University of Kent

Sleep problems are extremely common in young children.

Settling problems

Settling problems are difficulties in getting the child to bed and settled to sleep. They occur in about 20% of 1-2 year olds, 16% of 3 year olds, and about 12% of 8 year olds. Some children will not go to bed and settle to sleep alone. Instead they engage in bedtime battles, sometimes falling asleep downstairs or going to bed at the same time as their parents. Some children will only go to sleep if their parent lies down with them or rocks or cuddles them to sleep. Others keep coming downstairs or insist on a prolonged bedtime ritual.

Waking problems

Waking problems are when sleep is disturbed after the child has gone to bed and fallen asleep. These problems occur in about 20% of 2 year olds and 14% of 3 year olds, and are still found in 5% of 8 year olds. Some children wake up frequently in the night and disturb their parents by crying or calling for attention. Some wake only once or twice but cannot be resettled easily. Some children (about 10% of 1-2 year olds, 6% of 3 year olds, and 5% of 8 year olds) keep coming into their parents' bedroom and creeping into bed.

Disturbances of the sleep-wake cycle

In addition to settling and waking problems, children sometimes show other symptoms of sleep disturbance that interfere with their ability to sleep at the right times. These include variable sleep-wake patterns, feeling tired unusually early but waking early (before 5am), or not going to sleep until unusually late but staying in bed in the morning. These are disturbances of the sleep-wake cycle.

Other sleep problems

Children also sometimes suffer from strange episodes that happen in the night and disturb their sleep. These include strange movements during sleep - body rocking or headbanging, sleep talking, sleep walking, sleep terrors, and nightmares. Many of these problems are common in young children and disappear as the child gets older.

Children wake at other times when they are sick, teething, frightened, or in pain, but these are not true sleep problems. At these times children need comfort and they will soon settle back to sleeping soundly again.

Settling and waking problems can be caused by a variety of factors. The child may have incorrect sleep associations or night-time fears. He may be suffering from sleeplessness caused by stressful events. There may be a medical cause for his sleeplessness - a food allergy or an ear infection. However, if the sleep problem has become persistent, it may be due to a disturbance of sleep habits. Your child has got used to the cuddles and attention he was given when he was ill or upset and wants them to continue.

Here are some early warning signs to help you to recognise the presence of sleep problems.

In your child:

• Refusal to go to bed, bedtime battles, or taking a long time to settle to sleep more than 2-3 times a week.
• Refusal to go to sleep unless you lie down with him more than 2-3 times a week.
• Coming downstairs repeatedly or crying or calling out for you more than 2-3 times a week.
• Progressively later bedtimes.
• Waking at night and calling out for you more than 2-3 times a week.
• Coming into your bedroom or insisting on sharing your bed on a regular basis.
• Early waking (before 5am) more than 2-3 times a week.

In yourself:

• When you find yourself giving in for the sake of peace and quiet more than just occasionally.
• When the thought of putting your child to bed makes you feel apprehensive.
• When you start having frequent negative feelings towards your child at night-time.
• When you start to feel tired all the time.
• When you first find yourself shouting too loudly at your child at bedtime or during the night.

If you are experiencing several of these things in your family and feel you may be losing control of the situation, your child's behaviour, and your own emotions, then your child probably has a sleep problem.

Sleep problems cause great stress in the family. Parents of children who do not sleep well soon feel frustrated, anxious, and angry. After a few weeks with poor sleep your tiredness and fatigue will affect your daytime behaviour and you will be increasingly tense and edgy with your family. You may find it difficult to pay attention to what you are doing, particularly if it is repetitive, and your reaction time will be slowed down. If your child has a persistent problem you will start to feel tired all the time, irritable, tense, and sometimes tearful. You might start to have microsleeps - little lapses of attention when your brain goes to sleep for 5-10 seconds and then wakes up again. Sleep deprivation produces all kinds of symptoms of stress. The most common are worry, tiredness, backache, and being easily upset. Some parents get worried that they will punish their child too harshly because they have become so on edge. When a child sleeps badly it is easy for tired parents to get cross with each other, each blaming the other for the child's problem, until their marriage starts to suffer. Parents of a child with sleep problems have little time for themselves or each other. If the child stays awake late into the evening or wakes during the night, many of the relaxing activities that the parents enjoy together are made impossible.

Following treatment for sleep problems, a number of other improvements occur. We have shown in our research that when the child's sleep problems are resolved mothers are less stressed and show increased satisfaction with their marriages, report less irritability, and smack their children less frequently. They feel more positive, more confident, more in control, and more relaxed. The children too are happier, more affectionate, and more able to manage on their own. They have fewer temper tantrums and better concentration, and are easier to handle. For school aged children sleep problems may interfere with many aspects of their life. Children who are tired during the day may have difficulty concentrating in school and may have behavioural problems in the classroom. At home they may be difficult to manage, throw temper tantrums, or quarrel with brothers and sisters. Children with physical impairments, learning disabilities, or chronic illness already have enough to cope with without the addition of unnecessary sleep problems.

The good news is that sleep problems are usually very easy to solve using a set of simple step by step programmes. Research has shown that most problems can be solved within a few weeks.

You may have to teach your new conditions to associate with falling asleep, or you may have to set new rules for bedtime behaviour and encourage your child's cooperation by using incentives. You may have to teach your child to anticipate bedtime by starting a routine, or use controlled crying techniques.

You can find these programmes in Solving Children's Sleep Problems: A Step by Step Guide for Parents by Lyn Quine. Professor Quine is a health psychologist and Emeritus Professor at the University of Kent. She has spent many years researching children's sleep problems and developing successful treatments for common problems.

"Parents can feel confident that the step-by-step programmes described here are soundly based in scientific study and yet they can easily be used at home by any parent."
Colin Espie, Professor of Psychological Medicine, Gartnavel Royal Hospital, University of Glasgow

"A comprehensive and practical guide which enables parents to understand their child's sleep pattern and to solve most common childhood sleep problems by choosing from a range of clearly explained and easy to follow techniques."
Professor Gregory Stores, Park Hospital for Children, University of Oxford

Solving Children's Sleep Problems is priced £12.99 and is published by Beckett Karlson Ltd Westminster House Ermine Business Park Huntingdon Cambridgeshire PE18 6XY Tel: +44 (0)1733 244007 Fax: +44 (0)1733 243322