nutrition during the day only. If
your baby wakes up frequently for feeding, consult your
pediatrician to adopt a plan for gradual reduction in night
feeding
Toddlers and pre-schoolers:
At age two, the child sleeps for an average of 12-13 hours with
1-2 hours of nap time and 11 hours of night sleep. During this age
children starts to have better sleep schedule and circadian
rhythm. The main sleep problems at this age are; refusing to fall
asleep independently, bedtime crying and middle of the night
tearful awakenings.
A useful strategy at this age includes:
• Always let the child know when it is almost time for bed.
• Avoid exciting activities before bedtime
• Make the child’s room attractive by having attractive blanket
and linen in addition to a
favorite toy as he is falling asleep
• Bedtime routines are important like telling a story
• Resist requests for one more story or another drink
• Be consistent from night to night
• Teach the child that you do not have to stay in the room until
he falls asleep but assure
him that you will be around
• Like adults, children at this age may have some awakenings at
night, however, they should gradually learn how to go back to
sleep. Therefore, if the child cries (and you know that this is
his habit and nothing serious has happened to him), wait for five
minutes before going to his bed and when you go stay only briefly.
Do not pick the child up. Keep the conversation to minimum, then
leave even if the child is still crying. If crying continues, wait
for 10 minutes before going back. Stay briefly and leave again. If
the crying still continues, wait 15 minutes before returning and
so on.
• If the child won’t stay in bed use the door closing approach.
Either the child stay in bed or the door will be closed. Do not
lock the child in; that is too scary. Simply hold the door closed
for a minute before opening it and restarting the rule.
A parent’s coming and going will provide reassurance and show the
child that the parent is not going away forever. Although allowing
the child to cry during the learning process is stressful for the
parents, experts say it is not psychologically damaging to the
child.
School age (6-12):
In general, by age 6 most children no longer need naps, and sleep
time is reduced to about 11 hours. Sleep time of the 10-year-old
averages 10 hours. During these years, the sleep problems of early
childhood usually subside and most children sleep soundly at night
and are fully alert in the daytime. Like adults, some children are
early birds or morning people and others are night owls or evening
people. The major sleep problems at this age group is related to
bedtime rather than sleep. The commonest problem is bedtime
resistance. A child may push back bedtime to watch TV, play or do
homework. Poor sleep in this age group can result in some concern
during daytime. Insufficient sleep can make the child irritable or
cranky. The child may fall asleep or fail to pay attention in the
class.
Here are some tips that may assist the parents helping their
children to have better sleep.
• Enforce early bedtime. Although bedtime can be different from
one child to another, the
bedtime that results in sufficient sleep (for your child)
should followed regularly.
• The child’s bedroom should be comfortable and attractive
• The child’s bedroom should have no TV, computer games or
distracting toys. A
favorite toy can be allowed to sleep with the child.
• Teach your child to develop rituals before sleep like going to
the bathroom, brushing
teeth, etc.
• Start teaching your child the sleep prayers.
When to seek help?
The above was a guide to parents to help their children developing
good sleep habits and patterns. However, children may have sleep
disorders that need assessment by a specialist and hence medical
treatment. If a child’s sleep poses difficulties for the child or
other family members or if your child has any of the below
complaints, it is time to see a healthcare provider:
Snoring, inappropriate daytime sleepiness (like sleeping in the
class after good night sleep), inability to sleep at night,
frequent awakenings at night, sleep walking or nightmares.
Ahmed BaHammam, FRCP, FCCP
Professor of Medicine
Director, Sleep Disorders Center
College of Medicine, King Saud University
Associate Editor, Ann Thoracic Med
