By: Shanna McGinnis, MD
Good night, sleep tight. “Yeah, right.” That is the response of many parents that I speak with in my office. Bedtime can be very difficult for some families. Some sleep issues start in infants or toddlers while others may not arise until the adolescent years.
It is vitally important for children of all ages to get enough sleep each night as it is linked to many health, behavior, and academic problems. Although I will not address sleep in infants in this article, I want to remind parents to always place infants on their backs to sleep in their own crib or bassinet to decrease the risk of sudden infant death syndrome (SIDS).
There are a few things that, despite our best efforts, we cannot make our toddlers and preschoolers do: swallow food, use the toilet, and go to sleep. (I use the word “we” here because I am mommy to a 5 year old son and 3 year old twin girls and am well-versed in the ways of little people with strong wills.) However, we can set the groundwork to make all of those things more likely to happen. When it comes to sleep, establishing a routine is critical to achieving bedtime success. To borrow from healthychildren.org, using the 4 Bs of bedtime is a great method – bathing, brushing (teeth), books, bedtime. It may be fun to create a bedtime chart with pictures of the 4 Bs so your child will know what comes next and it will seem more like a game. Another tool to try is an incentive system where the child gets a sticker on a chart or a treat from a prize bucket for staying in bed after lights out. Using a transition object like a special blanket or teddy bear helps some children feel more comfortable, particularly after moving from their crib to their big kid bed. Finally, consistency is crucial. All caregivers who put the child to bed must be committed to following the routine, even on weekends and holidays or when the child is ill.
School-aged children who mastered the bedtime routine as toddlers and preschoolers typically have less difficulty, but as they get older, new challenges arise that can interrupt things. Homework, sports, and other activities can cut into bedtime. Beware of allowing your children to be overextended in extracurriculars. Not only can it be stressful for them to be involved in too many activities, but daytime sleepiness can affect their academic performance, behavior, and overall health. Utilize these times as teachable moments about priorities and time management. As with younger kids, the 4Bs still apply and maintaining a similar routine on weekends and holidays is important. Finally, avoid beverages with caffeine, especially in the evenings, and do not allow TV viewing within an hour of bedtime.
Adolescents can be a particular challenge. They are usually involved in extracurricular activities, which may require traveling to other towns for games or competitions. Many work part-time jobs and then, of course, there is their social life. All of this must be balanced with early start times at school, completing homework, and hopefully a few chores. It is no wonder that a recent poll by the National Sleep Foundation found that 59% of middle school students and 87% of high school students get less than the recommended amount of sleep each night. To overcome their drowsiness, some teenagers reach for caffeinated drinks or attempt to catch up on weekends, but these are not a good substitute for regular, adequate sleep. Again, these opportunities can become teachable moments. Establish guidelines on how many activities are appropriate for your teenager. It is also important to set limits on media use, i.e. no TV or cell phones in bedrooms at night. Along with establishing some rules, give your kids more autonomy at this age regarding bedtime. They may not always make the best choices, but sometimes suffering some mild consequences while they are in your care will help them avoid bigger mistakes in the future. Finally, model good habits for them. Most adults do not get adequate sleep either and our children usually do as we do.
The majority of sleep issues with children can be resolved by improving their bedtime routine. However, there are some special considerations. Some medications, particularly ADHD medications, can affect sleep. Also, sleep apnea can affect children and may lead to daytime drowsiness. Some young children who experience night terrors, which are different than nightmares, have frequent nighttime awakenings. If you are concerned about your child’s sleep habits, keep a sleep journal of all of the factors surrounding their sleep routine and make an appointment with your doctor. Otherwise, establish and enforce a healthy bedtime routine so your whole family can sleep tight.
Sleep: By the Numbers
Newborn to 2 months:
up to 18 hours per day.
3-11 months:
up to 16 hours per day.
1 year – 3 years:
12 to 14 hours per day.
3 years – 5 years:
11 to 13 hours per day.
5 years to 12 years:
10 to 11 hours per day.
Adolescents:
8.5 to 9.5 hours per day.
Reference: National Sleep Foundation,
this includes nighttime sleep and naps for up to 5 years.