Kid’s Sleep: Smooth slumber

Learn how to solve common sleep problems in children, without medicines

mother putting her son to sleep

Most of us are aware of adults having problems with sleeping or falling asleep. In fact, insomnia is one of the commonest disorders in adults for which medications are prescribed the world over. But another group, who is highly prone to sleep disturbances and disorders, is children.

Children vary in their sleep requirements from adults. Even their sleep patterns are unlike us. Their sleep disorders depend on their development and the maturity of their nervous systems. What might be normal for a newborn child would definitely be abnormal for a toddler or a pre-schooler. A newborn child often wakes up five or six times a night. This is normal for her, but if a five year old or a teenager does the same thing, it is considered abnormal. Also, sleep deprivation in adults is likely to manifest as fatigue, tiredness, grogginess, headache and daytime sleepiness while children usually manifest with hyperactivity, temper tantrums, under- or over-eating, poor performance at school, or with inability to pay attention during the day.

Sleep disorders in children are of two types. The first type of disorders are a result of an immature nervous system and the second type are behavioural in origin with no problems in the nervous system.

A faulty nervous system

These disorders result from an immature nervous system:

  • Narcolepsy, or excessive sleep.
  • Sleep walking and sleep talking.
  • Bed wetting [nocturnal enuresis].
  • Sleep apnoea, characterised by snoring and a temporary stoppage of breathing in sleep due to the collapsing of the air passages.
  • Confused arousals, where the child wakes up, is disoriented, looks lost and then goes back to sleep.
  • Sleep terrors, which occur between the ages of three and eight and where the child sits up and screams in fear, and takes a long time to go back to sleep, and eventually has no recollection of the episode in the morning.
  • Teeth grinding, which is considered a form of stress release in sleep.

These conditions usually need the intervention of a doctor to rule out any major neurological problem.

Behavioural issues

Behavioural or secondary sleep disturbances are more common and are often due to psychological reasons such as stress. The child either cannot fall asleep or is unable to sleep well. Many children get into the habit of needing some support or prop to fall asleep. This might take the form of a bedtime story, a feeding bottle, thumb sucking, rocking, or a lullaby, and might find it difficult to fall asleep in the absence of these stimuli. If they wake sometime in the night, they need the same support to go back to sleep. Also, children have a memory of the ambient conditions like lighting and noise levels when they fall asleep. When they accidentally wake up in the night, the absence of the same conditions of sound or light disturb them and prevent them from falling asleep again. Fear of darkness is another reason for sleeplessness in children. A child who has been trained to fall asleep on his own, and has learnt self-soothing behaviour without an external support system is often able to go back to sleep, even if she wakes up in the night.

Habitual awakening

Many children under the age of two or three years get into the habit of waking up in the night for no obvious reason. They refuse feeding and keep crying till they are picked up and rocked or carried around. They fall asleep when the parents fuss over them, only to wake up after a couple of hours. This is more common in children of working women, where the child knows that the mother will not be available to her in the morning. So she tries to extract the maximum amount of time, physicalcontact, love and affection from the mother at night. While the child never suffers, the parents are left tired and groggy the next day, finding it difficult to concentrate at work.

What to do: When the child wakes up again and again, ignore. Let her cry for a few days, so that she realises the futility of waking up, and slowly stops this habit. The same is true for those who are fed at night. They wake up as there is an incentive, in the form of breast or bottle feeding. This practice distresses the mother and can only be solved by stopping the feeding, letting the child cry and learn that there is nothing to be gained by waking up. A child does need to be fed at night till she is one year old. But beyond her first birthday, parents can safely discontinue night time feeds. Many parents are advised to voluntarily wake up such children at regular intervals, so that children do not develop their own waking time. Gradually, the time interval between waking up the child is prolonged. Eventually, the child never develops any pattern and learns to sleep for long.

In the first three or four months of life, a big reason for sleep problems is infantile colic, where the child wakes up frequently or refuses to go to sleep because of colic and stomach pain. This condition can be treated with medicines and goes away by the age of three or four months.

Sleep deprivation

Sleep deprivation is becoming a common problem even among children, as a result of spending too much time watching television, studying, socialising, and playing on the computer. They need 12-hours of sleep but get only six or seven hours. This leads to irritability, inattention, restlessness, poor scholastic performance and eating disorders.

What to do: Parents should recognise the need for good sleep and ensure that the children get at least 9 – 10 hours of sleep every night. Ideally, a child should go to sleep when he is sleepy and should wake up on his own, in the morning. This is how nature intended us to be. But the modern day academic and social pressures ensure that many older children today are sleep deprived, to varying levels. This deprivation has serious short- and long-term consequences and must be avoided at all costs. Long-term sleep deprivation can precipitate many lifestyle diseases like obesity, hypertension, diabetes, psychological disorders and even some form of cancers. Parents and children should take sleep seriously. Many other activities may safely be cut out, to make time for sleep, and not the other way around.

Sleep cycle

A typical newborn sleeps for 16 hours − 20 hours a day. This sleep requirement gradually decreases, and at one year, a child needs to sleep for about 12 hours − 14 hours. By the time she is five, her sleep requirement is about 10 hours − 12 hours. By the age of 17 or 18, the requirement of sleep is like an adult, which is about 8 hours − 9 hours a day.

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P V Vaidyanathan
Dr P V Vaidyanathan, MD, DCH, is a Mumbai-based paediatrician in private practice, hobbyist writer, and author of a book on childhood stress management.


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