II. Epidemiology
- Prevalence: 10-30% of children
- Gender predominance: None (boys and girls are affected equally)
III. Types
-
Sleep Onset Association Type of Behavioral Insomnia
- Difficulty sleeping without specific conditions met (e.g. parent rocks an infant to sleep)
- Frequent night awakenings
- Bedtime process is arduous
- Limit-Setting Type of Behavioral Insomnia
- Bedtime refusal or stalling
- Child refuses to sleep after night awakenings
- Parents make concessions to the child to ease bedtime routine (e.g. allow Co-Sleeping)
- Consider other reasons for bedtime resistance
- Fear or anxiety (e.g. Nightmares, dark room, sleeping alone)
IV. Management: Initial Measures
- Maintain consistent consistent schedules
- Consistent bedtime routines
- Maintain same bedtime and awakening time daily
- Child should be drowsy, but awake when placed in bed
- Child should learn to fall asleep alone
- Consistent meal times
- Consistent nap times
- Consistent bedtime routines
-
Sleep Hygiene
- See Sleep Hygiene
- Keep bedroom dark (nightlight if needed), quiet and at a comfortable Temperature
- Snack before bed may be given if child is hungry
- Avoid excessive fluid before bed
- Avoid caffeinated drinks or food (e.g. Chocolate) in the later part of the day
- Avoid vigorous activity before bed
- Maintain a positive bedtime
- Introduce calming activities prior to bed (e.g. reading bedtime story, bath time)
- Avoid television or electronic media (Screen Time) immediately before bed
- Introduce calming activities prior to bed (e.g. reading bedtime story, bath time)
- Extinction Technique: Avoid reinforcing behavior
- See Trained Night Crier
- See Trained Night Feeder
- Child learns self-soothing techniques to return to sleep
- Child is checked on for serious cries of distress or checked on briefly (<1 minute) at regular intervals
- Frequent calls, tantrums, crying is otherwise ignored
- No rewards are given (no food, additional time, hugs, reading)
V. Management: Advanced techniques
- Faded Bedtime
- Goal: Decrease the time a child spends awake in bed
- Bedtime is delayed until the predicted time of sleep onset (with a consistent awakening time)
- Similar to Sleep Restriction Therapy
- Used for adults in Cognitive Behavioral Therapy for Insomnia
- Response Cost
- If sleep onset does not occur within a specific time period
- Remove child from bed for a pre-determined amount of time (e.g. 30 minutes)
- Similar to Sleep Stimulus Control
- Used for adults in Cognitive Behavioral Therapy for Insomnia
- If sleep onset does not occur within a specific time period
- Scheduled Awakenings
- Parents log the times of night awakenings
- Awaken the child prior to the expected time of night awakening
- Slowly decrease the number of scheduled awakenings over time
- Medications
- Melatonin
- May be considered in children age >=2 years with neurologic disorders (e.g. Autism)
- Avoid Diphenhydramine (and other sedating medications)
- Lack of efficacy and risk of adverse effects
- Merenstein (2006) Arch Pediatr Adolesc Med 160(7):707-12 [PubMed]
- Melatonin
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Related Studies
| Concepts | Finding (T033) |
| ICD9 | V69.5 |
| ICD10 | Z73.81 |
| SnomedCT | 90361000119105 |
| English | behavioral insomnia of childhood, behavioral insomnia of childhood (diagnosis), Behav insomnia-childhood, Behavioural insomnia of childhood, Behavioral insomnia of childhood (disorder), Behavioral insomnia of childhood |
| Czech | Behaviorální nespavost v dětství, Behaviorální insomnie v dětství |
| Dutch | gedragsslaapstoornis op kinderleeftijd |
| French | Insomnie comportementale de l'enfance |
| German | Verhaltensbedingte Schlafstoerung in der Kindheit |
| Hungarian | Gyermekkori magatartásbeli alvászavar |
| Italian | Insonnia comportamentale dell'infanzia |
| Spanish | Insomnio conductual de la infancia, insomnio conductual en la infancia, insomnio conductual infantil, insomnio conductual infantil (trastorno) |
| Japanese | ｼｮｳﾆｷﾉｺｳﾄﾞｳｾｲﾌﾐﾝｼｮｳ, 小児期の行動性不眠症 |
| Portuguese | Insónia comportamental da infância |
