A growing body of scientific literature is highlighting the negative effects of inadequate sleep. A survey carried out in Japan concluded that “shortened nocturnal sleep is a growing social phenomenon in industrialized countries.”

Another study published in the Sleep Journal states: “It is widely recognized that sleep is important for children’s health and well-being and that short sleep duration is associated with a wide range of negative health outcomes.” Both studies agree that that lack of healthy sleep is associated with negative physical, emotional as well as cognitive outcomes.

Among several other reasons, the lack of adequate sleep among some children may be linked to the fact that parents do not have adequate knowledge about what constitutes healthy sleep and how they can ensure that their children get it. In this article, we look at everything you need to know about healthy sleep for your child.

We conclude that parents play an essential role in ensuring that their children get the sleep they require and are responsible for seeking help if the problems persist.

What is Considered Healthy Sleep?

Marc Weissbluth, an author, medical doctor, and father of four, says that healthy sleep does to the brain what weight lifting does the muscles. In his book entitled Healthy Sleep Habits, Happy Child, he advises that sleep increases brainpower. Dr. Weissbluth believes that sleep has a direct relationship with attention span and that it allows someone to be relaxed as well as alert.

Factors Influencing Healthy Sleep

While experts like Dr. Weissbluth are clear about the importance of healthy sleep, an important question remains: What sleep is considered healthy sleep? We identify some elements which have to be present for sleep to be perceived as healthy.

Sufficient

The number of hours that a child spends sleeping is a vital indication of whether or not the child gets healthy sleep. The length of sleep will differ from child to child depending on age.

The UK’s National Health Service website provides the following data on sufficient amounts of sleep.

Uninterrupted

Healthy sleep is uninterrupted sleep. Marie-Hélène Pennestri and several other scholars conducted a study entitled Uninterrupted Infant Sleep, Development, and Maternal Mood and concluded that uninterrupted sleep refers to sleeping through the night. For these researchers, sleeping through the night relates to “longest period of uninterrupted sleep without parental intervention.”

According to the Marie-Hélène Pennestri and others’ study report, uninterrupted sleep happens through sleep blocks ranging between six and eight hours for children from around six months of age. However, they still note that this may not apply to all children. However, they note that sleeping through the night after the age of 12 should be considered as the gold standard. What this implies is that if there is a need to attend to a child several times a night, that child may not be getting sufficient sleep.

Incorporate naps

Writing for WebMD.com, an American website which publishes health information and news, Michael J. Breus, PhD, notes “making sure your child gets good, sound sleep ensures he or she will have a sound foundation for proper mind and body development”. The same author notes that naps should be taken into account when determining whether a child is getting healthy sleep. He notes that the naps taken at different times of the day play different functions. Hence they should be managed by taking the child’s biological rhythm into account.

Rupal Christine Gupta, a medical doctor, writes for KidsHealth.com and provides a few reasons why naps are essential.

• Critical mental childhood processes take place during naps.
• Naps also ensure that the child gets sufficient downtime to rejuvenate and grow.
• Apart from giving parents the needed time to attend to other chores, Dr. Gupta notes that naps ensure that the child does not get “overtired, which not only takes a toll on their moods but may also make it harder for them to fall asleep at night.”

Is In Sync with Biological Rhythms

The relationship between being awake, being alert, feeling drowsy, and falling asleep follows what Breus calls “our natural daily biological rhythms” (Source). He notes that these rhythms will be irregular during the first few months after a child is born. However, as the child gets into a rhythm and matures, they begin to follow a system.

To ensure healthy sleep, the parent needs to study the timing of a child’s sleep and note any changes that take place as the child grows. This will make it possible to adjust to the child’s schedule as much as possible so that the parent is in synch with the child. What this implies is that forcing a child to sleep when they are not ready, and coercing them to wake up before they want to, could tamper with the child’s rhythms and lead to sleep problems.

Sleep Patterns for Children

In the last point above, we emphasize the importance of understanding your child’s sleep patterns or rhythms. Hence, it is essential to understand what these patterns look like for a child. The American Academy of Pediatrics, notes that if sleep patterns are not appropriately managed in a child’s early life, the child is likely to develop sleep disorders at later points in their growth.

Newborns

An article published by Stanford Children’s Health, an organization affiliated with Stanford University, notes that the sleep pattern of a newly born baby below the age of three months is quite simple: they sleep for around eight to nine hours during the day and about eight hours at night. It is expected that babies at this age will wake up every few hours to eat because their stomachs are still too small to hold food that will keep them satisfied for long.

Infants

According to the National Sleep Foundation, by the time the baby gets to around six months, they will no longer need to eat during the night. This makes it easier for them to sleep through the night. At this stage, the baby is now sleeping for between nine and twelve hours during the night and taking naps that range between 30 minutes and two hours, one to four times a day. As they reach their first birthday, these naps decrease in number.

Toddlers

The National Sleep Foundation advises that as children pass from their first birthday to their second, they will start to sleep between 11 and 14 hours with most of the sleep occurring at night. They also note that as children get to around one and a half years old, they will usually take only one nap a day; lasting between one and three hours. However, this is the time when children start to experience sleep problems as they may begin to resist going to sleep at night, experience nightmares, and fear of sleeping alone.

Preschoolers

Once the child is ready to go to preschool between the ages of three and five, they can be expected to sleep for between 11 and 13 hours per day. Almost all the sleeping happens at night with hardly any need for naps during the day. This is the period when the child’s imagination becomes more creative, leading to an escalation in sleepwalking and sleep terrors (Source).

School-Aged Children

As children grow older and start formal schooling, between the ages of six and 13, demands on their time increase. For instance, such children may start using electronic gadgets like computers, televisions, and other media. According to the National Sleep Foundation, their consumption of products with caffeine increases. All these elements can interrupt their sleep patterns. At this age, they are expected to sleep between nine and 11 hours with almost need no afternoon naps.

Encouraging Healthy Sleep for Children

Being clear about the elements that lead to healthy sleep and the sleep patterns common for different age groups indicates what needs to be done to ensure that a child gets healthy sleep. Below are some useful tips that will help your child fall asleep and remain asleep for an adequate period considered as healthy sleep.

Prepare Sleep Schedule

The first step towards establishing a consistent sleep pattern for your child is ensuring consistency regarding when they sleep and wake up. The NHS website supports the idea of sleeping at regular hours and notes that having a sleep schedule helps the internal body clock and the brain to adapt to a specific routine. The NHS also advises against changing the schedule on weekends and holidays because this could interrupt with the sleep routine you have already established.

Incorporate Exercise

The right level of exercising has been known to encourage healthy sleep among adults. Even though the advice to incorporate exercise may seem unwarranted for children because they are generally more active than adults, changing societal norms are making this advice important for them as well. The proliferation of electronic devices and arrangements where families live in high rise apartments could lead to a situation where children do not move as much as they need to.

Exercise could be incorporated by doing simple everyday things like walking to the store instead of driving. If your child’s school is close enough, you could also walk with them to school. When going up to your apartment, you and your child can use the stairs as opposed to an elevator. If you have a chance, you can take the child with you when jogging or swimming.

Avoid Late Dinners

Anyone who has gone to sleep hungry would know how difficult it may be to sleep in that state. The same applies to children. It is crucial to ensure that your child has had enough to eat before they go to sleep. However, it is also important to remember that it is not a good idea for a child to go to bed with a stomach that is too full. The general advice is that dinner should be at least two hours before bedtime (Source).

Sleeping immediately after eating means that the body is busy digesting food right through the night. This could make the child wake up feeling tired.

Avoid Caffeine

In an article entitled Healthy Sleep Habits for Children, the Cleveland Clinic advises that a child should not be given caffeine products in the late afternoon or just before they go to sleep. Some products which contain caffeine include coffee, iced-tea, chocolates, and energy drinks.

Get the Right Mattress

An essential step to creating a conducive environment for your child to sleep is by providing a good and safe mattress. When selecting a crib mattress focus on firmness and fit. Firmness in a mattress means that the mattress is able to push back on the weight of the child without being so stiff that the child feels uncomfortable. Fit generally refers to whether the mattress you buy will fit properly in the child’s crib.

Keep Screens Out of the Bedroom

The proliferation of gadgets such as smartphones, televisions, and computers means that children who are not adequately monitored can spend more time using these gadgets than they are supposed to. The NHS advises parents to turn their children’s bedrooms into screen-free zones. To ensure that children don’t wake up in the night and use their electronic gadgets, it may be a good idea to inculcate the habit of charging devices outside the bedroom.

Manage the Sleep Environment

To ensure a healthy sleep for your child, you will need to make sure that the environment in which they sleep is safe. For instance, attempting to get a child to sleep in a room next to the bathroom may mean that the child will be disturbed whenever someone goes into the bathroom. The same applies to a child sleeping in a room with a broken window that could make the room too cold during the night.

The parent will also need to watch against the risk of suffocation, strangulation, and entrapment. Working together with the U.S. Consumer Product Safety Commission (CPSC) and other safety organizations, the American Academy of Pediatrics (AAP) has produced a video dealing with safety in your child’s bedroom. You can watch the video below.

Why Healthy Sleep is Important for Children

The American Academy of Pediatrics notes that lack of sleep has negative effects on a child which could sometimes manifest well after their childhood. Below we look at some of the reasons why healthy sleep is important for children.

Boosts Immunity

In an article published by Webmed.com, Denise Mann, a freelance health writer in New York, reports that healthy sleep is essential for boosting the child’s immunity. The same writer refers to some studies which conclude that “sleep deprivation suppresses immune system function.” This implies that the healthier your child’s sleep is, the healthier the child will be.

Boosts Mental Well-Being

Rachel Dawkins, a medical doctor, writes for the John Hopkins’s All Children’s Hospital and notes that “studies have shown that kids who regularly get an adequate amount of sleep have improved attention, behavior, learning, memory, and overall mental and physical health.” She supports the view that children who do not get enough sleep could end up obese and suffering from blood pressure and depression later in life (Source).

Common Sleep Challenges

While there are many sleep challenges faced by children, such problems differ from child to child as well as from one age to another. For example, newborns fall asleep quickly and can spend lots of hours per day sleeping, but older children may start to face challenges as they become busier, and their imagination becomes broader. We have already indicated in the section dealing with sleep patterns that older children are prone to nightmares and sleepwalking.

Below are some of the common sleep challenges that affect children.

• Sleep regression: A child who used to sleep well suddenly works up many times during the night or refuses to sleep or nap.
• Development of separation anxiety: Fear of being left to sleep alone in a room
• Refusing to sleep: Especially when the child becomes active and starts exploring the world around them
• Only sleeping when held in an adult’s arms: Waking up as soon as they are put in bed
• Sleeping all day and staying awake all night: A concept popularly known as daytime and nighttime reversal.
• Failure to fall back asleep: After feeding or changing

Dealing with Sleep Challenges

Understanding the causes of your child’s lack of sleep is essential in formulating ways to handle the challenge. There is no single package of solutions that fits every child’s situation because every child is unique. This is why monitoring your child closely is necessary so that you can know the challenges they face. This will enable you to know which solutions best fit them (Source).

Below are some typical solutions for sleep challenges.

You can read more information regarding sleep challenges and how to tackle them by downloading this PDF.

Is Melatonin a Solution to Sleep Challenges?

Parents whose children face sleep challenges have sometimes been advised that a hormone supplement called melatonin can help. However, there have been some concerns about its safety. We took some time to find out what the experts say.

According to an article published by the Boston Children’s Hospital, there is sufficient evidence showing that melatonin can make children with ADHD, Autism, and other such neurodevelopmental disorders fall asleep faster.

With regards to the safety of the hormone supplement, the article by the Boston Children’s Hospital cites studies done in Australia, which show that it is generally safe. However, according to Canadian pediatricians, its use can be risky for children if used for the long term.

Life Difficulties Faced by Children with Sleep Problems

When it comes to the difficulties faced by children with sleep problems, the books On Becoming Baby Wise, written by authors Gary Ezzo and Robert Bucknam, and Healthy Sleep Habits, Happy Child by Wiessbluth provide some insight. The following are some of the challenges noted by the authors.

• Impaired neurological development which can cause many learning and behavioral problems for the child later in life
• Poor peer relations
• Poor performance in school
• Long-term adverse effects on the child’s brain function
• Lower IQ when compared to children who get healthy sleep
• Hyperactivity, making such children generally more demanding, less sociable, and not fun to be around
• Reduced concentration span
• Increased risk of emotional disorders later in life

Even though the connection between lack of sleep and obesity is still up for debate, some studies believe a relationship exists. For instance, one research study shows that 5.4% of participants who are short sleepers tend to be obese, while only 2.8% of those who get adequate quality sleep become obese.

The Connection between Healthy Sleep and Good Grades

Researchers from McGill University and the Douglas Health University Institute in Montreal have found that there is a link between healthy sleep and good grades, especially in math and languages. These subjects are often used as predictors of a child’s academic performance later in life. The findings of the research were published in the Journal of Sleep Medicine.These findings underscore the importance of adequate sleep in a child academic performance (Source).

The Role of Parents and Caregivers in Ensuring Healthy Sleep

In his article entitled, Good, Sound Sleep for Your Child, Michael J. Breus, PhD, places the ball in the parents’ court when he says: “Sleep is no less important than food, drink, or safety in the lives of children.” Children depend on their parents and caregivers to make crucial decisions such as when to go to sleep and when to wake up.

Training Children to Sleep

One of the most critical roles of parents and caregivers is to ensure that the child gets proper sleep training. According to Babycenter.com, a digital parenting resource that says it receives over 100 million visitors a month, “sleep training is the process of helping a baby learn to fall asleep and stay asleep through the night.”

Starting the Training

Babycenter advises that parents should look at beginning sleep training when the baby is around four to six months old. It is around this time that babies have started to develop a predictable sleep schedule. At this age, feeding the baby during the night is no longer necessary.

Developing a regular sleep schedule is an integral part of starting sleep training for a baby. This means that the baby has to know the signs that it is now time to go to sleep. This may include introducing a nighttime bath, a lullaby, or dimming the lights. Whatever you decide, you have to ensure that the bedtime is consistent so that the baby can predict it with ease.

Training Approach

Once you have decided to start the training, it’s crucial to identify the approach you will employ. It is vital to ensure that the approach you select will work for both you and the baby. Watch how the baby reacts to your training so that you can change it if it becomes clear that the baby doesn’t like it. This may involve stopping and waiting a few days before starting a new approach.

Generally, experts place sleep training for children into the three methods below.

The Cry it Out Technique

As the name suggests, the Cry it Out Approach involves not responding to the child even if they cry after you have placed them in bed. However, the child should be placed in the crib when they are drowsy even if they are not yet asleep. This is a method developed by Richard Ferber, a director at the Center for Pediatric Sleep Disorders at the Children’s Hospital Boston. Basically, you are training the child to fall asleep without your help through assisting them to acquire the ability to self-sooth.

However, the approach does not advocate that you leave the child to cry out indefinitely. It is essential to keep checking that the child is fine even if you are not attempting to get them to stay quite. It is also important to note that this approach has been discredited by some experts like Darcia F. Narvaez Ph.D. who writes for Psychologytoday.com and argues that “the practice comes from a misunderstanding of child development” (Source).

The No Tears Approach

This methods offers a more gradual approach where the parents soothes the baby until the baby falls asleep. When the baby cries, the parent provides comfort. It is advisable to take a chair and sit next to the baby so that you are available when they need you. You will be moving the chair further away from the crib each night until you are finally out of the child’s room.

The Impact of Reducing Screen Time

According to the NHS website, “more sleep and limiting screen time may improve children’s mental abilities.” The same website also cites a study carried out in the US intending to confirm whether limiting screen time to two hours resulted in children doing better in mental functions.

The study concluded that reducing screen time to less than two hours, combined with one hour of moderate to vigorous exercise and sleeping for nine to eleven hours, had a positive effect on mental functions. This study confirmed conclusions from earlier work by Canadian researchers.

The Connection between Unhealthy Sleep and Chronic Conditions

An article published by Johns Hopkins Medicine, an organization, affiliated to The Johns Hopkins University reports that “long-term sleep disruptions may raise the risk of some cancers.” The article cites Kathryn Ruble, M.S.N., and Ph.D., a researcher at the Johns Hopkins Kimmel Cancer Center who notes: “In our research, nearly one in four survivors of childhood cancer had difficulty falling asleep and staying asleep”.

Another study entitled, Association of Sleep Duration with Chronic Diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study, concludes that a lack of sufficient sleep is also attributed to conditions like stroke, type 2 diabetes, and other chronic diseases. The same study finds that children who do not get enough sleep are prone to chronic conditions later in life, especially stroke and cancer.

When to Get Help for Sleep Problems

While sleep challenges are normal for many children, you need to know when to seek the help of behavioral therapists or child development professionals. Below are some signs identified by the website Zerotothree.org that signify when to seek professional advice.

• If the child’s sleep challenges persists for more than four weeks when the child is over a year old.
• If the child keeps waking up at night and cannot go back to sleep without your intervention.
• When you notice that the child’s sleep challenges are interfering with his development or your own life.

Useful Resources

Even though healthy sleep for children has important consequences, the website Medicalxpress.com, a science, research and technology news service, reports that a study concluded that only 1% of US social service policies have educational and promotional materials dealing with healthy sleep in children. We identified some resources which provide more information on issues related to sleep for children.

Healthychildren.org: Is an organization affiliated to the American Academy of Pediatrics. This is an organization which indicates that “its member pediatricians dedicate their efforts and resources to the health, safety and well-being of infants, children, adolescents and young adults.” The organization has an estimated 67,000 members in different countries in North and South America. Its website provides information made available by pediatric medical subspecialists, pediatricians, and pediatric surgical specialists.

Startsleeping.org: Is a website that provides content that helps people to sleep better. It contains resources like How to Get Your Child to Bed, Parent’s Guide to SIDS and Newborn Sleep Safety, and Autism and Sleep: What Parents Need to Know, among other such content.

As the leader for Pediatric Sleep in Alaska, Alaska Sleep Clinic and our Pediatric Medical Director Harry Yuan, MD are here and ready to help you and your child get the quality sleep they need for a healthy childhood and life.