Whether they refuse to fall asleep without 19 stories, five gallons of water and your legs wrapped around them just so or they’ve suddenly taken to popping in at 2 a.m. to say hello (but not goodbye), kids and sleep deprivation are a dreadfully iconic duo. One that experts — and parents and caregivers — have logged countless hours researching.
“In general, children are able to sleep through the whole night after age 1 — but there are plenty of reasons why this doesn’t always happen,” says Dr. Brandon Smith, general academic pediatrics fellow in the Department of Pediatrics at Johns Hopkins in Baltimore. “The peak time for sleep problems in children is between 2 to 6 years of age, and that’s when we hear about them most often.” Smith notes that while sleep issues generally turn a corner after that, it’s important for parents and caregivers to know what’s normal and how to help manage sleep issues, and in some cases, sleep disorders.
From kids who wake up in the middle of the night crying to sleep disorders in children (no, they’re not necessarily the same thing), top experts offer advice and insight on kids and sleep issues.
What are common sleep problems in early childhood?
Kids have trouble falling — and staying — asleep for a variety of reasons, and some of these issues can be addressed by instilling proper sleep hygiene habits (more on this in a bit). However, there are pediatric sleep disorders that may require the help of a doctor and/or sleep specialist.
While some sleep problems in children aren’t officially recognized sleep disorders, Kelli-Lee Harford, clinical psychologist, Children’s Healthcare of Atlanta Sleep Disorders Program and assistant professor, Emory University School of Medicine Department of Pediatrics, says that if it’s wreaking havoc on everyday life, it’s more than just a problem. “Sleep issues are considered a disorder if they become more chronic and result in impairment in functioning for the child, parent and/or family,” she says.
Here are some of the most common sleep problems and disorders in kids:
Sleep apnea
According to Lauren Broch, a psychologist at the Northwell Health Sleep Disorders Center, sleep apnea is the most common official sleep disorder. “With sleep apnea, the child’s breathing is obstructed to some extent, and throughout the night, they wake up to open up their throat,” she explains. “Often this is due to enlarged adenoids and tonsils, and in some cases, doctors will suggest removing them.” An at-home monitor that measures things like heart rate and air flow, is often used to diagnose sleep apnea in kids.
Circadian rhythm sleep disorders
“These typically are found in adolescents,” says Harford. According to the Cleveland Clinic, adolescents most commonly suffer from delayed sleep phase disorder, which is where they fall asleep and wake up at least two hours later than what’s considered a normal sleep-wake cycle.
Restless leg syndrome
Restless leg syndrome (RLS) isn’t uncommon in kids, according to Harford, affecting 1 in 50 children. RLS causes discomfort in the limbs (potentially caused by low iron), making it difficult for kids to fall asleep.
Parasomnias
“Parasomnias are a group of sleep disorders that cause unusual behavior while sleeping,” notes Harford. “They include sleep talking, sleep walking, nightmares and night terrors.” Night terrors, it should be noted, can be very upsetting for parents and caregivers to witness, but it’s important not to intervene if a child is having one, as it may make the situation worse.
“When a child is having a night terror, they may wake up screaming, sweating, with a racing heartbeat — and they aren’t aware of their surroundings and can’t be consoled,” says Smith. “It’s best for parents or caregivers to remain with their children to make sure they’re safe, allow the episode to finish and then put the child back to bed.”
What is behavioral insomnia of childhood?
One of the most common sleep problems in children is behavioral insomnia of childhood, and more often than not, having a consistent bedtime and routine (where kids are soothing themselves to sleep) is the antidote.
“Behavioral insomnia comes in two forms – one where the child has trouble falling asleep and another where they wake up a lot in the middle of the night,” notes Smith. “The child’s sleep problems aren’t really tied to a medical problem, and instead are more of a learned behavior that needs to be tackled.”
Put another way: Often kids are falling asleep with the help of an adult and then wake up in the middle of the night, unable to put themselves back to bed. For kids who have a hard time falling asleep initially, anxiety can be a factor (in which it’s important to seek professional help), but more likely it’s not having a routine that’s conducive to sleep.
“Behavioral insomnia of childhood, which is more common in younger kids, can come in the form of bedtime resistance, taking a long time to fall asleep and/or having difficulties staying asleep,” says Harford “It often occurs because of difficulties with limit setting and/or sleep onset associations — something that a child gets used to having at the beginning of the night to fall asleep, such as a parent or a pacifier, and then seeks out in the middle of the night if it is no longer present.”
Why does my kid wake up in the middle of the night crying?
In some cases, kids wake up in the middle of the night crying — this often is a result of a nightmare or a night terror. “Nightmares and night terrors are two very common reasons why children may wake up crying,” explains Dr. Sara Siddiqui, a pediatrician and clinical assistant professor in the Department of Pediatrics at NYU Langone’s Hassenfeld Children’s Hospital in New York. “Both of these are signs of brain development and can be normal, but it is worth mentioning to the pediatrician, as an active imagination, with some anxiety and worry, may lead to sleep issues.” The best way to try to prevent this from happening, according to Smith, is by being consistent, having routines and offering kids reassurance if they’re scared.
How do I stop my child from waking in the night?
While there are sleep issues, such as sleep apnea and RLS, that warrant treatment from a healthcare provider, oftentimes the problem can be handled on the front-end at home. (Also, it should be noted there are circumstantial reasons kids occasionally have trouble sleeping — the birth of a sibling, potty training or transitioning to a toddler bed often resolve themselves on their own, according to Harford, and aren’t behavioral insomnia of childhood.)
For kids who refuse to go to sleep initially or wake up nightly, good sleep hygiene is key. “Kids should have a routine for the evening and bedtime that is done every day,” notes Smith. “Not having a routine is one of the most common reasons for kids to wake up at night or have trouble with falling asleep. For the youngest of children, they still may have some issues with parent separation, which can make things worse when they wake up at night and realize they are alone.”
Siddiqui recommends starting routines early. “I advise working on proper sleep techniques and routines as early as 6 months of age,” she explains. “I often recommend bath, book, bed. The routine can be modified a bit as they become older.”
Additionally, it’s crucial for parents and caregivers to remove themselves from the bedtime equation before the child is asleep. “How a child falls asleep is key,” says Broch. “If a child falls asleep on their own, self-soothing, when they enter a light sleep or wake up during the night, they’ll be able to get themselves back to sleep on their own since the situation is the same as when they first went to bed.”
The best way to incorporate this practice is when kids are young (Siddiqui recommends putting infants to bed drowsy so they learn to fall asleep on their own). But in cases where kids have been going to bed with a sleep association — such as you — Broch recommends gradually removing yourself from the picture. “You can start by lying in bed, then move on to sitting somewhere in the room to sitting at the door to eventually not being there at all when they’re falling asleep,” she says.
Other ways to promote good sleep hygiene, according to Harford:
- Avoid stimulating activities before bed.
- Avoid screens for two hours before bed.
- Have a sleep environment that’s cool, dark and quiet.
- Ensure children get adequate physical activity.
- Limit caffeine.
- Having a consistent sleep schedule.
Hard work for busy parents and caregivers? Yes. But worth it in the end, as it’s so important for kids (and parents) to get enough rest. “When kids don’t get enough sleep, it affects their daytime mood,” says Siddiqui. “Other issues, such as anxiety, depression and oppositional issues, can arise, as well.”
A good bedtime routine should start one to two hours before going to sleep and it can take up to three weeks to develop a habit, according to Siddiqui.
What to do when kids wake up at night
Even with a solid sleep routine and good habits, children sometimes awaken at night — particularly ones on the younger side. “The toddler and child brain is changing and developing very rapidly and sometimes dreams, nightmares and even night terrors can begin to occur with rapid brain development,” says Siddiqui. “A commercial on television or even a story discussed the night before can lead to being scared at night, which leads to a child having difficulty falling asleep or waking up.” When this happens, it’s best to make things as uneventful as possible.
“Minimize the reinforcement of middle-of-the-night wake-ups by making them boring and the same each time,” says Broch. “Walk them back to their bed to let them know that this is where they are for the night.”
Smith adds that while it’s easy to cave and allow kids to hop in bed with you out of sheer exhaustion — don’t. “Stay strong when kids wake up in the middle of the night,” he says. “Encouraging their independence and self-soothing is so important in that moment and also for their future.”
