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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
Sleep — or lack of it — is probably the most-discussed aspect of baby care. As new parents quickly discover, the quality and quantity of their baby's sleep affects the well-being of everyone in the household. And sleep struggles rarely end when child moves from a crib to a bed. Instead of cries, it's pleas or refusals; instead of a 3 a.m. feeding, it's a nightmare or request for water.
So how do you get kids to bed through the cries, screams, and avoidance tactics? How should you respond when you're awakened in the middle of the night? And how much sleep is enough for your kids?
How Much Is Enough?
Sleep quantity needs vary based on age. But common "rules" about how many hours of sleep an infant or a 2-year-old need might not be helpful when it comes to your own child. These numbers are simply averages reported for large groups of kids of particular ages.
There's no magical number of hours all kids need in a certain age group. Two-year-old Lilly might sleep for 12 hours, while 2-year-old Marcus is just as alert the next day after sleeping for only 9 hours.
Still, sleep is very important to kids' well-being. The link between a lack of sleep and a child's behavior isn't always obvious. When adults are tired, they can be grumpy or lack energy, but kids can become hyper, disagreeable, and have extreme changes in behavior.
Here are some approximate numbers based on age, with age-appropriate tips to help you get your child to sleep.
Babies (Up to 6 Months)
Newborns' internal clocks aren't fully developed. They sleep up to 18 hours a day, divided about equally between night and day. Newborns should be wakened every 3 to 4 hours until they have good weight gain, usually within the first few weeks. After that, it's OK if a baby sleeps for longer periods.
After those first weeks, infants may sleep for as long as 4 or 5 hours at a time — this is about how long their small bellies can go between feedings. If babies do sleep a good stretch at night, they may want to nurse or get the bottle more often during the day.
Just when parents feel that sleeping through the night is a far-off dream, their baby usually begins to sleep longer stretches at night. At 3 months, a baby averages about 14 hours of sleep total, with 8 to 9 hours at night (usually with an interruption or two) and two or three daytime naps.
It's important to know that babies can cry and make all sorts of other noises during light sleep. Even if they do wake up in the night, they may only be awake for a few minutes before falling asleep again on their own.
But if a baby under 6 months old continues to cry, it's time to respond. Your baby may be truly uncomfortable: hungry, wet, cold, or even sick. But routine nighttime awakenings for changing and feeding should be as quick and quiet as possible. Don't provide any unnecessary stimulation, such as talking, playing, turning on the lights, or using a bright mobile device while waiting for your child to sleep. Encourage the idea that nighttime is for sleeping. You have to teach this because your baby doesn't care what time it is as long as his or her needs are met.
Ideally, place your baby in the crib before he or she falls asleep. It's not too early to establish a simple bedtime routine. Any soothing activities (bathing, reading, singing) done consistently and in the same order each night can be part of the routine. Your baby will associate them with sleeping and they'll help him or her wind down.
The goal is for babies to fall asleep by themselves and learn to soothe themselves and go back to sleep if they should wake up in the middle of the night.
6 to 12 Months
At 6 months, babies still need an average of 14 hours of sleep a day, with 2 to 3 daytime naps, lasting anywhere from 2 hours to 30 minutes each. Some babies, particularly those who are breastfed, may still wake at night. But most no longer need a middle-of-the-night feeding.
If your baby wakes in the middle of the night, but you don't think it's due to hunger, wait a few minutes before going to your baby. Sometimes, babies just need a few minutes to settle down on their down. Those who don't settle should be comforted without being picked up (talk softly to your baby, rub the back), then left to settle down again — unless they are sick. Sick babies need to be picked up and cared for. If your baby doesn't seem sick and continues to cry, you can wait a little longer, then repeat the short crib-side visit.
Between 6 and 12 months, separation anxiety, a normal part of development, comes into play. But the rules at night are the same through a baby's first birthday: Try not to pick up your baby, turn on the lights, sing, talk, play, or feed your child. All of these activities do not allow your baby to learn to fall asleep on his or her own and encourage more awakenings.
From ages 1 to 3, most toddlers sleep about 12 to 14 hours over a 24-hour period. Separation anxiety, or just wanting to be up with mom and dad (and not miss anything), can motivate a child to stay awake. So can the simple toddler style of always saying "No!"
It's important to set regular bedtimes and naptimes, and to stick to them. Parents sometimes make the mistake of thinking that keeping kids up will make them sleepier at bedtime. But the truth is that kids can have a harder time sleeping if they're overtired. Though most toddlers take 1- to 3-hour naps during the day, you don't have to force your child to nap. But it's important to schedule some quiet time, even if your toddler chooses not to sleep.
Establish a bedtime routine to help kids relax and get ready for sleep. For a toddler, the routine might be 5-30 minutes long and include calming activities such as reading a story, bathing, and listening to soft music.
Whatever the nightly ritual is, your toddler will probably insist that it be the same every night. Just don't allow rituals to become too long or complicated. Whenever possible, let your toddler make bedtime choices within the routine: which pajamas to wear, which stuffed animal to take to bed, what music to play. This gives your little one a sense of control.
Even the best sleepers give parents an occasional wake-up call. Teething can awaken a toddler and so can dreams. Active dreaming begins at this age, and for very young children dreams can be pretty alarming. Nightmares are particularly frightening to a toddler, who can't distinguish imagination from reality. (So carefully select what TV programs, if any, your toddler sees before bedtime.)
Comfort and hold your child at these times. Let your toddler talk about the dream if he or she wants to, and stay until your child is calm. Then encourage your child to go back to sleep as soon as possible.
Preschoolers sleep about 11 to 12 hours per night. Those who get enough rest at night may no longer need a daytime nap. Instead, they may benefit from some quiet time in the afternoon.
Most nursery schools and kindergartens have quiet periods when the kids lie on mats or just rest. As kids give up their naps, they may go to bed at night earlier than they did as toddlers.
School-Age Kids and Preteens
School-age kids need 10 to 11 hours of sleep a night. Bedtime problems can start at this age for a variety of reasons. Homework, sports and after-school activities, computers, TVs, mobile devices, and hectic family schedules all can contribute to kids not getting the sleep they need.
Sleep-deprived kids can become hyper or irritable, and may have a hard time paying attention in school.
It's still important to have a consistent bedtime, especially on school nights. Leave enough technology-free time before bed to allow your child to unwind before lights-out. A good rule of thumb is switching off the electronics at least an hour before bed and keeping TVs, computers, and mobile devices out of kids' bedrooms.
Teens need about 9 hours of sleep per night, but many don't get it. Early school start times on top of schedules packed with school, homework, friends, and activities mean that many are chronically sleep deprived.
Sleep deprivation adds up over time, so an hour less per night is like a full night without sleep by the end of the week. Among other things, a lack of sleep can lead to:
being less attentive
short-term memory loss
delayed response time
This can lead to anger problems, trouble in school (academically and with teachers and peers), the use of stimulants like caffeine or energy drinks to feel more awake, and car crashes due to delayed response times or falling asleep at the wheel.
Teens also undergo a change in their sleep patterns — their bodies want to stay up late and wake up later, which often leads to them trying to catch up on sleep during the weekend. But this irregularity can make getting to sleep at a reasonable hour during the week even harder.
Ideally, a teen should try to go to bed at the same time every night and wake up at the same time every morning, allowing for at least 9 hours of sleep.
No matter what your child's age, establish a bedtime routine that encourages good sleep habits. These tips can help kids ease into a good night's sleep:
Stick to a bedtime, and give your kids a heads-up 30 minutes and then 10 minutes beforehand.
Include a winding-down period in the routine.
Encourage older kids and teens to set and maintain a bedtime that allows for the full hours of sleep needed at their age.
Reviewed by: Rupal Christine Gupta, MD
Date reviewed: September 26, 2016