Child Sleep Advice!

by Dr. Nicky Cohen
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The benefits of sleep are numerous – both physical and psychological. Parents are often aware of how they feel when sleep deprived. Even if your child is sleeping well now, you can probably recall the days when he wasn’t! However, parents sometimes forget to consider the impact that loss of sleep can have on their child and how children may be feeling when they don’t get sufficient sleep. Like adults, many children who do not get enough sleep, display signs of sleep deprivation during the day such as irritability, sleepiness, and poor concentration. Children may also appear “wired” and display more “tantrum” behaviour.

Several years ago, in the first nationwide study of its kind, the National Sleep Foundation’s Sleep in America poll investigated sleep habits of children (infants to 10-year-olds) and their parents/caregivers. It was found that 76% of parents reported that they would like to change something about their child’s sleep. It was estimated that some parents lose up to 200 hours of sleep a year due to their child’s nighttime wakings and that many children are getting less than the recommended number of hours of sleep a day based on their age. Additionally, many parents/caregivers reported that they get less sleep than they need, with 50% of all parents/caregivers reporting that their sleep is disturbed during the night, at least twice a week, on average. However, despite a large majority of parents being dissatisfied about their child’s sleep, the study found that many doctors (52%) don’t ask about children’s sleep habits.


Many parents face challenges regarding their child’s sleep, whether it be bedtime stalling, problems falling asleep independently, night wakings, early morning wakings, or daytime sleep difficulties (just to name a few). Usually these problems translate into less sleep – for everyone – as a result. The following tips are for parents looking to make some positive changes in their children’s sleep habits.



Establish a consistent and appropriate sleep schedule for your child.Having a regular bed time is helpful in getting your child to fall asleep more easily and quickly at night. Research has shown that children (and adults) who go to bed at roughly the same time each night, have less difficulty falling asleep than those who don’t have a regular bed time. Most young children do well with a bed time between 7:00-8:00pm, with some older toddlers and preschoolers needing to be put down closer to 8:00-8:30pm if they are still napping. Ensure that your child is awake for long enough before going to bed at night. This will help her fall asleep quickly. For example, a 6-month-old needs to be awake for 2.5 hours (of continuous wakefulness) before bed. Similarly, a regular wake time (with exposure to morning sunlight soon after waking) is important as it sets the “start” button for the day. A child’s wake time is also important in setting her nap time as well as her bed time.


Make sufficient sleep a priority. Understanding the importance of getting enough sleep and how sleep affects the overall health of your children, is the first step towards making sleep a priority. Parents need to determine the amount of sleep their children need and take steps to ensure that each child’s individual sleep needs are met. Parents should strive to make a good night’s sleep a regular part of each child’s daily routine.



Create a predictable and calming bedtime routine.A bedtime routine is important to help your child wind down before bed and signal to her that bedtime is approaching. Children learn that when certain things happen, for example, a bath, pajamas, books and songs, it means that ‘sleepy time’ is coming. Many parents of older toddlers and preschoolers report frustration with bedtime resistance. Children of this age are notorious for repeated requests at bedtime – also known as “curtain calls” (just one more kiss!). If this is happening in your home, establish an appropriate bedtime routine and stick to it. Be sure to incorporate everything (within reason) that your child needs to have done before falling asleep. Develop a simple bedtime checklist with your child. Checking off the items as you complete them can be helpful. Be careful not to reinforce multiple (or unreasonable) requests at bedtime. Once you are firm and consistent, your child will learn to accept the new rules. Avoid screens (including TV) as part of a bedtime routine.



Make sure your child’s sleeping environment is conducive to sleep.Most children sleep best on their own. Research has shown that children and adults who bed-share usually do not sleep through the night as everyone is disturbed by each other’s noises and movements. As well, parents are more likely to respond (and therefore reinforce) night wakings due to close proximity. Children, like adults, sleep best in an environment that is quiet, dark, and on the cool side of comfortable. White noise (a constant and even sound) at a verylow-level in a child’s room and room darkening shades can be helpful.


Introduce a transitional object.Many children can benefit from having a transitional (security) object such as a “blankie” when they sleep. However, the Public Health Agency of Canada and Canadian Paediatric Society (CPS) safe sleep guidelines outline that if your child is in a crib, soft and non-breathable materials such as blankets, toys, pillows, and stuffed animals should not be in a crib due to safety concerns including injury and suffocation. When your child has been transitioned to a bed, introducing a sleep-compatible security object such as a small blankie can be helpful. Things that can be played with and arouse a child, preventing her from falling asleep, or wake her if she rolls on them (such as toys) are best left out of a child’s sleep space.



Have your child fall asleep independently.Infants can learn to fall asleep on their own when they are at least 3 months of age (full-term) and healthy. This is an important life-long skill that all children need to learn. The earlier that parents allow for their child to acquire this skill, the easier it is for them to learn. Falling asleep independently is best learned at nighttime sleep-onset (bedtime) when the drive to sleep is relatively stronger than compared to daytime sleep periods. While it is never too late for children to learn how to fall asleep on their own, it is generally an easier and quicker process the younger the child is. However, before 3 months of age, babies should not be left to cry for more than 5 minutes, and possibly even less depending on the intensity of their cry.


The importance of a child learning to fall asleep on her own at night is related to her ability to sleep through the night. This is because children who fall asleep under certain conditions (e.g., with a parent present, while being fed or rocked) at bedtime, often need the same or similar conditions re-established upon waking at night in order to return to sleep. These children (“signalers”) will call or cry out to get the help they need to return to sleep. This may happen several times a night, as we all have several periods of brief arousal throughout the night. However, children who have learned to fall asleep independently are more likely to return to sleep on their own following these arousals. These children (“self-soothers”) will return to sleep, often without their parents being aware that they were briefly awake.


Respond to your child appropriately and consistently during the night.Once a child has acquired the skill of falling asleep independently at night, she will likely start applying the skill following night wakings. However, if night wakings continue to be inappropriately or inconsistently reinforced, they may continue. So, develop a plan to gradually eliminate unnecessary responding at night and stick to it. Consistency is key. For infants who still need nighttime feeds (usually up to 6 months of age, or longer if there are concerns with weight gain or solid food intake), scheduled “dream” feeds initiated by parents can be helpful. Dream feeds help to break the association between waking and being fed to return to sleep.



Ensure that your child gets adequate day sleep if she still needs a nap.Many children continue to nap until 3-4 years of age. Sometimes parents drop their child’s nap prematurely for social or other activities. Parents are encouraged to take their child’s lead and maintain the nap as long as the child still needs it. However, if napping is preventing your child from going to bed at a reasonable time at night (i.e., by 8:30pm), it may be time to reconsider the nap. Rather than dropping the nap entirely, parents can first try to limit the nap to 1 hour.



Practice safe sleep hygiene.Ensure that the area where your child sleeps is safe. Always place your baby on her back to sleep on a firm flat surface in a bassinet or crib (with only a fitted sheet) for all sleep periods (day and night). This position, until a child can move to another one on her own, is associated with a decreased risk of sudden infant death syndrome (SIDS). While room-sharing for the first 6 months may be a protective risk factor against SIDS, the Public Health Agency of Canada and CPS guidelines routinely advise that bed-sharing be avoided due to its association with an increased risk of SIDS as well as a risk of injury and suffocation. Soft materials including bumper pads, blankets, pillows, and infant sleep positioners should not be used due to the risk of suffocation. When a child is transitioned to a bed, guard-rails should be used to protect against falls. Parents are encouraged to speak with their child’s physician regarding safe sleep practices. For additional information see: “Is Your Child Safe? Sleep Time” (Health Canada) and “Safe Sleep for Your Baby” (Public Health Agency of Canada).



Get some sleep yourself!With research showing that many adults get less sleep than they need, make sleep a priority for yourself! The better rested we are as parents, the better able we are to effectively parent and cope with the many challenges we face during the day. Often it is helpful for adults to have a bedtime routine and some wind down time before bed.


Parents are encouraged to pay attention to sleep problems in their children and to follow-up with their child’s physician or other health care professional with training in this area if they have concerns. While sleep disturbances are one of the most chronic behavioural problems in children, often times these problems are easily resolved through behavioural interventions. Though the anticipation of trying to deal with these issues can be overwhelming – especially if you are sleep deprived to begin with – usually the anticipation is actually worse than tackling these problems.


Pleasant dreams!

The information provided by Dr. Cohen is not intended to be a substitute for professional advice. Individuals are encouraged to speak with a physician or other health care provider if they have concerns regarding their child’s sleep and before starting any treatment plan. The information provided by Dr. Cohen is provided with the understanding that Dr. Cohen is not rendering clinical, counselling, or other professional services or advice. Such information is intended solely as a general educational aid and not for any individual problem. It is also not intended as a substitute for professional advice and services from a qualified healthcare provider familiar with your unique facts.

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