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The Royal College of Psychiatrists Improving the lives of people with mental illness

Mental Health and Growing Up Factsheet

Sleep problems in childhood and adolescence: for parents, carers and anyone who works with young people


Sleeping well final

About this leaflet

This is one in a series of leaflets for parents, teachers and young people entitled Mental Health and Growing Up. This leaflet looks at the reasons behind why some children and young people have sleep problems, and offers some practical advice on how to deal with them.


Introduction

  Daytime sleepiness

One of the most common problems in toddlers and young children is sleeplessness. The child may have difficulty settling to sleep, or wakes in the night and wants a parent.

 

How much sleep does my child need?

The amount of sleep needed gradually decreases from infancy to adulthood.

Every child is different but as a general rule of thumb:

  • toddlers need about 12-14 hours sleep (including daytime naps)
  • preschoolers (aged 3-5) need 11-12 hours sleep
  • school-age children need 10-11 hours sleep
  • teenagers need 9-10 hours sleep.

Why can’t my child sleep?

There can be different reasons.

  • Very young children often fear being left alone at night. This is called ‘separation anxiety’ and is normal at a young age.
  • Bedtime fears- many young children are afraid of the dark.
  • Bad habits- napping too much during the day.
  • “I’m not sleepy”- you might find that when your child gets very tired, they get irritable, aggressive or even overactive- (hence the phrase “overtired”!).

Sleep problems in adolescents

Teenagers can also have problems with sleeplessness. They might find it hard to sleep if they are worried, drinking too much tea or coffee, cola or energy drinks, or are using illegal drugs. Some will just get into the habit of going to sleep very late. After a while, they find that they can't get to sleep at an earlier time.

 

Sometimes, difficulty in sleeping is part of depression.

 

 

This can simply be caused by your child not getting enough sleep at night. They could be going to bed too late or be having problems sleeping, for reasons as described above.

 

Less common reasons include:

  • Large tonsils and adenoids at the back and sides of the throat can cause breathing difficulties that can wake a child many times each night. The child may not remember waking up, but you may notice that they snore loudly and sleep restlessly. This is called obstructive sleep apnoea. An operation to remove the tonsils and adenoids may be needed.
  • Restless legs syndrome is a condition where the child complains of crawling feelings or ‘growing pains’ in their legs that make them want to keep moving them, which stops them getting to sleep.
  • Narcolepsy is an unusual condition that causes unpredictable attacks of sleep during the day. People with narcolepsy may also have sudden attacks of weakness - this is called cataplexy.
  • In teenagers, drug or alcohol misuse is sometimes a factor.
  • Some young people who have depression sleep more than usual.

 

Nightmares

 

Night terrors

Most children have nightmares occasionally. These are vivid and frightening dreams. Children will usually remember the dream, and will need to be comforted so that they can get back to sleep.

 

Nightmares can also be caused by worry, by nasty accidents, by bullying and by abuse of any kind.
 
You can help by encouraging your child to talk about the dream or draw a picture of it. This will help you to find out the cause of the upset and work out what help or support your child needs.

 

 

Night terrors most commonly affect children between the ages of 4 and 12 years. They are completely different from nightmares or anxiety-related dreams.

Unlike nightmares, they happen to young children an hour or two after falling asleep. The first sign is that your child is screaming uncontrollably and seems to be awake. In spite of appearances, your child is still asleep. They will not be able to recognise you, will be confused and unable to communicate, and it is usually hard to reassure them. It is best not to try and wake them, but sit with them until the night terror passes, usually after about 5 minutes.
 
Try not to feel upset yourself. It can be very distressing to see your child so disturbed, but they will not remember it in the morning. Children usually grow out of this.
 

Sleepwalking

 

Why do sleep problems matter?

Sleepwalking is similar to night terrors, but instead of being terrified, the child gets up out of bed and moves around. The main thing you can do to help is to make sure that they don't hurt themselves.

 

You may need to take practical precautions, like using a stair-gate, making sure that windows and doors are securely locked, and that fires are screened or put out. This is also something that children tend to grow out of.
 
 

Sleep problems are very common. Most children's sleep problems happen only occasionally. They are not serious and get better on their own, with time. If they don't, you need to take them seriously. As well as being upsetting, they may interfere with your child's learning and behaviour.

There may be an underlying health problem, physical or mental.

 

What can I do to help my child sleep better?

Jason, 15, talks about his problems with sleeping

It is important that your child has a regular sleep routine:

  • Decide on regular times for going to bed and getting up.
  • Stick to these times.
  • Develop a consistent, relaxing bedtime routine with your child. This should start with quiet time to help your child to wind down - for example, a bath followed by a short bedtime story before you say goodnight. This helps children to settle, and should end with your child falling asleep without the need for you to be with them.
  • It is important to be loving, but firm, about when it is time for your child to settle down for the night. When your child cries out, it is important to be sure that they are not wet, ill or in pain. It is best to do this quickly, while still comforting and reassuring them. Don't spend too much time with them or take them into your bed, because this will reward them for being awake.
  • A dummy can help to comfort young infants who wake needing to suck. Once you have weaned your child on to solid foods, it is best not to give them a bottle or dummy at night - if they wake and can't find it, they will probably start crying. A cuddly toy or favourite blanket can often help young children to cope with their separation anxiety.

How can I help my teenager sleep better?

  • Agree with them reasonable and consistent bedtimes- for weekdays and weekends.
  • Most teenagers like to have a ‘lie-in’ at weekends - limiting the getting up time to only an hour or two later than weekdays will ensure they can get into a stable sleep routine.
  • Help them to get into a routine of 30 minutes ‘quiet time’ before bed - no TV, texting, homework or computer use.
  • They should avoid daytime napping.
  • Getting some fresh air, gentle exercise and day light each day will help them to sleep at night.
  • They should avoid caffeine and heavy exercise for four hours before bed, as these can cause problems getting to sleep.
  • Encourage them to do their worrying before getting into bed - perhaps by writing a “to do list” for the following day earlier in the evening.

Where can I get help?

Your GP or health visitor can offer advice and help. If things don't get better, your GP or another professional can refer your child for a specialist opinion from a paediatrician or the local child and adolescent mental health service (see our factsheet on Who’s Who in CAMHS). This will help to find out exactly what the problem is and how it can be best resolved.

 

 

“I never liked high school. I got named ‘junky boy’ on the first day. I have diabetes … I started doing my own injections in high school and had to wear a special wristband. It didn’t take long for the bullying to get worse. I stopped going out and spent more time alone.

I started getting irritable at home and didn’t want to see anyone, preferring to stay up late when I could be alone. I started to feel really tired in the morning, and soon I wouldn’t get up and refused to go to school.

I felt ‘ill’ all the time and my brother started to call me ‘vampire’. I looked pale and had no friends. My parents had had enough of trying to get me to school and I even remember seeing mum in tears. That was when we spoke to the nurse in the diabetic clinic and it was suggested that I go to see the psychiatry team in hospital. I was reluctant, but I did go and I’m really glad.

When we met the team, we talked about my problems and I was asked to keep a sleep diary. We also tried ‘sleep hygiene techniques’ – these are tips on helping you sleep, but these didn’t work.

The specialist doctor prescribed some medication and arranged for us to meet with some people from education and the diabetic clinic. It felt like the first time that people were listening. I now have a work placement and was lucky to get involved with an organisation that arranges activities for young people with similar problems to me. I met my girlfriend there.

I am really sleeping much better now and go to the special teenage diabetic clinic where I get more support. I still don’t go to school, but I have a home internet package and am hoping to go to College. My mum is smiling for the first time in months."

 

Further info  

References

  • Peterson J & Peterson M (2003). The Sleep Fairy. Omaha: Behave’n Kids Press. This is an American children’s book that, through the story, teaches your child to go to sleep in their own bed in order to get a reward from the “Sleep Fairy”! It has explanatory notes for parents.

    Ferber R & Beckerman D (2006). Solve Your Child's Sleep Problems. London: Dorling Kindersley.

     

 

 

Dahl R & Harvey AG (2008). Sleep disorders. In: Rutter M et al. (eds) (2008)

Rutter’s Child and Adolescent Psychiatry (5th edn). Oxford: Blackwell. pp894-905.

Kotagal S &, Pianosi P (2006). Sleep disorders in children & adolescents. BMJ; 332: 828-832.

Galland BC & Mitchell EA (2010). Helping children sleep. Archives of Disease in Childhood 2010;95:850–853.


Revised by the Royal College of Psychiatrists’ Child and Family Public Education Editorial Board.

Series Editor: Dr Vasu Balaguru

With grateful thanks to Dr Sarah Bates.

This leaflet reflects the best possible evidence at the time of writing.

© January 2012. Due for review January 2014.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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