Judith Palfrey: Children and Sleep Problems

Do children develop insomnia? If so, why? How is insomnia in children usually tackled?

Judith Palfrey: Sleep disturbances are common but transient in infants and children and usually can be handled by small adjustments in bedtime routines. Parents should rest assured that most infants and toddlers will get enough sleep, though some babies do develop patterns of waking that are problematic to their parents. Dr. Richard Ferber and his group at Children's Hospital in Boston have developed useful advice for the parents of young children to help establish good sleep routines. Their suggestions can be found in the book Solve Your Child's Sleep Problems.

Dr. Ron Becker of Children's Hospital's Center for Pediatric Sleep Disorders shared his thoughts with me about older children: 

As children enter school age, the competing demands of social activities at night and the need to wake for school can cause them to get insufficient sleep. Children at young school age can have what may be thought of as "pseudo-insomnia." A teacher or principal or parent will decide on an arbitrary "correct" bedtime that doesn't fit with their sleep need. For instance, bed at 7:30 p.m., child wakes at 7:30 a.m. Most 7- to 8-year-olds need only 10 to 11 hours of sleep, so they have one to two hours of difficulty falling asleep at night. This is fixed simply by adjusting the schedule.

Children at any age can have anxiety that affects their ability to settle into sleep. Treatment can focus on increasing their independence (if a mild case) to need for full treatment of anxiety if more severe.

As children approach middle school to high school age, they can develop a problematic sleep pattern called Delayed Sleep Phase. By waking late on weekends relative to weekdays, they shift their body clocks late and then have trouble with sleep onset on Sunday to Thursday nights. They may lie in bed and worry about their ability to fall asleep, which compounds the problem for them. This latter difficulty is often termed psychophysiologic insomnia and is a common cause of adulthood insomnia as well. 

Treatment means building good sleep hygiene: avoiding TV in bed, preparing for bed with a routine, avoiding going to bed until sleepy enough for sleep, and waking at the same time each morning—including weekends.

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