Sleep Difficulties

Getting a good night’s sleep is important for our mental and physical health. There are many things that can disrupt your child’s good sleeping habits. The most common are:

• School – Once children start school, they may have a hard time sleeping. School schedules, activities, and homework can add to these challenges.
• Electronics – Using electronics before bed can keep your child from falling asleep. This includes TVs, tablets, phones, computers, video game consoles, or smart watches.
• Age – Teens are more likely to be independent, meaning their caregiver doesn’t have to set as many limits for them. They may stay up later and wake up later due to changes in their sleep rhythms (circadian rhythms).

Common Sleep Problems Include:

Nightmares

Sleepwalking

Sleep terrors

Bedtime refusal

Nighttime fears

Needing caregiver to fall asleep

Difficulty falling and staying asleep

Sleep Difficulty Concerns

Having a hard time sleeping can lead to more problems. Problems can include:

Fatigue

Hyperactivity

Not able to focus

More tired during the day

Anxiety or depression

Tantrums or other disruptive behaviors

Irritability or moodiness

Hard time managing stress

Lower grades or functioning at school

Amount of Sleep

The amount of sleep a child needs in a 24-hour period depends on their age. For children under 3 years of age, this time includes naps throughout the day.

Getting Better Sleep

• Have a schedule during the day. Your child should go to bed around the same time each night. Do this on the weekends too.
• Create a bedtime routine. Do the same activities in the same order about 20 to 30 minutes before going to bed. Have or help your child:
  • Take a shower or bath
  • Brush their teeth
  • Read a book or listen to calming music
  • Change into pajamas
  • Use the bathroom
• Bedtime routines may be different for babies or toddlers. Put them in their crib or bed when they are awake but tired. The goal is for your child to fall asleep within 10 to 15 minutes.

  Feed them before bed – If your baby is over 6 months old, they should not need to eat during the night

  Give them a bath

  Change into pajamas

  Brush their teeth when old enough

  Change their diaper

  Read, sing, or listen to music
• Limit their amount of time in their bedroom. They should not be in bed during the day. They should only be in bed when they are sleeping. They should not be in bed when they eat, watch TV, use their phone, or do schoolwork. This will help their brain link their bed to sleeping. 
• Most children 3 to 5 years of age stop napping during the day. By the time they’re old enough to start school, they should not be napping during the day. 
• Have them go outside and be active. They can go for a walk, play basketball, jump rope, or play tag. Anything that gets their heart beating fast will help them sleep later (Picture 1).
• Be a good model. You should follow this sleeping advice too. Say what you are doing out loud. For example, “I’d like to watch my show right now, but I want to make sure I can sleep well tonight.”

Staying in Bed

• Your child’s sleep behaviors may get worse or not go away depending on how much attention you give them.
  • Limit attention and ignore negative behaviors like getting out of bed or leaving the bedroom.
  • Tell them when they have done a good job. For example, “I’m so happy that you stayed in bed and tried to fall asleep.”
• You can start a sticker chart for younger children. They can earn stickers to turn in for rewards like more TV time or a special meal.
• You can also try using bedtime passes. Give your child 2 to 3 tickets when they go to bed. These can be for a drink, another hug, or to use the bathroom. Give them 2 to 5 minutes to finish what they’re doing.

Needing a Caregiver to Sleep

• Come up with a quick reason to leave the room. You could go to the bathroom, put something in the sink or laundry, or get a drink, then come right back in. Give a lot of praise if your child is able to stay in their bed.
• Stay with them until they fall asleep for a few nights. Then move to just sitting on their bed, then sitting in the room, until you are out of the room.
• Leave the room and ignore any crying. Do not go back unless you are worried about your child’s health or safety.

Staying Up Late

As your child gets older, they will likely stay up later. Staying up late can cause them to sleep in later. This tends to happen more on the weekends or over school breaks. You can help them keep a schedule and create a routine that gets them to bed earlier.

Nightmares

Nightmares are common. Helping your child manage their nightmare fears will help them as they get older. Some things that may help your child include:

• Having them draw or write out their bad dream(s)
• Avoiding scary media like movies, videos, or books
• Getting enough sleep

Night Terrors

• Night terrors are different from nightmares. Kids remember nightmares. They do not remember night terrors.
• If you can tell when your child will have a night terror, wake them up fully before it happens. Put them back to sleep. This will often skip the night terror episode.

When to Call the Doctor

Call the doctor or health care provider if your child:

• Snores or has noisy breathing. Especially if snoring wakes your child up at night or you feel like their breathing changes while sleeping.
• Has a hard time falling or staying asleep after trying the tools mentioned above.
• Wakes up in the middle of the night with pain or what seems to be pain. You are not able to calm them down. They may pull at their ears or touch their body where pain is.
• Is more sleepy than normal during the day.
• Falls asleep during the day even after getting enough sleep.

Sleep Difficulties (PDF)

HH-IV-247 ©2022, Nationwide Children’s Hospital