A Parent’s Guide to Children’s Sleep

Children’s Sleep Cycles and How They Differ From Adults’

The sleep cycle is the natural progression through the different stages of sleep, consisting of non-REM and REM sleep.

The typical full adult sleep cycle lasts approximately 90 minutes, compared to around 50 minutes in very young children, increasing to about 60 minutes at age three, and reaching the adult duration by about five years of age.

The N-REM 3 sleep stage is also known as slow-wave or deep sleep. This is the phase that is important for rejuvenation, growth, and development.

Young children experience longer periods of deep sleep during their sleep cycle than adults. The amount of slow-wave sleep begins to decline in early adulthood, and elderly adults experience fewer and shorter periods of this type of sleep.

Rapid eye movement (REM) sleep is particularly important for babies. It plays a part in brain development and consolidation of experiences into memory and learning. Newborns and infants will spend approximately twice as long in REM sleep than adults.

During REM sleep, the body’s voluntary muscles are paralyzed; this is thought to be a protective measure to prevent us from “acting out” our dreams.

This function is not fully developed in newborns and means infants can be susceptible to dramatic jerking and twitching during sleep, to the extent it can cause them to wake.

The brain function that paralyzes the muscles during REM sleep does not develop enough to be effective until the second six months of life.

How Much Sleep Do Children Need?

The sleep needs of children change as they grow older. According to the American Academy of Family Physicians, the following are the normal sleep parameters (including napping) in children:

Age Range	Total Sleep Time	Naps
Newborn (0-2 months)	16-18 hours	Average of 3.5 naps per day at one-month-old
Infants (2-12 months)	12-16 hours	Average of two naps per day at 12 months old
Toddlers (1-3 years)	10-16 hours	Average one nap per day at 18 months old
Preschoolers (3-5 years)	11-15 hours	50% of 3-year-olds do not nap
School-age, pre-teen, early teens (5-14 years)	9-13 hours	After age five, most children do not need naps
Teenagers (14-18 years)	7-10 hours	Naps at this age could suggest a sleep disorder or general lack of sleep

The sleep of newborns is sporadic — they go through a cycle of eating and sleeping day and night.

Undisturbed sleep does not begin to consolidate into longer periods until 3-4 months of age, as the circadian rhythm develops and is entrained.

The need for daytime naps diminishes as children age and usually are not needed by age five, and will typically have stopped completely by age six or seven.

By this age, sleep should mirror that of adults — one period of undisturbed sleep at nighttime.

Tips For Establishing Healthy Sleep Habits In Children

Bedtime can be an arduous chore for some parents, often involving bargaining, tantrums, and the child employing just about any means possible to avoid going to bed.

Healthy sleep habits can be established with the help of a nightly routine that signals sleep time is approaching and prepares the child for it in a way that will get them to go to bed willingly without any conflict.

1. Wind Down and Relax

The evening period leading up to the child’s bedtime should be used as a “slow down” period where stimulation is reduced, relaxation is promoted, and the stage begins to be set for sleep.

2. Develop a Routine

It is essential to develop a nightly routine, one that is realistic; is easy to set, and easy to stick to. Discipline in sticking to a routine or schedule is important both for the child to get adequate sleep and for your sanity to remain intact!

The routine you establish is up to you, but for example’s sake, it may look something like this:

• Bathtime
• Brush teeth
• Pajamas on
• The child picks a storybook
• Storytime
• Tuck the child in and say goodnight
• Sleep

Your routine does not have to be complicated; it just needs to signal to the child sleep time is approaching, promote relaxation (a warm bath is particularly useful for this), and reduce stimulation. And most important of all, it must be regular and consistent.

3. Retain Control

Feel free to be flexible with the routine if required, but it is vital that you, as the parent, retain control — allow choices, but impose limits.

For example, allow them to choose which teddys or stuffed animals they sleep with, but limit the number; allow them to select the storybook, but limit the number of stories — and strictly stick to it.

4. Create a Sleep-friendly Bedroom Environment

Ensure your child’s bedroom is conducive to sleep. This means there should not be a lot of mess and clutter around — toys and things that may distract and entice your child out of bed. Part of the pre-bed routine could even be packing away toys and tidying the bedroom clutter.

Ensure the room is dark and does not contain any switched-on technology that may emit light, especially screens and other blue light emitters, which are very disruptive to sleep.

5. 5 More Tips to Get Your Child Prepared For Sleep

1. Keep them active and expending energy during the day.
2. Limit screen time before bed. Ideally, there should be no screen time an hour before bed, or 30 minutes at a minimum, according to the American Academy of Sleep Medicine guidelines. Screen-based devices should be kept out of the bedroom.
3. Keep the bed for sleeping only. There should be a strong association between the bed and sleep; using the bed for other activities may diminish this association.
4. Give a warning that bedtime is approaching. Coupled with a nightly bedtime routine, this can prevent objections and tantrums if the child is not prepared, for example, if they’re in the middle of an activity and do not wish to stop. Giving a warning signals it’s time to wind up whatever it is they’re doing and be ready for the nightly routine.
5. Teach your child the importance of sleep. This can be done in a way they can easily relate to, for example, through children’s books that deal with sleep.

Naps

Naps can be a contentious issue for parents — sure, they can give you some daytime relief from a cranky or boisterous child, but there can be a negative trade-off if it results in less nighttime sleep.

While napping is an inevitable area that parents need to navigate, it will pay to remember that children’s napping preferences are highly individual. As a parent, you need to be attentive to your child’s needs and offer flexibility around nap times.

Research from the Queensland University of Technology may be of comfort to those parents who may be concerned their child is not getting the benefits that are traditionally believed to be derived from daytime napping.

Leader of the QUT study, Karen Thorpe, says that in the childcare sector, where daytime naps are encouraged, and time is typically set aside during the day for “nap time,” it is generally acknowledged that napping promotes growth.

However, the QUT study found evidence of the benefit of good-quality nighttime sleep for children but little evidence of benefits from daytime naps. In fact, it found a correlation between napping and poor nighttime sleep in children aged three and over.

The data shows that beyond the age of two years old, taking naps during the day increases the time it takes for children to get to sleep.

While this is hardly a world-shattering revelation as generations of parents know that daytime naps can mean delayed sleep at night, the real surprise to come out of the study is the conclusion that naps may not be as necessary for your child’s development as generally believed.

One of the joint authors of the study, Dr. Sally Straton, says, “There is a lot of variation in how much daytime sleep an individual child will need, and it is important that parents and childcare staff work together to support children’s sleep during this time.”

The main takeaway for parents is that while naps are inevitable, the emphasis should be put on your child getting high-quality nighttime sleep, as this is where the most benefits in terms of growth and development will be derived.

Children’s Sleep Disorders

According to American Family Physician, up to 50% of children will experience some form of sleep problems.

Not only can these sleep disorders or parasomnias be distressing for both children and parents, but they can also result in behavioral problems, learning difficulties, diminished academic performance, daytime sleepiness, or irritability.

The following are some of the more common sleep disorders experienced by children:

1. Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is characterized by periods of disrupted breathing while sleeping due to airway obstruction.

Obesity, excess soft tissue in the upper airway, and a narrowed upper airway are common causes of OSA. Still, in children, obstruction is primarily caused by enlarged tonsils and adenoids, and will usually begin between the ages of two and eight.

Aside from snoring and apneas, other OSA symptoms in children include sleeping in unusual positions, excessive nighttime sweating, bedwetting, morning headaches, and daytime sleepiness.

In the case of enlarged tonsils or adenoids, the most effective treatment for OSA is an adenotonsillectomy or removal of both the tonsils and adenoids. It is a low-risk and highly effective procedure.

According to the American Academy of Family Physicians, incidences of obesity-related OSA in children are on the increase.

In these cases, the most effective form of treatment, unsurprisingly, is weight loss. The use of a “continuous positive airway pressure” (CPAP) device may be required until symptoms subside or cease.

2. Sleepwalking

Occurring in about 17% of children, sleepwalking, or somnambulism is characterized by (obviously) getting out of bed and walking around or performing everyday activities usually done during waking hours while asleep.

What should be of concern to parents is sometimes the activities sleepwalking children engage in can be unusual or dangerous while the child is consciously unaware of what they are doing. The child will have little to no memory of the incident once awake.

Often, sleepwalking children can be hard to wake, and once they are, they can often be confused and agitated. Children who sleepwalk will often suffer from confusional arousals and sleep terrors as well.

Sleepwalking is more common in males and typically peaks between the ages of eight and 12.

3. Confusional Arousals

Affecting roughly the same percentage of children as sleepwalking, though evenly distributed among males and females, confusional arousals are characterized by the sufferer appearing to wake from sleep but is in a confused, disoriented, and/or distressed state.

Parents will often be able to converse with children in this state; though they may be slow to respond, and speech may be slurred, the child may appear confused and even engage in inappropriate behavior.

Like with sleepwalking, the child will often have little to no memory of any arousal.

4. Night Terrors

Night, or sleep, terrors are characterized by symptoms similar to a panic attack while sleeping. Incidences can be distressing for both parents and children, and onset typically occurs during early childhood, affecting up to 6.5% of children.

During night terrors, children may appear to be in intense fear. They may cry out or scream, appear extremely agitated, and even get out of bed, where, like with sleepwalking, they are at risk of engaging in potentially dangerous activities.

Elevated heart rate and respiration are common during episodes, along with sweating and even violently kicking or thrashing about.

Children in the middle of a night terror episode may be difficult to wake and maybe highly agitated, confused, and unable to recognize familiar people like parents upon waking.

5. Nightmares

This is one parasomnia we’re all familiar with and have most likely experienced at some stage in our life. Nightmares are highly unpleasant dreams that can trigger a physical response similar to night terrors; increased heart rate, respiration, and sweating.

Unlike night terrors or confusional arousals, nightmares are often clearly remembered. This can be a problem in children as it can cause a fear of sleeping and reluctance to go to bed, which can prove to be a problematic issue in itself.

Nightmares can also be a sign of an underlying mood disorder or post-traumatic stress disorder.

6. Behavioral Insomnia of Childhood

Affecting between 10-30% of children, behavioral insomnia of childhood is characterized by a learned inability to fall asleep and/or stay asleep at night. It is divided into two types of insomnia — sleep onset association and limit-setting.

With sleep onset association insomnia, a child will be unable or unwilling to go to sleep unless certain conditions are met, or activities are undertaken, such as being comforted or rocked to sleep by a parent.

Limit-setting insomnia results from insufficient limits being set by parents, especially when coddling or indulging kids who can’t or will not sleep, such as when parents allow them into their bed when they refuse to sleep on their own.

These types of behavioral insomnias can be avoided by parents instilling healthy sleep habits in their children and setting limits, boundaries, and schedules.

7. Restless Leg Syndrome

Restless legs syndrome is a condition; characterized by the onset in the evening of an urge to move the legs due to odd, uncomfortable, and unpleasant sensations, including tingling, creeping, crawling, and aching. Symptoms worsen with rest, while relief comes from movement.

Adverse effects on sleep due to this disorder include bedtime resistance and insomnia and can result in overall drops in mood, behavior, and attention.

While restless leg syndrome is thought to be prevalent in only about 2% of children, it is more commonly found in children diagnosed with ADHD.

Treatments for restless leg syndrome include iron replacement (iron deficiency is believed to be one cause) and avoiding factors likely to exacerbate it, including too much or too little physical activity, caffeine, nicotine, antihistamines, and antidepressants.

8. Delayed Sleep Phase Disorder

Delayed sleep phase disorder is characterized by a child’s sleep-wake times being delayed two hours or more beyond conventional or socially-acceptable time.

Sufferers go to sleep and wake up later due to the circadian rhythm being out of sync with external stimuli, caused by a shift in the body’s internal clock.

This is a disorder that is most common in adolescents, affecting between 7-16%. This can be a particular problem in regards to schooling, due to late bedtimes, sleeping in, or difficulty waking up and being late for school.

Treatment of this disorder focuses on realigning the circadian rhythm with the desired sleep-wake times.

Developing good sleep hygiene and habits and maintaining a consistent sleep schedule are commonly involved in treatment. Light therapy is also an effective treatment for shifting the circadian rhythm and melatonin supplementation.

Where To Go For Help and Advice

Sleep disorders can be distressing for both children and parents. As a parent, the main thing to remember is that these disorders are common in children and can be managed or treated effectively once diagnosed.

It is important to know that your child may not need any kind of “treatment” or medical intervention at all — things like establishing a regular bedtime routine and reducing stress can help, and most children simply grow out of them by adolescence.

However, if your child’s sleep problems are causing you real worry, then a pediatric sleep specialist may be needed.

A specialist will help to reassure you as a parent and educate you on how to manage incidents and keep your child safe, and may ask you to keep a sleep log and record sleep, arousal, and behaviors/movements.

A physical and/or psychological exam may be required to identify and underlying causes or reasons for your child’s problems.

An in-clinic sleep study (polysomnography) may even be required, where your child’s brain waves and vital functions will be monitored using sensors and cameras.

The most important thing if you’re worried is getting a medical opinion — having a diagnosis can be reassuring. Once known, an appropriate treatment plan or course of action to remedy the sleep problem can be undertaken.

Signs of Sleep Deprivation In Children

If your child or teenager is not getting enough sleep, there will be tell-tale signs that you, as a parent, should be watching out for. If you notice any of the following symptoms, it may be a signal that your child’s sleep routine needs to be looked at and some adjustments made.

There are definite negative consequences that can arise from sleep deprivation over time, including:

• Problems with general behavior, attention, and learning
• Decreased physical and athletic performance
• A drop in academic performance
• An increased risk of developing conditions like hypertension, obesity, depression, and diabetes
• Increase in risky behavior and the likelihood of accidents and injuries

These are the signs that can indicate sleep deprivation in children of different ages:

Toddlers:

• They stay groggy or fall back asleep after being woken up
• Persistently wanting to rest or nap during the day
• Not as talkative as usual
• Hyperactivity or fidgeting
• Excessive clinginess or neediness
• Not wanting to share or take turns
• Generally being cranky, whiny, and fussy
• Difficulty or unwillingness to transition from two naps per day to one
• Falling asleep during short car trips

School-age:

• Inability to wake themselves up in the morning or need to be repeatedly woken
• Falling asleep during short car rides or at inappropriate times
• Regular naps or increased need for them
• Daytime drowsiness
• Decreased motivation, interest, attention, and alertness
• Decreased academic performance or struggles with school and learning
• Difficulty falling asleep at night
• Hyperactivity

Pre-teen/Teen:

• Difficulty waking, getting up, and getting to school on time
• Diminished academic performance
• Difficulties concentrating
• Lack of motivation
• Irritability and aggressive outbursts
• Hyperactivity
• Sleeping during the day, or “catching up” on sleep for long periods on weekends.
• Seeming confused, “spaced-out,” or not behaving like their usual self
• Excess caffeine consumption.

Choosing the Right Bed for Your Child

Ensuring the right bed for your child can make all the difference to their quality of sleep, and especially in the case of babies, to your peace of mind that they are safe and not at-risk.

We’ll now take a look at the appropriate bed size for each age group and some critical considerations to take into account when choosing a new bed for your child.

1. Babies — Crib Mattress

When it comes to your baby’s crib, safety is the most important word.

Crib mattresses are the smallest standard-sized mattress, measuring 27.5 inches wide by 52 inches long (70cm x 132cm), and are designed exclusively for babies sleeping in an enclosed crib.

Crib mattresses are firmer than a standard adult’s mattress as a firmer bed provides both support for rapidly growing bones as well as safety — soft mattresses can be a suffocation risk for babies.

While crib mattresses are designed to fit in a standard crib, it is vitally important to note that there should be no more than a 1.5-inch (4cm) gap between the side or end of the crib when the mattress is pushed all the way into a corner. If the gap is larger than this, the fit is incorrect and potentially unsafe — large gaps are also a suffocation hazard.

2. Toddlers — Toddler Mattress

For children not quite ready to graduate from the crib directly to a larger bed, toddler mattresses act as a good intermediary.

Measuring 27.5 inches wide by 52 inches long (70cm x 132cm), they are the same size as a standard crib mattress but are generally softer. There is not the same suffocation risk, so comfort is a consideration over practicality.

A toddler bed generally will not be enclosed like a crib, though they may have side rails. When a child graduates from the crib to a toddler bed’ pillows, sheets, and comforters can all begin to be used.

3. Preschoolers — Junior Mattress

While the Junior is a standard-sized mattress, it is not generally a popular size, as beds for young children are usually only needed for a short time.

A child could quickly graduate from a crib or toddler mattress to a larger size such as a Twin, but the Junior acts as an intermediary for kids who have outgrown a crib or toddler bed but do not yet need all the room of an adult-sized bed.

Junior mattresses measure 27.5 inches wide by 63 inches long. (70 x 160cm), the same width as crib and toddler mattresses, but are longer to accommodate growing children.

4. School-Age and Up — Twin/Twin XL

While a twin mattress is probably the bare minimum size a fully-grown adult would consider, school-age children and teenagers should be fine sleeping on a Twin or Twin XL mattress, which should serve them well throughout their teenage years.

A standard twin mattress measures 38.5 inches wide by 74.5 inches long. (98 x 189cm), while the Twin XL is longer, measuring 38.5 inches wide by 79.5 inches long (98 x 202cm), and a better option if you have exceptionally tall or rapidly growing teens.

Bed Size Considerations

If you have larger teens or just like to spoil your kids, you may want to go with a Double/Full or Queen size bed, but remember to take space into account — children’s bedrooms are generally smaller, so are a better fit for a smaller bed.

As a general rule, a comfortable clearance around the sides and end of a bed is 30 inches minimum — preferably 36 inches.

The shape of the room, the layout of other furniture, the location of doors, windows, and electrical outlets will all dictate to an extent the bed’s location and size.

The future growth of your child needs to be taken into account as well. Children outgrow clothes, car seats, prams, and strollers quickly — and beds are just another expense caused by this growth.

So if cost is an issue, think ahead — a bed that is bigger than your child needs right now may be a tight squeeze in a couple of years.

Read our handy mattress size guide for everything you need to know about choosing the right size mattress for your child.

Summary

One of the best investments you as a parent can make in both your child’s health and development, and your own sanity, is establishing a healthy sleep routine and habits in your children.

While it’s an inevitability that your own sleep suffers as a parent, it is vitally important to ensure your children get enough high-quality nighttime sleep to aid their growth and development.

While the relationship between children and sleep can be fraught with issues, investing the time and effort into establishing healthy sleep routines and seeking solutions for any sleep disorders or problems will pay dividends in the form of a child that is healthy, happy, well-behaved, and able to perform well in all areas; from school to sport to home life.