II. Epidemiology
-
Prevalence of sleeping through the night
- Age 6 months: 58% (on at least 5 nights weekly)
- Age 1 year: 90%
- Night awakenings may persist in 10-30% of children under age 3 years old
- Night awakenings transiently recur between 9 and 18 months
- Episodes coincide with period of increased stranger anxiety
-
Sleep deprivation
- Two thirds of high school students sleep <7 hours per night
- See sleep deprivation complications below
III. Physiology: Normal sleep patterns in children
- Age 0-2 months old
- Total sleep time: 16-18 hours/day
- Naps: 3.5/day (7-8 am, 9-11 am, 1-3 pm, 5-7 pm)
- Night awakenings at 2-4 am are common until 6 months old
- Age 2-12 months old
- Total sleep time: 12-16 hours/day
- Naps: 2/day by 12 months old
- Typical sleep schedule from 8 pm to 6 am by 12 months old (sleeping through the night)
- Age 1-3 years old
- Total sleep time: 10-16 hours/day
- Naps: 1/day by 18 months old
- Age 3-5 years old
- Total sleep time: 11-15 hours/day
- Naps: 1/day in up to 50% of 3 year olds (remainder do not nap)
- Age 5-14 years old
- Total sleep time: 9-13 hours/day
- Naps: Variable
- Age 14-18 years old
- Total sleep time: 7-10 hours/day
- Naps: Uncommon unless underlying sleep disorder
- References
IV. Types: Sleep Problems
- Night Awakening in Children
- Parasomnias
- Miscellaneous Sleep Conditions
- Insomnia-related conditions
V. Management: Night Awakening in Children
- See Trained Night Feeders
- See Trained Night Crier
- Behavioral management is not effective under age 6 months old
- Behavioral management is recommended for ages 6 months to 4 years old
- Unmodified Extinction
- Infant placed in crib at defined bedtime and not removed for crying
- Monitor infant for safety
- Modified Extinction (graduated extinction)
- Infant placed in crib at defined bedtime and not removed for crying
- Infant is periodically rechecked at intervals of increasing duration (without removing from crib)
- Positive Bedtime Routine
- Scheduled bedtime activites (e.g. reading) make bedtime enjoyable for child
- Unmodified Extinction
- Avoid sedating medications
- Diphenhydramine is not recommended (ineffective)
- Merenstein (2006) Arch Pediatr Adolesc Med 160(7):707-12 [PubMed]
VI. Complications: Sleep Deprivation
- Increased risk of Childhood Obesity and of Pediatric Type II Diabetes Mellitus
- Adverse effects on pediatric mental health
- May result in Academic Underachievement
- Increased risk of physical injury
VII. '
VIII. References
- Adair (1993) Curr Probl Pediatr 23:147-70 [PubMed]
- Carter (2014) Am Fam Physician 89(5): 368-77 [PubMed]
- Deshpande (2022) Am Fam Physician 105(2): 168-76 [PubMed]
- Mahowald (1990) Pediatrician 17(1):21-31 [PubMed]
- Nasir (2015) Am Fam Physician 92(4): 274-8 [PubMed]
- Thiedke (2001) Am Fam Physician 63(2): 277-84 [PubMed]