By  Samanta Rivas-Argueta, University of Toronto occupational therapy student

Edited by  Jacquie Martin OT Reg. (Ont) with appreciation

 As an adult, I can’t express how much I appreciate a nice night of sleep! The benefits of sleeping are endless. Sleep restores our health, gives us energy, helps us with weight management, improves concentration and memory, regulates our mood, and so much more. In simple terms, sleep determines whether or not we have a good day, and ultimately a good life.

Our children, however, often struggle with bedtime. In fact, 25% of children experience sleep challenges. Getting too little sleep will impact their health, their energy levels, mood and motivation to engage in daily occupations, such as learning and playing. And let’s be honest, if they’re not getting their sleep, neither are we! 

Fun Fact: Human beings sleep one third of their lives, which means we would have slept for 30 years if we live up to 90 years.

(De Lange, 2016; Weiss, n.d)

Sleep is the cornerstone to health!    

How do I know if my kids are getting enough sleep?

When your child is tired, it may look different than when an adult is tired. Children show fatigue in many different ways. Here is a list of indicators that your child may be having trouble with sleep;

  • Demonstrates challenging behaviour during bedtime routine, 
  • Requires longer than 30-45 minutes to settle before preparing to fall asleep,
  • Has rigid routines and set-up to fall asleep, 
  • Needs an adult in the room, next to the bed, or lying in bed to fall asleep,
  • Regularly wakes up or gets up during the night,
  • Has inconsistent sleep patterns (e.g. sleeps 6 hours one night and 10 hours the next night),
  • Has difficulty waking up in the morning,
  • Shows signs of restlessness or frequent change in position during the day,
  • Seems to have hyper-alertness and shorter attention span during the day

There are 2 important aspects to sleep, 

  1. QUANTITY – the number of hours of sleep required for optimal health and function.
  2. QUALITY – how ‘well’ you sleep. That is, how quickly you fall asleep, how soundly you sleep, how easily you fall back to sleep if you wake up. 

Sleep experts recommend children get a minimum range of hours of sleep each day according to their age;

  • 1-4 Weeks Old: 15 – 16 hours per day
  • 1-12 Months Old: 14 – 15 hours per day
  • 1-3 Years Old: 12 – 14 hours per day
  • 3-6 Years Old: 10 – 12 hours per day
  • 7-12 Years Old: 10 – 11 hours per day
  • 12-18 Years Old: 8 – 9 hours per day

With this information, you may be thinking, “my child sleeps enough for his age, but he/she is still tired”. This is the difference between quantity and quality of sleep. Although your little one is sleeping enough, he/she may be getting poor quality sleep. For instance, if your child experiences sleep apnea, it doesn’t matter how many hours of sleep they get, they will wake up feeling tired.

(WebMD, 2020; Weiss, n.d; Stanford University Medical Center Public Forum, 2018; Chaves, 2016)

Common Challenges with Sleep

Getting your child to sleep may feel like a battlefield. In fact, the majority of parents experience some difficulty getting their little ones to sleep. Don’t worry. Sleep challenges are common among children, and there are many factors that could contribute to them. Here are some common examples of sleep challenges;

Sensory processing challenges 

  • Comments or complaints about light or noise in room, 
  • Comments or complaints about the feeling of pajamas, sheets, or bed,
  • Comments or complaints about room temperature, e.g. the room is too hot or too cold,

Challenges related to the environment 

  • Presence of distractions in the bedroom, such as TV or electronics, 
  • Overly messy room affecting bed comfort

Challenges related to cognition 

  • Anxiety
  • Difficulty remembering and following through on steps before bed, e.g. brushing teeth, putting on pyjamas, reading a book, 

Behavioural challenges 

  • Refuses bedtime routine and/or is defiant, e.g. running away,  tantrums
  • Has excessive requirements to delay bedtime (drink of water, toilet, one more story),

Physical concerns 

  • Night-time growing pains, 
  • Night waking, 
  • Frequent toileting at night,

Other challenges 

  • Medical conditions, e.g. insomnia and sleep apnea, reflux, etc. 

 

GENERAL TIPS FOR HOME

Here are a few strategies that you can try at home to help begin to improve the quantity and quality of your child’s sleep: 

  1. Exercise makes us tired – Using our muscles during the day promotes better sleep.
  2. Last cup of liquid should be taken two hours before bedtime – if your child wakes up often to use the washroom, the quality and quantity of sleep will be compromised.
  3. Limit use of technology 90 minutes before bed – the light and visual stimulation prevents the mind from shutting off.
  4. Develop a consistent bedtime routine – Consistency reinforces the body’s sleep-wake cycle.
  5. Provide options during bedtime –  Get your child involved in the sleep routine by offering choices for the pyjamas they want to wear, the book they want to read, etc.
  6. Read stories about sleep – Consider incorporating bedtime stories about sleep themes. 
  7. Consider the room environment – Explore what is your child’s optimal set-up for light, noise, bed arrangement and pillows comfort. 
  8. Use lighting to your advantage – Dim light in the evening and open the curtains in the morning as light exposure sends a critical signal to the brain to be sleepy or awake. 
  9. Use calming strategies– These strategies foster a positive bedtime experience for your child by preparing the body and mind for rest. Examples include soft classical music, massage and a soothing toy.

 

(Kim & Jen, 2020; Stanford University Medical Center Public Forum, 2018)

 Patience is key.  It takes a minimum of 6 weeks to develop a routine. 

As parents, we often have to go to GREAT LENGTHS to get our kids to bed. And sometimes, despite our best efforts, our children continue to experience sleep disturbances. If this is the case, your child may benefit from additional assessment and support regarding sleep. Pediatric occupational therapists are well-positioned to address several challenges that children and families face related to children’s sleep.

(Dawkins, 2020; Chaves, 2016)

Occupational therapy can help!

As occupational therapists, we are trained to evaluate a child’s  physical, motor and developmental status, environmental factors, family and cultural factors to determine a holistic profile of sleep. Based on this information and in partnership with the family, OTs can support the following;

  • Develop a sleep treatment plan;
      • Goal setting 
      • Providing strategies to address areas of sleep difficulty (e.g., self-regulation techniques, environmental adaptations, cognitive-behavioural tools, physical accommodations, etc.)
      • Monitoring and adapting the intervention
  • Provide education on sleep;
      • Sleep misconceptions and expectations;
      • Health management behaviors, such a balanced diet and adequate exercise for children.
      • Cognitive-behavioral techniques to improve sleep hygiene;
  • Address secondary conditions; 
      •  Examples of secondary conditions include pain, positioning, mental health issues, etc.
  • Referral to specialized services as needed;

And much more…

(American Occupational Therapy Association, 2020)

In summary, sleeping is an important occupation for our children’s development and quality of life (and ours too). If bedtime has become an overwhelming task in your household, you may benefit from the help of an occupational therapist (OT). For more information, visit the TCTC website to learn about our available OT services. Please contact us directly at TCTC if you have any questions regarding your child’s sleep and learn how our OTs can help. 

Useful Sleep Resources 

TCTC website 

https://www.torontochildrenstherapycentre.ca/

Stanford Healthcare Sleep Clinic website

www.stanfordhealthcare.org/medical-conditions/sleep/pediatric-sleep-disorders.html

Sleep in Children Brochure – Etobicoke Brampton Sleep Clinic

http://ebsleepclinic.com/resources/files/Etobicoke_Sleep_in_Children.pdf

Books on Sleeping for Children – 7 soothing books to help children sleep soundly

https://www.penguin.co.uk/articles/children/2017/soothing-books-to-help-children-sleep-soundly/

Sleep Apps for Children -5 Best Baby Sleep Apps for a Better Bedtime

https://www.parents.com/toddlers-preschoolers/sleep/schedule/10-best-sleep-apps-for-better-bedtime/

References

American Occupational Therapy Association. (2020). Occupational Therapy’s Role in Sleep. Retrieved from: https://www.aota.org/About-Occupational-Therapy/Professionals/HW/Sleep.aspx

Chaves J. (2016). The Relationship between Sensory Processing and Sleep. Retrieved from: https://www.thecenterforconnection.org/blogarchive/2016/4/27/the-relationship-between-sensory-processing-and-sleep

Dawkins R. (2020). The importance of sleep for kids. Johns Hopkins All Children’s Hospital. Retrieved from: https://www.hopkinsallchildrens.org/ACH-News/General-News/The-importance-of-sleep-for-kids

De Lange. C. (2016). Why we sleep one third of our time. Retrieved from: https://www.technologist.eu/why-we-sleep-one-third-of-our-time/

Kim & Jen. (2020, May 30). 10 strategies that work to help your child sleep [Video format]. Youtube. Retrieved from: https://www.youtube.com/watch?v=Omnv2EQ3284

Stanford University Medical Center Public Forum. (2018). Stanford Forum V: Back-to-School – Vol. VII [Video format]. Retrieved from: https://stanfordhealthcare.org/medical-conditions/sleep/pediatric-sleep-disorders.html/presentation-mode/stanford-health-care-now/videos/stanford-forum-v-back-to-school-vii

WebMD. (2020). How Much Sleep Do Children Need? Retrieved from: 

https://www.webmd.com/parenting/guide/sleep-children#2

Weiss S. (n.d). Sleep in Children [Brochure]. Retrieved from: file:///Users/samantaargueta/Downloads/Etobicoke_Sleep_in_Children%20-%20brochure%20wiht%20facts.pdf