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MEETING YOUR CHILDS NEEDS

Tips to Help Children Sleep

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Creating an inviting place for sleep, getting on a schedule, and setting limits are helpful for improving sleep. Different methods also help with falling asleep more quickly and remaining asleep all night. These methods can be used with typically developing children as well as children with special health care needs (CYSHCN). Since every family’s situation is different, some methods may make more sense for your child than others.

Tips to Help Almost Anyone Sleep Better

Sleep Habits

Habits that help people sleep better are often called “good sleep hygiene." The following is a list of good sleep hygiene habits for children and adolescents. Most people who follow these tips will sleep better.
  • Bed-Time Routine: Follow a routine to get ready for bed. Relaxing, calm, enjoyable activities, such as reading a book or listening to soothing music, help the body and mind slow down enough to let you sleep. Many families plan a bedtime routine around the “B’s” – bath, brush teeth, book, and bed. But avoid exciting bedtime stories! Starting a calm wind-down routine 2 hours before bed can help your child get ready to sleep.
  • Consistent Schedule: Aim for the same bedtime and wake-up time every day.
  • No Caffeine: No caffeine in the afternoons or evenings (most kids shouldn’t have caffeine anyway). Caffeine is often in energy drinks, sodas, chocolate, coffee, and tea. Too much sugar can also make it hard to settle down.
  • Light Snack: Ideally, your child should not go to bed hungry. A light snack (such as milk or peanut butter on crackers) before bed is a good idea, especially if they often wake up hungry at night. Heavy meals within an hour or two of bedtime, however, may interfere with sleep.
  • No Electronics: No electronics in the bedroom (like tablets, phones, and TVs), and avoid using electronics 2 hours before bed because they stimulate the brain and make it less sleepy.
  • Limit Naps: Naps should be geared to your child’s age and developmental needs. Long naps or too many naps should be avoided; too much daytime sleep can result in your child sleeping less at night. In general, no naps after 4 pm.
  • Exercise Earlier in the Day: Daily exercise is good for helping people sleep, but it should happen earlier in the day so your child isn’t wound up at bedtime. Relaxation activities like gentle yoga can be done before bed to unwind.
  • The Right Environment: If possible, keep the room dark, quiet, and cool (less than 75 degrees if possible). Get rid of any unnecessary lights (especially LEDs). Alarm clocks can be turned away from the child if they are bright or if the child stares at the clock a lot. Consider weighted blankets, stuffed animals or comfort items, white noise or soothing background music, or quiet and slowly narrated stories to help children fall asleep. Some children like scents like lavender or peppermint to help them feel calm and sleepy.
  • Bed is Only for Sleep: Use the bed only for sleep rather than a place to play and hang out so that your child only thinks of the bed as a place for sleeping. Avoid using the bedroom for time-outs or punishments so they don’t feel a negative association with the space.
  • Don’t Stay Awake in Bed: If your child can’t fall asleep within 20-30 minutes, have them get out of the bed and come back later to try again.
Apps to Help Kids and Teens with Anxiety has information about apps that can help anxious kids and teens and includes some sleep and meditation apps that can be helpful to get them sleepy.

Visual Schedules

“Visual schedules” use images and pictures to help the child see all the parts of the bedtime routine. Kids can check off the different things they need to do as they go; this can help them feel more in control of the bedtime process.
Bedtime Routines Shown with Photos and Checklists (Autism Speaks) (PDF Document 2.1 MB) may be helpful for children with or without autism.

When It’s Hard to Fall Asleep

Learning to Fall Asleep Alone

“Graduated extinction” is a method doctors recommend for parents and caregivers to gradually teach children to fall asleep on their own. This method also can help them to go back to sleep on their own if they wake up a lot during the night and need a parent’s help to go back to sleep. Although children often get very upset anytime there is a change, they eventually get used to it. Some families are able to go through the whole process in a week, but sometimes it can take a lot longer.
  • Using a Chair: If you currently hold your child or lie down next to them for the child to fall asleep, you can start sitting in a chair next to the crib or bed. When you first start, you might need to touch the child with your hand while sitting next to the bed, but over time you need to stop touching them and talking with them. Then, over several days you gradually move the chair away from the bed until it is out of the child's view, and they can fall asleep on their own.
  • Using a Timer: Another version is when you put your child to bed at a set time and then check on them on a schedule with gradually increasing intervals until the child falls asleep on their own. Don’t talk or touch them when you check on them; just let them see you checking on them. For example, put the child to bed at 7 and say good night. Come back to quietly check on them at 7:05, then 7:10, then 7:20, then 7:35, then 7:55, and so on until they eventually fall asleep knowing you are keeping an eye on them.

Bedtime Fading

“Bedtime fading” is a good method when you have a child who goes to bed too late. In this method, you start putting the child to bed when they tend to fall asleep, which will be late. If your child does not fall asleep within 10-15 minutes, take the child out of bed, and a parent stays up with the child for 1 full hour. Then, the child is put to bed again and gotten up if they do not fall asleep within 10-15 minutes for another full hour. This process is repeated until the child falls asleep during the 10-15 minutes lying in bed. Initially, this may be quite late into the night. Once the child is falling asleep consistently after 10-15 minutes, the family gradually moves the bedtime up to a more reasonable set bedtime. This process can take weeks and involve a lot of crying, but it eventually helps get them on an earlier schedule.
Bedtime Fading: The “Secret Sauce” in Sleep Training (Dr. Craig Canapari) shows a 4-minute video focusing on bedtime fading.

Sleep Tickets

In this system, “sleep tickets” are used like hall passes used at school when a child gets out of bed a lot before falling asleep or during the night. When the child comes out of the room, they have to hand over the sleep ticket to the parent or caregiver. Parents and kids can make and decorate the sleep tickets together as an art activity before using them in the reward system.
Here are two different versions:
  • One Sleep Ticket: The child gets 1 “sleep ticket” to use in the night, and if it is not used, the child can exchange it for a reward in the morning.
  • Several Tickets: Alternatively, start with several tickets and gradually reduce the tickets over several days or weeks. The child can save the unused tickets to earn a reward.
Bedtime Pass (OHSU) (PDF Document 101 KB) is a 1-page handout with helpful steps for using the sleep ticket system.

When It’s Hard to Stay Asleep

Scheduled Awakenings

“Scheduled awakenings” is a way to deal with repeated night waking by working with the natural sleep cycles. In this option, you first track the pattern of your child’s night waking for several nights (see Tools below). If you realize there is a predictable time that the child usually wakes up, you can slightly wake up your child 30-45 minutes before that typical wake-up time. For example, if your child always wakes up around 2 am, you will gently awaken them around 1:15-1:30 am. While counter-intuitive to wake a sleeping child, this method works because you will wake your child during deep sleep when they will have an easier time going back to sleep, and it resets the sleep cycle so that they avoid going into the light sleep when they usually fully wake up.
If your child has trouble going back to sleep after you gently wake them up, this means the child has already moved into light sleep, and then you should wake the child earlier. Once the night awakenings have stopped, gradually reduce the scheduled awakenings. So, stop doing it 1-2 nights per week, and then 3-5, then stop all together.

Restricted Sleeping Time

Restricting sleep time is another way to deal with kids who wake up a lot at night. The idea is that, by limiting sleeping time, the body will stay in deeper sleep more of the night. First, track your child’s sleeping patterns for several nights (see Tools below). Add up the total number of hours asleep, not counting your child's time lying awake in bed. Then you will limit the total sleep time to only allow 90% of the usual sleeping time. For example, if the child currently sleeps for a total of 10 hours, you will limit the time they can sleep to 9 hours and then get them up. During this process, if the child is found lying awake in bed, allow the child to get up for a little while, and then put them back to sleep. Once the night awakenings have resolved, gradually allow your child 15 more minutes of sleep each day.

Sleep Tickets

The Sleep Ticket system, described in the section above, can also be helpful for kids who come out of their rooms frequently during the night.

Safety

Night Wandering

If the child wakes up during the night and wanders, advise parents to use room gates and/or door alarms to ensure the child remains safe.

Medications

Discuss any sleep medications, even over-the-counter ones like Benadryl or melatonin, with the child’s doctor before using them. Even over-the-counter (non-prescription) medications have risks of side effects you need to know about. If the doctor recommends prescription sleep medications, ask about the risks of any side effects and how long to use the medicine.

Referrals and Specialists

Families can consult with a sleep specialist for additional family education and support. There are some online consulting services to coach families through sleep training, and there are pediatric sleep medicine specialists (typically pulmonologists with specialized training) who can work with families as well.

Resources

Information & Support

Related Portal Content
Other Portal pages provide clinical information to help understand and address common sleep issues:

For Parents and Patients

Better Sleep in Kids and Parents (Dr. Craig Canapari)
Excellent, in-depth, and easy-to-read resource about sleep training, sleep hygiene, use of melatonin, and more; developed by Dr. Craig Canapari, a Yale Pediatric Sleep Medicine physician.

Sleep for Kids (National Sleep Foundation)
Fun for children and useful for parents and teachers to understand and overcome sleep problems.

Sleep Tips for Adolescents (Medical Home Portal) (PDF Document 193 KB)
A 1-page printable handout with basic suggestions for improving sleep.

Tools

Bedtime Routines Shown with Photos and Checklists (Autism Speaks) (PDF Document 2.1 MB)
Tips, sample visual bedtime routines, and a sample bedtime pass.

Sleep History Questionnaire (PDF Document 20 KB)
A 14-day sleep tracker and 1-page questionnaire about sleep routines and behavior.

Sleep Diary (PDF Document 2.3 MB)
Includes a 1-week, kid-friendly version for school-aged children who are able to communicate in writing and/or verbally.

Adolescent Sleep & Comfort Log (PDF Document 205 KB)
Features a 16-day sleep-time log and comfort tracker for teens to fill out on their own.

Services for Patients & Families in New Mexico (NM)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: January 2023
Current Authors and Reviewers:
Author: Jennifer Goldman, MD, MRP, FAAP