Sleep in Children
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“My child wakes up frequently at night”, “my child resist going to his bedroom when it is his bedtime”, “my child feels sleepy and tired in the daytime”, “my child refuses to sleep in his room” these are some examples of the common complaints we hear from parents. Most parents complain about the sleep pattern of their children and may wonder what sleep pattern is normal for their children. Sleep problems during night in children affect the parents more than their children. That results in sleep deprivation and tension in the parents which leads them to adopt wrong behaviors and patterns that may perpetuate the problem.

Sleep in children is a dynamic process that is evolving and changing as the child is older. During their growth, children may learn good or bad sleep habits. Once these habits are established, they may continue for months or years.

The First Year of Life:

Newborn infants sleep an average of 16-18 hours daily divided into 4-5 periods. By two months, the baby sleeps more at night giving the parents sometime for rest. Although sleeping time shifts gradually toward night sleep, the baby continues to nap during the daytime. Between ages 3-6 months, the baby needs around 3 naps daily, and that changes gradually to 2 naps per day from age 6-12 months and 1 nap around the first birth day with a total sleep time of 12-14 hours. Unfortunately, an increase in nighttime waking is common in the second half of the first year. This problem may persist into the first and second years of life. The good news is that children usually outgrow these problems with no medical or developmental problems.

Sleep in Children

These are some hints that can assist the parents helping their baby adapting a regular sleep schedule in the first year.

  • Train your baby to consider nighttime as sleep time and day time as a wake time. This can be done by confining playing and entertaining the baby to the daytime only.
  • Help your baby learning the association between bed and sleeping. This can be achieved by taking the baby to his bed at bedtime and resisting the temptation to let him sleep in the living room or the parent’s arms.
  • Lights should be low in the bedroom.
  • If the baby wakes up at night, do not show him attention. If he starts crying, be calm and reassure him, or change the diaper if necessary. Do not turn on lights, keep conversation and noise to minimum and do not loose your temper. If you give the baby a lot of attention on awakening and crying, he will be conditioned to that and will use that behavior as a way of attracting the parent’s attention.
  • Infants fed large quantities at night not only show continued waking, but frequent waking, often three to eight per night. By 6 months, all full-term healthy normally growing babies have the capacity to obtain satisfactory nutrition during the day only. If your baby wakes up frequently for feeding, consult your pediatrician to adopt a plan for gradual reduction in night feeding.

Toddlers and Pre-Schoolers:

At age two, the child sleeps for an average of 12-13 hours with 1-2 hours of nap time and 11 hours of night sleep. During this age children starts to have better sleep schedule and circadian rhythm. The main sleep problems at this age are; refusing to fall asleep independently, bedtime crying and middle of the night tearful awakenings.

A useful strategy at this age includes:

  • Always let the child know when it is almost time for bed.
  • Avoid exciting activities before bedtime.
  • Make the child’s room attractive by having attractive blanket and linen in addition to a favorite toy as he is falling asleep.
  • Bedtime routines are important like telling a story.
  • Resist requests for one more story or another drink.
  • Be consistent from night to night.
  • Teach the child that you do not have to stay in the room until he falls asleep but assure him that you will be around.
  • Like adults, children at this age may have some awakenings at night, however, they should gradually learn how to go back to sleep. Therefore, if the child cries (and you know that this is his habit and nothing serious has happened to him), wait for five minutes before going to his bed and when you go stay only briefly. Do not pick the child up. Keep the conversation to minimum, then leave even if the child is still crying. If crying continues, wait for 10 minutes before going back. Stay briefly and leave again. If the crying still continues, wait 15 minutes before returning and so on.
  • If the child won’t stay in bed use the door closing approach. Either the child stay in bed or the door will be closed. Do not lock the child in; that is too scary. Simply hold the door closed for a minute before opening it and restarting the rule. A parent’s coming and going will provide reassurance and show the child that the parent is not going away forever. Although allowing the child to cry during the learning process is stressful for the parents, experts say it is not psychologically damaging to the child.

School Age (6-12):

In general, by age 6 most children no longer need naps, and sleep time is reduced to about 11 hours. Sleep time of the 10-year-old averages 10 hours. During these years, the sleep problems of early childhood usually subside and most children sleep soundly at night and are fully alert in the daytime. Like adults, some children are early birds or morning people and others are night owls or evening people. The major sleep problems at this age group is related to bedtime rather than sleep. The commonest problem is bedtime resistance. A child may push back bedtime to watch TV, play or do homework. Poor sleep in this age group can result in some concern during daytime. Insufficient sleep can make the child irritable or cranky. The child may fall asleep or fail to pay attention in the class.

Here are some tips that may assist the parents helping their children to have better sleep.

  • Enforce early bedtime. Although bedtime can be different from one child to another, the bedtime that results in sufficient sleep (for your child) should followed regularly.
  • The child’s bedroom should be comfortable and attractive.
  • The child’s bedroom should have no TV, computer games or distracting toys. A  favorite toy can be allowed to sleep with the child.
  • Teach your child to develop rituals before sleep like going to the bathroom, brushing teeth, etc.
  • Start teaching your child the sleep prayers.

When to Seek Help?

The above was a guide to parents to help their children developing good sleep habits and patterns. However, children may have sleep disorders that need assessment by a specialist and hence medical treatment. If a child’s sleep poses difficulties for the child or other family members or if your child has any of the below complaints, it is time to see a healthcare provider:

Snoring, inappropriate daytime sleepiness (like sleeping in the class after good night sleep), inability to sleep at night, frequent awakenings at night, sleep walking or nightmares.


Ahmed BaHammam, FACP, FCCP
Professor of Medicine
Director, University Sleep Disorders Center
College of Medicine, King Saud University