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Sleep disturbance in a child
Last reviewed: 05.07.2025
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Sleep behavior is socially determined, and problems can be defined as deviations from generally accepted habits or norms. In a society where it is common for children to sleep separately from their parents in the same home, sleep problems are among the most common problems that parents and children face. A child usually gets used to a day-night sleep pattern between 4 and 6 months.
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Causes of sleep disturbance in a child
Sleep disturbances in children after this age take many forms, including difficulty falling asleep at night, frequent night awakenings, atypical daytime sleepiness, and dependence on feeding or being held to fall asleep. These problems are related to parental expectations, the child's temperament and biological rhythms, and the child-parent interaction. Innate biological patterns play a determining role in children in the first year of life, while emotional factors and established habits come to the fore in older children. In addition to the above, sleep disturbances become common at 9 months and again around 18 months, when separation anxiety and stranger anxiety, the child's increasing ability to move independently and control his or her environment, a long afternoon nap, and stimulating play before bedtime are noted.
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Who to contact?
What to do if a child has a sleep disorder?
Anamnesis
The history focuses on gathering information about the child's sleep environment, consistency of bedtime, bedtime rituals, and parental expectations. A detailed description of the child's daily routine may be helpful. The history should be reviewed for stressors in the child's life, such as difficulties at school, exposure to traumatic television, or drinking caffeine or other beverages. A history of inconsistent bedtime, a noisy, disorganized sleeping environment, or frequent attempts by the child to manipulate parents through sleep behavior may indicate a need for lifestyle intervention. Marked parental nervousness may indicate tensions within the family or persistent, complex problems with the parents.
A sleep diary completed over several nights may help identify a sleep disorder in a child (e.g., sleep walking, night terrors). In older children and adolescents, careful questioning about school, friends, worries, depressive symptoms, and mood often reveals the cause of the sleep disorder.
Examination, laboratory and instrumental examination
Examination, laboratory and instrumental examination, as a rule, provide little useful information.
Treatment of sleep disorders in children
The role of the physician in treating sleep disorders is to provide explanations and recommendations to parents, who should modify the child's daily routine so that the child has an acceptable sleep-wake pattern. Approaches vary depending on age and circumstances. Infants in the first year of life can be soothed by changing swaddling clothes, providing background noise, and rocking in arms or in a crib. However, constantly rocking a child does not give the child the opportunity to learn how to fall asleep independently, which is an important developmental milestone. Alternatively, parents can sit quietly by the crib until the child falls asleep, which will help the child learn to calm down and fall asleep without being held. All children wake at night, but children who have learned to fall asleep independently will be able to fall asleep on their own. If the child cannot fall asleep again, parents should make sure that there are no objective reasons for the sleep disturbance and soothe the child, but then allow the child to fall asleep on his own.
For older children, introducing a "slow-down" period of quiet activities such as reading before bedtime improves sleep. A consistent bedtime is important, and a fixed ritual works well for young children. Asking a child with developed language to list the events of the day often results in the elimination of nightmares and sleepwalking. Encouraging physical activity during the day, avoiding traumatic television and movies, and refusing to allow bedtime to become a manipulation also helps prevent sleep disturbances in the child. Stressful events (e.g., moving, illness) can cause acute sleep problems in older children; support and reassurance are always helpful. Continuing to allow the child to sleep in the same bed with the parents in such a situation almost always does not solve the problem, but only prolongs it.