Sleep problems

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.

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.

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”).

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.

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.

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

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.

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.

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.

• 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.

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 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.

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.

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

References

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.

Credits

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 Kennedy..

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