Emanuel Maidenberg Ph.D.

Belief and the Brain

Helping Your Child Sleep Tight

A lack of quality sleep impacts not only parents, but children as well.

Posted Apr 27, 2019

By Mina Yadegar

Parents know what it is like to be deprived of sleep. Not only does a lack of quality sleep impact you as a parent, it impacts children as well. Sleep deprivation is associated with a myriad of medical and pediatric psychiatric concerns, including mood, anxiety, attention, memory, emotion regulation, and behavioral issues (Paruthi et al., 2016). Similarly, parents of youth often observe that their child is more vulnerable to these emotional concerns when they did not get a good night's sleep.

Due to the busyness of our schedules, sleep is often sacrificed. In fact, on average, youth get less sleep than recommended (Galland et al., 2018). The American Academy of Sleep Medicine (Paruthi et al., 2016) recommends the following number of hours of sleep for children and adolescents:

Age Range                Recommended Sleep Hours Per 24-Hour Period

4-12 months              12-16 hours (including naps)

1-2 years                    11-14 hours (including naps)

3-5 years                   10-13 hours (including naps)

6-12 years                 9-12 hours

13-18 years                8-10 hours

Consistency is key

Children thrive on structure, including consistent bedtimes and bedtime routines. Bedtimes should allow for children to receive the above recommended sleep hours, including on weekends. Youth often stay up later and sleep in on weekends to try to “catch up” on sleep. While this may seem to make sense, it then becomes difficult to return to a regular bedtime when the school week starts. It is also best for bedtime routines to be consistent, as predictability allows children to know what the expectations are and helps decrease bedtime challenges. 

Depending on age, a bedtime routine may consistent of packing a school backpack, brushing teeth, changing into pajamas, and reading a book. For a young child whose bedtime routine is completed with a parent (or caregiver), after the child is tucked into bed, it's best for the parent to leave the room. This way, the child learns to fall asleep on their own. If this is too difficult, gradual approximations can be made towards this goal with positive reinforcement (see below) for each step achieved.

Setting a screen-time curfew

Many youth (and their parents) use screens before bed; however, light (including artificial blue light) delays our circadian rhythms (our natural internal clocks) and suppresses melatonin (a hormone that promotes sleep), thereby making it difficult to fall asleep. Ninety percent of studies show screen-time to be associated with adverse sleep outcomes in school-aged children and adolescents (Hale & Guan, 2015). Therefore, as recommended by the American Academy of Pediatrics, it is best for screens to be turned off an hour before bedtime, and to remove screens from bedrooms. 

Children are more likely to follow suit and agree to these conditions if parents follow these guidelines themselves. An alternative to screens is reading. As room light also suppresses melatonin (Gooley et al., 2011), it is better to use a lamplight for reading, instead of a bright overhead light. 

Rewarding positive behaviors

Efforts to follow bedtimes and bedtime routines can be bolstered with positive reinforcement of these behaviors. Positive reinforcement is giving a desirable reinforcer (e.g., praise) in response to a child’s positive behavior (e.g., being in bed in pajamas with brushed teeth by bedtime), which increases the likelihood of continuing this behavior. A reward plan can be developed to reinforce mini-goals, where points (or stickers) are earned for each positive behavior, which can later be exchanged for a special reward. It is best for points to be given immediately following the positive behavior, and for rewards to be motivating, practical for parents to implement consistently, and exclusive to only the agreed-upon reward plan. Once a reward is promised, it is also important for parents to follow through on the earned reward.

Ignoring negative behaviors

Positive reinforcement is most effective when coupled with an active ignoring of negative behaviors, including verbal protests to go to bed or frequent requests to sleep with parents. While positive reinforcement increases positive behaviors, ignoring decreases negative behaviors. Although providing an anxious child reassurance at bedtime may seem natural and can actually alleviate distress in the moment, continued reassurance (or attention of any form) encourages the child to seek reassurance in the long term. This often prolongs bedtime routines and sleep onset. Ignoring includes refraining from responses, eye contact, and attentive body language when the child is engaging in negative behaviors. As soon as the negative behavior stops, and the child engages in a positive behavior, the positive behavior is praised, and the child is attended to. So while we are ignoring, we are also actively waiting to catch the child being good. As the child may be accustomed to parental attention (whether in the form of arguing or consoling), there is likely to be an initial increase in the negative behavior before it decreases. 

Coping skills to manage bedtime worries

Sleep is often compromised by anxiety, and many of us can relate to lying in bed worrying at night. If anxiety is interfering with sleep, coping skills can be helpful, such as relaxation techniques (e.g., deep breathing, progressive muscle relaxation, and guided imagery) and mindfulness. If ruminative worries are keeping your child up at night, these worries can be targeted by practically evaluating them (e.g., checking the evidence for and against the worries and developing realistic coping thoughts). These skills can be taught by a Cognitive Behavioral Therapist, who can also help to monitor sleep with sleep diaries, develop relaxing bedtime routines, and create a reward plan to promote good sleep hygiene. A Sleep Center can also be helpful for more concerning sleep disorders.

References

References

Galland, B.C., Short, M.A., Terrill, P., Rigney, G., Haszard, J.J., Coussens, S., ... & Biggs, S.N. (2018). Establishing normal values for pediatric nighttime sleep measured by actigraphy: A systematic review and meta-analysis. Sleep, 41(4), 1-16.

Gooley, J.J., Chamberlain, K., Smith, K.A., Khalsa, S.B.S., Rajaratnam, S.M., Van Reen, E., ... & Lockley, S. W. (2011). Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. The Journal of Clinical Endocrinology and Metabolism, 96(3), E463-E472.

Hale, L., & Guan, S. (2014). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50–58.

Paruthi, S., Brooks, L.J., D'Ambrosio, C., Hall, W.A., Kotagal, S., Lloyd, R.M., … Wise, M.S. (2016). Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6), 785–786.