Sleep problems in children are extremely common, between 25%-40% of children aged 1-5 will develop some form of sleep problem. Studies show that sleep problems and disorders in childhood have a tendency to be chronic and not go away. The most common problems are difficulty falling asleep and multiple night awakenings. These problems affect both the quantity and quality of sleep.

Some of the problems arise from incorrect behaviors around settling down and going to sleep or as a result of incorrect management of refusal to sleep or nocturnal awakenings. Over time, these problems may worsen and even require professional intervention to treat them. However, many children respond well to treatments for these problems, which are usually short-term. Parental behavior change and explanation of the principles of promotion and proper conduct around sleep and the child’s sleep problems are the key to helping, preventing and treating these sleep problems.

In general, throughout the first 5 years of childhood, the number of night awakenings decreases and the quality of sleep increases. However, there is great variation especially in young children, both in terms of the amount of sleep and in terms of the number of nocturnal awakenings. Despite this, in general, the recommendations are that children aged 1-3 need between 12-14 hours of sleep, children aged 3-5, 11-12 hours of sleep and children of school age (6-12) 10-11 hours of sleep. It is important to note that the amount of sleep is sometimes a concept that can be misleading because the child’s sleep may be impaired because he suffers from a certain sleep disorder (for example, multiple awakenings or sleep apnea) so that a situation is created where he supposedly sleeps the desired amount of time but the quality of sleep at this time is extremely impaired.

When the parents perceive their child’s sleep as problematic, their complaints will mainly center around difficulty putting the child to sleep (“convincing the child to go to sleep”), multiple awakenings, long awakenings, difficulty falling asleep after the awakenings and early awakening. The main variable according to which the parents judge the quality of their child’s sleep is the frequency of night wakings.

Why is it important to diagnose and treat children’s sleep problems and disorders?

There are many findings that indicate the importance of sleep for normal development in childhood and that sleep problems and disorders in childhood have potential negative consequences on physical, cognitive, behavioral and emotional development. There are increasing findings on the relationship between sleep disorders and various problems in children:

• Negative effect on daily functioning. Disturbed sleep has been consistently linked
to behavioral problems in normal children without psychiatric problems

• Although this area has been studied less compared to adults, there are many

studies that link short sleep duration or disrupted sleep to mood disorders,
depressive and anxiety symptoms and other signs of difficulty in emotional
regulation. Longitudinal studies have shown that sleep disorders and problems in
childhood are related to behavioral and emotional problems in older ages

• Short sleep duration is associated with sleepiness in children and adolescents, and a wide range of behaviors is associated with sleepiness, from yawning to hyperactive and impulsive symptoms. Sleep disorders are even related to Attention Deficit Hyperactivity Disorder (ADHD) in children. In a longitudinal study, children with a relatively short sleep duration under the age of 3.5 were found to have an increased risk (2.5 times) of a high score on the hyperactivity-impulsivity index at age 6 compared to children with 11 hours of sleep

• Sleep and sleep disorders are related to cognitive development and the level of academic functioning. Longitudinal studies have shown that sleep disorders and problems in childhood were associated with lower neuropsychological functioning in adolescence

• Sleep disorders in children increase the risk of injury

• Additional studies have shown that sleep disorders in children have a negative effect on relationships and functioning in the family. For example, sleep disorders in children have been linked to maternal depression, and problems in marriage

• Finally, sleep disorders and problems were found to be a risk factor for obesity in children

Thus, sleep assessment and treatment in children is very important.

Principles of sleep hygiene:

There are several general principles that can be applied as an attempt to adopt better sleep habits and behaviors (“sleep hygiene”). These principles should be applied routinely during the day and night and they can lead to an improvement in the general picture of sleep.

Principles of sleep hygiene include:

• Follow a regular process (“ritual”) and at more or less regular times when preparing for sleep. It is important that this routine includes fun and relaxing activities, including time alone with the parent. A study in which this principle was applied to young children showed a significant improvement in the time of falling asleep and in the number and length of nighttime awakenings

• Keep a regular wake-up time

• Avoid caffeine consumption before bed (about 4 hours before). Caffeine is found in coffee, tea, chocolate, Coca-Cola and other products

• Make sure you have a comfortable sleeping environment. A dark, cozy and relatively quiet room. A night light is fine, but television can make it difficult to fall asleep

• Take care of your child’s physical activity but try to avoid such activity close to bedtime

• Keep clear boundaries. When do you go to bed, when do you turn off the lights, etc

• Make sure that the child sleeps in his bed and does not change places where he falls asleep

• Try to avoid daytime sleep for school-aged children

• Be sure to expose the child to sunlight during the day, especially in the morning and early afternoon

• If your child snores, moves a lot at night, is very tired or irritable during the day, wakes up a lot at night, suffers from worries or fears while going to sleep or needs an adult to put him to sleep during the night, you should consult

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