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
The amount of sleep needed gradually decreases
from infancy to adulthood.
Every child is different but as a general rule
- toddlers need about 12-14 hours sleep (including daytime
- 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
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
- In teenagers, drug or alcohol misuse is
sometimes a factor.
- Some young people who have depression sleep
more than usual.
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
Night terrors most commonly affect children between the ages of
4 and 12 years. They are completely different from nightmares or
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.
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
What can I do to help my child
||Jason, 15, talks about his problems with sleeping
It is important that your child has a regular
- 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
- 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
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
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
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
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."
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;
Galland BC & Mitchell EA (2010). Helping
children sleep. Archives of Disease in Childhood
Revised by the Royal College of Psychiatrists’
Child and Family Public Engagement Editorial Board (CAFPEB).
With grateful thanks to Dr Hussain
Farooq, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas
This resource reflects the best possible
evidence at the time of writing.
© Royal College of Psychiatrists March
Due for review March 2020