Sleep is a crucial component of a child’s overall health and well-being. However, many children do not get an adequate amount of rest. Approximately 69 percent of children under the age of 10 experience some difficulty with sleep, according to the National Sleep Foundation. 

Sleep requirements vary significantly from one age range to another and from child to child. Newborns often sleep up to 16 hours a day or more. As children grow older, they generally require less sleep. By the teenage years, most children require over 9 hours of sleep each night.

Many children have difficulty getting a full night’s rest because of various sleep problems. Common difficulties that interfere with children’s sleep include insomnia, bedwetting, breathing problems (e.g., sleep apnea, snoring) and nightmares, among others.

Some sleep problems (e.g., occasional nightmares, minor snoring) may not require treatment. In many cases, children will simply outgrow these conditions over time. However, other problems may require treatment such as lifestyle changes, medications, surgery or use of medical devices. Perhaps the single most important thing parents and caregivers can do is to help children establish good sleep habits early in life.

Sleep is a crucial component of a child’s overall well-being. Children who are properly rested are less likely to display behavioral problems, such as hyperactivity, or to be moody. They also concentrate better and have improved performance in terms of memory, physical activities and decision making. Well-rested children are also less likely to experience nightmares or sleep terrors.

However, many children do not get the necessary amount of rest. According to the National Sleep Foundation, 69 percent of children under the age of 10 experience some difficulty with sleep.  

Sleep consists of five stages, the first four of which are called non-rapid eye movement (REM) sleep. Stage 1 is the transition from being awake to sleeping, stage 2 is an intermediate level of sleep, and the third and fourth stages may be referred to as deep sleep or slow wave sleep. The fourth stage is also known as delta sleep, which is the deepest type of sleep. During delta sleep, growth hormone, which regulates cell division and protein synthesis necessary for growth, is produced. The fifth stage of sleep is called REM sleep. Dreaming occurs during this stage. Sleep is an active, complex process that involves the brain in multiple ways.

During the first six months of life, newborns have erratic sleep patterns because their internal clocks have not fully developed. Parents and caregivers are typically urged to wake children every three to four hours during the first two weeks of life, until the proper amount of weight gain is established. After the first six months, it is healthy for children to sleep as long as they want, although most children wake every three or four hours to be fed. By the age of 3 months, most babies are sleeping for five hours during the day and 10 hours at night. The vast majority of babies this age sleep between six and eight hours at a time during the night.

By the age of 6 months, babies generally nap for three hours during the day and sleep for 11 hours at night. Separation anxiety may become a problem between 6 months and 1 year of age, and babies of this age may begin to wake again at night. Parents are generally urged to let children of this age fall back to sleep on their own.

Between the ages of 1 and 3 years, toddlers usually sleep for anywhere from 10 to 13 hours. By the time a child is 5, average sleep time may have dropped by about an hour. Children ages 6 to 9 generally require about 10 hours of sleep, whereas children ages 10 to 12 need around nine hours of sleep.

As children move into the teenage years, they generally require over nine hours of sleep. However, many of today’s teens do not meet these basic requirements. In addition to impairing mood and performance, a lack of sleep may also be responsible for other negative consequences, such as car accidents, poor academic performance, bouts of depression and/or irritability, daytime sleepiness, and abuse of stimulants designed to keep the child awake. 

Parents and caregivers are encouraged to consult a physician if their newborn or infant becomes extremely fussy over an extended period of time. This may indicate that the child is sleep deprived. As children grow older, they may display other signs of sleeping problems that require the attention of a physician. These may include noisy breathing or other breathing problems, loud snoring, and consistent and unusual awakening at night. Children who consistently have difficulty falling asleep or remaining asleep may also need medical attention.

Other signs of potentially significant sleep problems include:

• Commonly occurring anxious, touchy and impatient behavior
  
  
• Bedwetting after age 5 years
  
  
• Daytime sleepiness (somnolence)
  
  
• Increased tearfulness
  
  
• Teeth grinding and clenching (bruxism)
  
  
• Tendency to wake early
  
  
• Waking up and crying at night

Many children have difficulty getting a full night’s rest because of various sleep problems. Common difficulties that interfere with sleep include:

• Insomnia. A condition in which a child has trouble falling asleep or remaining asleep. Typically, children with insomnia do not feel refreshed after a night’s sleep. There are many different potential causes of child insomnia. Insomnia is considered a type of dyssomnia, which involve disturbances in the amount and quality of sleep.
  
  
• Bedwetting. Also known as enuresis, this condition is relatively common in children up to about age 5. About 14 percent of preschoolers and 4 percent of school-aged children wet the bed a few nights a week, according to the National Sleep Foundation. When regular bedwetting continues past preschool age, it may indicate the presence of stress, a sleep disorder or a medical condition. Some children experience such deep sleep that messages sent about the need to urinate from the bladder to the brain do not generate the normal response to waken.
  
  
• Disordered breathing during sleep. Snoring is a relatively common sleep problem caused by blockages in the airway due to enlarged adenoids or tonsils. About one in five children of preschool or school age snore, according to the National Sleep Foundation. Sleep apnea is a potentially more serious sleep disorder in which children temporarily stop breathing during sleep. Snoring can be a sign of sleep apnea. Children diagnosed with sleep apnea may become drowsy during the day and may display hyperactivity and learning problems. Obesity can contribute to the development of sleep apnea in children, as well as in adults.
  
  
• Restless leg syndrome (RLS). A condition that causes uncomfortable feelings in the legs when not in motion, and causes the child to move the legs almost continuously. Such movements can interfere with proper rest, and children who regularly experience episodes of RLS lose an hour of sleep per night and are twice as likely to awaken at night when compared to their peers. In some children RLS is linked to low iron or vitamin levels.
  
  
• Nightmares and sleep terrors. Nightmares are “bad dreams” that typically occur later in the night during rapid eye movement (REM) sleep. They are normal in children and often occur when the child has experienced recent stress or change. In some cases, persistent nightmares can prevent children from getting the sleep they need. Sleep terrors are uncontrollable screaming by a child that occurs during sleep. In most cases, the child falls asleep again shortly after the terror subsides and has no memory of the event the next day. It is usually best not to try to wake the child during a sleep terror. Inadequate sleep or an irregular bedtime schedule may contribute to the development of night terrors in children.
  
  
• Sleepwalking and sleeptalking. Some children may make audible sounds during sleep, including crying, laughing or talking. This is known as sleeptalking (somniloquy), and it is usually harmless. Other children may get out of bed during the night and begin to walk while remaining asleep. Sleepwalking (somnambulism) usually occurs between the ages of 3 and 7 years, and an episode typically lasts anywhere from five to 20 minutes. It is sometimes a sign of sleep apnea. As with sleep terrors, it usually is best not to wake a child who is sleepwalking, but rather parents should gently lead them back to bed. Both sleepwalking and sleep talking are considered types of parasomnias, which involve abnormal events that occur during sleep.
  
  
• Rhythmic movement disorder. This condition is common in infants and young children, and involves the child making repetitive movements immediately before falling asleep. The movements include head banging, head rolling, or rocking of the body. The movements may persist while the child enters light sleep, and frequently involve the muscles of the head and neck.
  
  
• Narcolepsy. A condition in which a child experiences excessive sleepiness and sudden “attacks” of sleep that can occur at any time. This condition may develop as early as age 10, but is more likely to occur during puberty or early adulthood.

Disrupted sleep can trigger other negative health consequences for children, including learning problems and daytime sleepiness. Children who do not sleep well become more fatigued, which may lead to falls and other accidents. In contrast, some children with sleeping problems become hyperactive during daytime hours and may display aggressive behavior.

Sleep requirements vary significantly from child to child. However, experts generally recommend the following amounts of sleep for children:

Sleep problems such as occasional nightmares, sleeptalking and light snoring may not require treatment. In many cases (e.g., rhythmic movement disorders), children simply outgrow these conditions over time. However, other problems may require medical treatment. For example, medications such as iron supplements may relieve symptoms of restless leg syndrome in some children.

Surgery or use of medical devices may be necessary to treat some types of sleep apnea. For example, children who snore habitually or who are diagnosed with sleep apnea may require surgical removal of enlarged adenoids or tonsils. Children with sleep apnea may require a type of mechanical breathing aid known as continuous positive airway pressure (CPAP).

However, most sleep problems can be corrected through lifestyle changes. Perhaps the most important thing parents and caregivers can do is to establish good sleep habits early in the child’s life. Children who do not establish good sleep habits early in life are at increased risk of insomnia as adults. Parents and caregivers are urged to keep children on a consistent schedule of sleeping and waking. This should be maintained on weekends, although children may be allowed to sleep an extra hour or two when necessary.

Prior to bedtime, children should be encouraged to spend at least 15 minutes engaging in relaxing activity. During this period, children should not watch TV, play on the computer, exercise, use the phone or consume foods or beverages.

Many experts also urge parents to allow children to fall asleep alone in their room, so that children do not become dependent on the parent’s presence for going to sleep. It is also important to make sure that children receive adequate levels of sleep. Lack of sleep can cause many sleep-related problems, such as sleep terrors and sleepwalking.

Other tips for encouraging a child’s sleep include:

• Plan daytime naps. Young children need sleep both at night and during the daytime. Naps ranging from 30 minutes to two hours are recommended for children between the ages of 2 and 5 years.
  
  
• Do not allow children to consume liquids before bedtime. To reduce bedwetting and nighttime awakenings, children are urged to avoid drinking liquids shortly before bedtime. It is also important to avoid consuming caffeinated beverages, such as soft drinks, after late afternoon. Children should also be encouraged to go to the bathroom shortly before bedtime. Although parents may reward children for dry nights, it is important not to punish them for wetting the bed. This is likely to worsen the problem.
  
  
• Use night lights or provide children with other security objects. These tools have been shown to reduce nightmares in many children.
  
  
• Change a child’s sleep time. Children who do not receive enough sleep are at risk for sleep disorders such as sleepwalking or sleep terrors, and other problems such as learning difficulties. Having a child go to bed earlier can increase sleep time.
  
  
• Exercise regularly. Regular exercise that is not performed too closely to bedtime can increase the quality of a child’s sleep. In addition, exercise can help prevent obesity, which is a major contributor to sleep disorders, such as sleep apnea.
  
  
• Treat other medical conditions. Untreated medical problems such as allergies, asthma and gastroenterological reflux disease (GERD) can contribute to sleeping problems. Physical abnormalities, such as structural abnormalities of the face, and neurological (nervous system) disorders can also contribute to sleep problems.
  
  
• Allow children to awaken and fall back to sleep by themselves. Parents who rush to comfort a child during awakenings create a connection in the child’s mind between the parent’s presence and falling asleep. Although there are times when it is appropriate for the parent to respond in this way (such as when a child is ill), experts generally recommend that caregivers encourage children to fall asleep on their own.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or other healthcare professional the following questions related to sleep and children:

1. How can I tell if my child is getting enough sleep?
   
   
2. What steps can I take to help my child establish good sleep habits?
   
   
3. What is causing my child’s sleep difficulties?
   
   
4. Is it likely that a medical condition is causing my child’s sleep difficulties?
   
   
5. Is this a condition that my child will outgrow, or does it require treatment?
   
   
6. How can I determine when my child should be left alone to fall back asleep, and when he/she needs my attention?
   
   
7. What are some of the most common symptoms of sleep disorders in children?
   
   
8. How can I determine whether my child has sleep apnea?
   
   
9. What are my child’s treatment options? What are the side effects of these treatments?
   
   
10. How soon after beginning treatment will my child see improvement in symptoms?