It’s Sleep Awareness Week! Sleep is really important for mental and physical health - no matter your age. But what happens when your child won’t sleep? That’s what we’re going to talk about today.

Learn what childhood insomnia is, why childhood insomnia may occur, what it means for your child’s mental health, and how to help your child sleep easier!

A quick note: the recommendations here are rooted in Little Otter Co-Founder and Chief Medical and Scientific Officer Dr. Helen Egger’s professional research and experience, as well as an array of peer-reviewed medical studies. Those are cited at the end of the article.

We also collaborated with Little Renegades, the child mindfulness company, to create a Sleep Activity Guide full of relaxing activities before bed. It includes 9 guided meditations and calming activities. You can get it here!

Let’s start with a quick, research-backed primer on childhood insomnia:

What is childhood insomnia?

Childhood insomnia is a real thing! Even though we often think about adults when we think about insomnia, the truth is that sleep issues are not uncommon in children. (We often get questions from concerned parents about their child’s trouble with sleep and bedtime.)

Childhood insomnia can be broadly understood as difficult going to bed, challenges falling asleep, and/or trouble sleeping. (1) It might also look like a refusal to go to bed, resistance to bedtime or bedtime tantrums, frequent requests for stories or drinks after “lights out,” needing help or attention from a caregiver to sleep, waking up a lot, or just not being able to get enough quality sleep. (2)

Sleep difficulties can be just that - sleep difficulties. But they can also be a symptom of other disorders, both medical and psychiatric. Sleep symptoms can signal depression, anxiety disorders, as well as PTSD, and are also associated with ADHD and other disorders. That’s why it’s important to pay attention to sleep challenges and childhood insomnia, and seek additional support as necessary. We’ll talk more about when to worry later on.

Worried about sleep terrors? You’re not alone! The good news is that, even though sleep terrors can be worrying and uncomfortable, they are not associated with mental health disorders. 

Childhood insomnia can begin anytime from infancy through adolescence. In some cases, childhood insomnia can develop into adult insomnia.

So, why does getting enough sleep matter?

What does childhood insomnia mean for a child’s mental health and physical health?

Sleep is critical for your overall health, no matter your age! One study noted that sleep disorders may interfere with a child’s physical, cognitive, emotional, and social development. (3)

The CDC reports that 1 in 3 US adults don’t get enough sleep, and consistently failing to meet the recommended seven hours goal can result in more than just feeling grumpy and not working at your best; it can actually put you at an increased risk of serious medical conditions, including obesity, coronary heart disease and diabetes.

Let’s get even more specific: insufficient quality or quantity of sleep can result in measurable challenges with (4):

• Attention, vigilance, and reaction time, which can negatively impact not only your child’s ability to concentrate, but also the accuracy and efficiency of their work.

• Executive function. That means reduced time management, decision-making, organization, judgment, and impulse control (to name just a  few!) 

• Memory, especially verbal working memory.

• Academic performance, which can look like poorer test scores and grades, receptiveness to the teacher, and motivation.

• Emotional regulation. Children who don’t get enough sleep have a harder time regulating both negative and positive emotions, and may also be more inclined toward moodiness, irritability, depression, anxiety, and anger. 

• Behavior, such as hyperactivity, as well as an increased appetite for risk-taking behaviors, and more defiant or aggressive behavior.

These challenges are well-documented. The National Institutes of Health also says that poor sleep can also increase the risk of slowed reaction times, irritability, anxiety and high blood pressure. 

A solid night’s sleep is essential for a long and healthy life. It’s not just about getting enough sleep, but also needing to maintain consistent sleep routines for both children and adults. 

Plus, a child’s struggles with sleeping often impact the entire family in big and little ways.

Next, we’ll cover a few triggers for childhood insomnia, and after that, provide advice for how to help your child sleep better.

What causes childhood insomnia?

There are lots of potential triggers for childhood insomnia. Some common drivers include:

• Separation anxiety that occurs when a child knows they have to go to their own room alone.

• Lack of routine or sudden transition to bedtime - especially from something fun.

• Older sibling(s) staying up and doing something the younger child wants to participate in.

• Nightmare avoidance.

• Already too tired to sleep.

• TV or other screen time before bedtime.

• Struggles with impulse control or winding down.

There can also be physical reasons why your child might have sleep issues, such as:

• Medications, such as those that treat ADHD.

• Food or drinks that contain stimulants. There are lots of sneaky sources of stimulants. Sodas, chocolate, and even some cereals may contain caffeine.

• Medical conditions like asthma, allergies, or eczema - not to mention growing pains! (5)

• Child obesity.

Keep in mind that the COVID-19 pandemic may be a factor, since it’s had such an impact on children’s mental health.

Last year, Little Otter’s co-founder and Chief Medical & Scientific Officer Dr. Helen Egger conducted a study of kids 2-12 years old. She found that 80% of the children were at an increased risk for anxiety and depression. 

She also found, not surprisingly, that families are experiencing high levels of stress, which increases risk for physical and mental health challenges for all members of the family. These stressors could very well be another trigger for childhood insomnia.

How much should a child sleep?

It’s important that your child gets enough quality sleep. Challenges with sleep can interfere with a child’s physical, cognitive, emotional, and social development. (6) While the right amount for your child may vary somewhat, here are general recommendations for hours of sleep:

• Infants 4 to 12 months – 12 to 16 hours (including naps)

• Toddlers 1 to 2 years – 11 to 14 hours (including naps)

• 3- to 5-year-old children – 10 to 13 hours (including naps)

• 6- to 12-year-old children – 9 to 12 hours

• Teens 13 to 18 years – 8 to 10 hours (7)

5 expert tips to help your child sleep

The most important thing to help your child sleep better is good sleep hygiene - bedtime rituals that make bedtime a good part of the day. These bedtime rituals or bedtime routines help your child wind down, create positive associations with bedtime, and understand that it’s now time to rest. 

Studies show that difficulty sleeping, especially among young children, often has roots in behaviors. (8) That’s why a bedtime routine is so helpful.

Here are 5 tips to build a child’s bedtime routine and deal with childhood insomnia: 

1. Make sure that bedtime occurs at the same time each night, including weekends.

2. Provide plenty of transition time and let your child know bedtime is coming well before it begins.

3. Keep a consistent routine, i.e. brushing teeth, reading a book, then lights out.

4. If older children are allowed to stay up later, save fun activities for the following day when everyone can participate, thus reducing your child’s fear of missing out.

5. As you work to establish good sleep hygiene for your child and family, keep in mind that building healthy sleep habits can take weeks. While tantrums or resistance may persist at first, try to avoid conflict, as this may elevate stress and keep your child awake even more. 

The key is to make this bedtime routine predictable and consistent. 

Try to avoid giving your child attention for delaying bedtime, and do your best to be consistent. This will help avoid reinforcement of behaviors you’re working so hard to curb. Keep in mind that your little one will probably escalate their protests temporarily at the beginning of implementing better bedtime hygiene. (Experts call this a “post-extinction burst”!) (9) 

If you’re facing a lot of resistance to firm bedtime, you can let your child “cry it out” - this works - but it may be too difficult for you. If that’s the case, gradually reduce how present you are at bedtime. This means putting your little one to sleep when they’re drowsy, and waiting progressively longer to check on them. Don’t spend too much time checking on them (experts recommend one to two minutes), and keep it really simple - a loving pat, rather than a cuddle session. (10)

If your child wakes up in the middle of the night, it’s helpful to be intentional about your response as a parent. “Excessive parental attention” in response to waking up, including switching beds, can perpetuate the issue. (11)

This can be a lot. If you’d like a little extra support, know that Little Otter is here to offer a helping hand. 

The book “It’s Never Too Late to Sleep Train” provides additional advice on how to help your child to stay in bed at night.

One more thing: lots of parents have questions about whether their child should sleep in the parent’s bed, or in their own bed. Our culture values children sleeping alone, but it’s not the same in other cultures. We just want to recognize this, as it’s a common source of guilt and shame for parents. 

When to Worry about Childhood Insomnia

Sometimes, despite having a consistent bedtime routine and good sleep hygiene, childhood insomnia may persist. This can cause sleep deprivation for the child and family that can impact many aspects of development and wellbeing. (If your child is falling asleep in the car every time, they are sleep deprived!)

If you’re noticing that your child is consistently waking up tired and/or that their bedtime routines aren’t helping, it might be a sign that they are struggling with an underlying mental health concern. 

Fortunately, with early detection and the right support, your child can learn to adhere to a bedtime routine that works for your family. 

If you think you might benefit from additional support for your child, Little Otter can help. We offer parent coaching and child therapy as necessary to help your family navigate big and little worries. Register for Little Otter today. 

We’ve also partnered with Little Renegades, an amazing child mindfulness company, on a set of children’s sleep meditations, guided breathing exercises, and calming rituals for bedtime. 

Get the Sleep Activity Guide here.

Sources:

1. “Behavioral Sleep Problems in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/behavioral-sleep-problems-in-children

2. “Cognitive and Behavioral Consequences of Sleep Disorders in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/cognitive-and-behavioral-consequences-of-sleep-disorders-in-children

3. “Cognitive and Behavioral Consequences of Sleep Disorders in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/cognitive-and-behavioral-consequences-of-sleep-disorders-in-children

4. “Behavioral Sleep Problems in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/behavioral-sleep-problems-in-children

5. “Medical Disorders Resulting in Problem Sleeplessness in Children,” by Stephen H. Sheldon, DO, FAAP: https://www.uptodate.com/contents/medical-disorders-resulting-in-problem-sleeplessness-in-children

6. “Cognitive and Behavioral Consequences of Sleep Disorders in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/cognitive-and-behavioral-consequences-of-sleep-disorders-in-children

7. “Cognitive and Behavioral Consequences of Sleep Disorders in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/cognitive-and-behavioral-consequences-of-sleep-disorders-in-children

8. “Assessment of Sleep Disorders in Children,” Ignacio E. Tapia, MD, MS and Merrill S. Wise, MD: https://www.uptodate.com/contents/assessment-of-sleep-disorders-in-children

9. “Behavioral Sleep Problems in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/behavioral-sleep-problems-in-children

10. “Behavioral Sleep Problems in Children,” Judith A. Owens, MD, MPH: https://www.uptodate.com/contents/behavioral-sleep-problems-in-children

11. “Assessment of Sleep Disorders in Children,” Ignacio E. Tapia, MD, MS and Merrill S. Wise, MD: https://www.uptodate.com/contents/assessment-of-sleep-disorders-in-children