Sleep in different age groups: Sleep requirements change with age and differ between children. An average newborn sleeps 16 – 18 hours per day with sleep-wake periods in 3 – 4-hour cycles throughout the day and night. Infants are physically able to sleep more than 6 hours without overnight feeding from 6 months of age. By 12 months of age, children commonly have two sleep periods per day including overnight sleep and daytime nap. By school age sleep is usually consolidated into one-night sleep of 11 – 12 hours. The duration of sleep then reduces to 10 hours in pre-pubertal children to 7 – 9 hours by 16 years of age.
Night wakings: Night wakings are common during childhood, are part of normal developmental patterns and are mostly transient, however problematic night wakings may persist for months or years and disrupt child and family functioning. Fortunately, most night wakings are amenable to simple measures. Night wakings come from dyssomnias (difficulty falling asleep or staying asleep) or parasomnias (incomplete arousal from sleep). Although sleep problems are more common in children with ADHD (attention deficit hyperactivity disorder) or Autism, the management approaches are broadly similar for all children.
Limit setting disorder: This is common in preschool or primary school age children. They come in and out of the room on multiple occasions before falling sleep. Common requests include “I want a drink, I need to go to the toilet, I’m scared, I want to talk to you…”. Limit the child to 1 – 2 requests at the start of the night. Use of “bedtime pass” method can help where the child gets one “pass” at the beginning of the night and thereafter needs to stay in their room until they have fallen asleep.
Sleep onset association disorder: Behaviours used to help children fall asleep at bedtime can become habits that children seek to re-create when they wake up at night. These include being rocked, cuddled, or soothed by a parent, watching TV, or having a sleep associated object. This is common in toddlers (1 – 3 years of age) through to school age where the child falls asleep if the person (mother or father) or the object is there but has difficulty falling asleep in the absence of the person or object. The child often wakes up 1 – 4 times per night seeking comfort.
It is important to recognise the sleep association and phase-out the association.
This can be done by promoting your child’s independence in falling asleep. Having regular predictable bedtime routine, quiet activities for 30 – 60 minutes prior to bedtime, and avoiding stimulating activities such as TV or screen time are key to a good sleep.
Behavioural strategies such as checking method and camping out method are simple measures that work in majority of children. In checking method, the parent settles the child, leaves the room for 1 – 2 minutes and promises to return after the set time. Parents then gradually increase the time spent outside the child’s room and eventually find the child asleep. In camping out method, parents gradually distance from the child’s bed or cot. The parents initially pat the child to sleep. After a few nights, once the child is falling asleep easily, the parent sits next to the bed / cot without touching the child. The parent then gradually moves away from the child over 7 – 10 days.
Other strategies, such as rewards, can be helpful in older children. It is important to remember that the rewards are simple and to be aware that the novelty wears off by two weeks so the desired behaviour should be established by then.
Children with problematic night waking that is unresponsive to simple measures may benefit from review with their family doctor, a referral to a psychologist, or a paediatric sleep physician as appropriate.
