Help! My Kid Won’t Go to Bed

Getting enough sleep is important for all of us, and especially for the growing bodies and developing brains of children and teens. But convincing your child to stick to their bedtime and stay in bed all night can be a struggle. The stress of the pandemic and the resulting changes to our daily routines have negatively impacted sleep schedules. But you can support your family’s wellness with a few techniques that encourage deep, restorative sleep.

What happens when kids don’t get enough sleep?

Infants, children, and adolescents who get insufficient sleep are more likely to suffer with:

• Injuries
• Poor mental health
• Attention issues
• Behavior problems in school and at home
• Delayed cognitive development
• Poor mood/grumpiness
• Problems completing schoolwork
• Struggles with interpersonal relationships/friendships

When poor sleep habits continue into adulthood, people become more at risk for obesity and Type 2 diabetes.

How many hours should a child sleep?

“It’s important for parents to understand how much sleep their child really needs,” says Salim Dib, M.D., a neurologist and sleep medicine specialist with the University of Miami Health System. 

The following guidelines from the National Sleep Foundation are based on the child’s age.

 Age Group: Recommend Sleep 

“Within each age group, there’s variability based on each person’s unique needs to feel alert and rested throughout the day,” Dr. Dib says.

How to encourage deeper, longer sleep

Set a bedtime, and stick with it.

Establish a bed and rise time for your kids that support the recommended sleep duration for their age.

“Bedtime and rise-time should remain the same each day, with no more than one hour difference, even on the weekends. Otherwise, it’s like experiencing a form of jet lag every Monday,” Dr. Dibs says. If your child experiences too many awakenings throughout the night, don’t put them to bed too early.

While parents can have the best of intentions for their child’s sleep, as well as their own, real life often gets in the way, pushing bedtimes later than planned. Don’t let a couple of off-nights become the new norm in your household.  

Begin the nightly bedtime routine one hour before sleep.

This routine can include bathing, teeth brushing, reading a story, and turning off all electronics and screens. Try relaxation techniques like breathing exercises, guided visualizations/meditations, jigsaw puzzles, or simple art projects like doodling or coloring. If the hour before bed is family time, find a calming activity that isn’t watching TV.

Dr. Dib recommends establishing “worry time” or “planning time” in the early evening and away from the bedroom to address family or personal problem-solving. This will help your child or teenager avoid these intrusive thoughts and ruminations when they’re trying to fall asleep. 

“I want to remind parents that no one should go to bed hungry, nor should you have a heavy meal before bed. Light, low-sugar snacks (like cereal with milk or cheese and crackers) are better for encouraging sleep without feeling hungry. Avoid caffeine at night, including chocolate.”

Create a safe, dark, quiet sleeping environment.

The most sleep-conducive temperature is the mid-60s F. Dim household lights and turn on a low-level nightlight if your child needs it to feel safe. 

Reset your internal clock.

Ensure your kids get enough daily sunlight exposure. There’s a benefit to being outside or near an open window first thing in the morning. It tells the brain that it’s time to wake up and get active. The same applies at sunset, which tells the brain it’s time to start winding down.

“We recommend exercising in the morning or early afternoon,” says Dr. Dib. “Avoid strenuous activity at night, which can make you more alert.”

Get daily physical activity.

Children have a lot of energy to burn off. Ensuring they move around throughout the day and ideally get at least an hour of moderate to high-intensity daily physical activity will help them feel tired when it’s time for bed.

The bed is for sleeping — period.

Don’t allow your child to use their bed or yours as a spot for playing, hanging out, watching TV, doing homework, or eating. Avoid using their bedroom for punishments/time-outs. This way, the bedroom won’t trigger your child’s alertness at night, as they learn to associate the bed only with sleep.

Are sleep aids safe for children?

If your child is consistently having difficulty falling asleep at bedtime, low-dose melatonin (a natural supplement available in pill form) might be an option. Before giving any supplements to your child, speak with your pediatrician because supplements are not FDA approved as a medical treatment and may interfere with certain medications or conditions.

An over-the-counter, pediatric dose of an antihistamine like Benadryl may be recommended in some cases because one of its side effects is drowsiness.

“On a short-term basis, antihistamines can address transient insomnia related to a specific trigger (like anxiety or illness). Long-term use of antihistamines for sleep is not recommended because it establishes dependency and can negatively affect sleep quality. Don’t give your child Benadryl as a sleep aide unless your pediatric sleep specialist recommends it,” Dr. Dib says.

In addition, don’t give any child any alcohol. “Alcohol can kill brain cells, impair brain development, suppress deep quality sleep, and can encourage bad dreams. Even a ‘nightcap’ for adults can disrupt deep sleep,” he says.

“The focus should be on behavior modification instead of medications,” Dr. Dib says.

In addition to the sleep-conducive activities mentioned earlier, cognitive behavioral therapy (a drug-free psychological treatment) for insomnia can be successful, especially in older children, teenagers, and young adults who struggle with their sleep. 

If you’re ready to contact your pediatrician or a sleep medicine specialist for help, maintain a sleep diary/log for a week or two to accurately capture your child’s sleeping habits, including when they nap and wake in the middle of the night.

Talk to your teen about sleep

As kids get older, their bodies and brains require a little less sleep for optimal function and wellness. But teenagers still need more hours of daily sleep than adults.

Talk to your teen about the real effects of sleep loss on their cognitive and physical performance. “They may not realize how much lack of sleep affects their mood, causing issues with social interactions,” says Dr. Dib.

“Most adolescents prioritize their social lives and their physical appearance, both of which can be impaired by lack of adequate sleep. Engage teenagers in the solution, including maintaining a regular sleep-wake schedule, even on the weekends. Teens’ bedtimes can be gradually moved up an hour or two earlier in 15- to 20-minute increments every few nights.”

Dr. Dib also recommends making a family rule about putting away cellphones and tablets.

“Everyone in the household can put their phones in another room an hour before bedtime. Parents can help set the example.”

Don’t allow adolescents and teens to sleep with their phones in their beds or on their bedside tables. Use an alarm clock instead.

“Teens can talk to their friends about it too, and make a pact to turn off their phones at a certain time, so no one feels left out of late-night socializing. That way, everyone can wake up thinking, feeling, and looking their best.” 

Sleep issues can vary based on the child’s age.

“Very young kids can have sleep-onset association disorder, relying on being rocked or fed to go to sleep. This prevents them from being able to self-soothe,” he says. “Try replacing rocking or feeding your child with something they can rely on without your presence or intervention, like a blanket or a plush toy. 

“We also recommend putting the kid to bed when they’re awake and drowsy, so they can learn to fall asleep without parental presence. Children may wake at the end of every sleep cycle (every 90 minutes or so), but if they learn to self-soothe, they can put themselves back to sleep without caregiver intervention.”

It’s also important to recognize certain sleep disorders that may contribute to sleep disruption. 

These include: 

• Sleep-related breathing disorders (like sleep apnea)
• Limb movement disorders, including restless leg syndrome
• Parasomnias, like sleepwalking or night terrors, among others
• Narcolepsy 
• Insomnia
• Circadian rhythm disorders 

Some of these disorders can start in early childhood. Pediatric sleep disorders are sometimes misdiagnosed as attention deficit disorders.

“If you’ve already tried the other recommendations, and they fail to improve your child’s sleep, speak with their pediatrician or see a sleep specialist for evaluation and management. Keep a sleep log to ensure you have all the information they need during the initial consultation. A sleep study may also be considered in certain cases.” 

Psychophysiological insomnia is triggered by the anxiety of not being able to fall asleep or stay asleep, resulting in heightened vigilance, a self-fulfilling cycle of anxiety and sleeplessness.

Sleeping at irregular times, constantly checking the clock when they should be sleeping, taking naps, and relying on caffeine to feel alert can perpetuate the problem and prevent children and teens from returning to a regular pattern of healthy sleep. 

“Addressing a sleep or anxiety disorder with proper treatment can make all the difference,” Dr. Dib says. 

Dana Kantrowitz is a contributing writer for UMiami Health News.

Tags: adolescent mental health, Dr. Salim Dib, pediatric sleep