No. 34; Updated March 2023
Sleep is very important for mental, physical and overall health. According to the American Academy of Sleep Medicine, the amount of sleep needed varies by age:
- Infants up to 12 months: 12 to 16 hours of sleep
- Children 1 to 2 years: 11 to 14 hours of sleep
- Children 3 to 5 years: 10 to 13 hours of sleep
- Children 6 to 12 years: 9 to 12 hours of sleep
- Teenagers 13 to 18 years: 8 to 10 hours of sleep
Many children have sleep problems. Examples include:
- Problems falling asleep or staying asleep
- Feeling sleepy during the day (daytime fatigue)
- Having nightmares or night terrors
- Teeth grinding and clenching
- Snoring and mouth breathing
- Sleepwalking or talking during sleep
- Moving around too much during sleep
- Sleeping during the day and staying awake at night (sleep-wake reversal)
Many childhood sleep problems are related to poor sleep habits or anxiety about going to bed and falling asleep. Regular bedtime and sleep routines for children can be helpful. Bedtime routines, such as reading stories and teeth-brushing, help children understand it is time for bed.
Nightmares are fairly common during childhood. Children may remember nightmares, and this may lead to fears and worries about bedtime. For some children, nightmares are frequent and interfere with restful sleep. Ways to help a younger child with nightmares can include helping the child know before bed the dreams are not real, using “dream catchers”, or even writing up the story of the nightmare and ripping up the paper. These are ways to give the child some sense of control over the nightmares. Some children have sleep terrors which are different from nightmares. Children with sleep terrors will scream uncontrollably and appear to be awake but are confused and cannot respond. Sleep terrors can also be scary for parents and caregivers to see. The child usually has no memory of the sleep terror in the morning. Sleep terrors begin between the ages of 4 and 12 years. Like sleep terrors (night terrors), sleepwalking and sleep talking are part of a rare group of sleep disorders, called "parasomnias.” Children who sleepwalk may seem awake as they move around but they are actually asleep and in danger of hurting themselves. Sleepwalking usually begins between the ages of 6 and 12 years. Both sleep terrors and sleepwalking run in families and affect boys more often than girls. Sometimes a sleep specialist can help with sleep terrors, sleepwalking and talking during sleep.
Sleep problems for teens can be different than for younger children. Sleep-wake reversal, meaning someone is awake in the night and asleep during daytime hours, is common in teens and can cause problems with daily life. Sleep-wake disorders are due to the circadian rhythm (internal biological clock) that controls sleep being mismatched with the sleep-wake schedule needed for school and other activities. Many travelers have experienced this as “jet lag” with the circadian rhythm signaling sleep for the previous time zone.
Sleep problems during teenage years could also be from problems such as mood disorders, post-traumatic stress disorder (PTSD), substance use, attention-deficit/hyperactivity disorder (ADHD), and anxiety.
Behavioral changes can help improve your teen’s ability to fall asleep and wake up at appropriate times. Here are some recommendations to support a restful sleep plan:
- Have planned bedtime and wake up times. For weekends, sleep and wake schedule should be within 1 to 2 hours of weekday schedule.
- Build a simple and relaxing bedtime routine.
- Try not to exercise within 3 to 4 hours of bedtime. Exercise earlier in the day can help with sleep.
- No caffeinated/’energy” drinks within 6 hours of bedtime. Nicotine, alcohol and drugs can affect sleep as well and should be avoided.
- All use of electronics (computer, tablet, smartphone, etc.) should be stopped within 1 hour of bedtime. Screens can affect the brain’s natural signal to fall asleep.
- The bed should only be used for sleep. Using computers, tablets, smart phones, and watching TV in bed can tell the brain that the bed is not for sleep. This includes not eating or doing homework in bed.
- Keeping electronics out of the bedroom at bedtime is preferred.
- Keep the bedroom quiet, comfortably cool, and dark at night.
- If your child is unable to fall asleep within 15 to 20 minutes of going to bed, they can try getting out of bed and doing a quiet and relaxing activity. They should not return to bed until they are sleepy.
- If your child returns to bed and is still unable to fall asleep, try doing a quiet and relaxing activity again.
- No matter how many hours your child slept, have your child wake up at a regular time each day.
- Try not to take naps during the day even if tired.
Fortunately, as children age, they usually get over common sleep problems and the more serious sleep disorders (parasomnias). However, some sleep problems require a comprehensive medical evaluation. Examples include:
- Loud snoring and mouth breathing can be from a condition called obstructive sleep apnea. Your child will need to be checked for enlarged tonsils and/or adenoids.
- Restless legs, which can be happen during sleep, can be from low blood iron levels
- Daytime sleepiness despite getting enough hours of sleep can be from a condition called narcolepsy
- When your child has medical or psychiatric disorders that are significantly impacting their sleep.
For a comprehensive review and assessment of sleep problems and available treatments, please refer to the AACAP Sleep Disorders: Parents’ Medication Guide
Parents with ongoing concerns about their child’s sleep should contact their pediatrician, a sleep specialist, or a trained child mental health professional for a comprehensive evaluation.