Kids and Sleep – ADD Resource Center

Sleep Help For Children

Introduction

While the biological mechanisms responsible for sleep are still unknown, it is clear that adequate sleep is required for a healthy mind and body. All mammals need sleep, and research shows that a lack of sleep not only impacts mood, but also learning and memory. A lack of sleep can have a slew of negative impacts on our daily lives, including slower reaction times, increased risk of accident, mood, behavior, and performance problems, and issues with memory and concentration.

Infants, children, and adolescents need significantly more sleep than adults to support their physical and mental development, and they are not immune to the sleep problems that can plague adults. Missing even 60 minutes of sleep can have an impact. This guide will introduce you to the types of sleep problems children can experience, offer sleep help for children, and suggest ways to support good sleep hygiene in the home.

How Much Sleep Do You Need?

Children respond differently to insufficient sleep than adults do. Unlike adults, who generally become sluggish when they’e tired, drowsy, overtired children often become more hyper. In fact, sleepiness in children often mimics the symptoms of attention-deficit-hyperactivity disorder (ADHD). Children who act like they aren’t tired, resist bedtime, and become increasingly rambunctious are often just in need of sleep.

Children are not immune to sleep disorders, and can suffer from a range of issues from sleep apnea to night terrors. The good news is less than 5% of children and diagnosed with a sleep disorder, and most sleep deprivation in children can be alleviated with simple changes to their sleeping environment and bedtime habits. Research shows that early bedtimes work best for infants through school-aged children, and that consistent routines are critical for quality sleep.

While every child is different, there is a certain amount of sleep that every child needs in order to feel rested and develop properly. The following chart details how much sleep a child needs, according to how old they are.

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	Newborn-2 months	2-4 months	4-6 months	6-9 months	9-12 months	12-18 months	18 months – 2 years	2-3 years	3-5 years	5-12 years
Night- time sleep	8-9 hours	9-10 hours	10 hours	10-11 hours	10-12 hours	11-12 hours	11 hours	10-11 hours	10-13 hours	10-11 hours
Naptime sleep	7-9 hours	4-5 hours	4-5 hours	3-4 hours	2-3 hours	2-3 hours	2 hours	1-2 hours	0-1 hours	None
Total sleep	16-18 hours	14-16 hours	14-15 hours	14 hours	14 hours	13-14 hours	13-14 hours	12-14 hours	11-13 hours	10-11 hours
Sleep tips	Swaddling and white noise can help babies sleep at this age.	As soon as baby looks sleepy, put them down for a nap or bedtime.	By four months, your baby may be ready to sleep through the night.	Begin to establish a relaxing bedtime routine.	Separation anxiety can begin to show at this age. Try playing peek-a-boo during the daytime to help establish that you’ll always come back.	Avoid late afternoon naps at this age – they can interfere with bedtime.	As your toddler becomes more mobile, make sure they can’t reach anything dangerous from their crib.	Remove any items children might use to climb up and over their crib rails.	Use a waterproof mattress cover to help children get back to sleep after bed-wetting accidents.	Be mindful of school commitments and extra-curriculars that might interfere with your child’s sleep schedule.
	Newborns can sleep between 30 minutes and 4 hours at a time at this age, without regard to day or night time.	Remove blankets and toys from your baby’s crib – they are a suffocation risk.	Now is the time to begin transitioning your baby out of swaddling. Consider a sleep sack if your baby needs warmth at night.	Babies at this age may be able to climb out of their crib, so get their mattress down to the lowest available position.	Take care to avoid bright lights at night, which can confuse your baby’s developing circadian rhythm.	Maintain a regular bedtime routine every night to signal to your toddler that it’s time to slow down and get to bed.	Allow your child to pick out their PJs to make going to be more exciting.	Stop screen time at least one hour before bedtime.	Start talking to your children about sleep to make dreaming less intimidating and nightmares less scary.	Keep a consistent bedtime and nighttime routine even for older children.
	Babies should sleep on their backs to minimize the risk of SIDS.	Give your baby a few moments to self-soothe when they cry, and they may fall back asleep on their own.	Feeding a baby as they sleep can help them sleep longer.		Avoid cereal until your baby’s digestive track has had more time to develop, at this age it can cause indigestion.		Enforce nap time even as your child gets older.	Prevent your child from eating or drinking before bedtime to prevent accidents at night.	Trade nap time for quiet time to give your child some time to relax.	Be consistent with bedtime and wake time, and also monitor access to screens, including computers and televisions.
	Avoid changing nighttime diapers unless there is a leak, it’s better to let the baby continue to sleep.	Establish a regular bedtime routine that includes soothing activities like a warm bath or reading a few picture books.						Children who are mobile and attempting to escape their cribs are ready for a big kid bed.

To read about the methodology used to determine sleep times by age, check out the National Sleep Foundation’s research paper published in the academic journal Sleep Health.

Infants and Toddlers

Infants experience extremely rapid growth and development and require much more sleep than toddlers, let alone the adults who are tending to them. Infant sleeping patterns are also very erratic in their first 6 weeks of life, as they have not yet developed the circadian rhythms that will govern sleep and wake states for the rest of their lives. Daily exposure to light and dark helps develop these cycles, and by 6 weeks old infants should begin to differentiate between night and day. Until then, infants will sleep in small increments of 30 minutes to 4 hours at a time, divided roughly equally between daytime and nighttime. By 2 years old, most children will have spent more time sleeping than awake.

Any sleep concerns for an infant should be quickly discussed with a pediatrician or other health professional. Sleep disorders in babies can be serious and need to be addressed as soon as possible to ensure growth and development progress as normally as possible. Sudden Infant Death Syndrome, or SIDS, is the most common cause of death for babies between one month and one year of age, and its cause is unknown. A combination of genetic and environmental factors leads an otherwise healthy baby to stop breathing, and when they are not encouraged to breath again, they die. While the cause of SIDS is unknown, infants who are at risk can sleep with a monitoring system that alerts the parents should the child stop breathing.

It can be very difficult for parents to adjust to an infant’s sleep schedule. Infants should be put to bed while they’re tired, but still awake. This avoids associating other rooms or people as requirements for sleep. Here are some other helpful tips aimed at improving the quality of sleep for infants:

Expose infants to natural daylight and daytime noises to establish regular daytime cues.
Avoid stimulating activities at night, and perform passive activities such as reading bedtime stories or singing soothing lullabies.
Unlike school-aged children, infants will often sleep longer on a full stomach.
Keep interactions between caretaker and baby calm, and avoid too much noise or movement.
When an infant wakes up, avoid immediate stimulation, it may prevent a still sleepy baby from falling back to sleep.

Elementary School

School-aged children require between 10 and 11 hours of sleep every night. In addition to increasingly demanding school obligations and after-school activities that can impact sleep quality, there are two types of sleep disorders that can affect children: parasomnias and dyssomnias.

Parasomnias include disorders that disrupt sleep, such as nightmares or night terrors, head-banging, or sleepwalking. Typically, these do not affect children under 18 months old.
Dyssomnias include disorders that cause issues falling asleep, remaining asleep, or experiencing restful sleep. Dyssomnias can include things like central or obstructive sleep apnea, restless legs syndrome, upper airway resistance syndrome (UARS), and even snoring. Dyssomnias in children can sometimes result in failure to thrive, and should be taken seriously.

While some sleep issues in children are easily resolved, others require medical intervention to alleviate. For example, most children will grow out of sleepwalking, but sleep apnea in children sometimes requires removing the tonsils or adenoids. Sleep apnea occurs when a person stops breathing, or inadvertently holds their breath during sleep, which causes them to wake up dozens of times over the course of the night. Often the person does not know this happens as they fall back asleep very quickly each time. Children who snore have a greater risk of sleep apnea, and the American Academy of Pediatrics recommends screening for this disorder in any child who snores regularly.

Changes in mood and behavior in school-aged children might indicate sleep deprivation. Inadequate sleep can result in decreased cognitive abilities, delayed reaction times, diminished creativity, and hyperactivity, so it’s important to address right away. Here are a few pointers to help school-aged children sleep well:

Maintain regular bedtimes and wake times.
Maintain a consistent bedtime routine that includes relaxing activities and some one-on-one time.
Provide an appropriate sleeping environment that is absent of noise and light.
Keep the bedroom cool, dark, and quiet. That means no TV, radio, computer, phone, or music access while a child is attempting to go to sleep.
Enforce limits not only about TV and screen time, but also about lights-off time, or the number of books a child is allowed to read.
Eliminate caffeine from your child’s diet.

Teenagers

During adolescence, changes to the circadian rhythm pattern occur, and some teens experience a delayed sleep phase disorder that can make it difficult for them to get enough sleep. Teens are also impacted by the same parasomnias and dyssomnias as younger children.

To help your teenagers achieve good sleep, here are a few tips:

Limit cell phone use at least 3 hours before bed €“ exposure to blue light can shorten the deepest sleep-stage.
Minimize the amount of caffeine your teen consumes €“ including sodas and chocolate.
Talk to your teen during daytime hours about any issues that might be bothering them. Getting real fears out in the open during the day can minimize nightmares at night.
Make sure you know what they’re watching on TV and online €“ scary movies and videos can keep them up at night.

How to setup a child’s bedroom

In order to help children achieve good sleep, they need to go to bed in an environment that is conducive to sleep. This won’t always solve all the issues that might arise, but it can help.

Mattress Type

A supportive environment for kids and sleep starts with kids who feel comfortable in their beds. Letting them try out different mattresses before you buy one is a good way to ensure they will feel confident lying down at night. Mattress firmness is a matter of personal preference, but most people prefer a medium-firm sleeping surface. Children, however, should always sleep on a firm mattress to support their growing bodies. For children who have trouble sleeping on a bed with a lot of bounce, a memory foam or latex bed may provide more stability and reduce nighttime movement. Keep in mind that while there are memory foam crib mattresses available, any memory foam option made for infants or toddlers needs to be designed with increased firmness in mind. Infants and toddlers should always sleep on their backs to reduce the risk of SIDS.

The size of your child’s mattress will depend on many factors, including how much space there is in the bedroom, and if your kids share a room. Children and teens are more likely to change their sleeping positions at night, and this restlessness can sometimes lead to children rolling off the bed. Using a bedrail, or putting a child’s mattress directly on the floor, can help reduce the risk of injury from rolling out of bed at night. A bed tent can also help block light and provide a sense of security, and serve as a psychological cue that it’s time for bed..

Pillows

Like mattresses, pillows come in soft, medium, and firm options and are a matter of personal preference. Some people like to have several firmness options available when they’re sleeping, and having the right pillow can be the difference between waking up well rested and waking up with a crick in the neck.

For children who are active sleepers, pillows can serve as a softer alternative to a bed rail. Body pillows, which are long and squishy, are great for stomach sleepers, as they can provide spinal support. Placing a pillow between the knees can help side sleepers balance their hips during sleep.

Bedding

Bedding includes sheets, blankets, and comforters. Bedding should be soft and comfortable, and not too hot or too cold. For children with sensory issues, bedding can be a very difficult aspect of creating a positive sleeping environment. Children who refuse blankets at night might be more comfortable in footed or layered pajamas, which will keep them warm. Weighted blankets are another option that provide gentle, deep pressure on the body, and might help children fall asleep and stay asleep.

Light

Minimizing light in the bedroom is critical for a good night’s sleep. Making changes to the bedroom environment that limit the amount of time children spend in their rooms using computers or smartphones is an important first step. Children who use their devices in their bedrooms will generally stay up later, but using these devices also increases their exposure to blue light. Blue light exposure decreases the hormone melatonin, which is responsible for influencing circadian rhythms and inducing sleepiness.

Here are some additional tips to help minimize light in the bedroom:

Invest in dark curtains or blackout shades.
If your child sleeps with a nightlight, put it on a timer and have it turn off automatically after 1 hour.
Remove all electronic devices. If you use a digital clock, let it face the wall.
Use night lights or €œtouch lights€ with low wattage bulbs to move around at night.
Consider using a sunrise alarm clock to wake up €“ they mimic the sunrise by slowly and gradually brightening until a pre-set time.

Color + Noise

Research has demonstrated that darker rooms allow for deeper sleep than lighter rooms. This does not mean you need to paint all the bedrooms in your home black. Colors like burgundy, forest green, royal blue, and purple will all be nice to look at during the day, but very dark at night. You might also consider the use of red bulbs in your children’s nightlights; they emit warm, dull light that is less activating to the brain.

While noise in a bedroom should be minimized as much as possible, for children sharing a room, a low volume background noise can help ensure one child doesn’t wake the other. This might include a blowing fan, a white noise machine, or soothing nature sounds.

Helping your child understand the importance of sleep

There are two states of sleep: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Tissue growth and repair occurs during NREM sleep, and dreaming occurs during REM sleep.

Unlike adults, who spend only 30% of their sleeping time in REM, infants spend 50% of their asleep time in active REM. Children also have a much shorter sleep cycle than adults, but spend more time in slow-wave, restorative sleep. It can be difficult for children to understand the importance of getting good sleep, and they may not understand the connection between feeling good and sleeping well. Talking about dreams with your child, whether they be fanciful or bizarre or scary, can help them learn to be reflective and introspective adults, and might also reduce the likelihood of you sharing your own bed. There are many resources online that are aimed at helping parents discuss the importance of sleep with their children. Here are just a few:

Why do I need sleep? is a guide from KidsHealth aimed at helping children understand why sleep is important for their bodies.

Sleep for Kids is an interactive resource that teaches kids the importance of sleep.
The National Sleep Foundation examines the roles each stage of sleep play in producing restful, quality sleep on a nightly basis.

Additional Resources for Parents

Sleep Training

There are phases during a child’s growth and development that will interrupt sleep, such as growth spurts and teething. These phases can cause regressions in a child’s sleeping schedule. Regressions occur when a child who was sleeping well begins to wake up more frequently, or to refuses to nap. Here are a few resources to help parents decide if sleep training is right for them, and what methods are available:

Sleep Challenges will help parents understand the sleep problems that can arise during infancy and toddlerhood, as well as ways to address them.
Methods for sleep training: This guide provides tools and techniques to help parents establish a regular sleep schedule.
Regression support will help fatigued parents who are dealing with a child’s sleep regression.
Keeping your sleeping baby safe is a high priority for every parent. This resource provides pre & postnatal recommendations for infant sleep safety.

Sleep Aids for Children

It’s not uncommon for adults with sleep issues to rely on sleep drugs to get the rest they need. However, children generally respond better to behavioral treatments. Here is some information on medications used to induce sleep, and the potential side effects:

Side effects of sleep medications can vary from mild to life threatening, use this resource to weigh the risks and rewards.
Sleep medications for children are prescribed to over 80% of children who visit the doctor, but this resource introduces alternative methods that can help kids with sleeping problems.
Boston Children’s Hospital suggests melatonin as a low risk alternative to sleeping medications, but it should only be taken after consultation with a child’s health care provider.

Sleep Disorders

Less than 5% of children are diagnosed with a sleep disorder, but many more suffer from general sleep problems. Use these guides to help identify red flags that might indicate your child might not be getting enough sleep:

University of Michigan Medicine answers common questions about kids and sleep.
Stony Brook University Hospital identifies signs a child isn’t getting enough quality sleep, and offers suggestions on how to encourage healthy sleeping behaviors.
Sleep problems in children: what to look for, how to identify them, and when to seek professional help.

Sleep Studies

What is a sleep study and why does my child need one? There are myriad reasons a child might be prescribed a sleep study. The following resources can help parents prepare themselves and their child for an overnight sleep study:

Golisano Children’s Hospital explains what a sleep study is, what measurements it takes, and why.
National Sleep Foundation discusses why a child might be prescribed a sleep study, and gives advice for children and parents on how to prepare.
Children’s Hospital of Philadelphia walks you through expectations for an overnight sleep study, and discusses the standard follow-up procedures.

Sleep Habits

Every child is different, but the following resources will help parents identify normal sleep habits and provide some helpful tips and guidelines to encourage a supportive and comfortable sleeping environment.

Building healthy sleep habits begins at birth. This resource provides guidelines for building and maintaining healthy sleep habits for everyone in the home.
The National Parent Hotline is a service for any parent who is having a tough time and needs emotional support.
Parenting challenges do not end with sleep difficulties. This resource offers support and coping strategies for struggling parents.

Nutrition

When children don’t get enough sleep, they can experience hormonal changes that affect hunger and appetite, which can lead to overeating. These changes also impact the way the body metabolizes food, and can trigger insulin resistance. Proper dietary support is critical for children’s growth and development. Here are a few resources that deal with nutrition as a method of supporting healthy sleep:

Nutrition and sleep are linked, and this guide explains the connection between a healthy diet and quality sleep.
Sacrificing sleep has consequences, and this resource explains how poor sleep quality can affect a child’s diet and nutrition.
The Mayo Clinic outlines ways to know if your baby is ready for solid foods, and answers questions about how to introduce new foods to a baby’s diet.

If you have ADHD or think you might:The A.D.D. Resource Center can help!