How can I get my child to fall asleep and stay asleep?

Article at a Glance

• A full night of quality sleep is important not only for a child’s health—but for the health of the entire family.
• Sleep disorders are not uncommon in children, and simple behavioral changes often provide a solution.
• If you think your child suffers a sleep disorder, document their sleep routines and talk to your pediatrician about interventions.

When Anne’s son Carson was eight months old, he quit napping. By age two, getting him to sleep took hours of effort and netted only a few stolen hours of low-quality rest. By three, he would stay awake for stretches as long as thirty-three hours. In desperation, Anne consulted her pediatrician, who—in coordination with other specialists—helped uncover the causes of Carson’s sleep troubles.

“Many of the sleep disturbance issues we see in older children stem from behaviors they developed in their first two years of life. Like with many health issues, if we identify potential problems and fix them early, the intervention needed can be minor and not require medication.”—Dr. Joseph Hershkop

Sleep disorders are not uncommon in kids. Because sleep disorders like obstructive sleep apnea (OSA) can lead to other health complications, the AAP’s practice guidelines recommend that all kids who snore regularly be screened for OSA. What’s more, a child with a sleep disorder is very likely to have a family that also suffers from a lack of sleep. If you’re struggling with a child who cannot fall asleep or who cannot stay asleep, these tips are the first actions a pediatrician or sleep clinic will often recommend:

Look for Stressors and Changes

Just like adults, kids can develop sleep problems during big transitions like a divorce or death in the family. While we can’t remove these stressors, understanding that they impact sleep can help us to be more understanding and patient. 
Underlying conditions like asthma and allergies can also compromise sleep. In these cases, addressing the root cause will be far more useful than seeking a sleep aid.

Create a Nightly Routine

Good sleep habits, like all habits, are born from routines. A good nightly routine not only trains our brains to prepare for sleep, but can soothe anxiety and lower stimulation levels.

• Turn off all electronics an hour before bedtime. The light cast by these devices is known to disrupt circadian rhythms, making it difficult to fall asleep and stay asleep.
• Prepare for morning by laying out clothes and backpacks. This can be a mental load off for kids who have anxiety about being prepared.
• Get all the teeth-brushing and face-washing done, then settle down for quiet activities in a common area.
• Use late evening time for quiet activities like reading, drawing, and coloring.

Audit Their Sleep Space

It’s possible the answer lies within the room, not the child.

• Check your child’s sleep space by lying in his or her bed. Is there an annoying street light shining in your eyes? Itchy blankets? A tree branch scraping at the window?
• Use blinds or blackout curtains to achieve darkness—especially during summer’s shorter nights.
• Most of us sleep best in cool, dark places. Aim for temperatures between 65 and 75 degrees Fahrenheit.

Wean Kids from Needing Help to Fall Asleep

A child who can put herself to sleep is a child who can put herself back to sleep should she wake in the night—and that’s a win for everyone. If your child has been trained to need rocking, reading, or singing to fall asleep, it’s time to transition. After story time, send your child to bed on her own with a promise to come check on her. Follow through on that promise, but begin adding a minute or two each week to how long you wait to check.

Help Them Get Their Exercise

We’re continually reminded that physical activity is vital to our health, but did you know that regular exercise also improves the quality and duration of our sleep cycles? Children need at least an hour per day of exercise. Reaching this goal on wet or cold days may require getting creative, but can yield a better night’s sleep for all.

Understand Your Child’s Sleep Requirements

Sleep requirements evolve throughout our lifespan, and the Centers for Disease Control (CDC) recommend the following amounts of sleep by age for each 24 hour period:

• Newborns 0-3 months: 14-17 hours*
• Infants 4-12 months: 12-16 hours*
• Toddlers 1-2 years: 11-14 hours*
• Preschoolers 3-5 years: 10-13 hours*
• School-aged Children 6-12 years: 9-12 hours
• Teens 13-18 years: 8-10 hours
• Adults 18-60 years: 7 or more hours

*Including naps

Document, Document, Document

If you’ve established a healthy evening routine and ruled out health conditions but your child is still battling sleep problems, make an appointment with your pediatrician and start documenting the following:

• Sleep and wake times
• Not feeling rested after a full night of sleep
• Difficulty falling asleep
• Excessive daytime sleepiness
• Snoring or pauses in breathing while sleeping
• Mood swings and irritability

In Carson’s case, Anne tried all the usual tips and more. She cut sugar, caffeine, and even food coloring from his diet, put away electronics and established a consistent routine. The changes helped make him calmer at night, but didn’t help him fall asleep. It was a long road to diagnosis (while enduring her own sleep deprivation), but Anne’s detailed documentation helped Carson’s healthcare team find the right combination of treatments that helped.

Today, Carson is a thriving first grader. After being diagnosed with OSA and persistent insomnia, he had his tonsils and adenoids removed. He now gets his sleep through the combination of a solid bedtime routine and the help of a prescription sleep aid.