Baby & Toddler Sleep Problems

How does sleep develop in early childhood?

As babies and young children grow, their sleep patterns change a great deal. One of the most striking shifts happens during the first six months, when babies move from sleep spread across roughly five or six periods a day to more consolidated sleep — with longer stretches at night and a gradual fall in the number of daytime naps.

During this process, most babies learn to sleep at least five hours at a stretch with minimal waking. For some, though, difficulties appear — trouble settling and frequent night waking — and these are among the most common reasons families seek help with their baby’s or toddler’s sleep.

The structure of sleep changes too. Newborns spend around half of their sleep in dream (REM) sleep, about eight hours a day. Over the first two years this falls to roughly 20–25% and then stays relatively stable through later childhood. International studies show that children today sleep less than in the past, which raises the risk of sleep problems. Medical, physiological, environmental and emotional factors — such as reflux, cow’s-milk allergy, skin problems, teething, feverish illnesses or pain — can all disrupt sleep significantly.

What regulates sleep and waking?

Sleep is regulated by two main systems:

• Sleep pressure (the homeostatic, or “S”, process) — the longer a child has been awake, and the less they slept before, the stronger the drive to sleep.
• The body clock (the circadian, or “C”, process) — responsible for the roughly 24-hour biological rhythm.

Disruption to either or both of these systems can lead to sleep difficulties.

How common are sleep problems in babies and toddlers?

Trouble settling and night waking are very common in the early years. Around 20–30% of children from infancy to school age experience sleep problems, and among babies and toddlers over six months, roughly 25–50% continue to wake during the night. These difficulties can persist into the school years and affect attention and learning, emotional regulation and mood, and behaviour and quality of life. A child’s sleep also affects parents, and can contribute to emotional strain, maternal depression and relationship stress.

Biological, developmental, environmental and behavioural factors all contribute. Parents’ beliefs play a central role: unrealistic expectations or misreadings of a child’s sleep can lead to responses that unintentionally keep the difficulty going. Cultural context matters too — for example, sharing a room with siblings or living in cramped conditions.

How are sleep problems assessed?

Assessment includes a professional clinical evaluation, sometimes objective tools (a sleep study or actigraphy), and subjective tools (questionnaires and sleep diaries). More detailed investigation is needed when there are signs of disordered breathing during sleep, movement disorders, extreme tiredness or seizures — in which case it is best to start with your GP.

How is treatment delivered?

Treatment is based mainly on behavioural approaches and parent guidance. Many babies and toddlers learn to fall asleep under particular conditions — a parent’s presence, rocking, feeding or touch — and when they wake at night they struggle to settle again without those same conditions. Treatment focuses on:

• Gently changing the way a child falls asleep.
• Strengthening the child’s ability to self-soothe.
• Building consistent sleep routines.
• Adjusting parental responses that maintain the difficulty.

Research shows this approach improves not only sleep but also behaviour, reduces anxiety, improves family communication and supports parents’ wellbeing. The NHS recommends gentle behavioural methods as the first step for most baby and toddler sleep problems.

Parent guidance for better sleep

• Keep bedtimes and waking times regular.
• Use a consistent, calm and pleasant evening routine, including quality time with a parent.
• Provide a comfortable sleep environment: a dark, quiet, pleasant room.
• Set clear, gentle boundaries around sleep.
• Settle your child in their own bed when drowsy but still awake.
• Avoid frequent changes to where your child sleeps.
• Encourage physical activity during the day (not close to bedtime).
• Provide daylight in the morning and afternoon.
• Avoid caffeine, and limit daytime naps once a child is school age.
• Use a transitional object gently if it helps.
• If your child cries, offer brief, calming check-ins and gradually lengthen the gaps; move away from the room gradually once they settle independently.
• Seek professional advice if there is snoring, restless sleep, anxiety or reliance on a parent to fall asleep.

Consistency and steady follow-through are the key to success.

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, with more than 25 academic publications and 17 books.