Children’s & Teen Sleep Problems

Difficulty settling at bedtime and repeated night-time waking are the most common sleep problems in early childhood. They affect both how much a child sleeps and how good that sleep is. As children grow older, their sleep problems become more like those seen in adults — sometimes as part of insomnia, and sometimes alongside anxiety or low mood.

Why do children’s sleep problems persist?

Many sleep difficulties grow out of unhelpful patterns around settling and bedtime — inconsistent responses to a child’s reluctance to sleep, or unhelpful reactions to night-time waking. Over time these patterns can become entrenched and may need professional support to change. A particularly important factor is a child’s reliance on a parent to help them calm down. A child who is worried about the dark, or anxious about the day ahead, may need a parent present in order to relax and fall asleep. In the short term this helps. Over time, however, the dependency can deepen the worries, worsen the sleep difficulty and prevent the child from developing their own ability to cope.

The reassuring news is that consistent guidance, steady follow-through and a clear understanding of the principles of healthy sleep are the key to prevention, treatment and relief.

Why does it matter to treat children’s sleep problems?

Sleep is essential for healthy development in childhood. A large body of evidence links sleep problems in children and teenagers to a range of difficulties:

• Daytime functioning — disrupted sleep is consistently linked to behavioural difficulties, even in children with no psychiatric diagnosis.
• Emotional difficulties — short or broken sleep is associated with low mood, anxiety and problems regulating emotions. Long-term studies link childhood sleep problems with emotional difficulties later on.
• Sleepiness and attention — short sleep is linked to daytime sleepiness, hyperactivity and impulsivity, and there is a clear association between sleep difficulties and ADHD.
• Cognitive and academic development — childhood sleep problems are linked to lower neuropsychological functioning and poorer school attainment in adolescence.
• Other effects — including a higher risk of injuries, strain on family life (linked to maternal depression and relationship stress), and a recognised association with childhood obesity.

When sleep difficulties last for some time, cause significant distress, or affect the child or the family, it is well worth seeking professional guidance.

How are children’s sleep problems treated?

The main treatment is behavioural — a form of cognitive behavioural therapy for insomnia (CBT-I) adapted for children, working closely with parents. It is evidence-based, safe and drug-free, and is delivered online to families throughout the UK. Treatment focuses on changing the patterns that maintain the difficulty: building a child’s ability to self-soothe, establishing consistent routines, and adjusting parental responses that unintentionally keep the problem going. The NHS recommends behavioural approaches as the first step for most childhood sleep problems, with medication reserved for specific situations.

General principles for better sleep in children

• Keep bedtimes and waking times as regular as possible.
• Use a calm, enjoyable and consistent bedtime routine that includes quality time with a parent.
• Provide a comfortable sleep environment: a dark, quiet, pleasant room (a night light is fine; a television is not).
• Set clear, kind boundaries around bedtime and lights-out.
• Help your child fall asleep in their own bed.
• Encourage physical activity during the day, but avoid vigorous activity close to bedtime.
• Make sure your child gets daylight during the day.
• Avoid caffeine before bed (coffee, tea, chocolate, cola).
• For younger children, ensure enough daytime naps; for school-age children, avoid long daytime naps.
• A transitional object such as a soft toy or blanket can help (never forced).
• Settle your child when they are drowsy but still awake.
• If your child cries, check on them at regular intervals, keep the interaction brief and calming, and gradually lengthen the gaps. An alternative is to sit on a chair beside them and move further away each night until they settle independently.
• If your child snores, wakes frequently, sleeps with an open mouth, has fears or needs an adult to fall asleep, it is worth consulting a professional.

The key is to apply these principles consistently and over time.

This online clinic is led by Dr Jonathan Kushnir, a clinical psychologist (HCPC PYL042430) whose doctorate examined sleep disorders and night-time fears in children, and who has published more than 25 academic papers and 17 books in this field.