Sleep problems in childhood and adolescence: information for
parents, carers and anyone who works with children
About this leaflet
This is one in a series of leaflets for parents, teachers and
young people entitled Mental Health and Growing Up. The
aims of these leaflets are to provide practical, up-to-date
information about mental health problems (emotional, behavioural
and psychiatric disorders) that can affect children and young
people. 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
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. Very young children often
fear being left alone at night. This `separation anxiety' is normal
at a young age.
Difficulties in sleeping are due to a number of reasons such
as napping too much in the daytime, bedtime fears and bedwetting
(
see leaflet 8 about children who soil or
wet themselves). You might find that when your child gets very
tired, they get irritable, aggressive or even overactive - not
sleepy (hence the phrase `overtired'!).
Older children and 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. 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.
Daytime sleepiness
This can simply be caused by your child not getting enough
sleep at night. Reasons for this might include:
- Going out too late with friends, working or studying.
- Stress or worry.
- Less commonly, loud snoring can wake a child - this is called
obstructive sleep apnoea. It can be caused by
large tonsils and adenoids at the side and back of the throat.
Taking them out can sometimes help.
- Some young people sleep too much if they are depressed.
- Drug or alcohol misuse may be a factor.
- 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.
Nightmares
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
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 scream-ing 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
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.
Why sleep problems matter
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.
Where can I get help?
There are some simple things you can do to help your child
sleep better:
- 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.
Your general practitioner (GP) or health visitor can offer
advice and help. If things don't get better, it is worth thinking
about asking for a specialist opinion from a paediatrician or child
psychiatrist. This will help to find out exactly what the problem
is and how it can be best resolved.
Your GP or another professional can refer your child to the
local child and adolescent mental health service - the team will
include child psychiatrists, psychologists, social workers,
psychotherapists and specialist nurses.
References
- Carr, A. (ed.) (2000) 'What Works with Children and
Adolescents?' - A Critical Review of Psychological Interventions
with Children, Adolescents and their Families. London:
Brunner-Routledge.
- Douglasm J. & Richman, N. (1984) 'My Child Won't
Sleep'. Hammondsworth: Penguin. Out of print.
- Ferber, R. (1986) 'Solve Your Child's Sleep Problems'.
London: Dorling Kindersley.
- Rutter, M. & Taylor, E. (eds) (2002) 'Child and
Adolescent Psychiatry' (4th edn). London: Blackwell.
- Scott, A., Shaw, M. & Joughin, C. (2001) Finding the
Evidence' - A Gateway to the Literature in Child and Adolescent
Mental Health (2nd edn). London: Gaskell.
Sources of further information
- `Coping with Children's Sleep Problems' audiotape
produced by Talking Life, available from the Royal College of
Psychiatrists: www.rcpsych.ac.uk/publications.
- Royal College of Psychiatrists' Help is at Hand: Sleeping
Well leaflet. Available to download: www.rcpsych.ac.uk/info/help/sleep/index.asp
- The Mental Health and Growing Up series contains 36
leaflets on a range of common mental health problems. To order the
pack, contact Book Sales at the Royal College of Psychiatrists, 17
Belgrave Square, London SW1X 8PG; tel: 020 7235 2351, ext. 146;
fax: 020 7245 1231; e-mail: booksales@rcpsych.ac.uk, or
you can download them from this website.
© [2004]
Royal College of Psychiatrists. This leaflet may be downloaded,
printed out, photocopied and distributed free of charge as long as
the Royal College of Psychiatrists is properly credited and no
profit is gained from its use. Permission to reproduce it in any
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