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Managing Children's Insomnia

Angela Oswalt Morelli , MSW, edited by Mark Dombeck, Ph.D.

Consistent night-time routines that encourage the transition from activity to restfulness go a long way towards helping children get to sleep, but they are not panaceas for all sleep problems. Some children will still have problems falling asleep, or staying asleep throughout the night. They may wake up early, just because or due to their having bad dreams. Several different strategies can be used to address children's insomnia. The common link between these strategies is that they all involve examination and alteration of children's habits that might negatively affect sleep.

boy with insomniaChildren's eating and drinking habits can affect their sleep quality. Parents should continue to carefully supervise children's nighttime consumption of snacks and beverages. Typically, a child who is too hungry or too full at bedtime will have trouble sleeping. Furthermore, large amounts of liquid consumed just before bedtime can increase the chance of overnight accidents, even if most nights, this has ceased to be a problem. Nighttime bed-wetting accidents are unpleasant and may wake children from what otherwise would be restful sleep. More information about children's bed-wetting issues can be found in our article on Toilet Training.

Parents should examine what children are eating and drinking prior to bedtime with an eye for identifying and eliminating foods and beverages that contain caffeine, sugar and other stimulating substances. For instance, most sodas and teas (including iced teas) will contain generous amounts of caffeine. Hidden sources of caffeine and similar stimulants are also found in chocolate, sports drinks and various medications, both over the counter and prescription. Most medications prescribed for ADHD are stimulants, for example. Stimulating foods, beverages and medications affect the nervous system and may prevent children from being able to calm down enough to sleep. If possible, children should entirely avoid products containing stimulants . If this is not practical, at least their stimulant intake should be severely restricted in the late afternoon and evening.

It's a good idea for parents to look at the intensity of children's afternoon activities as well. Children may need a longer period of time to unwind before bed if they are involved in particularly stimulating sports activities after school that continue into the evening.

Parents should make sure that the larger home environment is conducive to children's sleep. Loud noises and activity in the rest of the house need to be kept at a minimum after children's bedtime has passed.

If children share a bedroom with other siblings, parents should look to see if siblings are doing anything that might distract from restful sleep, such as snoring, or using a computer or video game after bedtime.

Siblings that share a room may not have coordinated bedtimes. For instance, one child may be older than another. If this is the case, parents should look at the possibility that the process of getting the sibling with the later bedtime off to bed is somehow waking up the sibling with the earlier bedtime. Depending on family resources, this sort of problem might be addressed by shuffling sibling bedrooms so that children with the same bedtimes are together; by providing each child with a private bedroom; or by making a special effort to be quieter upon putting the sibling with the later bedtime to bed. It may be necessary to talk to siblings sharing a room about the importance of being sure to be quiet whenever other siblings are sleeping

Children who are having frequent nightmares may be consuming too much frightening media, in the form of scary television shows, movies, books or video games. Caregivers who suspect this may be the case can eliminate scary media from the household for a few weeks in order to determine whether this action helps improve children's sleep quality. Please refer to our article on media in which you will find a full section on parental rating systems and parental controls which can help parents accomplish this goal.

If Nothing Else Works, See a Pediatrician

If the above types of interventions do not solve a child's sleep difficulties, or if a child's sleep problems appear to be related to breathing difficulties (including snoring), or possibly to medical difficulties such as allergies or asthma it is important that parents arrange for their child to be examined by a pediatrician as soon as they can. Children may have undiagnosed medical conditions such as sleep apnea which are contributing to their insomnia. Alternatively, insomnia may be a side effect of medications they are taking for other diagnosed conditions, or due to an emotional response to stress or trauma which may have not yet been recognized or adequately addressed. In addition to conventional medical tests (such as blood work), the pediatrician may recommend that a sleep study be done, or that the child be seen by a mental health practitioner for assistance with anxiety related conditions.