Patient and family education is important to us. Here you can learn more about sleep and healthy sleep habits, and view trusted insights from KidsHealth.org, the No. 1 most viewed health site for children, created by the experts at Nemours. We've also provided information from the most-respected non-profit organizations.
All children need a good night’s sleep. It’s not only a time for rest, but sleep gives your child’s brain a chance to sort and store information from their day. When kids don’t get enough sleep or quality sleep, it can affect how they feel, act and do in school. Our pediatric sleep medicine specialists are here to get to the bottom of your child’s sleep problems and set your child on the path to a good night’s rest.
Natural Sleep Cycles: Five Stages of Sleep
Natural brain cycles are responsible for sleep, which is defined by 2 states:
Non-REM (non-rapid eye movement) sleep, considered “quiet sleep” (5- to 20-minute intervals)
REM (rapid eye movement) sleep, considered “active sleep” (60-70 minutes)
Normally, sleep occurs in stages that cycle several times throughout the night.
Stage 1: Non-REM Sleep
This is the transition from wakefulness to sleep. During this period the brain reduces activity and polysomnography (sleep study) shows high amplitude theta waves (slow brain waves).
Stage 2: Non-REM Sleep
At this time, the body’s temperature begins to decrease and the heart rate begins to slow to prepare for sleep. Bursts of rapid rhythmic brain waves (called sleep spindles) begin to appear.
Stages 3 & 4: Non-REM Sleep
These stages mark the transition between light and deep sleep where delta (very slow) brain waves begin to emerge in stage 3 and continue in intensity. Sleep walking and bedwetting often occur at the end of stage 4.
Stage 5: REM Sleep
After about 90 minutes of non-REM sleep, brain activity increases as the eyes begin moving rapidly and dreaming begins. REM is referred to as paradoxical sleep because muscles become more relaxed as the brain’s other systems become more active.
Good Sleep Habits
Consider the following recommendations to help your child develop good habits for getting to sleep on his or her own.
Keep your child’s room neat and clean — responsibility for this task will vary depending on your child’s age and abilities.
Put a nightlight or small light within your child’s reach.
A quiet fan or humidifier may allow for some “white noise” to filter out the noise coming from the rest of the house.
Place a few of your child’s favorite items around the bed so it becomes sort of a "mini-home."
Have a bedside table or shelf stocked with your child’s favorite books.
Give your child plenty of notice that bedtime is approaching. A predictable, consistent bedtime routine helps kids wind down toward sleep.
Set aside time to do something special with your child before bed. Avoid any activities that will excite your child. Let your child know your special time together will end at bedtime.
Once you finish playing or reading a story, tell your child goodnight and leave the room. If your child comes out, take your child back to bed and leave again.
Helping Your Preschool Child Develop Good Sleep Habits
Helping kids get enough sleep involves creating soothing and consistent bedtime routines.
The goal is for your child to learn to:
fall asleep on his or her own
not rely on your presence for this to happen
be able to go back to sleep during the night
go to bed at the same time every night — let your child know 30 minutes ahead of that time to get ready
Other ways to help your child develop better sleep habits:
make sure your child goes to the bathroom, washes up, and brushes his or her teeth
read a book with your child
make sure your child has a cup of water, a nightlight or anything else your child may need
remind your child to stay quiet and in bed
When your child goes to bed, make sure everything is done:
said goodnight to everyone
had a drink of water
used the toilet
After your child is in bed, keep the TV and the rest of the home fairly quiet. Your child can awaken easily in the first hour of sleep.
If your child awakens, the goal is have the same conditions present that were there when your child fell asleep — that means you’re not present when your child falls asleep. Follow these recommendations for naptime too. You may be asked to track your child’s sleep in a sleep diary so you can measure progress made.
Sleep Tips for Teens
Try to stay on a schedule — go to bed and get up at roughly the same time each day, even on weekends. Don't sleep more than 2-3 hours later than usual.
Get into bright light as soon as possible in the morning, but avoid it in the evening.
Try not to nap during the day; or nap only for 20-30 minutes.
Avoid caffeine in the afternoon.
Don't exercise within 3 hours before going to bed.
Keep the temperature in your room comfortable.
Keep the room quiet and dark when sleeping.
Use the bedroom only for sleep, not for fun or watching TV. This will signal the body that when you are in your room, it's time to sleep.
Leave time to unwind before bed. Avoid stimulating activities like TV or lively music 30 minutes prior to bedtime.
Do not go to bed until you are drowsy. Trying to “make yourself fall asleep” will only make you wake up more.
Do not go to bed too hungry or too full — a light snack such as pretzels, crackers or popcorn just before bed may help make you drowsy.
Use a relaxation exercise, such as progressive muscle relaxation or guided imagery, just before bed.
If you are unable to fall asleep within 30 minutes, get out of bed and do something quietly in another room until sleepy.
Common Sleep Conditions
Bruxism (Teeth Grinding)
Bruxism can be a serious condition. Kids who grind their teeth are more likely to do it in the first half of the night, when they are less likely to be dreaming.
Teeth Grinding in Babies and Toddlers
Nearly half of all babies grind their teeth. It usually begins at about 10 months old, after the two top front teeth and two bottom front teeth come in. Generally, it’s nothing to worry about and usually goes away on its own without any damage to permanent teeth. After baby teeth are lost, if your child is still grinding, consult with your child’s dentist.
Teeth Grinding in Children and Teens
Children and teens also grind their teeth. Children with disabilities are more likely to grind their teeth, especially children with cerebral palsy and intellectual disabilities. Teeth grinding can cause tooth pain, jaw pain, and headaches. Also, it can wear down teeth.
Nothing needs to be done if a child is grinding teeth once in a while and if it’s not too intense. It is usually nothing to worry about, as long as there is no damage to the teeth and no other symptoms.
Delayed Sleep Phase Syndrome
If your child or teen remains awake at least two hours past their usual bedtime because they are unable to fall asleep, it may signal Delayed Sleep Phase Syndrome (DSPS).
Often, it’s hard for someone with DSPS to wake up in the morning. If allowed to sleep until the late morning or early afternoon, your child feels rested and can function well. Many teens with DSPS describe themselves as being at their best in the evening and at night. They tend to “catch up” on their sleep during weekends.
Causes and Symptoms of Delayed Sleep Phase Syndrome
DSPS usually starts during the teen years and affects about 7% (1 out of 15) of teens. While the cause is unknown, sometime after puberty, most teens start staying up later at night and sleeping later in the morning.
Some symptoms may include:
Trouble falling asleep at a usual bedtime: Most teens with DSPS fall asleep late at night or in the early morning.
Difficulty with awakening in the morning: Since teens fall deeply asleep so late, most have difficulty getting up and ready on time in the morning.
Daytime sleepiness: Often teens who fall asleep late at night and awaken early for school suffer from feeling tired and sleepy during
Other symptoms during the day: Sleepiness during the day and lack of energy may be mistakenly interpreted as depression. In addition, these teens may suffer from poor attention and motivation, sometimes diagnosed as attention deficit disorder.
Diagnosing and Treating DSPS
Keeping a sleep diary for a week gives enough information about when your child goes to sleep and wakes up to make a diagnosis.
Treatment includes resetting your child’s internal clock to establish the habit of being sleepy at a normal bedtime. If your teen isn’t motivated, it’s difficult to change the pattern.
To get back into a more regular schedule:
Don’t smoke and avoid caffeine or other stimulating drugs.
Limit daytime sleeping to one 15- to 20-minute nap, if any.
Go to bed earlier.
Gradually move back bedtime by 15 minutes intervals, that is, if your teen is going to bed at midnight, set bedtime at 15 minutes earlier at 11:45 p.m., for one or two nights, then 11:30 p.m. for one or two nights. Continue 15 minutes earlier every two nights, until bedtime is at 10 p.m.
Go to bed later: It’s easier for the body to get used to a later bedtime than an earlier one. Using a technique called “phase delay,” bedtime is delayed by 2 to 3 hours each night. For example, if a teenager usually falls asleep at 2 a.m. bedtime is delayed until 4 a.m. one night, 6 a.m. the next night.
Melatonin: There is limited evidence to support use of melatonin an hour prior to bedtime and this therapy should be used in consultation with your child’s doctor. Once the desired bedtime is reached, your teen must stick with their schedule every night for several months. Even one night of late night studying or socializing can return the internal clock to the delayed state.
Head Banging and Body Rocking
Babies often fall asleep when they are rocked back and forth by adults. Sometimes, babies and children rock themselves to sleep. When these rhythmic movements become intense, it results in head banging and body rocking, and known as “rhythmic movement disorders.” Your child may do this mostly when falling asleep (at naptime or bedtime) and then settle down once asleep.
Should You Worry About Your Child’s Head Banging or Body Rocking?
For most children, this behavior is not a cause for concern and most stop by age 4; however, you may have to watch your child a little closer. Children with other issues such as developmental delay, autism, or blindness may rock or bang their heads more forcefully and hurt themselves; consult your doctor.
Follow these tips:
It’s unlikely your child will hurt himself. There is no need to put extra bumpers in the crib or place pillows around it.
Be careful not to reinforce the head banging — try not to go to your child every time — you may be accidentally encouraging this behavior.
Move the crib or bed — move the crib or bed away from the wall if the noise is disturbing the rest of the family. If your child is in a bed, put guardrails on all sides.
Head banging and rocking can loosen the screws and bolts in your child’s crib or bed — tighten these fasteners on a regular basis.
Periodic Limb Movement Disorder (Twitching and Jerking at Night)
Periodic Limb Movement Disorder (PLMD) is a repetitive, sometimes intense movement of the limbs — usually the legs — during sleep that typically lasts a few seconds.
Most children and teens are unaware of the movements that feel like a tingling, crawling, creeping pain and look like brief muscle twitches or jerking movements. They tend to occur in groups, and last from a few minutes to a few hours, and can cause your child to awake during the night, which may lead to daytime sleepiness.
Children and teens with PLMD may also experience Restless Leg Syndrome, a related disorder that can happen at night or during times of rest, or on long car rides.
Causes of Periodic Limb Movement Disorder
PLMD may be related to low iron levels in the blood (anemia) or due to chronic illnesses, such as diabetes and kidney disease. However, for most children with PLMD, the cause is not known.
Symptoms may include:
behavior and academic problems
Diagnosing and Treating Periodic Limb Movement Disorder
Your child’s doctor may order an overnight sleep study or polysomnography, in which you and your child will spend the night in a sleep lab at a hospital or clinic. While your child is sleeping, a sleep technologist will look for movements or wakings.
Treatments may include:
treatment of iron deficiency
Other recommendations may include:
keeping your child's room neat, clean and clutter-free
using a nightlight or small light within his or her reach which may help your child feel more secure during the night
using a quiet fan or humidifier
placing favorite items around your child’s bed
having a bedside table or shelf stocked with his or her books
giving your child notice that bedtime is approaching
avoiding activities that may excite your child at bedtime
The practice of cosleeping, or parents sharing a bed with their infant, is controversial in the United States. Supporters of cosleeping believe that a parent's bed is just where an infant belongs. But is it safe?
Why Do Some People Choose to Cosleep?
Cosleeping supporters believe — and some studies support their beliefs — that cosleeping:
encourages breastfeeding by making nighttime breastfeeding more convenient
makes it easier for a nursing mother to get her sleep cycle in sync with her baby's
helps babies fall asleep more easily, especially during their first few months and when they wake up in the middle of the night
helps babies get more nighttime sleep (because they awaken more frequently with shorter duration of feeds, which can add up to a greater amount of sleep throughout the night)
helps parents who are separated from their babies during the day regain the closeness with their infant that they feel they missed
But do the risks of cosleeping outweigh the benefits?
Is Cosleeping Safe?
Despite the possible pros, the U.S. Consumer Product Safety Commission (CPSC) warns parents not to place their infants to sleep in adult beds, stating that the practice puts babies at risk of suffocation and strangulation. The American Academy of Pediatrics (AAP) recommends the practice of room-sharing with parents without bed-sharing. The practice of room-sharing according to the AAP is a way to reduce the risk of sudden infant death syndrome (SIDS).
Cosleeping is a widespread practice in many non-Western cultures. However, differences in mattresses, bedding, and other cultural practices may account for the lower risk in these countries as compared with the United States.
According to the CPSC, at least 515 deaths were linked to infants and toddlers under 2 years of age sleeping in adult beds from January 1990 to December 1997:
121 of the deaths were attributed to a parent, caregiver, or sibling rolling on top of or against a baby while sleeping
more than 75% of the deaths involved infants younger than 3 months old
Cosleeping advocates say it isn't inherently dangerous and that the CPSC went too far in recommending that parents never sleep with children under 2 years of age. Supporters of cosleeping feel that parents won't roll over onto a baby because they're conscious of the baby's presence — even during sleep.
Those who should not cosleep with an infant, however, include:
other children — particularly toddlers — because they might not be aware of the baby's presence
parents who are under the influence of alcohol or any drug because that could diminish their awareness of the baby
parents who smoke because the risk of SIDS is greater
What About SIDS?
But can cosleeping cause SIDS? The connection between cosleeping and SIDS is unclear and research is ongoing. Some cosleeping researchers have suggested that it can reduce the risk of SIDS because cosleeping parents and babies tend to wake up more often throughout the night.
However, the AAP reports that some studies suggest that, under certain conditions, cosleeping may increase the risk of SIDS, especially cosleeping environments involving mothers who smoke.
CPSC also reported more than 100 infant deaths between January 1999 and December 2001 attributable to hidden hazards for babies on adult beds, including:
suffocation when an infant gets trapped or wedged between a mattress and headboard, wall, or other object
suffocation resulting from a baby being face-down on a waterbed, a regular mattress, or on soft bedding such as pillows, blankets, or quilts
strangulation in a bed frame that allows part of an infant's body to pass through an area while trapping the baby's head
In addition to the potential safety risks, sharing a bed with a baby can sometimes prevent parents from getting a good night's sleep. And infants who cosleep can learn to associate sleep with being close to a parent in the parent's bed, which may become a problem at naptime or when the infant needs to go to sleep before the parent is ready.
Making Cosleeping as Safe as Possible
If you do choose to share your bed with your baby, make sure to follow these precautions:
Always place your baby on his or her back to sleep to reduce the risk of SIDS.
Always leave your child's head uncovered while sleeping.
Make sure your bed's headboard and footboard don't have openings or cutouts that could trap your baby's head.
Make sure your mattress fits snugly in the bed frame so that your baby won't become trapped in between the frame and the mattress.
Don't place a baby to sleep in an adult bed alone.
Do not place a baby on a soft surface to sleep such as a soft mattress, sofa, or waterbed.
Don't use pillows, comforters, quilts, and other soft or plush items on the bed. Consider using a sleeper instead of blankets.
Don't drink alcohol or use medications or drugs that could keep you from waking or might cause you to roll over onto, and therefore suffocate, your baby.
Don't place your bed near draperies or blinds where your child could be strangled by cords.
Transitioning Out of the Parent's Bed
Most medical experts say the safest place to put an infant to sleep is in a crib that meets current standards and has no soft bedding.
If you've been cosleeping with your little one and would like to stop, talk to your doctor about making a plan for when your baby will sleep in a crib. Transitioning to the crib by 6 months is usually easier — for both parents and baby — before the cosleeping habit is ingrained and other developmental issues (such as separation anxiety) come into play.
Eventually, though, the cosleeping routine will be broken at some point, either naturally because the child wants to or by the parents' choice.
You can still keep your little one close by, just not in your bed. You could:
Put a bassinet, play yard, or crib next to your bed. This can help you maintain that desired closeness, which can be especially important if you're breastfeeding. And the AAP says that having an infant sleep in a separate crib, bassinet, or play yard in the same room as the mother reduces the risk of SIDS.
Buy a device that looks like a bassinet or play yard minus one side, which attaches to your bed to allow you to be next to each other while eliminating the possibility of rolling over onto your infant.
Of course, where your child sleeps — whether it's in your bed or a crib — is a personal decision. As you're weighing the pros and cons, talk to your child's doctor about the risks, possible personal benefits, and your family's preferred arrangements.