As a pediatric occupational therapist, one of the biggest concerns parents bring to me is the concern that their child is having difficulty falling asleep and staying asleep. Good sleep habits help to improve our mood, improve our ability to think clearly, and help us to maintain good health. As a parent, I have always felt that if I had a good night’s sleep, I could deal with almost anything - and getting a good night's sleep was highly dependent upon my kids getting a good night's sleep! Developing healthy sleep habits can take time and consistent effort. This blog will briefly cover topics related to the basic science of sleep, easy strategies to improve sleep, and some additional sensory based bedtime strategies that my clients have used over the years to help their children sleep better. Because of the unique sleep needs for infants and teenagers, the strategies presented in this blog are geared toward toddlers through children12-years of age.
Sleep Science
Circadian Rhythms. Your circadian rhythm refers to your own personal internal clock, and includes the physical, mental, and behavioral changes that are experienced over a 24-hour period. Circadian rhythms are heavily influenced by light and dark and have an influence over our physiological processes including our sleep patterns, the release of hormones, appetite, and body temperature. Although light and dark are highly influential in maintaining a circadian rhythm, your brain can also use reliably repeating events (routines) such as mealtimes, exercise, and temperature changes to assist in this maintenance. Keeping a steady daily routine helps to establish a consistent circadian rhythm. Interestingly, circadian rhythms begin to develop at around 6-months of age.
Adenosine. Another key component to understanding how we become sleepy is related to the buildup of adenosine, a chemical component that builds up in your brain and subsequently signals a need for sleep. Adenosine builds up in your brain throughout the day and creates what is known as “sleep pressure.” The longer you’re awake, the more sleep pressure you will build up, which will increase your desire to sleep. This is important when you start to consider the timing of naps for your little one. Caffeine interferes with sleep and the feeling of being tired by blocking adenosine receptors.
Melatonin. Melatonin is often thought of as a sleep aid. In fact, melatonin does not play a role in sustaining sleep throughout the night, rather melatonin provides the signal to the body that it’s time to get ready for sleep. Melatonin is released at night, shortly after dusk, and announces to our bodies that it’s time to get ready for sleep.
Sleep Stages. It may not seem like much is happening when we look at our little one peacefully asleep in bed, but underneath all that cuteness, there is quite a bit going on inside that developing brain! Every night while we sleep, our brains cycle through various stages of sleep multiple times. These stages of sleep allow for a host of processes that contribute to restoration for our body and mind, tissue growth and repair, and cleansing away of toxins produced in the brain during the day. When we are sleeping, our brain begins to integrate new ideas and concepts that we have learned throughout the day with those that we already know.
Recommended Hours of Sleep for Children and Adolescents
The American Academy of Pediatrics has made the following recommendations for the number of hours of sleep needed in a 24-hour period, based upon age range:
0-3 months: 14-17 hours
4-12 months: 12-16 hours
1-2 years: 11-14 hours
3-5 years:10-13 hours
6-12 years: 9-12 hours
13-18 years: 8-10 hours
The Impact of Not Enough Sleep
Insufficient sleep has been linked to deficits in attention, behavioral issues, learning difficulties, hyperactivity, irritability, restlessness, and difficulty with self-regulation. We have all experienced irritability and poor focus due to a lack of sleep. Imagine what chronically poor sleep patterns or chronic lack of adequate sleep would look like in a child. In addition, obesity has been linked to a lack of adequate sleep, as the levels of hormones responsible for the sensations of hunger and satiety are regulated while we sleep.
10 Strategies to Help Your Child Fall Asleep and Stay in Bed
1. Consistent Daily Routines
Routine, and being consistent with that routine, is the number one strategy to be implemented when trying to solve problems related to sleep. Establish a consistent daily routine as much as possible, even on the weekends. Kids thrive on routine because they know what to expect! Include daily outdoor play and exposure to light. Remember that your circadian rhythm, which is responsible for sleep patterns, is dependent upon a consistent routine, as well as light and dark cycles. Be sure to spend time during the day playing, talking, or simply being with your child, giving them your undivided attention.
2. Naps
Make sure that younger children are not napping too closely to bedtime. Napping too late in the day will deplete adenosine stores resulting in not enough “sleep pressure” to help your child feel tired at bedtime. On the other hand, avoid situations that will produce an over tired child. Being over tired and missing naps could result in the release of cortisol, a stress related hormone, that can result in hyperactivity and restless sleep.
3. Prep Time
Get ready to get ready for bed! Just as melatonin alerts our bodies that it’s time to get ready for sleep, children benefit from cues that it’s time to get ready for sleep. Some things you can do to cue your kids that it will soon be time to get ready for sleep could be to announce that in an hour you are going to be starting baths, brushing teeth, or whatever else you determine to be a part of your bedtime routine. For children who don’t yet understand time, you can use cues such as “after this game” or “one more show.” You can use a timer such as a sand timer that will provide a visual cue. Create a quiet environment by turning off electronics and dimming the lights, a sure clue that it’s time to start winding down.
4. Bedtime Routine
Establish a bedtime routine. Remember, kids thrive on routine because they know what to expect! Keep in mind that a bedtime routine should be an enjoyable and positive experience of somewhat short duration. Bedtime routines may involve a warm bath, brushing teeth, putting on pajamas, and reading a book. There is no one size fits all, and this is dependent upon your own preferences. Just keep it consistent. Giving your child some choices during the bedtime routine is always a great way to keep them motivated to stick to the routine and to give them a sense of agency and control. Maybe your little one can choose the book that you are going to read or, given a choice between two sets of PJs, she can choose which ones she will wear.
Another highly effective bedtime strategy is to include the use a bedtime routine picture schedule. These are typically pictures of specific activities or objects that provide a visual clue to your child. For example, you can take pictures of the bathtub, a toothbrush, pajamas, a book, and your child’s bed. Use these as visual cues for what is on your bedtime schedule and put each one away as you complete it. You can download my bedtime chart for free here https://17d5188b-0698-49cd-9f38-f1006b135047.usrfiles.com/ugd/17d518_b6585f87ff6745688428180b614a407b.pdf. I find it best to print on cardstock or laminate.
5. Limit Screens
No screens for at least one hour before bedtime is essential for good sleep hygiene. Blue lights on screens, as well as the rapidly changing images on a screen, are stimulating to our brains. Screens include television, tablets, phones, and computers.
6. Anticipate Needs
Make sure all of your child’s physical needs are met. Make sure they are not hungry or thirsty, and they don’t have to use the bathroom.
7. Caffeine
Avoid caffeine and foods that contain caffeine, including soda, candy, and some other snacks. Remember, caffeine will block the receptors that tell our brains that we are tired.
8. Play Detective
Spend a few quiet moments in your child’s room playing detective. Is there something in the room that could potentially be keeping him awake? Shadows on the wall that may look scary, ticking clocks or fans, toys on the shelf that are beckoning to be played with, or maybe a scratchy blanket.
9. Lights Out
Although some children will benefit from the use of a soft light such as a night light or lava lamp, these can sometimes cause a distraction by casting shadows and drawing attention to high preference objects around the room. Consider the use of room darkening blinds.
10. Additional tips
For kids who may need a little extra help or some sensory based strategies, here is a short list of sleep tips that you can try out, and remember there is no one size fits all solution.
Use a soft, quiet voice when talking, reading, and interacting.
Rock slowly and gently in a rocking chair while reading or talking.
Quietly talk about the adventures of the day that has passed and what will happen tomorrow.
Use a weighted stuffed animal for your child to hold or a weighted blanket. Weighted blankets should be no more than 10% of your child’s body weight and are generally considered to be safe for children over three who weigh at least 50 pounds. They should be comfortable and allow your child to move.
Lycra sheets are an alternative to weighted blankets and provide a calming compression.
Make sure that your child’s bed is not too big. If a child does not have a sense of physical boundaries, it can be difficult to fall asleep. Try putting the bed against a wall to provide a boundary on at least one side. Bed tents can also provide children with a sense of body boundaries.
White noise machines can help to cover up background noises and can also be useful for kids who have bedtime anxiety.
Get out of bed free card. This card can be used once each night for one trip to see a parent or get a drink of water, etc. If your child gets out of bed again after using her card, simply walk her back to bed without any words or eye contact. If your child doesn’t use the pass at all, reward her the next day with a small reward and verbal praise.
Write a short note or draw a picture for your child that they can hold onto while they fall asleep.
Try some gentle deep breathing techniques or simple body scans to promote relaxation.
Prior to starting your bedtime routine, try implementing quiet evening activities, rather than physical activities, such as coloring, puzzles, journaling, or painting.
Some kids will find value in a simple explanation. Try to explain why it’s important to sleep. You can use simple language to let them know that when they get sleep, they have more energy to play and they will feel good and be in a good mood for the next day.
Establishing healthy sleep habits for your child will contribute greatly to their overall well-being and development. With a little patience, consistency, and the right strategies, you can create a nurturing bedtime routine that promotes restful sleep and makes everyone happy!
It is important to consult your child’s pediatrician when it comes to any concerns with your child’s health and development. There are many underlying medical conditions that can cause a variety of symptoms in children, and these are best to be formally assessed by a professional who is knowledgeable in your child’s specific set of circumstances.
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