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Sleep tips for children

2021 dot 8 min read
Good morning exercise

1. Sufficient quality sleep is important for children

Sleep is important for rest and restoration, repair and growth as well as learning and memory consolidation, directly impacting on the mental and physical development of children. Both duration and quality of sleep is important for optimal function.
Recommendations by age for sleep duration are as follows:
  • Newborn 0-3 months: 14-17 hrs
  • Infant 4-11 months: 12-15 hrs
  • Toddler 1-2 years: 11-14 hrs
  • Pre-school 3-5 years: 10-13 hrs
  • School age 6-13 years : 9-11hrs
  • Teen 14-17 years: 8-10 hrs

Quality of sleep may be impaired by coexisting medical conditions or sleep disorders. It is important to recognise and manage these in order to ensure good sleep for optimal function.

2. Effects of insufficient or poor sleep

Sleep deprivation and or disrupted sleep may result in the following consequences:
  • Excessive daytime sleepiness
  • Fatigue, lethargy and increased bodily complaints e.g. aches or pains
  • Impairment of mood, behavioural control
  • Impairment of cognition, vigilance and attention
  • Declining academic and sporting performance
  • Compromised immune system and affected appetites
  • Overuse of potentially harmful alertness-promoting agents e.g. caffeine, nicotine
  • Increased risk-taking behaviour, sports, occupational and motor vehicle injuries
  • Increased risk of poor cardiovascular and metabolic health e.g. hypertension, diabetes, heart disease

3. Coexisting medical conditions or sleep disorders can affect children

Many medical conditions are associated with disrupted sleep:
  • Acute illnesses e.g. coughs and colds, fevers
  • Asthma
  • Allergic Rhinitis
  • Eczema
  • Gastro oesophageal reflux
  • Developmental disorders e.g. Autism, ADHD
  • Psychiatric disorders

Sleep disorders are common and up to 50% of children will experience a sleep problem. The spectrum of sleep disorders varies across the ages in childhood. Disorders range from frequent arousals related to poor sleep associations such as rocking, breast feeding, persistent night feeding and limit setting issues, for example bedtime rules of set bedtimes and sleep routines, in infant and toddler years to night terrors, sleepwalking and obstructive sleep apnea syndrome (OSAS) in the preschool years, to chronic sleep deprivation, delayed sleep phase and narcolepsy, a chronic sleep disorder characterised by overwhelming daytime drowsiness and sleep attacks, in later childhood. Increased awareness, early identification and optimal management of associated medical problems and sleep disorders can improve the quality of sleep and prevent the onset of negative consequences.

4. Obstructive sleep apnea syndrome (OSAS) is underdiagnosed

OSAS is an important but often undiagnosed sleep disorder in children. Snoring is a common symptom of OSAS. Up to 28% of children snore. In many cases, children who snore are perfectly healthy. Up to 6% of children snore because they suffer from sleep and breathing problems or OSAS. Prevalence is higher if there is a known predisposing factor such as large tonsils, allergies, obesity, nerve and muscle problems, abnormality in the jaw and face area or a family history of OSAS. OSAS occurs when intermittent interruption of airflow occurs as the throat narrows or even closes during sleep. Undiagnosed OSAS can lead to behavioural problems, poor school performance, impaired growth, heart failure and even death as a result of sleep disruption, swings in blood oxygen and carbon dioxide levels. 
Symptoms of OSAS may include the following:
  • Unusual sleep positions e.g. sleeping with head off the edge of the bed, propped up with many pillows or sleep sitting up
  • Frequent or loud snoring
  • Restless sleep
  • Breathing pauses, snorting, gasping or arousals
  • Sweating in sleep
  • Difficulty in waking in the morning, even with sufficient duration of sleep
  • Morning headaches
  • Irritable, aggressive or simply "cranky"
  • School or other behavioural problems
  • Falling asleep easily or daydreaming in school or at home

5. The sleep assessment checklist "BEARS" is a useful tool

This checklist helps elucidate possible sleep problems in your child:
 
  • Bedtime problems - Does your child have any problems going to bed or falling asleep?
  • Excessive daytime sleepiness - Does your child have difficulty waking in the morning or seem overtired or sleepy a lot during the day? Do they still take naps (inappropriate for their age)?
  • Awakenings during the night - Does your child seem to wake up a lot at night? Do they have trouble getting back to sleep? Any sleepwalking or nightmares?
  • Regularity and duration of sleep - Does your child have a regular bedtime and wake time? Do you think he/she is getting enough sleep?
  • Snoring - Does your child have loud or frequent snoring, or breathing difficulties at night?

6. Visit a child sleep specialist when…

  • Consider visiting a child sleep specialist when the sleep problem is:
  • Unusual
  • Frequent and disruptive
  • Associated with daytime symptoms
  • When there is habitual snoring
  • When there are concerns or doubts

7. Healthy sleep habits

Cultivating healthy sleep habits from an early age helps both child and parent to achieve a good night's sleep. Good practices include:
 
  • Consistent sleep schedule
    Regular nap times, bedtime and wake times to accommodate children's natural preferences, activity and family lifestyle. Avoid discrepant weekday and weekend schedules.

  • Consistent bedtime routine
    A consistent but enjoyable bedtime routine is important to help transit children from a high level of daytime activity to bedtime. It should be pleasant, so that your child looks forward to bedtime. A regular daytime schedule (e.g. mealtimes and playtimes) also helps to stabilise the sleep wake schedule.

  • Avoid sleep onset associations
    Always put your child to bed awake but drowsy, so that they can learn to settle themselves and fall asleep both at bedtime and if they wake at night. Avoid sleep associations such as breast-feeding, bottle-feeding, and rocking to sleep. Transitional objects such as a blanket, stuffed animals, dolls, may assist independent settling and self-soothing.

  • Minimise night feedings after age 6 months
    Night feedings are not physiologically necessary in most cases after the age of 6 months and do not improve the quality or quantity of sleep. A persistent requirement for night feedings may be related to sleep onset associations or conditioned hunger. Unnecessary night feeds also increase wetting and more disturbed sleep.

  • Avoid stimulating activities just before bedtime
    This includes vigorous exercise, heavy meals, screen time, caffeinated drinks.

  • Ideal bedroom
    The bedroom should be at a comfortable temperature, quiet, and dark. A night-light is acceptable if preferred by your child. Avoid using the bedroom for time-out or punishment, and the bed for activities other than sleeping. Keep the television, laptops, tablets and smart phones out of the bedroom.

  • Appropriate naps
    Naps should be geared towards child's age and developmental need. Avoid long naps or naps too close to bedtime.

  • Encourage adequate Sleep
    Children should have sufficient sleep i.e. age-appropriate total number of hours of sleep per day.
This article was contributed by Dr Jenny Tang, AIA Preferred Provider, and Consultant Paediatrician with a special interest in Asthma, Lung, Sleep and Allergy. To request an appointment with Dr Jenny Tang, please click here. 
References:

  1. Hirshkowitz M, the National Sleep Foundation's sleep time duration recommendations: methodology and results summary, Sleep Health (2015).
  2. Jenny Tang. Normal sleep in infancy, childhood and adolescence. Chpt 23 Sleep Medicine. A Clinical Guide to Common Sleep Disorder (2008).
  3. Medic et al. Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep 2017:9 151–161
  4. Teoh OH, Anne Goh. Medical Conditions Affecting Sleep in Children. Chpt 28 Sleep Medicine. A Clinical Guide to Common Sleep Disorder (2008).
  5. Chay OM, Jenny Tang. Obstructive Sleep Apnoea in Children. Chpt 25 Sleep Medicine. A Clinical Guide to Common Sleep Disorder (2008).
  6. Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study Judith A. Owens et al. Sleep Medicine 6 (2005) 63–69.

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