Healthy sleep is important for children’s physical, intellectual and social growth and development. Performance at school, in sports and at home can be influenced by a child’s sleep patterns. Additionally, children who get an insufficient amount of sleep are more likely to become obese. Therefore, it’s very important to help children get the quantity and quality of sleep that they need. Determining the cause of a child’s sleep problem can be challenging and may include everything from emotional distress to bad dreams, breathing problems, stomach pains, medical conditions or behavioral problems.

Getting the right diagnosis: the sleep diary

The first step in helping to uncover the cause of a child’s sleep problem is to keep a detailed sleep diary* for 2 weeks. A sleep diary should include 10 important points of information each day:

1. Time the child went to bed
2. Time the child fell asleep
3. Awakenings/events during the night (bedwetting? snoring?)
4. Time the child wakes up
5. Eating schedule
6. Daytime naps
7. Perceived quality of sleep
8. Degree of alertness or sleepiness during the day
9. Medical or psychological stressors
10. Behavioral problems

A sleep diary will help your primary care provider to figure out what might be causing the insomnia and whether or not consultation with another doctor (such as a behavioral, respiratory or gastrointestinal specialist) may be helpful.

Keep in mind that children often experience sleep deprivation symptoms differently than adults. For example, adults who don’t get enough sleep commonly complain of feeling drowsy or slow, while children may become hyperactive or irritable when fatigued. Breathing problems such as sleep apnea usually only occur in adults who are overweight or obese, however, normal weight children commonly have sleep apnea.

How much sleep does a child need?

As with adults, individual children may require more or less sleep than average, depending on their genetic predisposition. However, the CDC recommends the following number of hours of daily sleep for children of different ages:

• Newborns: 16-18 hours a day
• Preschool-aged children: 11-12 hours a day
• School-aged children: At least 10 hours a day
• Teens: 9-10 hours a day

Healthy sleep do’s and don’ts

For most children who do not have an underlying medical condition as a cause of their insomnia, there are several strategies that can be helpful to get their sleep back on track:

DO:

1. Exercise daily – The CDC recommends 60 minutes of physical activity per day for children and adolescents. Without this level of activity, kids may have difficulty blowing off steam and settling down to sleep.
2. Eat quality foods –A diet rich in lean protein, dairy, fruits, vegetables, healthy fats and complex carbohydrates can help to regulate hormone levels, bowel habits and improve physical and psychological wellbeing in children and adolescents.
3. Limit TV/texting time – Most parents struggle to reduce their children’s use of digital media for daily entertainment. However, the American Academy of Pediatrics recommends limiting entertainment media time to two hours per day. The Mayo Clinic warns that too much TV time can lead to violence, obesity, poor school performance, behavior problems and sleep disorders.
4. Stick to a routine – Keeping the same bedtime and wake up time helps the body get into a regular sleep rhythm. Going to bed at different times has a similar effect to jet lag.
5. Keep the bedroom for sleep – Having a TV in the bedroom invites distraction. Maintaining a sleep ritual whereby you associate the bed with sleep time only (rather than watching TV, playing video games, reading books, etc.) can help to train the body to fall asleep faster once in bed.

DON’T:

1. Drink caffeine. Caffeine (especially before bedtime) can contribute to insomnia. “Energy drinks” containing high levels of caffeine can be especially dangerous for teens and in rare cases have been associated with heart-related deaths.
2. Eat right before bedtime. Late night meals can increase the risk for gastroesophageal reflux disease (GERD) or heartburn. Lying down immediately after eating can encourage acidic stomach contents to leak up into the esophagus, causing a painful burning sensation and disrupting sleep.
3. Use OTC cold and flu medicine as a sleep aid for kids. OTC night-time cold and flu medicines can cause drowsiness as a side effect of one of their active ingredients (diphenhydramine). However, it’s not appropriate to give a well-child a combination medication for colds and flu and these medicines should not be used in children with cold/flu symptoms who are under the age of 4. These medicines can have unwanted side-effects, and are best reserved for treating actual cold and flu symptoms. Diphenhydramine alone is approved by the FDA for “mild nighttime sedation” for children 12 or older. However, this is a treatment of last resort because it can cause drowsiness that extends into the daytime, affecting school and sports performance and other unwanted effects. In some children, diphenhydramine can actually cause hyperactivity.
4. Give your prescription sleeping pills to your child. Prescription-sharing should be avoided in all circumstances, but it is especially important with children. Adult dosing of certain medications can harm or even threaten the life of a child. Never share your prescription medicines with others. Ask a healthcare professional if your child would benefit from prescription medication for sleep.

When to call your doctor

If you think your child may have a medical condition causing his or her sleep problem, it’s important to contact a healthcare professional. Reflux disease (heartburn), asthma, anemia, sleep apnea (due to large tonsils or a partially blocked airway), drug side effects, bad dreams, phobias (darkness and monsters in younger children) and attention deficit hyperactivity disorder are fairly common causes of sleep problems.

If your child’s sleep problems begin to impair their performance in school, or their ability to participate in sports, this could be a sign that professional help is warranted.

Sleeplessness in the setting of high fevers, abdominal or chest pain, neck stiffness, headaches, vomiting, or seizures should be evaluated by a healthcare professional. Breathing difficulties that do not respond to asthma medications are a medical emergency and require immediate attention.

By strictly adhering to the sleep do’s and don’ts, and possibly with the help of the right medical professionals (who can review sleep diaries to confirm the cause of insomnia), parents can rest assured that their kids’ sleep can be brought back on track.

*Adapted from: Wise MS, Glaze DG. Assessment of sleep disorders in children. UpToDate.com January, 26 2013.