Addressing sleep issues in children

Sleep problems can linger well into the school-going age bracket.  Sleep issues are not reserved for infants and toddlers, but if parents have reached the stage when their older child doesn’t sleep well you may also feel resigned to the situation.  Obviously the older the child is, the more difficult it may be to change long ingrained sleep associations and expectations of your child within the context of their sleep. 

With age, the emotional landscape shifts as well- language development, a greater sense of self and of control may emerge, childhood fears and anxieties may also become heightened; however, the principles of healthy, positive sleep practices can still be adopted, and your child’s sleep can always be improved. 

Of course, some children are better sleeper than others, and yes, some children require more and some a little less than average, but ultimately, all typically developing children, have the capacity to learn and experience their sleep without a parent present or by delaying sleep for 2-3 hours at bedtime and they can also be encouraged and shown how to say asleep overnight without wandering into the parent’s bedroom or indeed looking for the parent to join them in their bed.

The importance of quality, un-interrupted and consolidated sleep for your child’s health and development should not be underestimated.  Studies routinely demonstrate that sleep, serves a far greater function than rest alone, contributing to optimised learning and mental alertness, increased ability to retain and process information along with enhanced cognitive development.

With preschool and school going children between 3-7 years of age, that do not sleep well, the challenges are typically, either not being able to go to sleep easily at a reasonable time or not being able to stay asleep; and very often parental presence is required either at the onset of sleep, overnight or both.

Another common occurrence in this age range is staying awake for long periods of time overnight. Just with younger children, in order for healthy sleep to develop and for your young child to be masterful and efficient at sleeping, core sleep principles are helpful. 

Quality, healthy sleep may be described as getting enough sleep for the age group, taking a daytime sleep when age appropriate, together with the ability to go to sleep at a regular time and to be able to consolidate the sleep without unnecessary adult intervention.

How much sleep?

Each child is entirely unique and individual and thereby their sleep needs will vary hugely, and this is proven in numerous studies, especially within the first year of life. Within this variability, there are typical recommended amounts as agreed in the most recent research detailed below. 

(Hirshkowitz, et al., 2015) 

What is the right bedtime for your child?

In this age group bedtime may be from 7-9.30pm and awakening from 6am onwards, but in a lot of instances, 8pm onwards is simply too late, causing bedtime battles, frequent waking and shorter sleep duration.  If you are struggling with your child’s sleep then consider an earlier bedtime, even temporarily. Consider their mood and behaviour in the evening time, together with the current amount of sleep/need for sleep versus current wake time and work on bringing timings forward in an effort to establish their natural bedtime

If you find that your child struggles to go to sleep much before 10-11pm and then sleeps late in the morning.  You may need to consider waking them earlier in the morning in an effort to establish a regular age-relevant bedtime, enough sleep in general and an earlier wake time. 

Sleep Strategies

Explain Talk to your child about the changes that you intend to make. Do this during the daytime, on a walk or over lunch. Let your child be involved in the decisions, rearrange the bedroom, choose the books, pyjamas, and engaging activities. Give them a sense of control and involvement over the situation. Ask for their input, suggestions, and own impressions of what they would like their bedtime to include- co creatively develop a plan for sleep.

Illustrate Create together, a personal book of sleep to help illustrate the changes you are going to make and what you are hoping to achieve.  Make it specific to your family, use photos and text that show, explain, and guide what bedtime and their expectations may adjust to.  Get your child involved in this process, encourage ownership of their “sleep happiness” within the narrative that you are creating and develop common sleep goals to works towards.

Relax Establish a bedtime routine in your child’s bedroom-allocate 20-30 minutes to help your child become quiet and relaxed and to bridge the gap between the busy and alert of the day and sleep itself. Be creative and loving; indulge in plenty of physical contact.  Gentle massage, stretching and relaxing exercises. Cuddles and stories. Chat about the day and what you are looking forward to doing tomorrow.  Use music or audio books during the wind-down making sure that you turn off before sleep time. Consider meditations and deep breathing exercises for children if your child finds it difficult to switch off.  

Make sure that you have an ending to the bedtime routine. Bedtime works well if there is a clear beginning, middle and end. Complete the ritual with an I love you ending or a conversation that encourages them to discuss 2 things they loved today and 2 things that they are looking forward to tomorrow. Common issues here involve delaying tactics, calling you back after you have left the room: hunger, pain, not tired, scared, needs a drink or a wee-wee, or both. 

Try to meet the objections, stalling strategies in advance and be mindful of giving into demands for extra drinks, toilet runs or one more story as they can quickly become a way of delaying bedtime and also drinks that are part of the bedtime routine often undermine your child’s sleep ability to maintain overnight sleep, so it may be best to finish drinks before the bedtime routine begins.

With a bedtime routine that is focused- logical, linear, and even illustrated with a check list on the wall, can set the scene for lights out and sleep time. You may even need a few expectation guidelines such as once the lights go out-no talking…. close eyes…. go to sleep.  Communication is key- allowing your child to know what you would like and to help show and explain to them, without feeding delays, so that you continue to help your child to feel seen, heard, connected, and belonging.

Environment Make sure your child’s bedroom is a calm, safe place to be.  Avoid too many distractions or stimulating activity in advance of sleep.  Keep electronics and televisions out of the bedroom and restrict their use at least 1-2 hour before sleep time as using gadgets close to sleep can make it difficult for your child to switch off and have a restful sleep.  To help develop good form and feelings, spend lots of non-sleep time in the bedroom so that the room itself does not represent the big separation that is sleep.

Emotional Environment: feeling safe, confident, and able to sleep without a parent may mean that extra work to ensure that your child feels safe and connected to you by day is observed.  We are all doing our best and often in the busyness of real life, our children may feel that they do not see or get enough of you by day- ensure that time together by day- is present, quality, undiluted one to one time that fosters a felt sense of love and availability to their emotional needs as well as their physical needs.

Exercise Outside exercise and fresh air are a significant component to healthy sleep.  At least 1 hour a day is the recommendation.  Don’t do this too close to sleep time though as in advance of sleep your need to help relax your child’s body, not stimulate it.

Diet As with all lifestyles, diet plays a large role. Your child will need sleep well if hungry and requires three structured meals, 2-3 healthy snacks and to be adequately hydrated throughout the day. Avoid high sugar and processed food. Encourage dinner in the evening- consider protein and carbohydrate type meals that potentially have a slow energy release and are sustainable until morning. Allow 2 hours between eating and sleep to let the digestive system relax. Avoid vitamin supplements in the evening time-give early in the day if applicable.  Consider foods that promote sleep such as the banana, wholemeal and warm milk.

Sleep Learning With the above measures established, a sleep learning process like my staged based, stay and support method, may need to be implemented. If your child requires your presence, then working on phasing the parent out of the room gradually as the nights goes by may be necessary- children who experience their sleep with a parent present are 50% more likely to wake overnight than a child who can achieve sleep themselves.  You can begin by sitting beside the bed rather than lying in the bed and then follow the stages to sleep in my book The Baby Sleep Solution, this covers to age 6.

Help your child learn a new way of going to sleep both at bedtime and when they awaken overnight. Expect a level of frustration as new practices are established- support your child as they process the changes. If your issues involve bed sharing overnight, then after explaining that you are making changes, you need to help them learn to stay asleep in their bed overnight-this is the tough part, as you yourself will be tired. 

It can take many, many nights for this to improve with your supporting your child beside the bed, rather than in their bed or yours, but this activity may prove, well worth the effort if you have decided that you no longer want this to continue and that learning to sleep without interruptions throughout the night is what is best for your family.