Patient information from BMJ

Your child: getting to sleep and staying asleep

Last published:Feb 01, 2022

Many children have problems settling at bedtime or wake up often during the night. But there are some simple things you can do to help your child sleep better.

We've looked at the research about sleep problems to see what methods work. You can use our information to talk to your doctor and decide which methods are best for your child.

This information is for children over the age of 2 years.

This information covers common problems that children have falling asleep or staying asleep. It does not cover specific conditions such as obstructive sleep apnoea, parasomnias (these include things like sleepwalking, night terrors, and teeth grinding), and sleep problems in children with conditions such as autistic spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD).

How do I know if my child has a sleep problem?

All of this information is for children over the age of 2.

Not all children who occasionally wake at night or who make some fuss about going to bed need any special attention. But doctors say a child may have a sleep problem if they have one or more of the following symptoms:

• It takes your child a long time to fall asleep and you have to make special preparations to try to get him or her to sleep.

• Bedtimes are difficult and stressful for you and your child. Your child may have regular tantrums at bedtime.

• Your child doesn't have an illness or other condition that makes it hard for them to get to sleep or stay asleep, and is not on any medication that makes them less sleepy.

• Your child has a lot of trouble getting back to sleep if they wake up, and can't get back to sleep unless you help them.

What methods work?

Positive bedtime routine

You might like to try a positive bedtime routine. This can help your child settle more quickly and make them wake less during the night.

Some research has found that children have fewer tantrums and settle more quickly at bedtime within six weeks of starting a positive bedtime routine. Doctors sometimes call it 'good sleep hygiene.' A positive routine includes:

• having a short, regular, calming routine leading up to bed

• making your child's bedroom quiet, dark, comfortable, and not too hot or cold

• avoiding boisterous play before bedtime

• not giving your child caffeine, for example in cola drinks and chocolate.

Sleep training

Sleep training is another option. It may help your child settle at night, learn to settle themselves, and reduce waking during the night.

Sleep training involves gradually waiting before responding to your child. For example, you might wait two minutes before going to your child. The next time your child wakes up, you might wait four minutes.You might then extend the time gradually to a maximum of 20 minutes.

Or you can gradually increase the distance between yourself and your child when settling them for sleep. You might start off sitting next to your child's bed. Then on the next night you move 30 centimetres (one foot) away, and so on until you are outside the bedroom.

Remember, this information on sleep training is for children over the age of 2 years. Ignoring a crying baby or any child with a health problem is not recommended. And some experts think that sleep training might cause distress for the child, so it's always a good idea to discuss any plans for sleep training with your doctor.

Medicines

Medications are not generally used for most children who have trouble falling asleep or staying asleep. Behavioural methods, such as the ones described above, are used instead. In rare instances, for example in children with ADHD or autism, a medication called melatonin might be used. Antihistamines and sleeping pills should not be given to children for sleep problems.

Other things you can try

Doctors often advise some other things for children who have problems sleeping, although there hasn't been much research on these methods:

• Try not to let your child nap too late in the day or for too long.

• Making sure your child is fairly active during the day may mean that they sleep better at night.

• Daylight helps the body to make natural melatonin, which keeps our 'body clock' regular. So being outside for some time during the day might help.

What will happen?

If your child has problems staying asleep at night they may find it hard to concentrate during the day. This can make them moody and can lead to issues with behaviour. Bear in mind that most young children's sleep patterns improve with behavioural methods.

If you are having trouble coping, talk to your doctor. There may be local groups or services that can help. You may also be able to find an online support group.