Strategies to help children sleep

We often see young children, who are overly tired and fatigued in our practice, because they are not getting enough sleep. Often the biggest obstacle is their parents.

We live in a very different culture than we did 25 to 50 years ago. Now there is more emphasis on letting children have more to say in their daily lives. I’m not here to argue whether this is good or bad, but I will say that children still need structure when it comes to their bedtime schedule, and many are not getting that from their parents.

Children are not adults and do not have the insight to know when they should go to bed. They don’t have a concept about sleep hygiene and what is appropriate or not. Parents must set limitations and make some ground rules.

Remember to remind parents that sleep hygiene is not only for adults. It’s a good idea to have a simple handout ready that you can give to parents to help them make their child’s environment conducive to sleep. This should include watching what children eat and drink before bedtime and doing quiet activities with the child, such as reading a book. Keeping the child’s room cool but comfortable, and using minimal lighting is also important. If necessary a small night-light is okay.

Noise should be minimal. Warn parents that it isn’t a good idea to put children to bed with music or television, as this can stimulate the child and keep them awake. It also promotes behaviors that can last into their adulthood. Neither children, nor their parents, should have television in their bedroom.

Table 1. Hours of Sleep Needed Per Night

Child’s Age	Average Sleep Needs
6 months to 2 years	13 hours
2 to 3 years	12 hours
3 to 5 years	11 hours
5 to 9 years	10.5 hours
9 to 13 years	10 hours
13 to 18 years	8.5 hours

Durand VM. When Children Don’t Sleep Well: Interventions for Pediatric Sleep Disorders. New York: Oxford University Press, 2008.

Remind parents that their children need a regular bedtime. This should be the same every day of the week. You can teach even young children to understand that when the big hand and the little hand are in a certain position, it is time to go to bed. This actually helps the child to feel as if they are an active participant in the process.

There should be activities that help the child to know it is time for bed including putting on their pajamas and brushing their teeth.

Avoid any activity in bed other than sleep. It is not a good idea for children to play or eat food in bed — they should understand that the bed is for the purpose of going to sleep or taking a nap.

Assure parents that there may be resistance from their children. This is normal. Tell the parent that if they are persistent in their expectations of the child, they may see behavior change sooner than later. However, if only takes once for a child to realize that if he cries long enough, the parent will give in to their demands.

If the child is snoring or has a parasomnia, such as sleepwalking or night terrors, set up an appointment with a sleep specialist for further evaluation. These issues need to be addressed.

Lastly, encourage parents not to make bedtime seem like a punishment. Talk to children about the importance of sleep. It may help them from being future patients with difficulties sleeping.

Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.