Sleep in children – what to expect

• Newborns sleep between 9-18 hours per day with an average of 14.5 hours sleep.
• Infants (2-12 months) sleep 12-13 hours including about 3 hours of naps during the day.
• Toddlers (1-3 years) sleep 11-13 hours per day including naps but by 18 months most toddlers have one nap of 1-3 hours per day.
• Pre-school children (3-5 years) sleep 11-12 hours per day. Most stop taking naps between 3-5 years.

A recent large study looking at sleep in Irish children found that substantial proportions of mothers report children’s sleep patterns are at least a small problem for them (30% in infancy; 22% at 3 years and 12% at five years). This study highlights the need for parents to have information on how to develop positive sleep patterns.

Most sleep problems involve children having difficulty getting to sleep or difficulty staying asleep. The most common type of sleep problem is a sleep association which requires physical contact from a parent or feeding during the night.

Sleep Hygiene:

This is the phrase used to provide an environment conducive to sleep. This will make it easier for the child to fall asleep and stay asleep.

Babies by 3-4 months of age begin to settle in to a bedtime routine. You can help this by:

• Making a clear difference between day and night.
• When at home always put the baby to sleep in the same place
• Put the baby in to the cot drowsy but awake
• Avoid feeding or rocking the baby to sleep
• Ensure that your baby is not hungry going to bed

The following are ways to promote satisfactory sleep in all ages (Stores 2009; p.27)

Principle	Routine
Sleeping Environment conducive to sleep	Familiar Setting Comfortable bed Correct Temperature (ideally between16-20 C) Darkened quiet room (the sleepy hormone melatonin is produced in the dark. Children with sensory issues can be sensitive to noise.) Non-stimulating (not too many toys or gadgets. The bedroom should be restful) No negative associations (punishment)
Encourage	Bedtime routines Consistent bedtime & wakening time (even on weekends) Going to bed only when tired Falling asleep without parents Regular daily exercise & exposure to daylight
Avoid	Too much time awake in bed Overexcitement before bed or using the bedroom as a place for entertainment Excessive late napping during the day (no naps after 3.30pm after 9 months of age) Late evening exercise. Caffeine containing drinks

Setting limits at bedtime

It is natural for children to test boundaries and many children do this at bedtime. Some children resist going to bed whilst others go to bed but get up repeatedly. Children are most likely to test limits between 3-6 years.

As a parent you need to set clear limits and boundaries at bedtime, even if your child objects. Here’s how you can make this easier.

• Have consistent limits at bedtime. If you say two stories then stick to this! Ensure that your child has had supper, a drink and been to the toilet to avoid requests for this after you have settled them.
• Don’t put your child to bed too early! If they are taking a long time to fall asleep then they may be in bed too early. A child should fall asleep within 30 minutes of going to bed. You may need to make bedtime later for a while until they can do this then gradually bring bedtime back by 15 minutes a night to the bedtime you want.
• Have a consistent bedtime routine, done in the same way each night, they learn to know what to expect.
• If your child gets out of bed or comes in to your room then return them to their own bed. Reward your child for staying in their own bed. Use a reward chart and have a “bigger” reward if they get 3 stickers on their chart. The “bigger” reward could be an activity like a trip to the park.
• The key to success is consistency! Keep going even if you meet resistance initially, it will get better!

Night wakenings

Night wakenings are one of the most common problems parents report and are mostly seen in babies and toddlers.

To understand night wakenings it is important to realize that we all waken briefly during the night. There are two different types of sleep. Deep sleep (called non rapid eye movement sleep) and the lighter stages of sleep (called rapid eye movement sleep). We all have sleep cycles during the night were we transition between deep and light sleep.

For small children they typically fall in to a deep sleep within 5 minutes of going to sleep. This first sleep cycle lasts about 3-4 hours and is mostly deep sleep. As the child transitions to lighter sleep they stir and move around and may open their eyes. If everything is the same as when they first went to sleep they will fall asleep again quickly. However if there is something missing then the child will try to recreate the conditions they had to initially fall asleep.

In order to avoid night wakenings the child needs to learn to fall asleep in his own bed without props or a parent present. Common props or sleep associations are physical contact from a parent; rocking or feeding.

You can help your child sleep well by:

• Establishing a good bedtime routine done in the same way each night at around the same time.
• Encourage the use of blankets/teddies which can help the child feel secure when the parent is not present. (Avoid toys with music or lights).
• Ensure the bedroom is dark and quiet.
• Put the child to bed drowsy but awake (they should wake up where they went to sleep).
• If you usually hold your child or rub their back then sit beside the cot/bed to let them know you are there without the physical contact (if they have contact falling asleep they usually need it to get back to sleep during the night).

Your local Public health Nurse can provide more information and support relating to behavioural sleep difficulties if you need it.

References:

Mindell JA & Owens JA (2015) A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems, 3^nd edition.

Hanafin S. Sleep patterns and problems in infants and young children in Ireland. Child Care Health Dev. 2017: 1-6. https://doi.org/10.1111/cch.12539