Dr C P Ravikumar

One of the most challenging aspects of parenting, especially while dealing with babies and young children, is their sleep patterns. The first six months with a new baby is hard with varied feeding schedules. Battles over bedtime are quite common as children get older. Setting a child’s sleeping pattern to ensure they get the right amount of good quality sleep per day , is an uphill climb for parents, but is well worth the effort for the multitude of benefits its provides in the long run.


The American Academy of Sleep Medicine (AASM) produced a ’Consensus Statement ‘in 2016 , detailing the amount of sleep required by children in different age groups, detailed below:

Child’s age Recommended Sleep time in 24 hours
Infants 4 to 12 months 12 to 16 hours including naps
Children 1 to 2 years 11 to 14 hours including naps
Children 3 to 5 years 10 to 13 hours including naps
Children 6 to 12 years 9 to 12 hours
Teenagers 13 to 18 years 8 to 10 hours

Along with the number of hours a child sleeps it is also important to pay attention to the quality of sleep the child is getting. For healthy sleep, in addition to ensuring a sufficient number of hours of sleep, it is important to ensure uninterrupted sleep, accompanied by age appropriate naps, to make a sleep pattern that is in tune with the child’s circadian rhythm or inner biological clock.

A good sleep cycle will ensure that the child is:
1. Well rested, happy and playful
2. Emotionally well regulated, lesser mood swings or tantrums
3. Optimally alert: able to pay attention and concentrate on tasks or in school
4. Not fatigued during the day.
The natural tendency for a child who is sleep- deprived during the day is to fight the compulsion to sleep, causing a rush of adrenaline to course through their system. This will result in the child becoming wide awake, but cranky, ill tempered and hyperactive.

Chronic sleep deprivation due to even small changes in sleeping patterns over a period of time will lead to an increase in negative effects on the child’s mood, behaviour and attention span. Inadequate sleep in adolescents has been linked to increased depression and suicidal thoughts. At the same time, sleeping more than the recommended number of hours may lead to health issues like hypertension, obesity, and diabetes.

Hence it is advisable to set sleep schedules from an early age. There are various steps that one can take in order to help set a suitable pattern of sleep for children.

1. Nutritional Intake
The steps to good sleep hygiene starts during the day, where the child’s food and drink intake is considered.
• Eating a large meal before bedtime may lead to indigestion
• Drinking sugary drinks like colas, fizzy drinks or sodas, may increase caffeine levels. Caffeine is also present in coffee and tea, so older children who drink these beverages should also limit their intake after lunch time, as caffeine is a stimulant and will make it difficult for the child to fall asleep.
• Drinking warm milk has been known to help put children to sleep.

2. Physical Activity
Ensuring that the child is active during the day, either engaged in sports or free play outside, even walks in the fresh air, can help to burn off extra energy and makes the child feel tired enough to sleep at the end of the day. However, exercise should be avoided immediately before bedtime as it can stimulate the child even more and delay bed time instead.

3. Surroundings
Adjustments can be made to make the child’s sleeping environment safe and secure, taking into consideration their individual natures, as well.
For example, some children may be afraid of the dark and may sleep better with a night light on, while some may prefer to sleep in darkness.
Room temperature and noise levels can be adjusted to the child’s comfort. The room should not have toys accessible to the child, which could potentially distract him from sleeping.

4. Schedules
Establishing a bedtime routine can go a long way in teaching children to adopt good sleeping habits. The routine can start from half an hour to two hours before a set bed time and can include activities like a warm bath, change into designated sleep wear like pajamas, reading a story to younger children. They can be encouraged to use the bathroom just before getting into bed, to avoid waking up in the night. Keeping to this schedule will help children to calm themselves down before sleeping.

5. Gadgets and Technology
Electronic devices like TVs, tablets phones etc, should be avoided before bedtime as they stimulate a child’s brain instead of relaxing it, further prolonging bed times .

6. Self-soothing
Even though it will be tempting and definitely less tiring to allow small children to join a parent’s bed, if they wake up at night , especially if they do so multiple times a night.
The most ideal way is to lead the child back into his or her own bed and allow them to fall back to sleep over there. This will help them to self settle or self soothe.
Just like enforcing any good habit in children, rewarding them for staying in their own beds can also be a useful too, to cultivate this, until it becomes a normal part of their sleeping pattern.

Parents who struggle with their children’s sleep cycles and are concerned about their sleep hygiene can consult a clinical neurologist or a pediatric neurologist to help them diagnose the issue.
There are various tools available, some of which are:
• Adolescent Sleep Hygiene Scale (ASHS)
• Pittsburgh Sleep Quality Index (PSQI)
• Sleep Disturbance Scale for Children (SDSC)
• Paediatric Daytime Sleepiness Scale (PDSS)
These are questionnaire based tools that may help to evaluate sleeping habits of children and adolescents, at sleep clinics. This can also determine if abnormal sleeping patterns can be corrected with lifestyle modifications or further investigations and treatments are required for other sleeping disorders.

Disclaimer: The above information is for awareness and education purposes only and cannot be used for diagnosis or treatment of any condition. Please consult with a physician for any concerns or questions

References
1.https://bmcpediatr.biomedcentral.com/track/pdf/10.1186/1471-2431-12-189.pdf
2.https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/sleep-hygiene-children/
3.https://aasm.org/resources/pdf/pediatricsleepdurationconsensus.pdf

Dr C P Ravikumar

Dr C P Ravikumar

CONSULTANT – PEDIATRIC NEUROLOGY
Aster CMI Hospital, Bangalore